EUS-FNA FOR DIAGNOSIS OF AN OSTEOSARCOMA METASTASIS EXTENDING INSIDE THE CONFLUENCE

Rita Vale Rodrigues, Joana Lemos Garcia, Sandra Faias, Maria Manuel Lemos, Inês Marques, António Dias Pereira

Gastroenterology Department, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Lisbon, Portugal

We present the case of a 34-year-old male with a prior diagnosis of a scapular chondroblastic osteosarcoma and history of lung metastases during follow-up. Because of pulmonary disease progression, a PET-CT was ordered and showed a pancreatic mass. For better description and cytological diagnosis, he was submitted to and Endoscopic Ultrasound, which detected a peri-pancreatic hypoechoic well-defined heterogeneous mass, with a mosaic pattern of green and blue in elastography was detected. The mass had three nodular components, one of which within the splenoportal confluence lumen. Fine Needle Aspiration with a EchoTip ProCore® HD Ultrasound Biopsy Needle was performed (three passes with rapid on-site evaluation by pathologist) and cytology revealed a mesenchymal neoplasia consistent with an osteosarcoma metastasis. Osteosarcoma is the most common primary bone malignancy in young ages, but few imaging findings of vascular involvement have been reported and, to the best of our knowledge, none through EUS.

GIANT THORACIC AORTA ANEURYSM BELOW AN ENDOVASCULAR STENT – AN UNEXPECTED FINDING DURING LINEAR EUS

Marta Moreira¹, João Fernandes^1,2, Sílvia Giestas¹, Tarcísio Araújo¹, José Ramada¹, David Martinez-Ares¹, Manuela Certo¹, Jorge Canena³, Luís Lopes^1,4,5

¹Gastroenterology Department, Hospital Santa Luzia, Viana do Castelo, Portugal; ²Gastroenterology Department, Centro Hospitalar Cova da Beira EPE, Covilhã, Portugal; ³Gastroenterology Department, Nova Medical School/Faculdade de Ciências Médicas de Lisboa; ⁴Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ⁵ICVS/3B’s PT Government Associate Laboratory, Braga/Guimarães, Portugal

A 50-year-old woman was referred for endoscopic ultrasound (EUS) due to suspicion of choledocholithiasis. In her medical history, the patient had a thoracic aneurysm repaired with an endovascular endoprosthesis 12 years ago. The choledocholithiasis was confirmed and an ERCP was successfully performed.

While following the aorta, in the mediastinal station during EUS, the endoprosthesis was clearly defined inside the aorta. Surprisingly at its distal end, a large aneurysm was observed, with the classic Yin-Yang sign (bidirectional flow) at color Doppler and the to-and-fro waveform flow at duplex sampling. Subsequently, a CT scan confirmed the large aneurysm diagnosed by EUS, and the patient was submitted to a new endovascular repair.

This very rare incidental finding underscores the usefulness of a systematic approach when performing EUS, allowing the diagnosis of significant abnormalities in some patients.

GIANT PANCREAS AS PRESENTATION OF NEUROENDOCRINE TUMOR

Filipe Taveira, Luís Elvas, Daniel Brito, Miguel Areia, Mafalda João, Susana Alves, Sandra Saraiva, Ana Teresa Cadime

Serviço de Gastrenterologia, Instituto Português de Oncologia de Coimbra, Coimbra, Portugal

53 years old man in the context of unintentional weight loss performed abdominal CT (Fig1) showing a marked enlargement of the entire pancreatic gland, heterogeneous structure, multiple calcifications and two nodular formations in the head and tail of with 4.5 and 2.5 cm. EUS (Fig2-4) was performed confirming an enlarged pancreas, hypoechoic but heterogeneous texture, outlining several millimetric nodular formations and multiple hyperechogenic millimetric foci, but no large nodular formations revealed on CT. Wirsung irregular (4mm). No locoregional adenopathies. Performed EUS-FNA of the body/tail (transgastric) and of the head (transbulbar). Nonconclusive Cytology: Neuroendocrine tumor vs. Autoimmune pancreatitis. Repeated CT biopsy – Neuroendocrine (G1) tumor of the pancreas, with amyloid stroma. PET/CT with 68Ga-DOTANOC confirmed intense uptake throughout the gland, particularly in the tail. Has started on octreotide and awaits distal pancreatectomy. We present a peculiar presentation of a pancreatic neuroendocrine tumor, with very unusual echo-endoscopic and radiologic imaging findings.