Ji Woong Jang

Clinical characteristics of intraductal papillary mucinous neoplasm manifesting as acute pancreatitis or acute recurrent pancreatitis

Comparatively little is known about acute pancreatitis or acute recurrent pancreatitis (AP/ARP) with intraductal papillary mucinous neoplasm of the pancreas (IPMN) as the causative lesion although there have been many reports about the malignant potential of IPMN as a premalignant lesion.

Diagnostic role of endoscopic ultrasonography-guided fine needle aspiration of gallbladder lesions.

BACKGROUND/AIMS Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is a well-established diagnostic technique for examining various organs of the gastrointestinal tract and pancreas, but little is known about its use in the diagnostic work-up of GB lesions. The objective of this retrospective study was to evaluate the efficacy of EUS-FNA of GB lesions. METHODOLOGY Twenty-eight patients who underwent EUS-FNA for evaluation of GB lesions were enrolled. The pathological results and complications were assessed. RESULTS EUS-FNA of GB was performed in 13 patients and that of enlarged lymph nodes was done in 18. Of the 13 GB lesions sampled by EUS-FNA, 10 were diagnosed as malignant and 3 were negative for malignant cells. Of the latter 3, two were false negatives for malignancy. All 14 metastatic lymphadenopathy cases were diagnosed with EUS-FNA of lymph nodes. EUS-FNA could differentiate adenocarcinomas and other malignant diseases. Cholecystitis occurred in one patient after EUS-FNA of the GB. CONCLUSIONS EUS-FNA is a feasible, safe and reliable method for obtaining samples from GB lesions. EUS-FNA of lymph nodes is complementary to EUS-FNA of the GB and provides nodal stage as well as histological diagnosis.

Effectiveness of cholangioscopy using narrow band imaging for hepatobiliary malignancies

Purpose Recently, cholangioscopy using narrow band imaging (NBI) has been used as a diagnostic modality for better visualization in hepatobiliary malignancies; however, there are few reports on it. Our aim is to evaluate the effectiveness of cholangioscopy using NBI in hepatobiliary malignancies. Methods Between January 2007 and December 2016, 152 cholangioscopies using percutaneous approach were conducted in total 123 patients. Among these, 36 patients were suspicious of hepatobiliary malignancies. Thirteen patients with an ambiguous margin on endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP), for whom NBI tipped the balance in diagnosis of lesion and decision of lesion extent by adding NBI, were involved in our study. Results Underlying diseases were all malignant in 13 patients (11 bile duct cancers, 1 liver cancer, 1 pancreas cancer with common bile duct invasion). In 7 cases with papillary type tumor, minute superficial spreading tumor was detected by NBI more easily, and NBI provided a better visualization of tumor vessel and margin evaluation in 4 cases with infiltrative tumor. In 2 cases with mucin-hypersecreting tumor, NBI showed better penetration through the mucin and gave us a much clearer image. Nine patients ultimately underwent surgical resection. The margins predicted by NBI cholangioscopy were consistent with the pathological margins on the resected specimens. Conclusion In conclusion, cholangioscopy using NBI is very useful for evaluation of suspected hepatobiliary malignancies with an ambiguous margin on ERCP or MRCP. It can give us an accurate pathologic mapping, and this information seems to be essential before deciding on a treatment strategy.

High-Grade Mixed Adenoneuroendocrine Carcinoma in the Cecum: A Case Report

Gastrointestinal neoplasms with an exocrine and a neuroendocrine component are rare. Such neoplasms are called “mixed adenoneuroendocrine carcinomas” (MANECs) according to the most recent World Health Organization classification of gastrointestinal tract neoplasms. MANECs have no specific findings that distinguish them from pure adenocarcinomas. In addition, the optimal management strategy of MANECs is largely unknown. We describe the case of a 32-year-old man with dizziness and abdominal bloating. A cecal mass was suspected based on an image study done at a local clinic. We evaluated the cecal mass by using colonoscopy, contrast enhanced computed tomography of the abdomen, positron emission tomography-computed tomography, and laboratory studies. The patient underwent a right hemicolectomy and adjuvant chemotherapy. The final histopathological diagnosis was a high-grade MANEC of the ascending colon, tumor stage T3N2M0.