Endoscopic ultrasound-guided fine-needle aspiration vs fine-needle biopsy for the diagnosis of pancreatic neuroendocrine tumors.

Background and study aims Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) as a method of obtaining preoperative diagnosis of pancreatic neuroendocrine tumors (PanNETs) has been reported in several series. Fine-needle biopsies (FNB) are increasingly employed to obtain core specimens during EUS. However, the differences in efficacy between these sampling methods in the diagnosis of PanNETs still needs to be defined. Patients and methods Over a 13-year period, all patients who underwent EUS-guided tissue sampling of suspicious pancreatic lesions with clinical, endoscopic and pathologic details were entered into an electronic database. Lesions underwent EUS-FNA or FNB sampling, or a combination of the two. The accuracy and safety of different EUS-guided sampling methods for confirmed PanNETs were investigated. Results A total of 91 patients (M/F: 42/49, median age: 57 years), who underwent 102 EUS procedures had a final diagnosis of PanNET. Both EUS-guided sampling modalities were used in 28 procedures, EUS-FNA alone was used in 61 cases, while EUS-FNB alone in 13 cases. Diagnostic yield of EUS-FNA and EUS-FNB alone, including the inadequate specimens, was 77.5 % (95 %CI: 68.9 - 86.2 %) and 85.4 % (95 %CI: 74.6 - 96.2 %), respectively. The combination of both sampling modalities established the diagnosis in 96.4 % of cases (27/28) (95 %CI: 89.6 - 100 %), significantly superior to EUS-FNA alone ( P  = 0.023). Diagnostic sensitivity among the adequate samples for EUS-FNA, EUS-FNB and for the combination of the two methods was 88.4 % (95 %CI: 80.9 - 96.0 %), 94.3 % (95 %CI: 86.6 - 100 %) and 100 % (95 %CI: 100 - 100 %). There was one reported complication, a post-FNA bleeding, treated conservatively. Conclusions EUS-FNB improves diagnostic sensitivity and confers additional information to cytological assessment of PanNETs.

Bleeding from peristomal varices: a complication of portal hypertension.

Peristomal varices are a recognised complication of stomas in the presence of portal hypertension. There has been a progression of treatment options described in the literature, including the transjugular intrahepatic portosystemic shunt (TIPS). The use of TIPS, a percutaneous procedure allowing connection between the portal and systemic circulations within the liver, is a well-recognised method of treating the complications of portal hypertension. This report presents a case of peristomal varices successfully treated with TIPS and subsequently reviews the literature relating to its management.

The disappearing abdominal mass: a duodenal pseudotumour.

Reports of inflammatory pseudotumours can be found in the literature affecting different organs of the body. The authors present a case and discuss the differential diagnosis of an inflammatory duodenal mass. Both symptomatology and radiological findings suggested a more sinister cause, such as a malignancy. However, histological analysis revealed normal mucosa and after conservative management the mass spontaneously resolved.

Spontaneous gastrosplenic fistula secondary to primary splenic lymphoma.

A gastrosplenic fistula is a rare complication of gastric and splenic lymphomas which can occur spontaneously or secondary to chemotherapy. We report a case of a spontaneous gastrosplenic fistula secondary to a diffuse splenic large B cell lymphoma in a previously well 43-year-old patient. CT imaging demonstrated the fistula, which was subsequently managed with chemotherapy. The clinical management of this rare condition is discussed with a review of the literature.

Hepatic vein morphology: a new sonographic diagnostic parameter in the investigation of cirrhosis?

OBJECTIVE: The purpose of this study was to evaluate the accuracy of a new sonographic marker for the diagnosis of cirrhosis using hepatic vein wall changes. METHODS: A prospective pilot study evaluating 88 patients, 38 with cirrhosis and 50 with no evidence of liver disease, was undertaken. Hard copy sonograms of the hepatic veins were obtained and reviewed in a blinded fashion by 2 radiologists. The hepatic vein morphology was assessed by 3 parameters: hepatic vein wall straightness, uniformity of hepatic vein wall echogenicity, and visualization of a complete 1-cm hepatic vein segment. The 3 parameters were compared to evaluate sensitivity and specificity for the diagnosis of cirrhosis. Interobserver and intraobserver errors for each parameter were also calculated with kappa statistics to assess reproducibility. RESULTS: There was a strong correlation between altered straightness and nonuniformity of hepatic vein wall echogenicity and cirrhosis. The straightness parameter had superior sensitivity of 97% (95% confidence interval [CI], 85%-100%) and specificity of 91% (95% CI, 78%-97%) for diagnosis of cirrhosis. Uniformity of hepatic vein wall echogenicity was the next most useful parameter, with sensitivity of 88% (95% CI, 73%-97%) and specificity of 86% (95% CI, 72%-95%). The continuous 1-cm segment of the hepatic vein had sensitivity of 68% (95% CI, 49%-83%) and specificity of 91% (95% CI, 78%-97%). Hepatic vein evaluation was found to show both good intraobserver and interobserver error. CONCLUSIONS: Hepatic vein morphology on sonography, in particular, changes in the straightness and uniformity of hepatic vein wall echogenicity, is a new sign of cirrhosis, which may increase the overall accuracy of sonographic diagnosis of cirrhosis and which appears to have a moderately high degree of reproducibility.