Peripancreatic Tuberculous Lymphadenitis Diagnosed via Endoscopic Ultrasound-guided Fine-needle Aspiration and Polymerase Chain Reaction.

We performed endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) on a patient presenting with an asymptomatic peripancreatic mass-like lesion. The aspiration cytologic finding was class II. On positron emission tomography-computed tomography (PET-CT), there were hot spots in the left supra-clavicular lymph node and the peripancreatic lesion. A whole biopsy of the left supra-clavicular lymph node revealed tuberculous lymphadenitis. Polymerase chain reaction (PCR) using tissue obtained via EUS-FNA showed that the peripancreatic mass-like lesion was also positive for tuberculosis. We made a diagnosis of peripancreatic tuberculous lymphadenitis. In patients with enlarged lymph nodes, including those in the abdominal area, tuberculous lymphadenitis is a potential diagnosis.

Electrocautery vs non-electrocautery dilation catheters in endoscopic ultrasonography-guided pancreatic fluid collection drainage.

AIM: To investigate the safety and utility of an electrocautery dilation catheter for endoscopic ultrasonography (EUS)-guided pancreatic fluid collection drainage. METHODS: A single-center, exploratory, retrospective study was conducted between August 2010 and August 2014. This study was approved by the Medical Ethics Committee of our institution. Informed, written consent was obtained from each patient prior to the procedure. The subjects included 28 consecutive patients who underwent EUS-guided transmural drainage (EUS-TD) for symptomatic pancreatic and peripancreatic fluid collections (PFCs) by fine needle aspiration using a 19-gauge needle. These patients were retrospectively divided into two groups based on the use of an electrocautery dilation catheter as a fistula dilation device; 15 patients were treated with an electrocautery dilation catheter (electrocautery group), and 13 patients were treated with a non-electrocautery dilation catheter (non-electrocautery group). We evaluated the technical and clinical successes and the adverse events associated with EUS-TD for the treatment of PFCs between the two groups. RESULTS: There were no significant differences in age, sex, type, location and diameter of PFCs between the groups. Thirteen patients (87%) in the electrocautery group and 10 patients (77%) in the non-electrocautery group presented with infected PFCs. The technical success rates of EUS-TD for the treatment of PFCs were 100% (15/15) and 100% (13/13) for the electrocautery and the non-electrocautery groups, respectively. The clinical success rates of EUS-TD for the treatment of PFCs were 67% (10/15) and 69% (9/13) for the electrocautery and the non-electrocautery groups, respectively (P = 0.794). The procedure time of EUS-TD for the treatment of PFCs in the electrocautery group was significantly shorter than that of the non-electrocautery group (mean ± SD: 30 ± 12 min vs 52 ± 20 min, P < 0.001). Adverse events associated with EUS-TD for the treatment of PFCs occurred in 0 patients and 1 patient for the electrocautery and the non-electrocautery groups, respectively (P = 0.942). CONCLUSION: EUS-TD using an electrocautery dilation catheter as a fistula dilation device for the treatment of symptomatic PFCs appears safe and contributes to a shorter procedure time.

[Two cases of gastric cancer expressing Glypican 3, but producing AFP with different lectin affinity].

We encountered 2 cases of AFP-producing gastric cancer. In the first patient, an 82-year-old man was found to have advanced type II advanced carcinoma in the stomach with a massive tumor embolus in the portal vein. In the second case, an 80-year-old man was given a diagnosis of multiple liver metastases of gastric cancer with portal vein thrombosis. Our diagnosis of gastric cancer in both cases was AFP-producing. It was supposed that the elevation of serum level of AFP might be caused by enteroblastic differentiation in the first case and hepatoid differentiation in the second case. Although, in both cases, the biopsy specimens of the gastric neoplasm proved moderately to poorly differentiated adenocarcinoma without hepatoid differentiation, the localization of Glypican 3 in gastric cancer cells was observed using immunostaining with a monoclonal antibody. In both cases, Glypican 3 was a sensitive and useful marker for AFP-producing gastric cancer with or without hepatoid differentiation.