[show abstract][hide abstract] ABSTRACT: Abstract Background and aims. Few randomized studies have assessed the clinical performance of 25-gauge (25G) needles compared with 22-gauge (22G) needles during endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) biopsy of intra-abdominal lesions. We aimed to compare the diagnostic yield, as well as performance characteristics of 22G versus 25G EUS biopsy needles by determining their diagnostic capabilities, the number of needle passes as well as cellularity of aspirated tissue specimen. Methods. The study is a prospective, randomized, multicenter study. Patients were referred between January 2009 and January 2010 for diagnostic EUS including EUS-guided FNA of different lesions adjacent to the upper GI tract. All patients were randomized to EUS-FNA performed with either a 22G or 25G aspiration needle. Results. EUS-FNA was performed in 135 patients (62 patients with a 22G needle). Sensitivity and specificity of the 22G needle was 94.1% and 95.8%, respectively, and for the 25G needle 94.1% and 100%, respectively. Investigators reported better visualization and performance for the 22G needle compared to the 25G (p < 0.0001). The number of tissue slides obtained was higher for the 22G needle during the second and third needle passes (p < 0.05). We did not observe significant differences between the number and preservation status of obtained cells (p > 0.05). Conclusions. A significant difference was found between the two types of needles in terms of reduced visualization of the 25G needle and suboptimal performance rating. However, this did not impact on overall results since both needles were equally successful in terms of a high diagnostic yield and overall accuracy.
Scandinavian journal of gastroenterology 07/2013; 48(7):877-883. · 2.08 Impact Factor
[show abstract][hide abstract] ABSTRACT: Gastrointestinal cancers represent a major cause of morbidity and mortality, with incomplete response to chemotherapy in the advanced stages and poor prognosis. Angiogenesis plays a crucial part in tumor growth and metastasis, with most gastrointestinal cancers depending strictly on the development of a new and devoted capillary network. Confocal laser endomicroscopy is a new technology which allows in vivo microscopic analysis of the gastrointestinal mucosa and its microvascularization during ongoing endoscopy by using topically or systemically administered contrast agents. Targeting markers of angiogenesis in association with confocal laser endomicroscopic examination (immunoendoscopy), as a future challenge, will add functional analysis to the morphological aspect of the neoplastic process. This review describes previous experience in endomicroscopic examination of the upper and lower digestive tract with emphasis on vascularization, resulting in a broad spectrum of potential clinical applications, and also preclinical research that could be translated to human studies.
World Journal of Gastroenterology 01/2011; 17(1):21-7. · 2.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Contrast-enhanced power Doppler (CEPD) and real-time sonoelastography (RTSE) performed during EUS were previously described to be useful for the differential diagnosis between chronic pseudotumoral pancreatitis and pancreatic cancer.
To prospectively assess the accuracy of the combination of CEPD and RTSE to differentiate pancreatic focal masses.
Cross-sectional feasibility study.
A tertiary-care academic referral center.
The study group included 54 patients with chronic pancreatitis (n = 21) and pancreatic adenocarcinoma (n = 33).
Both imaging methods (CEPD and RTSE) were performed sequentially during the same EUS examination. Power Doppler mode examination was performed after intravenous injection of a second-generation contrast agent (2.4 mL of SonoVue), and the data were digitally recorded, comprising both the early arterial phase and venous/late phase. Three 10-second sonoelastographic videos were also digitally recorded that included the focal mass and the surrounding pancreatic parenchyma. Postprocessing analyses based on specially designed software were used to analyze the CEPD and RTSE videos. A power Doppler vascularity index was used to characterize CEPD videos, the values being averaged during a 10-second video in the venous phase. Hue histogram analysis was used to characterize RTSE videos, with the mean hue histogram values being also averaged during a 10-second video.
To differentiate chronic pancreatitis and pancreatic cancer.
The sensitivity, specificity, and accuracy of combined information provided by CEPD and RTSE to differentiate hypovascular hard masses suggestive of pancreatic carcinoma were 75.8%, 95.2%, and 83.3%, respectively, with a positive predictive value and negative predictive value of 96.2% and 71.4%, respectively.
A single-center, average size of study population.
A combination of CEPD and RTSE performed during EUS seems to be a promising method that allows characterization and differentiation of focal pancreatic masses.
[show abstract][hide abstract] ABSTRACT: Confocal laser endomicroscopy (CLE) has been recently proposed as a new technique that allows in vivo histologic assessment of mucosa during endoscopy. The most commonly used contrast agents are acriflavine hydrochloride and fluorescein sodium. For colon pathology assessment, the administration of fluorescein intravenously produces a strong staining of both surface epithelium and deeper layers of lamina propria. Confocal laser endomicroscopy is a feasible method to diagnose colon cancer in vivo. Furthermore, confirmation of neoplastic changes using CLE during colonoscopy may lead to major improvements in the clinical management of the patients with inflammatory bowel disease. Biopsies can be limited to targeted sampling of relevant lesions. Confocal laser endomicroscopy will certainly play an important diagnostic role during gastrointestinal endoscopy in the future, enabling the elimination of the diagnostic delay associated with conventional biopsy preparation and processing.
Journal of gastrointestinal and liver diseases: JGLD 06/2010; 19(2):207-11. · 1.86 Impact Factor
[show abstract][hide abstract] ABSTRACT: Endoscopic ultrasound has been recently established as a routine diagnostic and staging procedure in lung cancer patients, mainly because of the possibility of tissue sampling. Transesophageal endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) represents a method which not only allows the visualization of the upper gastrointestinal tract, but also offers good visualisation of the posterior and inferior mediastinum. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) permits the assessment of the tumors in the anterior mediastinum. Based on previously published literature, it is obvious that this minimally invasive procedure now offers the possibility of tissue diagnosis in mediastinal masses including primary tumours or secondary lesions from both benign and malignant diseases.
Journal of gastrointestinal and liver diseases: JGLD 03/2010; 19(1):93-7. · 1.86 Impact Factor
[show abstract][hide abstract] ABSTRACT: Intraductal papillary mucinous tumors (IPMTs) are benign and malignant lesions that arise from the epithelial lining of main pancreatic duct and/or branch pancreatic ducts, with excessive mucin production (especially hyperplastic/adenomatous variety). Based on the degree of cytoarchitectural atypia on microscopic examination, IPMTs are classified as benign, borderline, carcinoma in situ and invasive tumors. Imaging examinations are very important to establish the diagnosis. Two or more tests are usually required. Transabdominal ultrasound, endoscopic ultrasound, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangio-pancreatography have been used for the diagnosis of IPMTs. The correct diagnosis, achieved until recently only with endoscopic retrograde cholangiopancreatography, can be currently obtained with non-invasive imaging modalities, particularly computed tomography and magnetic resonance imaging. Confirmation of the diagnosis requires, however, endoscopic-ultrasound fine-needle aspiration biopsy, followed by cytological or microhistological exams. The natural evolution of IPMTs is still not clear and the management is consequently still evolving.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 01/2010; 51(3):447-53. · 0.62 Impact Factor
[show abstract][hide abstract] ABSTRACT: The incidence of pancreatic cancer is increasing. It is usually diagnosed in an advanced stage despite the improvement in diagnostic techniques. The current study was designed to prospectively analyze several demographic and tumour related variables identified by EUS and EUS-FNA cytology that may affect survival in patients with unresectable pancreatic cancer receiving chemotherapy.
The study prospectively included 72 patients diagnosed with pancreatic cancer. Only patients without surgery were selected. All the patients received chemotherapy with the same drug (5-FU). They underwent power Doppler EUS followed by EUS-FNA in all cases. The following information obtained by EUS and EUS-FNA cytology were prepared for inclusion in multivariate survival analysis (tumour localization, portal vein invasion, power Doppler signals presence, collateral circulation, signs of chronic pancreatitis, T and N status, nuclear atypia, nuclear enlargement, pleomorphism, nuclear/cytoplasm ratio, and coarse chromatin).
The entire included population was analyzed to identify factors affecting prognosis. The overall Cox model had a significance level of p = 0.032. There were three factors that had a major impact on the survival time of the patients: regional lymph node involvement (p = 0.029), nuclear pleomorphism (p = 0.037) and nuclear enlargement (p = 0.019).
The current pre-treatment evaluation of the pancreatic cancer patients by EUS and EUS-FNA could offer some valuable information for appreciation of patients' future evolution. However, extensive studies are required for a complex prognosis scoring system.
[show abstract][hide abstract] ABSTRACT: Dowling-Degos disease (DDD) is a rare autosomal dominant inherited pigmentary disorder of the flexures with a reticulate aspect and with presence of prominent comedone-like lesions and pitted scars. The diagnosis includes acanthosis nigricans as well as other reticulate pigmentary disorders classified into: dyschromatrosis symmetrica hereditaria (DSH), dyschromatosis universalis hereditaria (DUH) and reticulate acropigmentation of Kitamura (RAPK). We present a 35-year-old woman, which presented with flexural hyperpigmentation considerate as acanthosis nigricans. At a close clinical and histopathological examination, we obtained sure data for Dowling-Degos disease, with a possible familial history of this disease in her son. We review the literature data concerning this disease.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 01/2010; 51(1):181-5. · 0.62 Impact Factor
[show abstract][hide abstract] ABSTRACT: We present the case of a girl, aged 8-year-old, with a history of acrocyanosis and repeated respiratory infections with beta-hemolytic streptococcus, which was consulted for the presence of skin lesions in the right buttock area. Clinical examination showed, in the right buttock region, an oval plaque with a diameter about 12 cm, hard, well defined, with irregular outline. The biopsy was performed and it revealed typical aspects of plaque-type morphea. The epidermis was mostly atrophic, with areas of ridge reduction; an important proliferation of collagen fibers within superficial and deep dermis and an abundant lymphocytic inflammatory infiltrate throughout the dermal thickness reaching hypodermic level and infiltrating it. General treatment consisted of antibiotics; vitamin E; local treatment with topical cortisone; analogues of vitamin D3 to which we associated topical adjuvants with repairing and healing role applied to the biopsied area. Evolution was favorable after three months of treatment, with obvious improvement of skin lesions; skin became more elastic and the purple red contour ring disappeared.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 01/2010; 51(3):559-63. · 0.62 Impact Factor
[show abstract][hide abstract] ABSTRACT: The postcholecystectomy syndrome includes a heterogeneous group of diseases, usually presenting as abdominal symptoms following gallbladder removal. The clinical management of these patients is frequently without an evidence-based approach.
We evaluated 80 patients with postcholecystectomy problems consecutively admitted during a period of 36 months. The liver function tests (LFTs) assessment and transabdominal ultrasound (TUS) were followed by endoscopic ultrasound (EUS). Endoscopic retrograde cholangio-pancreatography (ERCP) was then performed depeding on the results. With knowledge of the final diagnosis, the probable evaluation and outcomes were reassessed assuming that ERCP would have been performed as the initial procedure. Final diagnosis was confirmed by a combination of imaging findings, as well as clinical follow-up of 6 months.
In 53 patients biliary or pancreatic diseases were diagnosed: common bile duct stones, chronic pancreatitis, pancreatic cancer, papillary tumors, cholangiocarcinoma, insufficient cholecystectomy or sphincter of Oddi dysfunction. The other 27 patients had non-biliary symptoms (dyspepsia, IBS, etc.) and were consequently managed according to the symptoms. The sensitivity and specificity of EUS were high in the subgroup of patients with biliary or pancreatic symptoms (96.2% and 88.9%) and helped to indicate subsequent ERCP.
An algorithmic approach which used EUS for the initial evaluation of the patients with postcholecystectomy problems decreased the number of ERCPs by 51%, having as a consequence a decreased morbidity and mortality in this group of patients.
Journal of gastrointestinal and liver diseases: JGLD 04/2009; 18(1):67-71. · 1.86 Impact Factor
[show abstract][hide abstract] ABSTRACT: The paper aims at analyzing the histopathological modifications induced by the amniotic infection on present fetal membranes and in the absence of clinical signs of chorioamnionitis. Such an evaluation is important in the context of postpartum fetomaternal complications. The objective was to determine the relation between the microbial invasion in the amniotic cavity and the severity of inflammatory lesions of the placenta, of the membranes and the umbilical chord.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 02/2009; 50(1):67-72. · 0.62 Impact Factor
[show abstract][hide abstract] ABSTRACT: BRCA1-positive tumors characterize a heterogeneous group of breast cancers with a specific range of histopathological and immuno-histochemical features. We evaluated the relationship between morphological characteristics and immunohistochemical profile of 14 BRCA1-positive breast tumors from an initial study group of 40 breast tumors. Morphological parameters of all cases were studied on Hematoxylin-Eosin-stained sections and their immunophenotypic profile was assessed using antibodies against estrogen receptors (ER), progesteron receptors (PR), c-erbB2 oncoprotein (Her2/neu), BRCA1-protein, and the proliferative rate of the tumoral cells was assessed by Ki-67-proliferative index. All patients were females with an average age of 43.71-year-old. Fourteen out of the 40 tumors were BRCA1-positive. All breast carcinomas in this study were invasive. The most common histological type in our study was invasive ductal carcinoma. The majority of the tumors were high-grade G3. The examination of the lymph node found metastasis in eight cases. We found 11 cases of triple negative (ER, PR and Her2/neu), while the rest showed positivity for all these three markers. We observed a high-celullar proliferation index in all cases. The immunohistochemical study of BRCA1-protein is important to the study of the development and progression of the disease.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 02/2009; 50(3):419-24. · 0.62 Impact Factor
[show abstract][hide abstract] ABSTRACT: We studied 27 patients diagnosed with pericardial effusion with cardiac tamponade on which pericardiocentesis was performed. The purpose of the study was to evaluate the benefits and limits of the cytological examination of the pericardial liquid in the etiological diagnosis and the treatment of patients with cardiac tamponade. The pericardial liquid taken was examined macroscopically, biochemically (content of proteins, glucose, cholesterol, and LDH), cytologically (MGG stained smears from pericardial liquid) and bacteriologically. The obtained results were compared to the clinical data, the laboratory and paraclinical tests, to differentiate the cause and therapeutically procedure. The cardiac tamponade remitted after pericardiocentesis in all patients. The pericardial liquid was exudate (Ligth criteria) in 82% of all patients. The cytological examination of the pericardial liquid showed malignant smear in 40.74% of the patients, smear of the TBC specific inflammation type in 7.40% patients, smear of non-specific inflammation type in 25.94% of patients, reactive type smear in 25.9% of patients.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 02/2009; 50(2):251-6. · 0.62 Impact Factor
[show abstract][hide abstract] ABSTRACT: We present the case of 10-year-old girl who have had from birth a plane tumor, of tan color, 3-4 mm of diameter, localized on the face on the cutaneous part of the superior lip. This tumor has been stabile until 8-year-old. Then, after repeated sunlight exposures, the lesion has become more stark, hemispheric in shape, has increased in size becoming about 5-6 mm, with irregular borders, and after an accidental traumatism it began to bleed. We have performed the electroexcision of the lesion for diagnostic and therapeutic purpose. The histopathologic exam distinguished typical images of Spitz nevus on some of the histological sections but also of melanocytary tumor with uncertain malignant potential on the others where atypical mitoses localized in the deeper component of the tumor are being noticed. The immunohistochemical assessment of the tumoral cells showed positivity for the melanocytic markers HMB45 and Melan A, within junctional intraepidermic nevic cells and in the nevic cells from superficial dermis, and also for CD44 protein (belonging to the adhesion molecules family). However, cyclin D1 was positive in rare nevic cells, and the proliferation rate of the tumor was small, with a proliferation index for Ki67 lesser than 5%. The correlation between histopathological and immunohistochemical data conducive to final diagnosis of Spitz nevus with uncertain malignant potential. The clinical evolution confirmed the histopathological diagnosis by the fact that the patient did not presented clinical signs of local recurrences or metastasis at three years after the excision of the tumor.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 02/2009; 50(2):275-82. · 0.62 Impact Factor
[show abstract][hide abstract] ABSTRACT: The subungual exostosis is a benign bone tumor on the distal phalanx of a digit, beneath or adjacent to the nail, often bringing in discussion many differential diagnosis. We present a 14-year-old boy with a cutaneous nodular lesion, painful to the easy touch on the latero-internal half of the nail of right big toe with extension in the cutaneous part of this. He suffered many treatments, especially cauterization, but with recurrence. In the present, the radiological findings of the affected finger and the histopathological ones from the fragment excised confirmed the diagnosis of subungual exostosis. The local excision of the entire region with the removal of the cartilaginous cap has been followed by a silent period without recurrences of almost two years when he as revised.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie 02/2009; 50(3):501-3. · 0.62 Impact Factor