Pinit Kullavanijaya

Combination of EUS-FNA and elastography (strain ratio) to exclude malignant solid pancreatic lesions: A prospective single-blinded study.

Negative results of EUS‐FNA for solid pancreatic lesions (SPL) can be false ones. Combination with strain ratio (SR) may ensure a correct benign diagnosis of SPL.

The risk of gastric cancer in patients with gastric intestinal metaplasia in 5‐year follow‐up

Gastric intestinal metaplasia (GIM) is the premalignant stage of gastric cancer; however, consensus on its management has not been established.

The predictors of complications in patients with drug-induced liver injury caused by antimicrobial agents

Aliment Pharmacol Theru200231, 1200–1207

Hepatobiliary and Pancreatic: Epstein-Barr virus-associated smooth muscle tumors: Unusual cause of hepatic mass in AIDS patient

A 33-year-old man presented with chronic watery diarrhea, fever, and weight reduction of 9 kg in 6months. On physical examination, body temperature was 37.5 °C. Abdominal examination revealed hepatomegaly without splenomegaly. Liver function test was normal except for elevated alkaline phosphatase (371 IU/L) with normal alpha-fetoprotein (0.76 IU/ml). Through work-up, he was first diagnosed with acquired immunodeficiency syndrome (AIDS) with mycobacterium avium complex enteritis. His CD4 count was 4 cells/mm. Epstein–Barr virus (EBV) serology was negative for anti-EBV viral capsid antigen IgM and positive for anti-EBV viral capsid antigen IgG and anti-EBV nuclear antigen. Plasma EBV viral load was 661 copies/mL. Tests for hepatitis B and C virus were negative. Abdominal magnetic resonance imaging showed multiple well-defined hyposignals in T1/intermediate in T2 with rim enhancing on arterial, portovenous, and delayed phase lesions (Fig. 1a,b) scattering at both lobes, and innumerable intra-abdominal lymph nodes. Liver biopsy of the largest lesion. Histological examination demonstrated neoplastic spindle cell arranged in short fascicles. Scattered tumor cell process mild to moderate pleomorphic, hyperchromatic tapering-end nuclei, and mitosis were noted (Fig. 1c). Immunohistochemistry study showed positive result for smooth muscle actin (Fig. 1d) and negative for CD117, DOG1, CD34, Desmin, and S-100, which is compatible for smooth muscle cell tumor (SMT). The tumor showed strong nuclear staining for EBV-encoded small RNA-1 in situ hybridization (Fig. 1e). Indicating that these are EBV-associated SMTs. Following treatment of Mycobacterium avium complex (MAC) infection with clarithromycin, ethambutol, and levofloxacin, he was administered antiretroviral drugs, consisting of efavirenz, emtricitabine, tenofovir. Surgery was planned for management hepatic lesions. EBV-associated SMTs are rare hepatic tumors in immunocompromised patients, such as those with AIDS or organ transplant. Unique clinical features are multicentric involvement, a preference for central nervous system involvement both cranial and spinal epidura, but extra-central nervous system lesions especially liver involvement as in this patient are unusual. Brain imaging was not performed on this patient because of a completely normal neurological exam. The imaging features of hepatic EBV-SMT is non-specific, mostly contrast-enhancing mass(es), which is difficult to differentiate from other primary or metastatic liver tumors. Test of plasma EBV viral load is less helpful for diagnosis because of low sensitivity; thus, tissue diagnosis is an important issue. The differential diagnosis of hepatic spindle cell neoplasms in HIV infection includes mycobacterial spindle cell pseudo-tumor and Kaposi sarcoma. Tissue smooth muscle actin immunohistochemistry and EBV-encoded small RNA-1 in situ hybridization are the most helpful tools for diagnosis. At present, there is no standard treatment for EBV-SMT. Case series of hepatic EBV-SMT suggested complete surgical resection showed satisfactory results. In contrast, chemotherapy and radiotherapy appear to be ineffective in these tumors.

Detection rate of nonalcoholic steatohepatitis among non-viral hepatitis B, non-viral hepatitis C chronic hepatitis in King Chulalongkorn Memorial Hospital

Detection rate of nonalcoholic steatohepatitis among non-viral hepatitis B, non-viral hepatitis C chronic hepatitis in King Chulalongkorn Memorial Hospital