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1.
Medicine (Baltimore) ; 99(16): e19885, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312014

RESUMO

RATIONALE: Gastrointestinal stromal tumor (GIST) is one of the most common malignant mesenchymal tumors of the gastrointestinal tract. They generally arise from the fourth layer (muscularis propria) and rarely from the second or third layer. Although the manifestations of gastric stromal tumors are diverse, to our knowledge, there are only several cases of an extra-gastric stromal tumor in the literature appearing with a pedunculation. Pedunculated large GISTs are not frequent and compress the neighboring organs. When they were huge, it is difficult to differentiate the origin of the masses. Thus, in the clinical setting, physicians should pay more attention to the pattern of manifestation of the gastric stromal tumor. PATIENT CONCERNS: A 62-year-old man had no gastrointestinal symptoms or significant medical and family histories. During the health examination with US, a cystic-solid tumor was found below liver. The results of the physical examination were unremarkable, and routine laboratory data on admission did not show any abnormal findings. DIAGNOSIS: Computed tomography of the abdomen showed a mixed echoic mass measuring 10 × 8 × 8 cm and located below the liver, adjacent to the gastric antrum. After endoscopic ultrasound-guided fine-needle aspiration, cytopathology showed that the specimen was filled with red blood cells, and it had no malignant cells. Histopathology revealed that the mass was a GIST, and immunohistochemical analysis showed the following: CD117(+), CD34(+), desmin(-), Dog-1(+), Ki-67% <1%, and smooth muscle actin(-). INTERVENTIONS: Surgical resection was performed on the patient. OUTCOMES: The lesion was diagnosed as a gastric stromal tumor with a pedicle and an old hemorrhage. The patient's recovery was uneventful. After surgery, computed tomography at the 6-month and 1-year postoperative follow-up visits did not reveal relapse or any metastasis. LESSONS: In the clinical setting, physicians should pay more attention to the pattern of manifestation of the extra-gastric stromal tumor in patients with a pedicle or hemorrhage. Additionally, endoscopic ultrasound-guided fine-needle aspiration can be used to make an accurate preoperative diagnosis of such diseases, and its findings can serve as an important basis for surgical excision of the lesions.


Assuntos
Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Gástricas/patologia , Estômago/patologia , Assistência ao Convalescente , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas c-kit/metabolismo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
Gastroenterol. hepatol. (Ed. impr.) ; 43(1): 1-8, ene. 2020. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188284

RESUMO

Introducción: A pesar de los avances en las técnicas de imagen, en muchos casos son insuficientes para establecer el diagnóstico de las lesiones quísticas pancreáticas (LQP). Son escasas las publicaciones en nuestro medio que evalúan la combinación de varios métodos obtenidos mediante la punción aspirativa con aguja fina con ultrasonografía endoscópica (USE-PAAF). El objetivo del estudio fue evaluar la utilidad global de la USE-PAAF en el diagnóstico de las LQP. Material y métodos: Estudio retrospectivo a partir de una base de datos actualizada prospectivamente de una cohorte de pacientes remitidos para USE-PAAF por LQP. Se estudió la sensibilidad, la especificidad, el rendimiento diagnóstico del antígeno carcinoembrionario (CEA), la citología y la viscosidad para detectar lesiones mucinosas. Resultados: Desde noviembre de 2013 a abril del 2018 se realizaron 122 USE por LQP. Se realizó USE-PAAF en 94/122 (77%) y se intervinieron 21/122 (17,2%) pacientes. Se incluyeron 33/122 pacientes que tuvieron confirmación diagnóstica mediante histología, imagen (quiste seroso con patrón típico) o evolución clínica. El estudio de la curva ROC determinó el punto de corte ≥419ng/ml para diferenciar lesión quística mucinosa/no mucinosa. El rendimiento diagnóstico del CEA fue del 87,5% (21/24), de la citología del 81,8% (27/33) y de la viscosidad del 84,4% (27/32). Los 3 parámetros en combinación obtuvieron el mejor resultado (30/33, 90,9%). Conclusión: La combinación del análisis del CEA, la citología y la viscosidad del líquido pancreático obtenido mediante USE-PAAF aumenta el rendimiento en el diagnóstico de las lesiones quísticas pancreáticas mucinosas, siendo superior al 90%


Introduction: Despite advances in imaging techniques, in many cases they are insufficient to establish the diagnosis of pancreatic cystic lesions (PCL). There are few publications in our setting that evaluate the combination of several methods obtained by endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). The aim of the study was to evaluate the overall utility of EUS-FNA in the diagnosis of PCL. Material and methods: Retrospective study based on a database updated prospectively of a cohort of patients referred for EUS-FNA due to PCL detected in an imaging test. The sensitivity, specificity and diagnostic yield of carcinoembryonic antigen (CEA), cytology and viscosity were studied to detect mucinous lesions. Results: From November 2013 to April 2018, 122 EUS were performed for PCL. EUS-FNA was performed in 94/122 (77%) and 21/122 (17.2%) patients were operated on. We included 33/122 patients who had diagnostic confirmation by histology, imaging (serous cyst with typical pattern) or clinical evolution. The study of the ROC curve determined the cutoff point ≥419 ng/ml to differentiate mucinous/non-mucinous cystic lesions. The diagnostic yield of CEA was 87.5% (21/24), cytology 81.8% (27/33) and viscosity 84.4% (27/32). The three parameters in combination obtained the best result (30/33, 90.9%). Conclusion: The combination of CEA analysis, cytology and viscosity of pancreatic fluid obtained by EUS-FNA increases the performance in the diagnosis of mucinous pancreatic cystic lesions, with it being greater than 90%


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Cisto Pancreático/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico , Estudos de Coortes , Antígeno Carcinoembrionário/administração & dosagem , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Cisto Pancreático/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Císticas, Mucinosas e Serosas/diagnóstico , Curva ROC , Endossonografia/métodos
3.
PLoS One ; 15(1): e0228565, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999789

RESUMO

Pancreatic cancer (PC) is a highly lethal malignancy, with a 5-year survival rate of 6%. Cancer gene panel testing is expected to allow selection of suitable therapeutic drugs in individual patients with PC and improve their prognosis. Although somatic mutations can be identified in formalin-fixed, paraffin-embedded samples derived from surgical specimen, the rate of surgical indication among patients with PC is only 20%. To acquire genome information with a less invasive method, we used rapid on-site evaluation (ROSE) specimens from endoscopic ultrasound-guided fine-needle aspiration. The present study aimed to retrospectively evaluate the utility of comprehensive cancer gene panel testing with ROSE specimens. DNA was extracted from preserved ROSE specimens of 26 patients diagnosed with PC between 2011 and 2017. DNA sequences of oncogenes and cancer-related genes were determined using the Ion AmpliSeq Comprehensive Caner Panel. We compared KRAS mutations between cancer gene panel testing by next-generation sequencing (NGS) and KRAS mutation analysis by polymerase chain reaction. The mean yield of DNA per extraction from ROSE specimens was 171 ng (range, 34-478 ng). On cancer gene panel testing, we noted KRAS mutations (92%), TP53 mutations (50%), CDKN2A mutations (15%), and SMAD4 mutations (31%). The concordance rate of KRAS mutations between cancer gene panel testing by NGS using ROSE specimens and KRAS mutation analysis by the companion diagnostics using residual materials was 81%. Among five cases of KRAS discordance, three showed KRAS mutations in cancer gene panel testing but not in KRAS mutation analysis. Cancer gene panel testing with ROSE specimens can help stratify unresectable PC patients without additional invasive approaches, and it can be used for therapeutic drug selection.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Redes Reguladoras de Genes , Neoplasias Pancreáticas/patologia , Análise de Sequência de DNA/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidor p16 de Quinase Dependente de Ciclina/genética , Feminino , Predisposição Genética para Doença , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/genética , Sistemas Automatizados de Assistência Junto ao Leito , Reação em Cadeia da Polimerase , Proteínas Proto-Oncogênicas p21(ras)/genética , Estudos Retrospectivos , Proteína Smad4/genética , Proteína Supressora de Tumor p53/genética
4.
Acta Cytol ; 64(1-2): 124-135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31509835

RESUMO

Pancreatic cysts are increasingly detected on imaging studies. Accurate determination of the cyst type is important to provide appropriate care for the patients. It is also very clear that not one single modality can provide adequate diagnostic information. A multidisciplinary approach is the key to the diagnosis of pancreatic cysts. In this setting, the role of ancillary testing, which includes biochemical testing (carcinoembryonic antigen and amylase levels in the cyst), molecular testing (e.g., KRAS, GNAS, VHL, and CTNB1), and/or immunohistochemical tests are very important to obtain an accurate diagnosis. This review will discuss helpful ancillary tests in common pancreatic cyst neoplasms and how to approach the diagnosis of pancreatic cysts.


Assuntos
Carcinoma Ductal Pancreático/diagnóstico , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Cisto Pancreático/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Antígeno Carcinoembrionário/metabolismo , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/metabolismo , Análise Mutacional de DNA/métodos , Humanos , Imuno-Histoquímica/métodos , Mutação , Cisto Pancreático/genética , Cisto Pancreático/metabolismo , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/metabolismo , Proteínas Proto-Oncogênicas p21(ras)/genética
5.
J Clin Pathol ; 73(2): 102-106, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31462450

RESUMO

AIMS: The cell block technique for assessing endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) specimens from pancreatic mucinous cystic lesions (MCLs) was systematically evaluated for the first time, including comparisons with three traditional methods of assessing such specimens. METHODS: The prospective arm comprised EUS-FNA specimens from EUS-suspected pancreatic MCLs. The retrospective arm comprised EUS-FNA specimens from pancreatic MCLs surgically resected before the study start. For each specimen, these data points were collected: macroscopic likelihood of mucin, cyst fluid carcinoembryonic antigen (CEA) level and presence of mucin in air-dried, direct smears and in cell block preparations. RESULTS: The prospective and retrospective arms of the study comprised 80 and 30 EUS-FNA specimens, respectively. Seven prospective cases led to surgical resections during the study, and therefore, 37 EUS-FNA specimens were confirmed to have originated from MCLs. In the prospective arm, macroscopic mucin was suspected, cyst fluid CEA level exceeded 192 ng/mL, mucin was detected in direct smears and cell block preparations in 78%, 30%, 39% and 73% of cases, respectively. Of the 37 specimens confirmed to originate from MCLs, macroscopic mucin assessment, cyst fluid CEA level, direct smear mucin assessment and cell block mucin assessment had sensitivities for diagnosing MCL of 87%, 45%, 45% and 81%, respectively. CONCLUSIONS: Cell block preparations are as likely to identify mucin from pancreatic MCLs as macroscopic assessment but are twice as likely to diagnose MCL than direct smears and fluid CEA biochemistry. The cell block technique is easy for sample collection and processing especially because these are identical for solid and cystic pancreatic lesions.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Mucinas/análise , Cisto Pancreático/química , Cisto Pancreático/patologia , Inclusão em Parafina , Biomarcadores/análise , Antígeno Carcinoembrionário/análise , Humanos , Cisto Pancreático/cirurgia , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fixação de Tecidos
6.
Ann Thorac Surg ; 109(3): 879-886, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31843636

RESUMO

BACKGROUND: Preoperative radiotherapy and/or chemotherapy of lung cancer in patients with locally advanced disease is an option in multimodal treatment. Sleeve lobectomy has an important part in decreasing complications and sparing lung function. We present our experience in a large cohort of patients after sleeve lobectomy with or without neoadjuvant treatment and standardized assessment of bronchial anastomotic healing. METHODS: The data used for this study were collected in a prospective database in our hospital. Anastomotic healing was documented by bronchoscopy on the seventh postoperative day and thereafter only when necessary, using a standardized scoring system. From 2006 to 2017, we performed 501 sleeve lobectomies representing 19% of all lung cancer resections. A total of 365 of patients had no preoperative treatment (73%), 41 had neoadjuvant chemotherapy (8%), and 95 had radiochemotherapy (19%). RESULTS: Using our scoring system of the bronchial anastomosis from 1 (excellent) to 5 (insufficient), we found the anastomosis was worse than grade 2 after no treatment, chemotherapy, or radiochemotherapy in 17%, 10%, and 30%, respectively (P = .002). The rate of anastomotic insufficiency was equally low after no pretreatment and chemotherapy (2.7% and 2.4%) and rose to 10.4% after radiotherapy (P = .002). Similarly, the risk for pulmonary complications was higher after radiochemotherapy (39%) compared with no pretreatment (29%) or chemotherapy (27%), respectively (P = .382). CONCLUSIONS: Neoadjuvant radiotherapy is associated with worse wound healing of the anastomosis after sleeve lobectomy in lung cancer. There seems to be a higher risk for anastomotic insufficiency and complications.


Assuntos
Brônquios/cirurgia , Neoplasias Pulmonares/cirurgia , Neoplasias Pulmonares/terapia , Pneumonectomia/métodos , Cicatrização , Idoso , Anastomose Cirúrgica/métodos , Broncoscopia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias/métodos , Prognóstico , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
7.
Nihon Shokakibyo Gakkai Zasshi ; 116(12): 1039-1048, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31827044

RESUMO

Anaplastic pancreatic carcinoma is a rare form of pancreatic cancer with an extremely poor prognosis. Its diagnosis is often based on surgical specimens and few reports have described the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis. In this study, we examined six patients (mean age, 70.5 years;sex ratio, 1:1) who were diagnosed with anaplastic pancreatic carcinoma using EUS-FNA. The carcinomas were located in the pancreatic head, body, and tail in one, three, and two patients, respectively. The mean tumor diameter was 49.2mm. Five patients opted for best supportive care due to poor performance status and one underwent chemotherapy (GEM+nab-PTX). The median survival was 40.5 (14-98) days. The characteristic imaging findings of anaplastic pancreatic carcinoma, including central necrosis, marginal contrast enhancement, cystic findings, and internal calcification, were frequently observed in the patients. Anaplastic pancreatic carcinoma can also be diagnosed using biopsy tissue;however, a pathologist's consultation is required to differentiate the disease based on imaging findings for an accurate diagnosis.


Assuntos
Adenocarcinoma , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Pancreáticas , Idoso , Humanos , Pâncreas , Estudos Retrospectivos
9.
Arq Bras Cir Dig ; 32(4): e1471, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31859924

RESUMO

BACKGROUND: Intraductal papillary mucinous tumor (IPMN) are being diagnosed with increasing frequency. Computerized tomography scanning is commonly used as the primary imaging modality before surgery nonetheless magnetic resonance cholangiopancreatography (MRCP) provides better characterization. Endosonography-guided fine needle aspiration (EUS-FNA) has emerged as a way to reach pathological diagnose. AIM: To compare results of both methods with surgical pathology findings for classification of IPMN. METHODS: Thirty-six patients submitted to surgical resection with preoperative suspect of IPMN were submitted preoperatively to MRCP and EUS-FNA. Images obtained were analyzed according to a classification determined for each method. ROC curve was used for statistical analysis, that compared the images tests with the purpose of finding the best method for diagnosis and classification of IPMN. RESULTS: Sixteen patients underwent pancreatoduodenectomy, 16 to subtotal pancreatectomy and only four laparotomy. Pathological diagnosis was IPMN (n=33) and pancreatic intraepithelial neoplasia type 2 (n=3). Twenty-nine revealed non-invasive neoplasia and invasive form in four patients. MRCP and EUS-FNA have correctly diagnosed and classified (type of IPMN), in 62.5% and 83.3% (p=0.811), the affected segment location in 69% and 92% (p=0.638) and identification of nodules and/or vegetation presence in 45% and 90% (p=0.5). Regarding to histopathological diagnosis by EUS-FNA the sensitivity was 83.3%; specificity was 100%; positive predictive value was 100%; negative predictive value was 33.3% and accuracy was 91.7%. CONCLUSIONS: There was no significant difference in the diagnosis of IPMN. However, EUS-FNA showed better absolute results than MRCP to identify nodule and/or vegetation.


Assuntos
Neoplasias Intraductais Pancreáticas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Colangiopancreatografia por Ressonância Magnética , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
11.
Isr Med Assoc J ; 21(11): 738-742, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31713362

RESUMO

BACKGROUND: Transesophageal endoscopic ultrasound-guided fine-needle aspiration using a bronchoscope (EUS-B-FNA) allows clinicians to determine mediastinal staging and lung mass evaluation of lesions not accessible by endobronchial ultrasound (EBUS) or where endobronchial ultrasound-guided transbronchial needle aspiration might not be safe. OBJECTIVES: To evaluate the safety, diagnostic accuracy, and feasibility of EUS-B-FNA. METHODS: The study comprised patients who underwent a pulmonologist-performed EUS-B-FNA of mediastinal lymph nodes and parenchymal lung lesions between June 2015 and September 2017 at the Carmel Medical Center, Haifa, Israel. RESULTS: EUS-B-FNA was performed in 81 patients. The transesophageal procedure was performed for easier accessibility (49.4%) and in high-risk patients (43.3%). The most frequently sampled mediastinal stations were left paratracheal and sub-carinal lymph nodes or masses (38.3% and 56.7%, respectively). There were no complications (e.g., acute respiratory distress, esophageal perforation, or bleeding). An accurate diagnosis was determined in 91.3% of cases. CONCLUSIONS: Pulmonologist-performed EUS-B-FNA is safe and accurate for evaluating mediastinal and parenchymal lung lesions and lymphadenopathy. Diagnostic accuracy is high. EUS-B-FNA may allow access to sites not amenable to other forms of bronchoscopic sampling, or may increase diagnostic accuracy in patients where anatomic position predicts a low diagnostic yield.


Assuntos
Broncoscópios , Carcinoma Pulmonar de Células não Pequenas/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Mediastino/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Esôfago , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos
12.
Pathologe ; 40(Suppl 3): 311-315, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31705231

RESUMO

BACKGROUND: Cytology has a key role in the step-wise diagnostic approach to pancreatic mass lesions. Brush cytology and ultrasound-guided endoscopic fine-needle aspiration provide specimens for diagnosis prior to surgical or conservative therapy. The diagnostic system of the Papanicolaou Society of Cytopathology provides a conceptual framework for reporting these specimens. Cystic lesions represent a particular challenge in pancreatic cytology, as in many instances a purely morphological approach will not result in an adequate diagnostic interpretation. Noteworthy from a conceptual point of view is how the Papanicolaou Society System incorporates non-morphological methods: laboratory chemical (CEA >192 ng/ml) and molecular (KRAS and/or GNAS mutations) findings are part of the formal diagnostic criteria for neoplastic cysts. RESULTS: The Bern experience shows that such an integrated approach results in a significantly increased diagnostic yield. Among 83 samples analyzed, adequate DNA could be extracted in 79 samples (95%). Next generation sequencing identified pathogenic mutations in 46 cases (58%). Of these, in 35 (76%) a neoplastic cyst could not have been diagnosed by morphology alone. CONCLUSION: These findings illustrate a new perspective for diagnostic situations, where morphology alone does allow for a sufficient diagnostic work-up. Along this line of thinking, liquid biopsy should not be regarded as a replacement, but rather an extension of the cytology's diagnostic armamentarium, according to the principle of "doing more with less."


Assuntos
Pâncreas/citologia , Cisto Pancreático , Neoplasias Pancreáticas , Análise Mutacional de DNA , DNA de Neoplasias/genética , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Humanos , Mutação , Cisto Pancreático/diagnóstico , Cisto Pancreático/genética , Cisto Pancreático/patologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/patologia
13.
Arch. Soc. Esp. Oftalmol ; 94(11): 566-570, nov. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-187415

RESUMO

El 25% de las metástasis de la órbita suelen ser de origen primario desconocido y requieren confirmación histopatológica e inmunohistoquímica. La toma de biopsia con aspiración con aguja fina de la órbita es un procedimiento alternativo a la orbitotomía convencional. Describimos el caso de una mujer de 60 años que presenta una masa tumoral en la órbita derecha y lesiones neoformativas en el cerebro y el cráneo. Incidentalmente, la paciente presentó un trombo en la aurícula izquierda, por lo que se desestimó la orbitotomía y se realizó la biopsia con aspiración con aguja fina de la órbita guiada por ultrasonido con evaluación rápida in situ de las muestras obtenidas. Se encontraron células malignas de adenocarcinoma pulmonar confirmadas con inmunohistoquímica e imágenes diagnósticas del tórax. En conclusión, las muestras obtenidas por biopsia con aspiración con aguja fina de la órbita, junto con el análisis citopatológico e inmunohistológico, permitieron identificar la metástasis orbitaria en el caso mencionado, siendo este procedimiento una alternativa segura, efectiva y mínimamente invasiva


Twenty five percent of orbital metastasis is usually of unknown primary origin and it requires histopathological and immunohistochemical confirmation. The fine-needle aspiration biopsy of the orbit is an alternative procedure to conventional orbitotomy. The case is presented of a 60 year-old woman with a right orbit tumour mass and neoplastic lesions in her brain and cranium. As an incidental finding, she had a thrombus in her left atrium, and so an orbitotomy procedure was ruled out. An ultrasound-guided fine-needle aspiration biopsy was performed instead with rapid on-site evaluation of biopsy samples. These showed malignant cells of a lung adenocarcinoma, which was confirmed with immunohistochemistry and chest diagnostic images. In conclusion, biopsy samples obtained by fine-needle aspiration biopsy, together with cytopathological and immunohistological analysis, enabled orbital metastasis to be identified in the case described, and showed that fine-needle aspiration biopsy is a safe, effective, and minimally invasive alternative


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Adenocarcinoma/secundário , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Pulmonares/patologia , Neoplasias Orbitárias/secundário , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/patologia
14.
Medicine (Baltimore) ; 98(41): e17555, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593139

RESUMO

RATIONALE: Endobronchial ultrasound has revolutionized the field of bronchoscopy and has become one of the most important tools for the diagnosis of intrathoracic lymphadenopathy and para-bronchial structures. The reach of this technique has not been limited to these structures and pleural lesions have been at times accessible. To our knowledge, pleural fluid collections have not been accessed with endobronchial ultrasound (EBUS). PATIENT CONCERNS: 52-year-old women with dyspnea, fever and a new loculated pleural effusion that was suspected to be the source of the fever but was not accessible through traditional thoracentesis. DIAGNOSIS: Malignant pleural effusion. INTERVENTIONS: Sampling and drainage of the loculated pleural fluid collection using EBUS scope introduced via the esophagus. OUTCOMES: Infection excluded. Resolution of fever and improved dyspnea after drainage of effusion. LESSONS: The convex curvilinear ultrasound bronchoscope allows unprecedented access to thoracic structures. The reach is not limited to mediastinal lymph nodes and parenchymal masses adjacent to the airways, and pleural space and pleural fluid are at times accessible, particularly when one considers the esophageal approach.


Assuntos
Derrame Pleural Maligno/diagnóstico por imagem , Derrame Pleural Maligno/cirurgia , Toracentese/métodos , Broncoscópios , Drenagem/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Pleural Maligno/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 98(39): e17242, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574837

RESUMO

BACKGROUND: Lung cancer is a major health problem, with estimates of 1.6 million tumor-related deaths annually worldwide. The emergence of endobronchial ultrasound (EBUS), a minimally invasive procedure capable of providing valuable information for primary tumor diagnosis and mediastinal staging, significantly changed the approach of pulmonary cancer, becoming part of the routine mediastinal evaluation of lung cancer in developed countries. Some economic evaluation studies published in the last 10 years have already analyzed the incorporation of the EBUS technique in different health systems. The aim of this systematic review is to synthesize the relevant information brought by these studies to better understand the economic effect of the implementation of this staging tool. METHODS: The systematic review will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Eletronic databases (Medline, Lilacs, Embase, Cochrane Library of Trials, Web of Science, Scopus, National Health System Economic Evaluation Database) will be searched for full economic analyses regarding the use of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) compared to the surgical technique of mediastinoscopy for the mediastinal staging of lung cancer. Two authors will perform the selection of studies, data extraction, and the assessment of risk of bias. Occasionally, a senior reviewer will participate, if necessary, on study selection or data extraction. RESULTS: Results will be published in a peer-reviewed journal. CONCLUSION: This review may influence a more cost-effective mediastinal staging approach for patients with lung cancer around the world and help health decision makers decide whether the EBUS-TBNA technique should be incorporated into their health systems and how to do it efficiently. PROTOCOL REGISTRY: PROSPERO 42019107901.


Assuntos
Broncoscopia/economia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/economia , Neoplasias Pulmonares/diagnóstico , Mediastinoscopia/economia , Estadiamento de Neoplasias/economia , Broncoscopia/métodos , Análise Custo-Benefício , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Humanos , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/patologia , Mediastinoscopia/métodos , Estadiamento de Neoplasias/métodos , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
16.
Medicine (Baltimore) ; 98(39): e17365, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574884

RESUMO

RATIONALE: Periorbital cellulitis or an orbital abscess caused by acute sinusitis is a serious acute infectious disease. If not treated in time, serious complications may occur. PATIENT CONCERNS: A 16-year-old girl with a history of right-sided proptosis, periorbital swelling, chemosis, hypophasis, restricted ocular movement in the upward direction, and diminution of vision was referred to our institution. The clinic, computed tomography (CT) and magnetic resonance imaging (MRI) examination indicate right orbital abscess in the upper quadrant and sinusitis. DIAGNOSES: She was diagnosed with orbital abscess, acute sinusitis. INTERVENTIONS: She underwent medical management, transnasal endoscopic surgery and then ultrasound-guided fine needle aspiration (FNA) and catheter drainage. OUTCOMES: She was completely cured without any complications or sequelae. LESSONS: Performance of surgical drainage in a timely manner and administration of effective antibiotic treatment according to bacterial culture can reduce the complications of orbital abscesses. Ultrasound-guided FNA and catheter drainage is a safe, simple, and effective method for the treatment of orbital abscess.


Assuntos
Abscesso/cirurgia , Drenagem/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Doenças Orbitárias/cirurgia , Sinusite/cirurgia , Abscesso/microbiologia , Doença Aguda , Adolescente , Cateteres , Drenagem/instrumentação , Feminino , Humanos , Doenças Orbitárias/microbiologia , Sinusite/microbiologia
17.
World J Gastroenterol ; 25(36): 5530-5542, 2019 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-31576098

RESUMO

BACKGROUND: DNA mutational analysis of pancreatic cystic fluid (CF) is a useful adjunct to the evaluation of pancreatic cysts. KRAS/GNAS or RAF/PTPRD/CTNNB1/RNF43 mutations are highly specific to precancerous or advanced neoplasia. Several studies recently demonstrated the ability of next-generation sequencing (NGS) analysis to detect DNA mutations in pancreatic CF, but few studies have performed a systematic comparative analysis between pancreatic CF and neoplastic surgical tissue (NT). The value of CF-NGS analysis indicators for determining surgical resection necessitates evaluation. AIM: To confirm whether CF genomic profiles are a reliable malignancy predictor by comparing NGS mutational analyses of CF and NT. METHODS: Patients requiring surgery for high-risk pancreatic cysts were included in a multicenter prospective pilot study. DNA from CF (collected by endoscopic ultrasound-guided fine needle aspiration (known as EUS-FNA)) and NT (collected by surgery) were analyzed by NGS. The primary objective was to compare the mutation profiles of paired DNA samples. The secondary objective was to correlate the presence of specific mutations (KRAS/GNAS, RAF/ PTPRD/CTNNB1/RNF43/POLD1/TP53) with a final cancer diagnosis. Sensitivity and specificity were also evaluated. RESULTS: Between December 2016 and October 2017, 20 patients were included in this pilot study. Surgery was delayed for 3 patients. Concordant CF-NT genotypes were found in 15/17 paired DNA, with a higher proportion of mutated alleles in CF than in NT. NGS was possible for all pancreatic CF collected by EUS-FNA. In 2 cases, the presence of a KRAS/GNAS mutation was discordant between CF and NT. No mutations were found in 3 patients with NT or pancreatic cysts with high-grade dysplasia. The sensitivity and specificity of KRAS/GNAS mutations in CF to predict an appropriate indication for surgical resection were 0.78 and 0.62, respectively. The sensitivity and specificity of RAF/PTPRD/CTNNB1 /RNF43/POLD1/TP53 mutations in CF were 0.55 and 1.0, respectively. CONCLUSION: Mutational analyses of CF and NT were highly concordant, confirming the value of NGS analysis of CF in the preoperative malignancy assessment. However, these results need to be confirmed on a larger scale.


Assuntos
Biomarcadores Tumorais/genética , Líquido Cístico , Pâncreas/patologia , Cisto Pancreático/genética , Neoplasias Pancreáticas/genética , Idoso , Idoso de 80 Anos ou mais , Análise Mutacional de DNA , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Estudos de Viabilidade , Feminino , Genômica/métodos , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Pâncreas/cirurgia , Pancreatectomia , Cisto Pancreático/patologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgia , Projetos Piloto , Estudos Prospectivos
18.
Acta Gastroenterol Belg ; 82(3): 359-362, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566322

RESUMO

AIM: Evaluate the diagnostic yield of biopsies obtained by EUS guidance in patients with gastric wall thickening and prior negative endoscopic biopsies. MATERIAL AND METHODS: Data collected from October 2008 to January 2016 were analyzed in a retrospective manner. All included patients had undergone at least one endoscopy with a negative biopsy and showed evidence of gastric wall thickening by tomography, confirmed by endoscopy. All patients gave their written informed consent before the procedure. Demographics and baseline characteristics, including age, sex, number of previous endoscopies, and histopathological diagnosis were recorded. Follow-up data were obtained from a review of the electronic medical records. RESULT: In total, 22 patients with previous negative endoscopic biopsies and gastric wall thickening were included. Using EUSFNA/FNB, the diagnosis was made in the first procedure in 19/22 (86.30%) cases, while in 1/22 (4.5%) patients the diagnosis was made in the second EUS-FNA. A total of 18 (81.82%) patients with EUS-FNA were assessed using a standard Echo-tip, while the remaining four (18.18%) patients underwent EUS-FNB and using a ProCore needle. All patients with a final diagnosis of malignancy had a thickened gastric wall with impaired gastric distension and a loss of wall structure determined by EUS. Of patients with a benign final diagnosis, all (n=8) showed a thickened gastric wall by EUS but with preservation of the deep layers. CONCLUSION: EUS-FNA/FNB is necessary in patients with a thickened gastric wall and prior negative biopsy on endoscopy. The procedure is safe and has a good diagnostic.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Neoplasias Gastrointestinais/diagnóstico por imagem , Endoscopia , Neoplasias Gastrointestinais/patologia , Humanos , Estudos Retrospectivos
20.
BMJ ; 367: l5553, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31641045

RESUMO

Sarcoidosis is a highly variable granulomatous multisystem syndrome. It affects individuals in the prime years of life; both the frequency and severity of sarcoidosis are greater in economically disadvantaged populations. The diagnosis, assessment, and management of pulmonary sarcoidosis have evolved as new technologies and therapies have been adopted. Transbronchial needle aspiration guided by endobronchial ultrasound has replaced mediastinoscopy in many centers. Advanced imaging modalities, such as fluorodeoxyglucose positron emission tomography scanning, and the widespread availability of magnetic resonance imaging have led to more sensitive assessment of organ involvement and disease activity. Although several new insights about the pathogenesis of sarcoidosis exist, no new therapies have been specifically developed for use in the disease. The current or proposed use of immunosuppressive medications for sarcoidosis has been extrapolated from other disease states; various novel pathways are currently under investigation as therapeutic targets. Coupled with the growing recognition of corticosteroid toxicities for managing sarcoidosis, the use of corticosteroid sparing anti-sarcoidosis medications is likely to increase. Besides treatment of granulomatous inflammation, recognition and management of the non-granulomatous complications of pulmonary sarcoidosis are needed for optimal outcomes in patients with advanced disease.


Assuntos
Glucocorticoides/uso terapêutico , Hipertensão Pulmonar/prevenção & controle , Imunossupressores/uso terapêutico , Fibrose Pulmonar/prevenção & controle , Sarcoidose Pulmonar/diagnóstico , Biomarcadores/sangue , Broncoscopia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Fluordesoxiglucose F18/administração & dosagem , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/mortalidade , Incidência , Pulmão/diagnóstico por imagem , Pulmão/patologia , Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Fibrose Pulmonar/etiologia , Fibrose Pulmonar/mortalidade , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/tratamento farmacológico , Sarcoidose Pulmonar/epidemiologia , Resultado do Tratamento
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