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1.
Nihon Shokakibyo Gakkai Zasshi ; 118(3): 264-271, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33692261

RESUMO

The patient was an 81-year-old man who presented with a complaint of hoarseness. When he was 80 years old, he had developed superficial esophageal cancer and had undergone endoscopic submucosal dissection (ESD) at our hospital. Two months after the ESD, he developed hoarseness. Computed tomography (CT) scan showed no abnormal findings at that time;therefore, he was diagnosed with idiopathic vocal cord paralysis, and followed up with symptom treatment in the Gastroenterology and Otolaryngology Departments. Ten months after the ESD, a CT scan revealed mediastinal lymph node swelling. He was admitted to our hospital for histopathological examination of the lymph node using endoscopic ultrasound-fine needle aspiration (EUS-FNA). The histopathological examination revealed squamous cell carcinoma of the lymph node, similar to the primary esophageal tumor. This result suggests that laryngeal nerve paralysis involving hoarseness is caused by lymph node metastasis of superficial esophageal cancer. We report that histopathological examination with EUS-FNA helps in determining the cause of hoarseness that develops after ESD.


Assuntos
Ressecção Endoscópica de Mucosa , Neoplasias Esofágicas , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Ressecção Endoscópica de Mucosa/efeitos adversos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Neoplasias Esofágicas/diagnóstico por imagem , Neoplasias Esofágicas/cirurgia , Rouquidão/etiologia , Humanos , Linfonodos , Masculino , Recidiva Local de Neoplasia
2.
Medicine (Baltimore) ; 100(10): e25106, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725907

RESUMO

INTRODUCTION: Cytological study of samples obtained by Endoscopic ultrasound (EUS)-guided fine-needle aspiration (EUS-FNA) allows for recognition of clear signs of malignant transformation. However, certain neoplasms can be difficult to diagnose without histological analysis. Recently, a novel EUS-guided fine needle biopsy (EUS-FNB) needle was developed to increase tissue acquisition. This study set out to investigate the usefulness of this novel EUS-FNB needle (NEFN) in terms of obtaining a proper histology compared with a conventional EUS-FNA needle (CEFN). METHODS: This investigation was a prospective, single-blind, randomized study in a single academic hospital. Primary outcome was the acquisition rate of an appropriate and sufficient specimen for histologic assessment. Secondary outcomes were diagnostic yield of peripancreatic masses using a CEFN and a NEFN. Furthermore, we assessed the feasibility of determining K-ras mutation status according to needle type. RESULTS: The study enrolled 56 consecutive patients. Technical success rates were 96.6% (28/29) for the CEFN and 100% (27/27) for the NEFN (P = 1.000). No complications occurred during or after the procedure in either needle group. An adequate sample for cytologic diagnosis was obtained in 89.7% (26/29) of patients in the CEFN group vs 96.3% (26/27) of patients in the NEFN group (P = .612). For histologic diagnosis, a sample with a biopsy adequacy score of 2 or more was obtained in 41.4% (12/29) of CEFN-acquired samples vs 88.9% (24/27) of NEFN-acquired samples (P < .001). K-ras mutation analysis using histologic specimens was possible in 13 (44.8%) CEFN-acquired samples and 25 (92.6%) of NEFN-acquired samples. This difference was significant (P < .001). CONCLUSIONS: The present study suggests that the NEFN is an effective and reliable alternative compared to a CEFN in terms of tissue acquisition rate and quality of histologic sampling.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Agulhas , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Método Simples-Cego
4.
Medicine (Baltimore) ; 100(7): e24728, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607816

RESUMO

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a simple, reliable, minimally invasive and effective procedure. However, a surgical technique may be required, if the results are negative. Therefore, there is a need for new studies to increase the diagnostic value of EBUS-TBNA and provide additional information to guide the biopsy in performing the procedure. Here, we aimed to investigate the diagnostic value of EBUS-TBNA and 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in diagnosis of hilar and/or mediastinal lymph nodes (LNs). It was also aimed to determine the contributions of real-time ultrasonography (USG) images of LNs to distinguishing between the malignant and benign LNs during EBUS-TBNA, and in the diagnosis of anthracotic LNs. MATERIAL AND METHOD: In the retrospective study including 545 patients, 1068 LNs were sampled by EBUS-TBNA between January 2015 and February 2020. EBUS-TBNA, 18-FDG PET/CT and images of USG were investigated in the diagnosis of mediastinal and/or hilar malignant, anthracotic and other benign LNs. RESULTS: The sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were found as 79.5, 98.1, 89.5, and 91.7%, respectively. Mean maximum standardized uptake value (SUVmax) values of 18F-FDG PET/CT were 6.31±4.3 in anthracotic LNs and 5.07 ±â€Š2.53 in reactive LNs. Also, mean SUVmax of malignant LNs was 11.02 ±â€Š7.30 and significantly higher than that of benign LNs. In differentiation of malignant-benign tumors, considering the cut off value of 18F-FDG PET/CT SUVmax as 2.72, the sensitivity and specificity was 99.3 and 11.7%, but given the cut off value as 6.48, the sensitivity, specificity, positive predictive value and negative predictive value was found as 76.5, 64, 20.49, and 78.38% for benign LNs, respectively. Compared LNs as to internal structure and contour features, malignant LNs had most often irregular contours and heterogeneous density. Anthracotic, reactive and other benign LNs were most frequently observed as regular contours and homogeneous density. The difference between malignant and benign LNs was significant. CONCLUSION: EBUS can contribute to the differential diagnosis of malignant, anthracotic and other benign LNs. Such contributions can guide clinician bronchoscopists during EBUS-TBNA. The triple modality of EBUS-TBNA, 18FDG PET/CT, and USG may increase the diagnostic value in hilar and mediastinal lymphadenopathies.


Assuntos
Antracose/diagnóstico por imagem , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Mediastino/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Ultrassonografia/métodos , Idoso , Antracose/patologia , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18/metabolismo , Humanos , Linfonodos/diagnóstico por imagem , Linfadenopatia/patologia , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
5.
Medicine (Baltimore) ; 100(5): e24625, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592915

RESUMO

RATIONALE: Primary breast angiosarcoma (PBA) is a rare and overly aggressive entity and account for less than 1% of all breast cancer cases. PBA had a high rate of delayed preoperative diagnosis due to absent distinctive radiographic characteristics. PATIENT CONCERNS: We report a case of a 47-year-old female patient who had a previous history of luminal cancer in the right breast with mastectomy; the patient complained of asymmetrically diffuse enlarged, accompanying with a painless mass in the left breast 12 years after the mastectomy of her right breast. DIAGNOSES: The tumor mimicked idiopathic granulomatous mastitis on magnetic resonance imaging (MRI) at the first presentation. Contrast-enhanced ultrasound (CEUS) was performed for further lesion characterization and showed heterogeneous rapid hyper enhanced. An ultrasound-guided core needle biopsy was performed, and the pathology report indicated a breast angiosarcoma. INTERVENTIONS: The patient underwent a nipple-sparing simple mastectomy with immediate reconstruction of the left breast. OUTCOMES: After 8 months later, the tumor recurred, CEUS and MRI examination suggested PBA recurrence, then re-excision with implant removal was performed, the patient had a lung metastasis 4 months later eventually died 22 months after diagnosis. LESSONS: It is not easy to diagnose PBA with the radiographic examination. This case's importance is by combining CEUS and MRI to reflect enhanced morphology and hemodynamic characteristics of PBA and help diagnose breast angiosarcomas.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Ultrassonografia Mamária
6.
Ann R Coll Surg Engl ; 103(2): e65-e68, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559545

RESUMO

Intraductal papillary mucinous neoplasm of the bile duct is a rare tumour only recently classified as a distinct pathological entity. These neoplasms, rarely encountered in clinical practice in the UK, are now considered to be important precursors for the development of cholangiocarcinoma. We present a histologically confirmed case of intraductal papillary neoplasm of the bile duct in a male patient and discuss the main radiographic manifestations of this rare condition across multiple imaging modalities, with an emphasis on the imaging features of endoscopic ultrasonography and its role in establishing the diagnosis.


Assuntos
Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Papilar/diagnóstico , Neoplasias dos Ductos Biliares/diagnóstico , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Endossonografia , Cuidados Pré-Operatórios/métodos , Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Mucinoso/cirurgia , Adenocarcinoma Papilar/patologia , Adenocarcinoma Papilar/cirurgia , Idoso , Variação Anatômica , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/anormalidades , Ductos Biliares Intra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Hepatectomia/métodos , Humanos , Achados Incidentais , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Rev. esp. enferm. dig ; 113(1): 48-51, ene. 2021. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-199889

RESUMO

INTRODUCCIÓN: el insulinoma pancreático esporádico es un tumor con frecuencia benigno, generalmente solitario y menor de 20 mm. Cuando es funcionante, los pacientes experimentan síntomas relacionados con la producción excesiva de insulina. El diagnóstico es clínico, con confirmación bioquímica y radiológica. El tratamiento suele ser quirúrgico, pero en la actualidad se está desarrollando la ablación guiada por ultrasonido endoscópico. MATERIAL Y MÉTODOS: realizamos una serie de casos prospectiva de pacientes con insulinoma pancreático con síntomas de hipoglicemia severa, a quienes se les ofreció el tratamiento ablativo con etanol al 96 % guiado por ultrasonido endoscópico como tratamiento alternativo a la cirugía. RESULTADOS: el éxito técnico y clínico se consiguió en el 100 % de los casos. No se presentaron complicaciones asociados al procedimiento. CONCLUSIÓN: el tratamiento del insulinoma sintomático mediante ablación por etanolización guiada por ultrasonido endoscópico podría ser una alternativa segura y eficaz a la cirugía en pacientes no candidatos o que rechacen la intervención quirúrgica


No disponible


Assuntos
Humanos , Feminino , Adulto , Idoso de 80 Anos ou mais , Insulinoma/diagnóstico por imagem , Insulinoma/terapia , Hipoglicemia/complicações , Etanol/administração & dosagem , Radioterapia Guiada por Imagem/instrumentação , Neoplasias Pancreáticas/diagnóstico por imagem , Estudos Prospectivos , Endossonografia/métodos , Ultrassonografia de Intervenção/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Neoplasias Pancreáticas/terapia
9.
Cir. Esp. (Ed. impr.) ; 99(1): 49-54, ene. 2021. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-200221

RESUMO

OBJETIVO: Valorar la utilidad de la técnica ROLL (Radioguided Occult Lesion Localization) como método de biopsia excisional en lesiones hipermetabólicas sospechosas de malignidad evidenciadas en exploraciones [18F]Fluordesoxiglucosa PET/TC. MATERIAL Y MÉTODOS: Se valoraron retrospectivamente 33 pacientes remitidos para la realización de un estudio metabólico por patología tumoral conocida o por sospecha de proceso neoplásico y que presentaban adenopatías hipermetabólicas con alta probabilidad de malignidad. El grupo estaba constituido por 19 mujeres y 14 hombres, con rango de 23 a 77 años. Los pacientes fueron sometidos a la técnica ROLL para la localización y extirpación de las adenopatías seleccionadas, mediante inyección de [99mTc] macroagregados de albúmina guiada con ecográfica o TC. Durante el acto quirúrgico se utilizaron una sonda de detección y una gammacámara portátil. RESULTADOS: En 31 pacientes (94%) se consiguió la localización y extirpación de las adenopatías radiomarcadas. En un paciente no fue posible la localización de la lesión y un segundo paciente no fue operado al confirmarse en estudio gammagráfico previo la inyección inadecuada de la dosis. El resultado del estudio anatomopatológico de las adenopatías dio como resultado 23 afectaciones tumorales y 8 procesos benignos, incluyendo un proceso granulomatoso. CONCLUSIÓN: La técnica ROLL demostró su utilidad como método de biopsia excisional radiodirigida para el estudio de lesiones sospechosas de malignidad evidenciadas en pacientes sometidos a estudios PET/TC. La técnica permitió confirmar la persistencia de proceso oncológico en unos casos y la existencia de falsos positivos del estudio de imagen en otros, modificando el manejo terapéutico de los pacientes


OBJECTIVE: To evaluate the utility of the ROLL (Radioguided Occult Lesion Localization) technique as a method of excisional biopsy in hypermetabolic lesions suspected of malignancy evidenced in [18F]Fluordeoxiglucose PET/CT scans. MATERIAL AND METHODS: 33 patients were retrospectively evaluated referred for metabolic studies due to tumoral pathology or suspected neoplastic process and presenting hypermetabolic adenopathies with high probability of malignancy. The group consisted of 19 women and 14 men, ranging from 23 to 77 years old. Patients were performed a ROLL technique for localization and removal the selected adenopathies, through the injection of [99mTc] macro-aggregates of albumin guided by ultrasound or CT. A detection probe and a portable gamma camera were used during the surgical procedure. RESULTS: In 31 patients (94%) the location and removal of the radiolabeled adenopathies was achieved. In one patient the location of the lesion was not possible and a second patient was not operated due to inadequate dose injection confirmed by gammagraphy study. The result of the anatomopathological study of adenopathies resulted in 23 tumor affections and 8 benign processes, including a granulomatous process. CONCLUSION: The ROLL technique proved its utility as a radioguided excisional biopsy method for the study of lesions suspected of malignancy evidenced in patients undergoing PET/CT studies. The technique allowed to confirm the persistence of oncological process in some cases and the existence of false positives from the imaging study in others, modifying the patients therapeutic management


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Cirurgia Assistida por Computador/métodos , Radiografia Intervencionista/métodos , Biópsia Guiada por Imagem/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias/cirurgia , Fluordesoxiglucose F18/administração & dosagem , Estudos Retrospectivos , Biópsia por Agulha Fina , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico
10.
Arq Bras Cir Dig ; 33(4): e1554, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33503114

RESUMO

BACKGROUND: Fine needle biopsy (FNB) histological samples by endoscopic ultrasound. It is important to obtain representative histological samples of solid biliopancreatic lesions without a clear indication for resection. The role of new needles in such task is yet to be determined. AIM: To compare performance assessment between 20G double fine needle biopsy (FNB) and conventional 22G fine needle aspiration (FNA) needles for endoscopic ultrasound (EUS)-guided biopsy. METHODS: This prospective study examined 20 patients who underwent the random puncture of solid pancreatic lesions with both needles and the analysis of tissue samples by a single pathologist. RESULTS: The ProCore 20G FNB needle provided more adequate tissue samples (16 vs. 9, p=0.039) with better cellularity quantitative scores (11 vs. 5, p=0.002) and larger diameter of the histological sample (1.51±1.3 mm vs. 0.94±0.55 mm, p=0.032) than the 22G needle. The technical success, puncture difficulty, and sample bleeding were similar between groups. The sensitivity, specificity, and diagnostic accuracy were 88.9%, 100%, and 90% and 77.8%, 100%, and 78.9% for the 20G and 22G needles, respectively. CONCLUSIONS: The samples obtained with the ProCore 20G FNB showed better histological parameters; although there was no difference in the diagnostic performance between the two needles, these findings may improve pathologist performance.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/normas , Agulhas/classificação , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/instrumentação , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agulhas/efeitos adversos , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Estudos Prospectivos , Sensibilidade e Especificidade , Adulto Jovem
11.
Expert Rev Med Devices ; 18(2): 211-216, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33435733

RESUMO

Background: No randomized trial has compared the yield of the ProCore needle, a novel needle for endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), with standard needles.Research design and methods: Consecutive subjects with intrathoracic lymphadenopathy due to suspected sarcoidosis were randomized 1:1 to undergo EBUS-TBNA with either the 22-gauge ProCore (EchoTip-ProCore, Cook-Medical) or the 22-gauge standard (Vizishot, Olympus) needle. The primary outcome was the diagnostic sensitivity; the secondary outcomes included the number of adequate aspirates obtained and procedure-related complications.Results: We randomized 100 (mean age, 43.4 years; 53% women) subjects. Of the 84 subjects finally diagnosed with sarcoidosis, the sensitivity of EBUS-TBNA was higher with the ProCore (36/42, 85.7%) versus the standard needle (31/42, 73.8%), although not statistically significant (p = 0.18). We obtained adequate aspirates in 95.2% and 90.5% subjects in the ProCore and the standard needle groups, respectively (p = 0.68). One complication (transient hypoxemia) occurred in each group. There were two incidences of the ProCore needle getting bent during the procedure.Conclusions: We found no difference in the sensitivity, specimen adequacy, or safety of EBUS-TBNA when performed with the ProCore or the Olympus needle in subjects with sarcoidosis. Larger studies are required to confirm our findings.[clinicaltrials.gov: NCT03656003].


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/efeitos adversos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/normas , Sarcoidose/diagnóstico , Sarcoidose/patologia , Adulto , Broncoscopia , Determinação de Ponto Final , Feminino , Humanos , Masculino , Agulhas , Padrões de Referência , Estudos Retrospectivos
12.
Expert Rev Med Devices ; 18(2): 197-201, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33482695

RESUMO

INTRODUCTION: Thyroid cancer is usually diagnosed both with imaging techniques and transdermal biopsy. Laboratory tests are also included in the initial work-up. PATIENTS AND METHODS: One hundred and thirty patients were included in our study with pathological imaging findings in the thyroid region. Biopsies were performed with 22 G with transdermal convex probe, EBUS 22 G Mediglobe® needle and 19 G Olympus® needle. We investigated the efficiency and safety of both techniques and identified the best candidates for each method. DISCUSSION: 19 G needle identified cancer types such as; Lymphoma, Medullary thyroid cancer, and Hurthle cell cancer, which we know from previous pathology studies that a larger sample is necessary for diagnosis. No safety issues were observed for both techniques and the EBUS technique produced more cell block material when 22 G needle was compared to transdermal biopsy in peritracheal lesions. CONCLUSION: The method of biopsy should be made based on the size and accessibility of the lesion.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Análise de Variância , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Humanos , Máscaras Laríngeas , Agulhas , Estudos Retrospectivos
13.
Int J Clin Pract ; 75(5): e14045, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33497028

RESUMO

PURPOSE: EBUS-TBNA is a frequently used diagnostic method for mediastinal/hilar lymphadenopathies and masses. This procedure is performed with intravenous sedation (IVS). During IVS, patients often develop hypoxemia and nasal oxygen delivery is insufficient in some patients. The aim of this study was to investigate the effect of oxygen application with nCPAP on hypoxemia during EBUS-TBNA. METHODS: Patients with EBUS-TBNA indication who did not have any serious heart-lung disease were randomly divided into two groups. One group received only oxygen and the other group received nCPAP+oxygen. Patient characteristics, arterial oxygen saturations, anesthetic agents, CPAP pressures, oxygen concentrations and processing times were recorded during the procedure. Practitioner satisfaction was evaluated at the end. RESULTS: 29 nCPAP+oxygen, 31 oxygen patients were included in the study. There were no significant differences in terms of age, sex, smoking history and presence of additional diseases in two groups. Neck circumference, BMI and STOP BANG questionnaire values were similar. Desaturation time was significantly longer in oxygen group than nCPAP+oxygen group (316±390 sec, 12±118 sec, respectively, p=0,019). Snoring was detected during the procedure in 22 patients in the oxygen group and in 11 patients in the nCPAP group (p=0,01). There were no serious complications in both groups. Practitioner satisfaction was higher in the nCPAP group but this was not statistically significant (p=0,052). CONCLUSION: Oxygen application by nCPAP during EBUS-TBNA under IVS, significantly reduces desaturation time. Oxygen delivery with nCPAP seems to be a better choice especially for the patients with high Mallampati index.


Assuntos
Neoplasias Pulmonares , Oxigênio , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Humanos , Linfonodos , Mediastino/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e Especificidade
14.
Medicine (Baltimore) ; 100(2): e24047, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466157

RESUMO

INTRODUCTION: Post-transplant lymphoproliferative disease (PTLD) is a series of proliferative diseases of the lymphatic system. Among patients receiving hematopoietic stem cell transplantation (HSCT), PTLD is a prevalent complication that severely affects rates of survival. Ultrasound plays an essential role in the early diagnosis of PTLD. Contrast-enhanced ultrasonography (CEUS) and CEUS-guided biopsy are critical procedures for tumor diagnosis. PATIENT CONCERNS: Herein, we report the case of a 40-year-old male patient with acute lymphoblastic leukemia who received HSCT more than 1 year ago. Sonography revealed a small hypoechoic nodule in the liver four months after HSCT. Eight months after HSCT, larger and more nodules were observed via ultrasound; CT was used to identify the lesions. DIAGNOSES: CEUS and CEUS-guided biopsy were performed, and the pathological diagnosis was PTLD. INTERVENTIONS: The final clinical diagnosis was PTLD, and cyclophosphamide, epirubicin, and dexamethasone were administered as chemotherapy. OUTCOMES: The patient was discharged after his condition improved. CONCLUSION: Ultrasound can be used to effectively detect lesions of PTLD early after HSCT. Furthermore, CEUS and CEUS-guided biopsy were effective for early confirmatory diagnoses of PTLD after HSCT.


Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transtornos Linfoproliferativos/diagnóstico , Transtornos Linfoproliferativos/etiologia , Adulto , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Humanos , Transtornos Linfoproliferativos/diagnóstico por imagem , Masculino , Ultrassonografia/métodos
15.
Medicine (Baltimore) ; 100(2): e24193, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466194

RESUMO

ABSTRACT: There is a growing need for tissue collection for immunostaining and genetic testing. Recently, several fine-needle biopsy needles are commercially available for endoscopic ultrasound-guided tissue acquisition.This prospective historical controlled study evaluates a 20G core biopsy needle with a forward bevel for solid pancreatic masses larger than 15 mm in diameter. The primary endpoint was the accuracy of histological diagnosis. The secondary endpoints included technical success rate, sample adequacy for histology, cytological diagnostic accuracy, and adverse events.Seventy consecutive patients were enrolled between January and October 2017. We achieved technical success in all cases regardless of the puncture sites or the endosonographer's experience. The final diagnoses were neoplasms in 67 patients (95.7%; pancreatic cancer in 65 patients, neuroendocrine neoplasm in 1, and malignant lymphoma in 1) and benign lesions in 3 patients (4.3%; autoimmune pancreatitis in 2 patients and mass-forming pancreatitis in 1). The obtained specimens were adequate for histological evaluation in all cases and the histological accuracy was 91.4% (95% confidence interval, 82.3-96.8%, P < .05) with the sensitivity and specificity of 91.0% and 100%, respectively. The cytological diagnostic accuracy was 95.7% and all patients were accurately diagnosed by combining cytological and histological examinations. As for adverse events, an asymptomatic needle fracture occurred in 1 case (1.4%).This 20G core biopsy needle with a forward bevel showed a high accuracy of histological diagnosis for solid pancreatic masses.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Pâncreas/anormalidades , Pâncreas/patologia , Pâncreas/cirurgia , Adulto , Idoso , Biópsia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/normas , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/patologia , Estudos Prospectivos
16.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408107

RESUMO

A 38-year-old male patient presented to the ear, nose and throat department with shortness of breath over last 2 months. The CT scan of the neck and chest revealed a 3.3×3 cm tumour behind the right thyroid lobe extending into the tracheo-oesophageal (TO) groove with tracheal compression. The ultrasound scan of the neck and targeted fine needle aspiration followed by core biopsy raised a suspicion of Hodgkin's lymphoma. The patient underwent a right hemithyroidectomy and incisional biopsy of the right TO groove tumour. The histology confirmed a Hasenclever's three nodular sclerosing Hodgkin's lymphoma for which he received adjuvant chemotherapy. An incidental pT1a pN0 thyroid papillary microcarcinoma in the adjacent thyroid parenchyma was completely excised. This represents a case of TO Hodgkin's lymphoma, of which there are no current published case reports. We aim to raise awareness about this rare condition by sharing the diagnostic work up and successful management in a multidisciplinary team setting.


Assuntos
Carcinoma Papilar/diagnóstico , Neoplasias Esofágicas/diagnóstico , Doença de Hodgkin/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Sons Respiratórios , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Traqueia/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia com Agulha de Grande Calibre , Carcinoma Papilar/complicações , Carcinoma Papilar/patologia , Carcinoma Papilar/terapia , Quimioterapia Adjuvante , Diagnóstico Diferencial , Dispneia/etiologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Esôfago/cirurgia , Doença de Hodgkin/complicações , Doença de Hodgkin/patologia , Doença de Hodgkin/terapia , Humanos , Achados Incidentais , Masculino , Esvaziamento Cervical , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/terapia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Tomografia Computadorizada por Raios X , Neoplasias da Traqueia/complicações , Neoplasias da Traqueia/patologia , Neoplasias da Traqueia/cirurgia , Resultado do Tratamento , Ultrassonografia
17.
BMC Surg ; 21(1): 36, 2021 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441131

RESUMO

BACKGROUND: Horner syndrome (HS), mainly characterized by symptoms including ptosis, miosis, and anhidrosis on the affected face, is a condition that is well documented but rarely reported as a postoperative complication of thyroidectomy, particularly in endoscopic thyroid surgery (ETS). We hereby report a case of HS due to ETS with a brief literature review on this topic. CASE PRESENTATION: A 31-year-old female was admitted to our hospital with an unexpected physical examination finding of two thyroid nodules that were hypoechoic, had an irregular shape, and exhibited calcification. Subsequently, the results of a fine-needle aspiration (FNA) biopsy from the thyroid nodules and BRAFV600E mutation further confirmed the malignancy of these nodules. Thus, total thyroidectomy combined with central lymph node dissection (CLND) by ETS via the bilateral axillo-breast approach was performed on this patient. Histology confirmed the diagnosis of papillary thyroid microcarcinoma (PTMC) concurrent with Hashimoto's thyroiditis (HT). However, this patient developed HS with ptosis in her left eye on postoperative day 3. All symptoms gradually resolved before the 3-month follow-up. CONCLUSION: HS subsequent to ETS is a rare complication. Thus, standardized and appropriate operative procedures, as well as subtle manipulation, are essential in preventing and reducing the occurrence of HS. In addition, the early diagnosis and management of this rare complication are also important for a favorable outcome.


Assuntos
Carcinoma Papilar/cirurgia , Doença de Hashimoto/cirurgia , Síndrome de Horner/etiologia , Neoplasias da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/diagnóstico por imagem , Tireoidectomia/efeitos adversos , Adulto , Carcinoma Papilar/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Doença de Hashimoto/patologia , Síndrome de Horner/diagnóstico , Humanos , Complicações Pós-Operatórias/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/patologia , Resultado do Tratamento
18.
Ultrasonics ; 110: 106289, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33130363

RESUMO

PURPOSE: Colonoscopy accompanied with biopsy works as the routine endoscopic strategy for the diagnosis of colorectal cancer (CRC) in clinic; however, the colonoscopy is limited to the tissue surface. During the last decades, enabling technologies are emerging to complement with the colonoscopy for better administration of CRC. The conventional low-frequency (<12 MHz) endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) has been widely used to assess the lesion penetration. With the high-frequency ultrasound transducer (>20 MHz), EUS allows more precise visualization of the colorectal abnormalities. In order to achieve the accurate detection or in situ characterization of the colorectal lesions, the EUS diagnosis needs more patho-physiological related information in the micro-structural or molecular level. Quantitative ultrasound (QUS) technique, which could extract the micro-structural information from the ultrasound radio-frequency (RF) signal, is promising for the non-invasive tissue characterization. To date, the knowledge of the high-frequency endoscopic QUS for the CRC characterization has not been fully determined. METHODS: In this work, to our best knowledge, it is the first application of the QUS technique based on a customized high-frequency EUS system (30.5 MHz center frequency) to characterize the colorectal malignancies in a VX2 rabbit CRC model. To eliminate the response from the ultrasound electronic system and transducer, the ultrasound signals from colon tissue were calibrated. And, the resulting quasi-liner ultrasound spectra were fit by the linear regression test. As a result, three spectral parameters, including the slope (k), intercept (I) and Midband Fit (M), were obtained from the best-fit line. The three spectral parameters were compared between the malignant tissue regions and adjacent normal tissue regions of the colon tissue specimen ex vivo. The independent t-test was conducted between the three parameters from the normal and malignant group. The statistical method of Fisher Linear Discriminant (FLD) was used to explore the linear combinations of the three parameters, so as to provide more tissue micro-structural features than the single parameter alone. The three FLD values were derived from three different combinations among k, I and M. The threshold was selected from the statistical analysis to optimize the differentiation criteria between the malignant and the normal tissues. The color-coded images were used to display the local FLD values and combined with the EUS B-mode image. RESULTS AND CONCLUSIONS: The mean Midband Fit (M) and intercept (I) showed significant differences between the malignant and normal tissue regions. The statistical analysis showed that there were significant differences in all the mean FLD values of the spectral parameter combinations (kI, kM and IM) (t test, P < 0.05). And, the combined image result from the B-mode image and color-coded image could visually correlate with the histology result. In conclusion, the high-frequency endoscopic QUS technique was potential to be used as a complementary method to distinguish the colorectal malignancies by leveraging its morphological and micro-structural ultrasound information.


Assuntos
Neoplasias Colorretais/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Animais , Calibragem , Linhagem Celular Tumoral , Modelos Animais de Doenças , Desenho de Equipamento , Masculino , Coelhos
19.
Medicine (Baltimore) ; 99(50): e23497, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327287

RESUMO

RATIONALE: Hematoma of the iliopsoas muscle is a rare condition. Prolonged pressure conditions due to hematoma of the femoral nerve can cause severe pain in the affected groin, hip, and thigh, and quadriceps weakness. We report a rare case of a spontaneous iliopsoas muscle hematoma that caused sudden femoral neuropathy. PATIENT CONCERNS: A 71-year-old woman presented sudden left hip pain and knee extensor weakness. The pain was aggravated with left hip extension. She had a bilateral total hip replacement surgery due to avascular necrosis. She was diagnosed as mild stenosis of the cerebral artery and took aspirin to prevent cerebral artery atherosclerosis. DIAGNOSIS: A hip computed tomography scan demonstrated a suspicious fluid collection at the left iliopsoas bursa. We considered the possibility of lower limb weakness due to neuralgic amyotrophy and performed electromyography and enhanced lumbosacral magnetic resonance imaging (MRI). Electromyography finding showed left femoral neuropathy of moderate severity around the inguinal area was diagnosed. On MRI, left iliopsoas bursitis or hematoma, and displacement of the left femoral nerve due to the iliopsoas bursitis/hematoma were observed. INTERVENTION: Ultrasonography (US)-guided aspiration of the left iliopsoas hematoma was performed. We started steroid pulse therapy for 8 days. OUTCOMES: After US-guided aspiration and steroid pulse therapy, the patient's knee extension motor grade improved from grade 1 to 2, and the pain was slightly reduced. At 3 weeks after the aspiration procedure, her hip flexion motor grade had improved from grade 3+ to 4 at follow-up. LESSONS: Imaging studies are fundamental to diagnose of iliopsoas hematoma. Electromyography examination plays an important role in determining the prognosis of patients and lesion site. Despite the negligible change in sitting position, hematoma can develop. Physicians should consider hematoma that cause femoral neuropathy.


Assuntos
Bursite/diagnóstico , Hematoma/diagnóstico , Músculos Psoas , Idoso , Bursite/complicações , Bursite/diagnóstico por imagem , Bursite/cirurgia , Diagnóstico Diferencial , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Neuropatia Femoral/etiologia , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Humanos , Imagem por Ressonância Magnética , Dor/etiologia
20.
Nihon Shokakibyo Gakkai Zasshi ; 117(11): 1008-1017, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-33177253

RESUMO

Upon abdominal ultrasonography, a woman in her 36 years old was diagnosed with a hypoechoic tumor with a diameter of 60mm surrounding the bile duct in the hepatic portal region. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed a tumor-like mass in the bile duct. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) confirmed the diagnosis of schwannoma. Considering the lesion location, it appeared to rise from the hepatoduodenal ligament. She was unwilling to undergo tumor resection;however, a year after the diagnosis, no change was observed in the tumor. Here, we report a case of schwannoma in the hepatoduodenal ligament, wherein EUS-FNA was useful for establishing a diagnosis and determining a treatment strategy.


Assuntos
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neurilemoma , Adulto , Colangiopancreatografia por Ressonância Magnética , Feminino , Humanos , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia
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