"Occult" mastocytosis with activating c-kit point mutation evolving into systemic mastocytosis associated with plasma cell myeloma and secondary amyloidosis.

A case of a 70-year-old man presenting with exsudative enteropathy due to light-chain-associated amyloidosis is reported. The diagnosis of systemic mastocytosis associated with IgG/lambda plasma cell myeloma and secondary generalised amyloidosis was carried out by morphological evaluation of bone marrow biopsy. The c-kit point mutation D816Y was detected by molecular analysis. Two years before, a cystadenolymphoma of the left parotid gland had been removed. A moderate increase of loosely scattered spindle-shaped mast cells, a subpopulation of them expressing CD25, an antigen that is not expressed by normal or reactive mast cells, was shown by retrospective analysis carried out on an intraparotideal lymph node. The c-kit mutation D816Y was shown by the molecular analysis of the lymph node. In summary, the notion that systemic mastocytosis may very rarely be associated with B cell neoplasms and that neoplastic mast cell infiltrates may be obscured because of only a minimal increase of atypical mast cells, which are outnumbered by other non-neoplastic cells in the same tissue, is supported by this case. This finding was preliminarily termed "occult" mastocytosis.

Selective uptake of low-density lipoprotein-associated cholesteryl esters by human fibroblasts, human HepG2 hepatoma cells and J774 macrophages in culture.

High-density lipoprotein-(HDL) associated cholesteryl esters (CE) are taken up by hepatic and extrahepatic cells at a higher rate than HDL apolipoproteins. This selective uptake of HDL CE is independent from HDL particle uptake. For low-density lipoprotein (LDL), receptor-mediated endocytosis by cells is well established. In this study, the question was addressed if LDL-associated CE are also taken up by cells independently from LDL particles, i.e., selectively. Human LDL (d = 1.02-1.05 g/ml) was doubly radiolabeled with intracellularly trapped tracers: [125I]Tyramine-Cellobiose ([125I]TC) traced apolipoprotein B, [3H]cholesteryl oleyl ether ([3H]CEt) traced CE. The uptake of doubly radiolabeled LDL by normal and LDL receptor-negative human skin fibroblasts, human HepG2 hepatoma cells and murine J774 macrophages was investigated. Each cell type took up LDL particles as indicated by [125I]TC. However, in fibroblasts, HepG2 cells and J774 macrophages the rate of uptake for LDL-associated [3H]CEt was greater than that according to [125I]TC. These results indicate that extrahepatic and hepatic cells selectively take up LDL CE and this uptake is independent from LDL receptor-mediated endocytosis. Loading cells with cholesterol down-regulated selective uptake of LDL CE. In summary, human skin fibroblasts, human HepG2 cells and murine J774 macrophages selectively take up LDL CE, i.e., CE are taken up independently from LDL particles.

Selective uptake of high-density lipoprotein-associated cholesteryl esters and high-density lipoprotein particle uptake by human monocyte-macrophages.

High-density lipoprotein (HDL) cholesteryl esters (CE) are taken up by many cells without parallel uptake of HDL apolipoproteins. This selective uptake of HDL CE was investigated in human monocyte-derived macrophages (HMM). HDL3 (d = 1.125-1.21 g/ml) was labeled in its apolipoprotein A-I moiety with 125I and in its CE moiety with [3H]cholesteryl oleyl ether. Cultured human monocyte-macrophages were incubated in the presence of doubly labeled HDL3 followed by determination of tracer uptake. HMM took up HDL3 particles as indicated by the uptake of HDL3 apolipoproteins. Uptake of HDL3-associated CE tracer was in significant excess of that due to HDL3 particle uptake indicating selective uptake of CE. Increased cell cholesterol due to preincubation with acetylated low-density lipoprotein (LDL) down-regulated selective uptake by HMM. According to several experimental approaches, selective uptake of HDL3 CE was independent from cell-secreted products, LDL receptor-mediated endocytosis or HDL3 retroendocytosis. The intracellular catabolism of HDL3 CE was investigated with HDL3 labeled in its CE moiety with [3H]cholesteryl oleate. The lysosomal inhibitor chloroquine had no effect on CE hydrolysis indicating that CE selectively taken up is hydrolyzed independently from lysosomes. In conclusion, HMM selectively take up HDL3-associated CE. The cellular mechanism of selective uptake is independent from endocytosis or retroendocytosis. Intracellularly, HDL3 CE selectively taken up are catabolized independently from lysosomes.

[Laparoscopic 2/3 resection of the stomach with intracorporal Roux-en-Y anastomosis]. / Laparoskopische 2/3-Resektion des Magens mit intracorporaler Anastomose nach Y-Roux.

In a patient with recurrent ulcer disease under medication, which was complicated by episodes of bleeding, a laparoscopic partial gastric resection with intracorporal Roux-en-Y anastomosis was performed. The operation was completed within 3 h with blood loss < 10 ml. The postoperative hospital stay of 6 days was uncomplicated as was the further follow-up (2 months so far). This operation and the study of results published in the literature showed us that a gastric resection can certainly be performed laparoscopically in the appropriate patient.

[Immunohistochemical localization of annexin VI in the endocytic compartment of rat liver hepatocytes]. / Localización inmunocitoquímica de la anexina VI en el compartimiento endocítico de hepatocitos de hígado de rata.

Annexin VI has been isolated from rat liver endosomes and affinity purified antibodies have been produced. By Western blotting, in rat liver subcellular fractions, anti-annexin VI was demonstrated to recognise a 68 kDa band in the three endosomal fractions. In the present study, immunogold labeling of ultrathin Lowicryl sections of rat liver has been used to get insights into the ultrastructural hepatocyte localization. Although at the immunofluorescence level the staining seemed located at the apical, canalicular plasma membrane, domain of the hepatocytes, the electron microscopy revealed that 80% of the labeling, with the anti-annexin VI antibody was specifically localized not at the plasma membrane but in the close subapical endocytic compartment surrounding the bile canalicular plasma membrane of the hepatocyte. Double immunogold labeling with an anti peptide antibody to Rab5 and anti-annexin VI showed that 80% of the Rab5 positive apical endosomes were also labeled with anti-annexin VI antibodies. However, there was no significant colocalization of annexin VI and structures labeled with antibodies to the polymeric immunoglobulin receptor. The results suggest that annexin VI could be involved in regulating the functioning of this apical compartment in the hepatocyte.

The polymeric immunoglobulin receptor is the major calmodulin-binding protein in an endosome fraction from rat liver enriched in recycling receptors.

Rat liver endosomes contain one major high-affinity calmodulin-binding protein (CaMBP) that now has been identified as the polymeric immunoglobulin receptor (pIgR). In isolated endosomes pIgR was enriched in the receptor-recycling compartment (RRC); lesser enrichment was found in 'early' endosome (CURL) and much less in 'late' endosome fractions (multivesicular bodies, MVB). The distribution of the major CaMBP, shown by Western blotting or by overlay with I125-calmodulin in the isolated fractions, was consistent with rapid accumulation of I125-immunoglobulin A (IgA) in RRC and CURL after intravenous injection into rats. The receptor was also found in sinusoidal plasma membranes but not in cell fractions containing apical (bile canalicular) or lateral plasma membrane domains of the hepatocyte. The interaction of pIgR with calmodulin was shown by direct binding assays and by affinity chromatography. Thus, calmodulin is the first cytoplasmic protein shown to interact with the pIgR. We postulate that calmodulin regulates pIgA trafficking in rat liver. In addition, the receptor recycling fraction emerges as an endosomal subcompartment involved in pIgA transport via pIgR.

Recycling of apolipoprotein E and lipoprotein lipase through endosomal compartments in vivo.

We have recently described a novel recycling pathway of triglyceride-rich lipoprotein (TRL)-associated apolipoprotein (apo) E in human hepatoma cells. We now demonstrate that not only TRL-derived apoE but also lipoprotein lipase (LPL) is efficiently recycled in vitro and in vivo. Similar recycling kinetics of apoE and LPL in normal and low density lipoprotein receptor-negative human fibroblasts also indicate that the low density lipoprotein receptor-related protein seems to be involved. Intracellular sorting mechanisms are responsible for reduced lysosomal degradation of both ligands after receptor-mediated internalization. Immediately after internalization in rat liver, TRLs are disintegrated, and apoE and LPL are found in endosomal compartments, whereas TRL-derived phospholipids accumulate in the perinuclear region of hepatocytes. Subsequently, substantial amounts of both proteins can be found in purified recycling endosomes, indicating a potential resecretion of these TRL components. Pulse-chase experiments of perfused rat livers with radiolabeled TRLs demonstrated a serum-induced release of internalized apoE and LPL into the perfusate. Analysis of the secreted proteins identified approximately 80% of the recycled TRL-derived proteins in the high density lipoprotein fractions. These results provide the first evidence that recycling of TRL-derived apoE and LPL could play an important role in the modulation of lipoproteins in vivo.

Regulation of the hepatic removal of chylomicron remnants and beta-very low density lipoproteins in the rat.

The contribution of the low density lipoprotein (LDL) receptor to the removal of chylomicron remnants was determined in vitro and in vivo by using interventions that up- or down-regulate the LDL receptor but not the LDL receptor-related protein (LRP). In vitro, chylomicron remnants and beta-very low density lipoprotein (VLDL) bind to the LDL receptor on endosomal membranes; their binding can be competed by LDL and beta-VLDL and the binding capacity is greatly augmented in membranes from estradiol-treated rats. Likewise, estradiol treatment almost doubled the removal of chylomicron remnants during a single pass through perfused rat livers. However, in vivo the removal of chylomicron remnants and beta-VLDL was very rapid even in untreated rats so that the effect of the stimulation by estradiol was barely detectable when trace amounts of lipoproteins were injected. Yet, when saturating doses of either lipoprotein were injected, the effect of estradiol treatment on the removal of chylomicron remnants and beta-VLDL was readily disclosed. In rats fed a diet containing lard, cholesterol, and bile acids, removal of chylomicron remnants or beta-VLDL was significantly retarded. Likewise, perfused livers from diet-fed rats removed only a mean of 16% of chylomicron remnants during a single passage as compared to 29% in livers from control animals. Also, when large doses of beta-VLDL had been infused into rats for 4 h, in subsequent perfusions of the livers the removal of chylomicron remnants was decreased to 11%. From these results it is concluded that the LDL receptor mediates the hepatic removal of a major fraction of chylomicron remnants and beta-VLDL.

Differences in the mechanisms of uptake and endocytosis of small and large chylomicron remnants by rat liver.

Initial binding and subsequent endocytosis of small and large chylomicron remnants by rat liver were compared. Small and large chylomicrons were obtained from mesenteric lymph of glucose- or fat-fed rats, respectively. The low-density lipoprotein (LDL) receptor was up- and down-regulated as shown by LDL receptor messenger RNA (mRNA). The rate of removal of small chylomicron remnants by isolated perfused rat livers followed closely the activity of the LDL receptor. When mRNA was undetectable, the uptake was as low as that of lymphatic small chylomicrons. In contrast, the uptake of large chylomicron remnants into perfused rat livers was unaffected by changes of the LDL-receptor activity, but significantly reduced after livers were flushed with heparin or heparinase. Large chylomicron remnants were cleared from plasma much faster than small chylomicron remnants, but were more slowly internalized into hepatocytes. Both, small and large chylomicron remnants entered the pathway of receptor-mediated endocytosis as shown by electron microscopy and analysis of isolated endosomes. Yet, large chylomicron remnants were taken up into the compartment of uncoupling of receptors and ligands and multivesicular bodies at a much slower rate. This was independent of the activity of the LDL receptor and the heparin-releasable binding site. From these findings it is concluded that large chylomicron remnants initially bind rapidly to surface components other than the LDL receptor, one of which may be hepatic lipase. Yet, the consecutive internalization is slow. In contrast, small chylomicron remnants are removed at a slower rate from plasma, binding predominantly to the LDL receptor, but are more readily taken up into endosomes.

Trafficking of the epidermal growth factor receptor and transferrin in three hepatocytic endosomal fractions.

Hepatocytes rapidly internalize epidermal growth factor (EGF) and transferrin by receptor-mediated endocytosis. Both EGF and its receptor are thought to be targeted for destruction in lysosomes, leading to down-regulation of the receptor, whereas transferrin, after unloading iron within the cell, is thought to recycle to the cell surface bound to its receptor. Previously, we isolated three endosomal fractions from livers of estradiol-treated rats and examined their roles in cellular trafficking of low density lipoproteins (LDL) and the LDL receptor, which cycles constitutively (Belcher, J. D., Hamilton, R. L., Brady, S. E., Hornick, C. A., Jäckle, S., Schneider, W. J., and Havel, R. J., Proc. Natl. Acad. Sci. U. S. A. (1987) 84, 6785-6789). In the current study we have taken advantage of the distinct trafficking of the EGF receptor and transferrin to evaluate further the functions of these endosome fractions. Intravenous injection of a saturating amount of EGF into estradiol-treated rats induced internalization of a single population of EGF receptors, which rapidly accumulated in the endosome fraction of intermediate density ("compartment of uncoupling of receptor and ligand" (CURL)) and subsequently in the low density endosome fraction (multivesicular bodies (MVBs)). The high density endosome fraction, whose membranes contain a high concentration of recycling receptors (designated receptor-recycling compartment (RRC)), failed to accumulate EGF receptors after injection of EGF. In livers of rats not given exogenous EGF, EGF receptors were found in small but comparable concentrations in RRC, CURL, and MVB membranes, consistent with other evidence that targeting of the EGF receptor to lysosomes is mediated by ligand-induced phosphorylation. Transferrin also accumulated first in CURL and later in MVBs, but it also accumulated rapidly in the RRC fraction, consistent with the proposed function of this fraction in receptor recycling. Since transferrin is not degraded during its endocytic cycle, these observations indicate that apotransferrin and its receptor recycle from late endosomes (MVBs) located at the apical pole of hepatocytes, as well as from early endosomes near the sinusoidal pole.

Evidence for the Involvement of annexin 6 in the trafficking between the endocytic compartment and lysosomes.

Annexins are a family of calcium-dependent phospholipid-binding proteins, which have been implicated in a variety of biological processes including membrane trafficking. The annexin 6/lgp120 prelysosomal compartment of NRK cells was loaded with low-density lipoprotein (LDL) and then its transport from this endocytic compartment and its degradation in lysosomes were studied. NRK cells were microinjected with the mutated annexin 6 (anx6(1-175)), to assess the possible involvement of annexin 6 in the transport of LDL from the prelysosomal compartment. The results indicated that microinjection of mutated annexin 6, in NRK cells, showed the accumulation of LDL in larger endocytic structures, denoting retention of LDL in the prelysosomal compartment. To confirm the involvement of annexin 6 in the trafficking and the degradation of LDL we used CHO cells transfected with mutated annexin 6(1-175). Thus, in agreement with NRK cells the results obtained in CHO cells demonstrated a significant inhibition of LDL degradation in CHO cells expressing the mutated form of annexin 6 compared to controls overexpressing wild-type annexin 6. Therefore, we conclude that annexin 6 is involved in the trafficking events leading to LDL degradation.

Isolation and characterization of three endosomal fractions from the liver of normal rats after lipoprotein loading.

In earlier research we isolated and characterized three endosomal fractions from livers of estradiol-treated rats (1987. Belcher et al. Proc. Natl. Acad. Sci. USA. 84: 6785; 1989. Jäckle et al. Proc. Natl. Acad. Sci. USA. 86: 1880). We now describe the isolation of comparable endosomal fractions from untreated rats. The fraction of lowest density was composed almost exclusively of lipoprotein-filled multivesicular bodies (MVBs); the intermediate density fraction was composed of smaller lipoprotein-filled vesicles that were also multivesicular and had more numerous membranous appendages; the fraction of highest density was composed of membranes resembling the appendages of the two vesicular fractions. The paucity of contamination of these fractions with nonendosomal organelles is supported by their ultrastructural characteristics and by the proteins, lipids, and marker enzymes of their membranes. Only small amounts of MVBs could be separated from untreated rats not given a load of lipoproteins. However, after injection of large amounts of beta-very low density lipoproteins (beta-VLDL) from cholesterol-fed rabbits, the mass of MVBs increased dramatically. Under these conditions radiolabeled beta-VLDL and epidermal growth factor taken up by the liver accumulated in isolated endosomes at rates similar to those found for LDL in estradiol-treated rats. Although chylomicrons and chylomicron remnants were rapidly taken up by the liver of normal rats, chylomicrons and chylomicron remnants accumulated in endosomes at a lower rate than beta-VLDL. These findings, which differ from earlier data in estradiol-treated rats (1989 Jäckle et al., Proc. Natl. Acad. Sci. USA. 86: 1880) that showed equivalent rates of processing of chylomicron remnants and beta-VLDL, suggest that extracellular processing of chylomicron remnants in the liver normally ; precedes endocytosis.

Isolation and characterization of two distinct species of human very low density lipoproteins lacking apolipoprotein E.

We have isolated two fractions of very low density lipoprotein particles in human plasma that lack apolipoprotein (apo) E by combined anti-apoE and heparin affinity chromatography of whole plasma followed by ultracentrifugation. The two fractions are distinguished by their ability to bind to heparin. Each of these fractions, designated "B" particles to distinguish them from very low density lipoproteins that contain apoE ("B,E" particles), comprises an appreciable fraction of total particles in very low density lipoproteins of normolipidemic and hypertriglyceridemic subjects. The heparin-unbound B particles, which have been reported previously by others, are larger and have negligible affinity for low density lipoprotein receptors. The heparin-bound B particles are smaller and do bind to low density lipoprotein receptors, albeit with much lower affinity than B,E particles. No differences in accessibility to limited protease digestion were found between apoB-100 in the two types of B particles. Our data indicate that a substantial fraction of human very low density lipoproteins lacks apoE, the principal ligand for lipoprotein receptors that mediate the terminal catabolism of these lipoproteins. Whereas the B particles that fail to bind to heparin are likely to represent a form of nascent lipoprotein, the origin of those B particles that bind to heparin remains to be determined.

Dissection of compartments in rat hepatocytes involved in the intracellular trafficking of high-density lipoprotein particles or their selectively internalized cholesteryl esters.

The trafficking of apolipoprotein E-deficient high-density lipoprotein particles and of their component cholesteryl esters in rat hepatocytes was studied. Human high-density lipoprotein 3, labeled with two nondegradable, intracellularly trapped tracers in their apolipoprotein A-I and their cholesteryl esters, were injected into rats, and five subcellular hepatocytic fractions were isolated at various time intervals. In control experiments with homologous lipoproteins, doubly labeled rat high-density lipoproteins depleted of apolipoprotein E were used. In endosomes and lysosomes the two labels were recovered at near unity, indicating that high-density lipoproteins are endocytosed as particles, transported to early and late endosomes and finally subjected to lysosomal degradation. No significant amounts of label were found in receptor-recycling endosomes. In contrast to label of those of low-density lipoproteins, label of component protein and cholesteryl esters of high-density lipoproteins from isolated endosomes floated at different densities in gradient ultracentrifugation, indicating early disintegration of high-density lipoprotein particles. In contrast to the endocytic organelles, in the whole liver, label of high-density lipoprotein-associated cholesteryl esters exceeded the label of high-density lipoprotein-associated apolipoprotein A-I twofold to threefold. This finding is compatible with selective uptake of high-density lipoprotein cholesteryl esters in addition to uptake of high-density lipoprotein particles. The excess cholesteryl esters accumulated in a nonendosomal fraction, whose major proteins differed from the integral proteins of endosomes. These data suggest two distinct intracellular routes of hepatocytic high-density lipoprotein trafficking in vivo. High-density lipoproteins free of apolipoprotein E are internalized intact by hepatocytes, are predominantly transported to early and late endosomes and are finally subjected to lysosomal degradation. High-density lipoprotein particles do not undergo retroendocytosis in hepatocytes. In addition, high-density lipoprotein-associated cholesteryl esters can be taken up by hepatocytes selectively. They, however, accumulate in a nonendosomal, nonlysosomal compartment.

In vivo removal of beta-VLDL, chylomicron remnants, and alpha 2-macroglobulin in the rat.

The low density lipoprotein receptor-related protein (LRP)/alpha 2-macroglobulin (alpha 2M) receptor has been suggested as a potential chylomicron remnant receptor. To investigate the involvement of LRP in chylomicron remnant metabolism in vivo, cross-competition experiments with chylomicron remnants, beta-VLDL, and receptor-active alpha 2M, complexed with trypsin (alpha 2M-trypsin), were performed in rats. Saturating concentrations of unlabeled beta-VLDL failed to inhibit the plasma clearance and hepatic uptake of 125I-labeled alpha 2M-trypsin and, vice versa, alpha 2M-trypsin failed to retard the removal of 125I-labeled chylomicron remnants. It has been demonstrated previously that bovine lipoprotein lipase (LPL) strongly enhances the binding of apolipoprotein E-containing lipoproteins to LRP (U. Beisiegel, W. Weber, and G. Bengtsson-Olivecrona. 1991. Proc. Natl. Acad. Sci. USA. 88: 8342-8346). Therefore, beta-VLDL were enriched with isolated LPL or heparin was injected simultaneously with beta-VLDL to increase the concentration of endogenous LPL bound to beta-VLDL. Yet, no inhibition of the plasma elimination and the hepatic uptake of 125I-labeled alpha 2M-trypsin was observed after injection of saturating amounts of beta-VLDL enriched with LPL. We conclude that in the rat triglyceride-rich lipoproteins and alpha 2M-trypsin bind in vivo either to different binding domains of LRP or to a different receptor protein.

Annexin VI defines an apical endocytic compartment in rat liver hepatocytes.

Annexin VI has been demonstrated previously to be a marker for hepatic endosomes. By western blotting with an affinity purified anti-annexin VI antibody it was shown that annexin VI was present in the three morphologically and functionally different endosomal fractions from rat liver. We have quantified the gold-labeled endosomes by immunoelectron microscopy in ultrathin Lowicryl sections of rat liver and now demonstrate that 80% of the total labeling with anti-annexin VI was associated with endocytic structures surrounding the bile canaliculus, the apical domain of hepatocytes, whereas only 20% was found in the subsinusoidal endosomes. In double immuno-gold labeling experiments 80% of the Rab5 positive apical endosomes were also labeled with anti-annexin VI antibodies. However, there was no significant colocalization with antibodies to the polymeric immunoglobulin receptor. Finally, we demonstrate that 50% of endosomes containing internalized gold-labeled transferrin were double labeled with anti-annexin VI antibodies. Thus, annexin VI becomes the first known structural protein at the apical 'early' endocytic compartment of the hepatocyte that may be involved in the receptor recycling and transport to late endocytic/lysosomal compartment pathways.

Bedside endosonography and endosonography-guided fine-needle aspiration in critically ill patients: a way out of the deadlock?

Endosonography and endosonography-guided fine-needle aspiration (EUS-FNA) are now established diagnostic techniques, which are performed electively in endoscopy suites. We report here the bedside use of EUS-FNA in three critically ill patients in an intensive-care unit, with a significant impact on the outcome. A mediastinal abscess after percutaneous dilational tracheotomy was aspirated in one patient, leading to appropriate antibiotic therapy and complete recovery. A paratracheal hematoma compressing the right main bronchus was aspirated in a patient with polytrauma, relieving the pressure effects. The third patient, who had end-stage dilated cardiomyopathy and was being evaluated for cardiac transplantation, was found to have an apical lung lesion suspicious for bronchogenic carcinoma. EUS was performed to exclude mediastinal metastasis and allow simultaneous resection at the time of transplantation. Although a metastasis was excluded by EUS-FNA, the patient died while awaiting surgery. We conclude that bedside EUS-FNA is a feasible procedure, and in experienced hands it can offer an alternative in life-threatening situations.

Late endocytic compartments are major sites of annexin VI localization in NRK fibroblasts and polarized WIF-B hepatoma cells.

Annexin VI is an abundant calcium- and phospholipid-binding protein whose intracellular distribution and function are still controversial. Using a highly specific antibody, we have studied the distribution of annexin VI in NRK fibroblasts and the polarized hepatic cell line WIF-B by confocal microscopy. In NRK cells, annexin VI was almost exclusively found associated with endocytic compartments, which were defined by their ability to receive fluid-phase marker internalized from the cell surface. However, extensive colocalization of annexin VI and the endocytic marker was only observed after about 45 min, indicating that annexin VI was primarily in late endocytic compartments or (pre)lysosomes. Consistent with this, annexin VI was predominantly seen on structures that contained the lysosomal protein lgp120, although not on dense core lysosomes by electron microscopy. Two major populations of annexin VI-containing structures were present in polarized WIF-B hepatocytes. One correlated to lgp120-positive (pre)lysosomes and was still observed after treatment with brefeldin A (BFA), while the other appeared to be partially associated with Golgi membranes and was BFA-sensitive. The striking association with prelysosomal compartments in NRK and WIF-B cells suggests that annexin VI could play a role in fusion events in the late endocytic pathway, possibly by acting as a tether between membranes.

Endoscopic ultrasound-guided fine-needle aspiration in focal pancreatic lesions: a prospective intraindividual comparison of two needle assemblies.

BACKGROUND AND STUDY AIMS: The results of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in focal pancreatic lesions are less impressive than those in the mediastinum. The aim of this prospectively randomized study was to compare two commercially available needle assemblies with regard to handling and cytopathological yield. PATIENTS AND METHODS: A total of 30 patients (19 men, 11 women; mean age 61) with focal pancreatic lesions underwent EUS-FNA with each of the two needles (GIP, Wilson-Cook). The sequence was randomized for the examiner and blinded for the cytologist. Three patients had to be excluded because of the impossibility of sample assignment or patient follow-up. EUS-FNA was performed using the standard technique with linear echo endoscopes. RESULTS: None of the characteristics evaluated by the examiner differed significantly between either of the needles. Inadequate results were obtained in 11% using the GIP needle, but in none with the Wilson-Cook needle. GIP needle cytology revealed malignancy in 11 patients (sensitivity, specificity, and accuracy were 55%, 100%, and 65%, respectively, including inadequate results). The aspirates obtained with the Wilson-Cook needle identified malignancy in 16 patients (sensitivity, specificity, and accuracy were 85%, 100%, and 89%, respectively). CONCLUSIONS: No statistically significant differences were detected in the handling of either of the two needle assemblies. No complications were reported using the GIP needles. However, in four procedures breakages of the outer Teflon sheath of the Wilson-Cook needle occurred, and in another four cases re-insertion of the stylet was impossible. Nevertheless, cytopathologic results were significantly better with the Wilson-Cook needle.