Squamous Cell Carcinoma of Pancreas: Mystery and Facts.

Squamous cell carcinoma of the pancreas is very rare as pancreas does not have any squamous cells. Only a few cases have been reported in the literature so far. We describe such a case where in the patient presented with painless jaundice. CT and EUS confirmed the pancreatic mass biopsy of which showed squamous cell cancer.

Management of gastric variceal bleeding: Role of endoscopy and endoscopic ultrasound.

Gastric varices (GVs) are notorious to bleed massively and often difficult to manage with conventional techniques. This mini-review addresses endoscopic management principles for gastric variceal bleeding, including limitations of ligation and sclerotherapy and merits of endoscopic variceal obliteration. The article also discusses how emerging use of endoscopic ultrasound provides optimism of better diagnosis, improved classification, innovative management strategies and confirmatory tool for eradication of GVs.

Extensive extramedullary disease involving the colon in multiple myeloma: a case report and review of literature.

INTRODUCTION: Organ involvement in multiple myeloma (MM) is characterized by infiltrative disease or by a myelomatous mass known as a plasmacytoma. We present a patient with MM who had extensive extramedullary involvement of the colon and a review of the literature on colon plasmacytomas. CASE REPORT: A 57-year-old male with MM presented with disease relapse in 2007, workup showing biopsy confirmed left perinephric extra-medullary disease involving the adjacent colon. Positron emission-tomography (PET) exhibited intense pan-colonic fluoro-deoxyglucose (FDG) uptake and computed-tomography confirmed extensive infiltrating soft tissue thickening in the ascending, transverse, and descending colon representing plasmacytomas. The patient underwent an autologous hematopoietic stem cell transplantation after conditioning with high-dose melphalan. Restaging PET-scan showed complete resolution of colonic extra-medullary plasmacytomas. Extramedullary plasmacytomas (EMP) are rare and constitute 4% of all plasma cell tumors. DISCUSSION AND CONCLUSION: Colonic plasmacytoma is an extremely rare site, with fewer than 25 cases reported in the literature. Colonic plasmacytomas have different presentations depending on the size and location. Treatment options for primary EMPs include surgical resection, radiotherapy, and chemotherapy. The primary treatment option for secondary EMP is systemic chemotherapy. This rare pan-colonic plasmacytoma, as a part of extramedullary myeloma, showed an impressive response to chemotherapy.

Intrapancreatic accessory spleen: investigative dilemmas and role of EUS-guided FNA for diagnostic confirmation.

CONTEXT: We submit a case of intrapancreatic accessory spleen. CASE REPORT: A 33-year-old patient with history of dyspepsia underwent imaging studies suggestive of a neuroendocrine tumor. After referral to our institute, endoscopic ultrasound guided fine needle aspiration (EUS-FNA) confirmed diagnosis as intrapancreatic accessory spleen. DISCUSSION: An accessory spleen may develop from estranged mesenchymal cells due to fusion failure of the splenic anlage. The prevalence of an accessory spleen is 10-30% with 80% of them present at the splenic hilum and 17% in the pancreatic tail. Intrapancreatic accessory spleen is commonly misdiagnosed as a pancreatic tumor. Since, the differential diagnosis includes pancreatic neuroendocrine tumors, additional investigation with EUS-FNA should be considered when radiological diagnosis is not definitive. CONCLUSION: For diagnosis of intrapancreatic accessory spleen, radiographic imaging is useful, but lacks specificity without tissue diagnosis. Diagnosis can be safely and reliably established with EUS-FNA, leading to a benign prognosis and avoidance of unnecessary surgical intervention.

In patients referred for investigation because computed tomography suggests thickened gastric folds, endoscopic ultrasound is superfluous if gastroscopy is normal.

BACKGROUND AND OBJECTIVE: Endoscopic ultrasound (EUS) is often requested in patients in whom computed tomography (CT) shows gastric wall thickening. It is unclear if EUS is useful if upper endoscopy is normal. The aim of this study was to prospectively compare the yield of upper endoscopy and EUS for this indication. METHODS: All patients referred for endoscopic ultrasound because of thickened gastric folds on CT from May 2001 and June 2003 were included. A single physician, questioned, examined, and performed upper endoscopy followed by EUS in all patients. Data were recorded prospectively. The main outcome measures were: upper endoscopy and EUS findings and predictors of abnormal EUS. RESULTS: Sixty-nine patients were enrolled. The average age was 57.9, 49% were male, 51% were asymptomatic, 57% had normal upper endoscopy, and 70% had normal EUS. If upper endoscopy was abnormal, EUS was abnormal in 70% of cases (95% CI 62%-78%). If upper endoscopy was normal, the EUS was normal in 100% of cases (95% CI 92%-100%). Multivariate analysis revealed that neither age, gender, presence of abdominal symptoms nor alarm symptoms predicted abnormal EUS. CONCLUSIONS: When CT shows gastric wall thickening: (a) Nnormal upper endoscopy is strongly associated with normal EUS; (b) abnormal upper endoscopy is associated with abnormal EUS in 70% of cases; (c) clinical variables such as age, sex, and the presence of symptoms do not predict or increase the likelihood of abnormal EUS. Therefore, in patients with thickened gastric wall on CT, upper endoscopy should be used to select patients for EUS.

Extraintestinal Applications of Endoscopic Ultrasound.

Since the joining of ultrasonographic and endoscopic technologies in 1980, there has been tremendous advancement in the use of endoscopic ultrasound (EUS). Initially EUS was used mainly to study the anatomic appearance of digestive organs. In the 1990s, with the development of the charge-coupled device, thinner, more flexible scopes were developed that simplified imaging for the endosonographer and improved patient safety. With the development of linear array EUS scopes, biopsies could be performed utilizing fine needle aspiration. Currently, several therapeutic techniques, which were formerly performed through radiologic or surgical procedures, are being safely done with EUS. These include celiac plexus neurolysis and endoscopic drainage of pancreatic cysts. With the advent of miniprobe technology, better delineation of the wall of the gastrointestinal tract can be obtained, facilitating endoscopic mucosal resection. Novel therapeutic uses for EUS are constantly emerging. This article describes the various extraintestinal applications of EUS that have been developed in the last 25 years. More gastroenterologists need training in order to utilize this challenging technology and improve patient access in the local community setting.