[ ISSN : 2573-3680 ]
A 47-year-old woman presented with recurrent abdominal distension for more than 2 years. The patient developed a feeling of fullness in the upper and middle abdomen after eating food 2 years ago. There was no nausea, vomiting, abdominal pain, diarrhea, acid regurgitation or heartburn.
A 47-year-old woman presented with recurrent abdominal distension for more than 2 years. The patient developed a feeling of fullness in the upper and middle abdomen after eating food 2 years ago. There was no nausea, vomiting, abdominal pain, diarrhea, acid regurgitation or heartburn. Gastroscopy in another hospital showed chronic superficial gastritis with erosion and biliary reflux. After taking omeprazole and other acid suppressants for a period of time, the symptoms disappeared and the medication was stopped. Gastroscopy in the other hospital showed chronic superficial gastritis with erosion, and abdominal distension was not significantly relieved after taking acid suppressants. On June 17, 2023, contrast-enhanced CT in the middle and upper abdomen showed diffuse enlargement of the pancreas with uneven enhancement, and malignant tumor. Autoimmune pancreatitis? On June 28, 2023, he was admitted to the outpatient department of Gastroenterology of our hospital, and his Immunoglobulin G4 (IgG4) was 1.25g/L. Blood routine test showed eosinophil count 0 × 109 /L, eosinophil percentage 0%. Liver function tests showed AST mitochondrial isoenzyme 3.1U/L, γ -glutamyl transpeptidase 113 U/L, alkaline phosphatase 115U/L, and aspartate aminotransferase 14U/L. Hemoglobin A1c 9.6%; Tumor markers: carcinoembryonic antigen 3.24ng/ml, carbohydrate antigen 199 8.85U/ ml. Physical examination: flat abdomen, no abdominal muscle tension, no tenderness, rebound pain. The liver and spleen were not palpable, and the family history was normal. Blood routine test showed eosinophil 0.03 × 109 /L and percentage of eosinophil 0.7%. On July 8, 2023, pancreas enhanced MRI showed pancreatic swelling, heterogeneous pancreatic signal, pancreatic changes, consistent with autoimmune pancreatitis, and pancreatic duct dilatation. After painless endoscopic ultrasonography, diffuse enlargement of the gland was found, and a round hypoechoic lesion was seen in the body and tail of the pancreas. The maximum section was about 4.5 * 2.9cm, and the hypoechoic pancreatic mass was found. EUS-FNA; Puncture pathology: cytology smear: (pancreatic puncture) no malignant cells were found; Liquid-based cytology showed tumor cells were found, epithelial origin, mild atypia, consistent with neuroendocrine tumors. Immunohistochemical: CAM5.2 (+), CK7 (-), CgA (+), Syn (+), CD56 (+), INSMI (+), ATRX (+), RB (+), CD38 (-), SSTR2 (+), p53 (< 5%), Ki67 (2%). Combined with immunohistochemical staining results, (pancreatic puncture) neuroendocrine tumor was considered as NET-G1 grade. Blood routine test on July 17, 2023: eosinophil 0×109 /L, eosinophil percentage 0%; Autoimmune antibodies were negative. Tumor markers: Alpha-Fetoprotein (AFP) 2.48 ng/ml, carcinoembryonic antigen 3.4ng/ml, carbohydrate antigen CA199 10.09U/ml. On July 22,2023, the patient was admitted to the Department of Pancreatic surgery for suspected “pancreatic tumor”. On July 20,2023, pancreatic artery CT enhancement was considered to indicate pancreatic sausage like swelling and pancreatic changes. Consistent with the manifestations of autoimmune pancreatitis, total pancreatectomy + splenectomy + portal vein lateral wall resection and reconstruction + retroperitoneal lymph node dissection under general anesthesia was performed on July 25, 2023. During the operation, a mass with a maximum diameter of > 3cm was palpable in the head, neck and body of the pancreas, the surface was not smooth, the boundary was unclear, and the activity was acceptable, with nerve involvement. Suspected lymph node metastasis was observed around the mass. Postoperative https://fanyi.youdao.com/ download pathology showed total pancreatic Neuroendocrine Tumor (NET G2), and the tumor partially grew along the main pancreatic duct and branch pancreatic duct. On September 14, 2023, the enhanced MRI of the pancreas showed postoperative changes of the pancreas, multiple metastatic tumors in the liver, and scattered diffuse limited slightly large lymph nodes near the mesenteric vessels. Radiofrequency ablation was performed in the Hongkou branch of our hospital on October 28, 2023.
Pancreatic Neuroendocrine Neoplasm (pNEN) is a relatively rare tumor, but the incidence of PNEN has increased 1 in recent years [1]. pNEN can be divided into functional and nonfunctional categories according to whether the patient has the corresponding clinical manifestations due to the secretion of hormones by the tumor. Functional pNEN accounted for 34.4% and non-functional pNEN accounted for 65.6% [2]. The most common primary sites of neuroendocrine tumors in China are pancreas, rectum and stomach [3]. Due to its onset in the pancreas, its clinical manifestations are insidious and its biological characteristics are highly heterogeneous, which makes its diagnosis and treatment difficult. In clinical practice, serum Chromogranin A (CgA) and Neuron Specific Enolase (NSE) are often used to assist in the diagnosis and determination of tumor burden, and even to evaluate the efficacy and prognosis [4]. In addition, the levels of hormones, such as gastrin, insulin, glucagon, etc., can also be detected to determine the type and whether the tumor is functional. In terms of imaging evaluation, CT or MRI methods are often used for localization diagnosis and clinical staging of non-functional pNEN. The sensitivity and specificity of spectral CT combined with perfusion in the diagnosis of neuroendocrine tumors were 83.1% - 96.2% [5], and MRI was superiorto CT in the diagnosis of liver metastases and small pancreatic lesions [6]. Compared with MRI and CT, the overall sensitivity and specificity of EUS in the diagnosis of pancreatic neuroendocrine tumors were 86.0% and 89.7% respectively [7]. The gold standard for the diagnosis of non-functional pNEN is pathology. Eus can directly obtain histopathological specimens through fine needle aspiration, which is conducive to the localization and qualitative diagnosis of non-functional pNEN. In terms of treatment, surgical resection is an important treatment for nonfunctional pNEN [8], and surgical resection is the main treatment for local tumors. The liver is the most common distant metastasis site of nonfunctional pNEN. The main treatment options for liver metastases include radiofrequency ablation, transcatheter arterial embolization and transcatheter arterial chemoembolization [9]. When the primary lesion cannot be completely resected or combined with surgical risk factors, medical treatment can be selected, such as immune checkpoint inhibitors (pembrolizumab, etc.),biological therapy (octreotide, etc.), targeted drugs (sunitinib, etc.), radionuclide scanning, etc. To delay the survival times of patients [10]. When the tumor involves the whole pancreas, it needs to be differentiated from autoimmune pancreatitis and other diseases. Autoimmune pancreatitis (AIP) is a special type of chronic pancreatitis, which is characterized by local or diffuse enlargement of the pancreas, irregular narrowing of the main pancreatic duct, elevated serum Immunoglobulin G4 (IgG4), accumulation of other organs, and steroid therapy [11]. According to its morphology, autoimmune pancreatitis can be divided into diffuse type and focal type on imaging [12]. Although AIP usually shows diffuse enlargement of the pancreas with a saussure-like appearance, delayed enhancement and band-like structure, and capsule formation on imaging findings [13], it still needs to be differentiated from other diseases. In order to avoid misdiagnosis and delay surgery, it is necessary to distinguish diffuse AIP from pancreatic neuroendocrine tumors [14]. Although it is rare in clinic, it still needs to be paid attention to by clinicians. The patient was a middle-aged woman with a long course of disease, 2 years of nonspecific abdominal distension and imaging findings similar to AIP. Endoscopic Ultrasoundguided Fine Needle Aspiration (EUS-FNA) was performed to obtain pancreatic tissue for pathological examination, and the final diagnosis was non-functional pNEN. Total pancreatectomy was performed. Therefore, it is very important to differentiate non-functional pNEN from AIP. We suggest that when the clinical features are nonspecific, the imaging diagnosis is unclear, and the IgG4 level is not increased, EUS-guided fine needle aspiration biopsy should be performed to confirm the pathological diagnosis (Figures 1,2).
Figure 1: Shows pancreatic swelling, uneven signal of the pancreas, no obvious focal abnormal enhancement after enhancement; Conclusion: Changes in the pancreas are consistent with autoimmune pancreatitis, dilated pancreatic duct.
Figure 2: Diffuse enlargement of the pancreas, low echo of the parenchyma, a round hypoechoic lesion can be seen in the body and tail of the pancreas, with the largest cross-sectional area of 4.5 * 2.9 cm, clear boundaries, uneven internal echoes. No dilated pancreatic duct, no abnormal echoes inside; Conclusion: Hypoechoic spaceoccupying lesion in the pancreas.
Liu Y, Wu C, Wan D, Zhang D, Huang H (2024) A Case of Neuroendocrine Tumor Misdiagnosed as Autoimmune Pancreatitis. SM J Clin Med Imaging 6: 3.
The purpose of this statement is none other than to highlight the importance of ethical standards and quality required in basic and applied research currently being done so we can subsequently inform health care professionals of new developments that are taking place in this area.
Ma. Esperanza Rodríguez-van Lier*
Chemotherapy is commonly used in cancer treatment. So far, chemotherapy agents can be categorized into three types: classical chemotherapeutic drugs, molecular target agents and cellular machineries target drugs.
Ziyou Wang1,2 and Zunnan Huang1,2*
Blood transfusion can cause some transfusion adverse reactions. In order to understand the incidence of adverse transfusion reactions, we performed a meta-analysis in Chinese hospitals. Of 809 literatures, seven studies involving a total of 211, 050 patients with blood transfusion treatment were included in this meta-analysis. Meta-analysis showed that the total incidence of adverse reactions was 0.4% [95% CI (0.2, 0.9), P < 0.0001]. Further subgroup analysis showed that the incidence of febrile and allergic reactions was 0.2% [95% CI (0.1, 0.5), P < 0.0001] and 0.2% [95% CI (0.1, 0.3), P < 0.0001], respectively. The common blood components caused adverse reactions were red blood cell, plasama, and platelet in clinical practice.
Yulu Gao1 , Qinyun Li2 , Zongshuai Gao2 , Yunxia Zhu4 , Yanqiu Liao5 , Changtai Zhu2 *# , Yongning Sun3 *#
Background: CT scanning remains one of the most routinely used diagnostic tools in a setting of Interstitial Lung Disease (ILD). New and improved technologies, such as High Resolution Computer Tomography (HRCT) have revolutionized the quality of imaging, leading to a prominent increase in number of incidental findings that may or may not be of any clinical significance. The aim of this study was to evaluate the prevalence of incidental findings on thoracic CT and their clinical significance.
Methods: Retrospective analysis was conducted on a cohort of 84 patients referred to our academic center as cases of ILD. Patients were referred for further evaluation between January 2000 and January 2014 and were followed over the disease course. CT scans were done annually as part of clinical management and patients were screened for any incidental findings. All incidental findings were reviewed, recorded in a clinical database and followed up on subsequent visits.
Results: 25 (30%) patients were found to have incidental findings. Liver abnormalities were found in 12 (14.29 %) patients. 11(13.10 %) patients were reported to have coronary artery calcifications. 5 (5.95 %) and 3 (3.57%) patients had thyroid abnormalities and renal cysts, respectively. A malignant lesion was found in 1 patient each in liver and thyroid abnormality subgroup.
Conclusion: Incidental findings are common on thoracic CT scans providing valuable and unexpected findings which warrant investigation by health care providers to exclude malignant processes.
Sonu Sahni1,2*, Sameer Verma1,2, Reeju S Thomas1 , Barbara Capozzi3 and Arunabh Talwar1,2
Hepatitis C Virus infection (HCV) is an increasing public health concern with an estimated 184 million people infected worldwide and approximately 350.000 yearly deaths from HCV-related complications.
Nesrine Gamal and Pietro Andreone*
We report a case of large cell undifferentiated lung carcinoma in a middle aged patient with previously treated tuberculosis and scarring. 20 pack years of smoking history was noted. He presented with metastasis at multiple sites including trochanter, liver and acute bilateral lateral rectus palsy. Chest radiography showed fibrosis of right upper zone with homogenous opacity. Sputum examination for AFB was negative. Computerized tomography of the thorax showed an irregular heterogeneously enhancing mass involving right upper lobe with cavitation, necrosis along with lymph node involvement and the erosion of the 4th rib with liver metastasis. Radiography of hip joint was suggestive of lesser trochanteric metastasis. MRI brain was suggestive of mass at base of brain in parasellar area. Fine needle aspiration cytology and CT guided biopsy confirmed undifferentiated large cell carcinoma of lung. Tuberculosis and smoking may increase the risk of lung scarring and malignancy and pulmonary scarring may be associated with increased lung carcinoma in ipsilateral lung. Clinician needs to be more sensitive to look for malignancy association particularly in patient with or previously treated for tuberculosis and even more emphasis to be laid if scarring of lung is observed.
Sreenivasa Rao Sudulagunta1 *, Shyamala Krishnaswamy Kothandapani2 , Mahesh Babu Sodalagunta3 , Hadi Khorram2 , Mona Sepehrar4 and Zahra Noroozpour1
Systemic Sclerosis (SSc) is a connective tissue disease characterized by fibrosis of the skin and internal organs, pronounced alterations in the microvasculature and frequent cellular and humoral immunity abnormalities. The rheumatic involvement of SSc is polymorphic and can reveal the disease or may appear during the course of its progression. Musculoskeletal involvement is dominated by non specific arthralgia, polyarthritis, and bony resorption especially acro-osteolysis. The diagnosis of these rheumatic manifestations is generally based on x rays examination. Musculoskeletal involvement in SSc is generally relieved with Non Steroidal Anti-Inflammatory Drugs (NSAID) or low dose of corticotherapy. The immunosuppressive therapy is used in corticoid-resistant or corticoid-dependent forms such us méthotrexate. The aim of our review is to presents an overview of the different osteoarticular and muscular involvement in SSc, their diagnosis and management.
Nessrine Akasbi*, Fatima Ezzahra Abourazzak and Taoufik Harzy
Sedigheh Mirhashemi1 , Mohammad Hosein Kalantar Motamedi1 *, Amir Hossein Mirhashemi2 and Hamid Reza Rasouli1
We encountered two autopsy cases of huge cardiomegaly with over 1000g in weight. Histochemical characteristics were examined using conventional staining including HE and Azan stains and immunohistochemical staining using antibodies against Complement Component 9 (CC9), RNA Binding Protein Motif 3(RBM3), Endothelial Type NO Synthase (eNOS) and Hypoxic Inducible Factor1α (HIF1). The reactive area with anti CC9 antibody, which presumed to be a marker of hypoxic change of myocardium, overlapped with eosinophilic area by HE and basophilic one by Azan. Although the reactive area with anti CC9 antibody showed relatively weak in the cytoplasm by anti eNOS antibody and no in the nucleus of cardiocytes with anti RBM3 antibody, outside of the reactive area with anti CC9 antibody there were intensive reactivity with anti eNOS antibody in cytoplasm and in a nucleus with anti RBM3 antibody. Anti HIF1 antibody showed weak reactivity with cytoplasm of endocardial cardiocytes and no with cytoplasm of cardiocytes in another area. The results obtained from the present cases revealed that the hypoxic change was equivalent even though the cause of cardiomegaly was deferred between two cases, and conventional staining such as HE and Azan utilized to detect hypoxic change in the heart and immunohistochemical studies seemed to be a useful tool for clarifying the cascade of hypoxic changes in the myocardium.
Satoshi Furukawa1,2*, Mayumi Kataoka1 , Satomu Morita1,2, Akari Uno2 , Masahito Hitosugi2 , Hiroshi Matsumoto1,3 and Katsuji Nishi1,2
A 45-year-old woman with multiple sclerosis was admitted to our hospital after out of hospital cardio-pulmonary resuscitation. The first ECG showed ventricular fibrillation. Following direct current defibrillation and mechanical reanimation, spontaneous circulation was restored and the ECG unremarkable without any signs of ischemia. Coronary angiography showed unobstructed coronary arteries Figure 1, (Panel A). Left ventriculography revealed apical wall obstruction, suggestive of apical aneurysm (Panel B, supplementary videos). Transthoracic echocardiography and Cardiac Magnetic Resonance Imaging (CMR) eventually lead to the diagnosis of a rare case of Apical Hypertrophic Cardiomyopathy (AHC) with ace of spades-form (Panel C,D). The patient underwent Cardioverter-Defibrillator Implantation (ICD) and amiodarone medical therapy for secondary prophylaxis. Patient’s family history and screening for HCM were unsuspicious.
Wiedemann S# *, Heidrich FM# , Speiser U and Strasser RH