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CURSO DE ELASTOGRAFIA BASEADA EM ULTRASSONS NO ESTADIAMENTO DA DOENÇA HEPÁTICA CRÓNICA

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US QUIZ JUNE 2021

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 […]

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US QUIZ JANUARY 2021

Case Report A 31-year-old Indian patient, living in Europe for the last 7 years, was admitted in the emergency department for jaundice, epigastric and right upper quadrant abdominal pain for the last 3 days, loss of 4.5Kg in the previous month, without fever or other remarkable symptoms. Physical examination showed tenderness on the right upper quadrant and icteric sclera. Laboratory studies revealed normal blood cell counts and C-reactive protein levels (3.5 mg/L), elevated total serum bilirubin levels (5.9 mg/dL), mainly due to direct bilirubin (4.4mg/dL), AST of 107U/L, ALT of 132 U/L, ALP of 354 U/L and GGT of 152 U/L.  Computed tomography (CT) showed a hypodense, multiloculated lesion with cystic areas and calcifications, measuring 7×4.5x7cm, in the pancreatic head, isthmus and body, involving the portal vein and extending to the hepatic hilum, including the main bile duct, without significant upstream dilation (Fig. 1 and 2). Endoscopic ultrasound (EUS) revealed a hypoechoic retroperitoneal heterogenous lesion, >58mm, with dispersed calcifications, involving the portal vein and distal portion of the bile duct. The lesion contacted the head, isthmus and corpus of the pancreas; the remaining parenchyma and main pancreatic duct appeared normal (Fig. 3 and 4). Fine needle biopsy (22G Cook® ProCore®) was performed with core tissue acquisition. Quiz Discussion Citologic analysis revealed several epithelioid granulomas with caseous necrosis and the presence of giant Langhans cells. Acid-alcohol-resistant bacilli were detected and nucleic acid amplification test positive for Micobacterium tuberculosis complex. The patient was started on tuberculostatic treatment. Thoracic CT did not show typical signs […]

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