Case Report A 65-year-old woman presented with new onset diabetes. Hes past medical history was remarkable for headache, anxiety and vasomotor symptoms for the last 3 years. Abdominal ultrasound followed by contrast-enhanced abdominal computed tomography (CT) revealed a 14-cm enhanced heterogeneous intra-abdominal mass, with cystic areas, in contact with the posterior wall of the gastric fundus (Figure 1). Figure 1. Abdominopelvic CT (axial and coronal view): a 14-cm enhanced heterogeneous intra-abdominal mass, with cystic areas, in contact with the posterior wall of the gastric fundus. Endoscopic ultrasound (EUS) was performed and showed a giant well-defined rounded hypoechogenic mass, without cleavage plane between the mass and the gastric wall. This was a very heterogeneous mass, with anechoic areas, suggestive of cystic transformation. Its size exceeded the endoscopic field (Figure 2-4). Figure 2. EUS (transgastric view): a giant well-defined rounded hypoechogenic and heterogeneous mass, with anechoic areas, suggestive of cystic transformation. Quiz Discussion EUS-fine needle biopsy (EUS-FNB) using a 25G needle with rapid on site cytological examination (ROSE) was performed. Cytological analysis performed on the cell block demonstrated irregular clusters of cells with finely eosinophilic granular cytoplasm and pronounced anisokaryosis with large and irregular nuclei (Figure 5). Immunohistochemistry was positive for vimentin and synaptophysin and negative for CD117, S100 and CD34; Ki67<3%. Figure 5. Cithology (Papanicolaou, 100x): irregular clusters of cells with finely eosinophilic granular cytoplasm and pronounced anisokaryosis with large and irregular nuclei. Toward these findings, 24-hour urine fractionated metanephrines were measured and were elevated (normetanephrine 5832pg/mL and metanephrine 11738pg/mL) and […]
Case Report A 38 year-old female patient, with no relevant previous medical history, was referred to our unit for evaluation of recurrent left iliac fossa pain, without associated symptoms. No blood test abnormalities were found. Physical examination, pelvic and abdomen ultrasound were normal. Colonoscopy was then performed identifying, at 15 cm from the anal verge, a 3cm bulge in the lumen covered by normal mucosa. These findings were suggestive of a subepithelial lesion (Figure 1). Figure 1. Colonoscopy: 3cm subepithelial lesion, at 15 cm from the anal verge. Endoscopic ultrasonography (EUS) showed a 30mm hypoechoic heterogeneous mass, with no precise limits and with all layers involved (Figure 2). Figure 2. EUS: 30mm hypoechoic heterogeneous mass, with no precise limits and with all layers involved. Quiz Discussion FNA (22G needle) of the lesion was performed and cytologic examination revealed the combination of endometrial glands and stroma. These findings were compatible with endometriosis. Pelvic MRI (Figure 3) and endovaginal ultrasound found no other endometriotic lesions in the pelvis. According to patient preference, hormonal therapy was started and symptoms remission was achieved. Figure 3. Pelvic MRI: coronal (left) and transverse (right) planes. Rectosigmoid endometriosis, with no other endometriotic lesions in the pelvis. Subepithelial lesions of the gastrointestinal tract are commonly incidentally discovered during routine upper endoscopy and colonoscopy. In the colon, subepithelial lesions mostly occur in the rectum and cecum, but lipomas (the most frequent colonic subepithelial lesion) may be seen in any part of the colon.1 Lipomas are usually yellowish, […]
Case Report An 81-years-old female presented to our department with obstructive jaundice (dark urine, pale stools) and a non-specific clinical picture of nausea and appetite loss. Laboratory tests demonstrated a mild leukocytosis with neutrophilia (13.000 cell/mm3; 86%), conjugated hyperbilirrubinemia (7.7 mg/dL), increased aspartate aminotransferase and alanine aminotransferase (10xULN and 8xULN, respectively), slightly increased alkaline phosphatase (2xULN), increased lactate dehydrogenase (10xULN) and serum lipase (3xULN). CA 19.9 was 342 U/mL (Ref value < 37 U/mL). On physical examination, there was no evidence of peripheral lymphadenopathy or hepatosplenomegaly. Abdominal ultrasound (Figure 1-A) revealed a diffuse enlargement of the pancreatic gland. The pancreatic parenchyma was hipoechoic and surrounded by an enhanced peripancreatic fat layer. Also the extra-hepatic and intra-hepatic bile ducts were dilated. The examiner did not notice any dilation of the main pancreatic duct. Contrast-enhanced abdominal computerized tomography (CT, Figure 1-B) revealed a marked homogeneous enlargement of the pancreas. The cephalic portion measured 7cm (antero-posterior diameter), more marked in the uncinate process, without any clear well-defined mass/lesion. There was a dilation of the extra-hepatic and intra-hepatic bile ducts. There was a moderate amount of ascites, especially peri-hepatic, peri-splenic, peri-pancreatic and in the parieto-colic gutter. In addition, there was a significant edema of the subcutaneous tissue of the abdominal wall and, bilaterally pleural effusions were noted. Endoscopic ultrasound (EUS) (Figure 1-C and 1-D) identified an enlarged homogeneous hypoechoic pancreas, without any well-defined lesion, no dilation of the main pancreatic duct, no peripancreatic or celiac enlarged lymph nodes. Using a 19C EchoTip Pro-Core@ HD […]
US Quiz of the Month
Instructions for Authors
US Quiz of the Month presents one or more striking ultrasound images in Gastroenterology that are meant to be a didactic challenge to readers. The clinical case is presented as unknown, with the diagnosis hinging on the correct interpretation and integration of the image and clinical data. Each month a new case is presented.
Manuscript must be sent as a Microsoft Word document to firstname.lastname@example.org and must follow the instructions below:
• Title: title cannot reveal diagnosis.
• Authors: maximum 5 authors. provide authors’ name and filiation.
• Structure: Case description; Multiple choice question (5 choices); Discussion; References.
• Word Count: maximum 600 words, excluding figure and video legends and references.
• Figures/Videos: maximum 4 images and/or 1 video. Figure and video legends are required. Figures must be submitted as separate attachments in JPEG or TIFF formats (minimum 150 PPI resolution) and videos must be submitted as separate attachments in MOV or MO4 formats.
• References: maximum 6 references. References should be cited according to the Vancouver reference style.
Prémio Melhor “US Quiz of the Month”
O Prémio “Melhor US Quiz of the Month”, da responsabilidade do GRUPUGE, destina-se a premiar o melhor US Quiz of the Month publicado, em cada ano, no site oficial do GRUPUGE (www.grupuge.com.pt).
- NATUREZA DO PRÉMIO:
Ao vencedor do prémio “Melhor US Quiz of the Month” será oferecida uma inscrição num congresso internacional de ecoendoscopia, designadamente no EURO EUS.
- DIVULGAÇÃO E ENTREGA DO PRÉMIO:
O Prémio “Melhor US Quiz of the Month” será entregue no decurso da Semana Digestiva de cada ano.
Serão candidatos ao Prémio “Melhor US Quiz of the Month”, os 12 US Quiz of the Month aceites para publicação no site do GRUPUGE nos meses de Maio do corrente ano a Abril do ano seguinte.
- CRITÉRIOS DE AVALIAÇÃO:
Os critérios a serem avaliados pelo júri incluem:
b) Relevância Clínica;
c) Rigor Científico;
d) Qualidade Iconográfica.
Cada um dos critérios será classificado de 0-5 pontos, completando um total de 20 pontos
- JÚRI DE ATRIBUIÇÃO:
O Júri, formado por 4 elementos, é nomeado anualmente pela Direcção do GRUPUGE.
- PEDIDOS DE INFORMAÇÃO: