Case Report A 79-year-old woman, with no relevant past medical history was admitted due to an idiopathic acute pancreatitis. Magnetic resonance cholangiopancreatography (MRCP) revealed a focal main pancreatic duct (MPD) stricture in the pancreatic head with moderate upstream dilatation (7 mm), as well as prominence of secondary branches. In the uncinate process, a 17 mm cystic lesion with no apparent communication with the MPD was also described. This acute episode had a good clinical course and the patient was discharged. One month later, she underwent another MRCP that showed no evidence of the aforementioned stricture but pointed a 9 mm dilatation of the MPD at the level of the pancreatic head. Serum CA 19.9 and CEA were normal. Four months later, she was admitted due to a new episode of mild acute pancreatitis. At that time, she was referred to our institution for endoscopic ultrasonography (EUS). This exam revealed a lesion in the pancreatic head along with an atrophic pancreatic parenchyma, with lobularity, hyperechoic foci and stranding. Elastography and contrast-enhanced harmonic EUS (SonoVue®) were performed. EUS revealed in the pancreatic head a cystic dilatation of the MPD (15×15 mm), with a hyperechogenic solid component and digitiform projections that conditioned almost complete occlusion of the duct (Figure 1). Figure 1. EUS: cystic dilatation of the MPD (15×15 mm) in the pancreatic head, with a hyperechogenic solid component and digitiform projections that conditioned almost complete occlusion of the duct. The solid component had a “hard” pattern on elastography (strain ration 18.79; Figure 2) and revealed an heterogenous […]
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, […]
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: