Case Report A 50-year-old female patient without significant past medical history, presented with isolated GGT elevation (135U/L) and weigh loss (3Kg) in the past 6 months. Abdominal and pelvic MRI revealed a well-defined, round, hypervascular solid lesion, with 10mm, located in the pancreatic tail (Fig. 1). She was then referred to our clinical center. Figure 1. Abdominal and pelvic MRI – T2 (axial view): 10mm, well-defined, round, hypervascular solid lesion, located in the pancreatic tail. A 99mTc-sulfur colloid scintigraphy was done and did not show any uptake in the location of the lesion previously described (Fig. 2). Figure 2. 99mTc-sulfur colloid scintigraphy: no uptake in the location of the pancreatic lesion previously described. An EUS was therefore performed and a 12x7mm hypoechoic lesion was identified in the pancreatic tail. It was a round-shaped, well-defined, homogeneous intrapancreatic mass (Fig. 3). The lesion characterization was complemented by EUS-elastography, which displayed a homogeneous green elastographic pattern (Fig. 4). The remaining pancreas was unremarkable. EUS-FNB (Acquire – Boston Scientific; 25G, 1 pass) was performed. Figure 3. EUS (transgastric view): 12x7mm round-shaped, well-defined, hypoechoic, homogeneous lesion in the pancreatic tail. Figure 4. EUS – elastography (transgastric view): pancreatic solid lesion, with homogeneous green elastographic pattern. Quiz Discussion Cytoblock showed groups of CKAE1-AE3 negative and CD45 positive cells, supporting the diagnosis of an intrapancreatic accessory spleen (Fig. 5). Figure 5. Pathology – cytoblock (H&E; CKAE1-AE3; CD45): groups of CKAE1-AE3 negative and CD45 positive cells. Accessory spleen is a common benign congenital anomaly, with an […]
Case Report A 65-year old female was referred to our Gastroenterology Department due to persistent upper abdominal pain and significant weight loss (20Kg) over the previous year. CT revealed a large retroperitoneal hypodense mass, in contiguity with the pancreatic body and tail, with encasement of the celiac trunk and superior mesenteric artery. Endoscopic ultrasonography (EUS) documented an extensive retroperitoneal hypoechoic lesion encasing the aorta, celiac trunk, common hepatic artery (Figure 1) and superior mesenteric artery (Figure 2), without vascular invasion (hyperechoic vascular wall interface was preserved), causing minimal compression of the pancreas. Figure 1. Endoscopic ultrasonography (transduodenal view): retroperitoneal hypoechoic lesion encasing the common hepatic artery, causing minimal compression of the pancreas. Figure 2. Endoscopic ultrasonography (transgastric view): retroperitoneal hypoechoic lesion encasing the superior mesenteric artery (AMS), without vascular invasion (hyperechoic vascular wall interface was preserved). Transgastric EUS-guided FNB (22G, Acquire, Boston Scientific) of the retroperitoneal mass was performed, coursing anterior to the aorta between the celiac trunk and the superior mesenteric artery (Figure 3). Figure 3. Transgastric EUS-guided FNB (22G, Acquire, Boston Scientific) of the retroperitoneal mass. Quiz Discussion Biopsy revealed spindle-shaped tumor cells and clusters of ganglion cells, with an eccentric large round vesicular nucleus and prominent macro nucleoli, consistent with ganglioneuroma (Figure 4). Figure 4. Cytology (Magnification: 400x; scale bar corresponds to 50 µm): Spindle-shaped tumor cells and clusters of ganglion cells, with an eccentric large round vesicular nucleus and prominent macro nucleoli (arrows). The retroperitoneum can host a wide spectrum of pathologies, including a […]
Case Report A 39-year-old female with no significant past medical history presented with intense epigastric, colic pain for the three previous days. Laboratory studies showed mild and isolated C-reactive protein (CRP) elevation (1.9 mg/dL); liver function tests and pancreatic enzymes were within normal range. An abdominal computed tomography (CT) was performed and revealed a duodenal (D2/D3) endophytic polypoid, high density, heterogeneous lesion, with 26 mm; biliary tree and pancreas were normal (Figure 1). Figure 1. Abdominal CT, coronal view: duodenal (D2/D3) endophytic polypoid, high density, heterogeneous lesion, with 26 mm. Upper endoscopy (Figure 2A) and duodenoscopy (Figure 2B) identified a 25 mm large subepithelial lesion, distal to the duodenal papilla (black circle in Figure 2A), with ulcerated top. Endoscopic ultrasound (EUS) examination confirmed a peripapillary subepithelial lesion with 22 mm and massively calcified, with posterior acoustic shadowing (transitionzone undefined)(Figure 3); the common bile duct was normal. Figure 2. A) Upper endoscopy; B) Duodenoscopy: 25 mm large subepithelial lesion, distal to the duodenal papilla (black circle in Figure 2A), with ulcerated top. Figure 3. EUS, D2 position: peripapillary subepithelial lesion with 22 mm and massively calcified, with posterior acoustic shadowing. Quiz Discussion In this patient, EUS findings raised the diagnostic suspicion of a gallstone impacted in the duodenal wall through a peripapillary bilioenteric fistula. Therefore duodenoscopy was repeated at day 6 but instead of the lesion previously seen there was now a large peripappilary orifice, suggestive of a bilioenteric fistula (40 mm large after contrast injection and guide-wire exploration) (Figure 4). There […]
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 email@example.com 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: