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Intraductal papillary mucinous neoplasm presenting as long standing idiopathic chronic pancreatitis
Abstracts / Pancreatology 14 (2014) S1eS129
Material from clamp biopsy was processed standardly and embedded to wax blocks. Volume of tumor tissue obtained from clamp biopsy was higher in comparison to EUS FNA. Conclusion: Sensitivity and specificity of both methods are almost the same. EUS FNA method is limited by smaller volume of tumor tissue, that is limitation for accurate definition of biological behavior of tumor, especially mitotic rate. Statistical analysis will be part of poster presentation.
S27
than 60 years (p¼0.001, odds ratio ¼ 2.874) were significantly associated with HP. In the subgroup analysis, VAT was a statistically significant risk factors for HP (p ¼ 0.010, odds ratio ¼ 5.665). Conclusion: HP is correlated with hepatic steatosis and age older than 60 years. VAT is positively correlated with HP regardless of BMI. HP may be one of the phenotypes of metabolic syndrome likewise fatty liver.
W-022. W-020.
Intraductal papillary mucinous neoplasm presenting as long standing idiopathic chronic pancreatitis
A Comparative study between a 22-gauge Aspiration needle and a 25gauge biopsy needle for EUS-guided sampling of pancreatic mass lesions
Samuel Fernandes a, Luis Correia a, Teresa Antunes a, Rui Esteves b, Afonso e Velosa a Gonçalves c, Helena Cortez Pinto a, Jos
Jin-Hong Kim, Byong-Moo Yoo, Jae-Chul Hwang Department of Gastroenterology, Ajou Medical Center, South Korea Background: EUS biopsy needles have recently been developed in order to obtain both histologic and cytologic specimens. Aims: To compare 22-gauge (G) aspiration needles (FNA) and 25G biopsy needles (FNB) for EUS-guided sampling of solid pancreatic masses. Patients & methods: Thirty-four patients with solid pancreatic masses underwent EUS-guided sampling with a 25G FNB from June 2012 to April 2013, and thirty-four patients with solid pancreatic masses, who underwent EUS-guided sampling with a 22G FNA from June 2011 to May 2012, served as the historical control group. EUS-guided sampling was performed using the standard technique without an on-site cytopathologist. Results: The diagnostic rates of cytology were 97.1% (33/34) with 22G FNA needles and 85.3% (29/34) with 25G FNB needles (P ¼ 0.197). The diagnostic rates of histology were 23.5% (8/34) with 22G FNA needles and 41.2% (14/34) with 25G FNB needles (P ¼ 0.194). There was no significant differences in the mean number of needle passes (5.09 vs 5.76, P ¼ 0.089) or needle malfunctions (2.9% vs 11.8%, P ¼ 0.356) between 22G FNA and 25G FNB needles, respectively. No complications were identified in either group. Conclusion: The 25G FNB needle was not superior to the 22G FNA needle in the diagnostic yield of histology for EUS-guided sampling of pancreatic mass lesions, as the diagnostic yield, technical performance, and safety profiles were comparable between both of them.
W-021. The role of obesity as a risk factor for a hyperechogenic pancreas on endoscopic ultrasound
a Hospital Santa Maria, Serviço Gastrenterologia e Hepatologia, Portugal b Hospital Santa Maria, Serviço Cirurgia, Portugal c Hospital Santa Maria, Serviço Imagiologia, Portugal
Background: Intraductal papillary mucinous neoplasms (IPMN) are rare pancreatic neoplasms (7.5%) characterized by cystic dilation of the main pancreatic duct or its branches. IPMN are often mistaken with other causes of chronic pancreatitis. Aims: We report a patient with occult IPMN manifested as chronic idiopathic pancreatitis. Patients & methods: A 67-year old man, with no alcohol consumption, and a history of recurrent pancreatitis of unknown etiology since age 37, pancreatic-jejunal bypass at age 40 for pain relief and radiological evidence of chronic pancreatic since age 48 was admitted with abdominal pain, melaena and asthenia. Results: Endoscopy revealed a lesion below D2 occupying half the circumference and a third of the lumen with histology of high-grade epithelial papillary neoplasm. Computed tomography showed enlargement and heterogeneity of the pancreatic head with calcifications. We assumed the diagnosis of pancreatic cancer and the patient was submitted to a Whipple procedure. Histology revealed IPMN with foci of invasive adenocarcinoma with negative margins of resection. Conclusion: Our report illustrates the difficulty in diagnosing IPMN. Over three decades the patient’s findings were interpreted in the context of the natural history of chronic pancreatic, with a correct diagnosis only after established disease. Changes in regional morphology following surgical bypass may have contributed to the delay in diagnosis. Surgery remains the treatment of choice owing to its malignant potential, with excellent survival at 5 years in local disease (90%). Although uncommon, IPMN should be considered in the differential diagnosis of idiopathic pancreatitis.
Hyeongseok Nam, Daehwan Kang, Cheolwoong Choi, Byeongjun Song, Su Bum Park, Su Jin Kim
W-023.
Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, South Korea
Intraductal papillary mucinous neoplasm associated with pancreatic calcification. Case report and review of the literature
Background: Identification of hyperechogenic pancreas (HP) is not uncommon during endoscopic ultrasound (EUS). However, the clinical significance of HP is still unclear. We hypothesized that HP is related to obesity in a similar way to its relationship with fatty liver. Aims: The aim of this study was determine the incidence of HP in patients undergoing EUS and to assess the relationship between HP and obesity. Patients & methods: 524 adults who underwent EUS were included. 240 patients with a history of pancreatic disease or with hepatobiliary or advanced gastrointestinal cancer were excluded. 284 patients were included in the analyses. We performed subgroup analyses according to visceral adipose tissue (VAT) in 132 patients who underwent abdominal computed tomography scans. Results: On univariate analysis, obesity (body mass index > 5m kg/m2), fatty liver, diabetes mellitus, hypercholesterolemia, age older than 60 years were identified as risk factors associated with HP (P < 0.05). On multivariate analysis, fatty liver (p ¼ 0.008, odds ratio ¼ 2.219) and age older
Vyacheslav Egorov, Natalia Starostina, Tatiana Silina, Natalia Ratnikova, Olga Kosheleva, Roman Petrov 5th Moscow City Hospital, Moscow, Russia, Russia Background: Intraductal papillary mucinous neoplasm (IPMN) associated with pancreatic calcification is a rare and important event because of the different therapy for the diseases. Aims: To show the difficulties in diagnostics of two pancreatic conditions, which can lead to wrong treatment Patients & methods: A 50-year old woman suffering with recurrent abdominal pain and diabetes mellitus was admitted to our hospital after endoscopic, CT and EUS examinations. There was no previous history of acute pancreatitis and patient was treated for chronic calcific pancreatitis. Radiologically, calcifications were seen diffusely throughout the gland and there were no mucus entry through the major papilla. Results: After work up the diagnosis was unclear, but the dilation of the main pancreatic duct and abdominal pain syndrome made surgery the best
Material from clamp biopsy was processed standardly and embedded to wax blocks. Volume of tumor tissue obtained from clamp biopsy was higher in comparison to EUS FNA. Conclusion: Sensitivity and specificity of both methods are almost the same. EUS FNA method is limited by smaller volume of tumor tissue, that is limitation for accurate definition of biological behavior of tumor, especially mitotic rate. Statistical analysis will be part of poster presentation.
S27
than 60 years (p¼0.001, odds ratio ¼ 2.874) were significantly associated with HP. In the subgroup analysis, VAT was a statistically significant risk factors for HP (p ¼ 0.010, odds ratio ¼ 5.665). Conclusion: HP is correlated with hepatic steatosis and age older than 60 years. VAT is positively correlated with HP regardless of BMI. HP may be one of the phenotypes of metabolic syndrome likewise fatty liver.
W-022. W-020.
Intraductal papillary mucinous neoplasm presenting as long standing idiopathic chronic pancreatitis
A Comparative study between a 22-gauge Aspiration needle and a 25gauge biopsy needle for EUS-guided sampling of pancreatic mass lesions
Samuel Fernandes a, Luis Correia a, Teresa Antunes a, Rui Esteves b, Afonso e Velosa a Gonçalves c, Helena Cortez Pinto a, Jos
Jin-Hong Kim, Byong-Moo Yoo, Jae-Chul Hwang Department of Gastroenterology, Ajou Medical Center, South Korea Background: EUS biopsy needles have recently been developed in order to obtain both histologic and cytologic specimens. Aims: To compare 22-gauge (G) aspiration needles (FNA) and 25G biopsy needles (FNB) for EUS-guided sampling of solid pancreatic masses. Patients & methods: Thirty-four patients with solid pancreatic masses underwent EUS-guided sampling with a 25G FNB from June 2012 to April 2013, and thirty-four patients with solid pancreatic masses, who underwent EUS-guided sampling with a 22G FNA from June 2011 to May 2012, served as the historical control group. EUS-guided sampling was performed using the standard technique without an on-site cytopathologist. Results: The diagnostic rates of cytology were 97.1% (33/34) with 22G FNA needles and 85.3% (29/34) with 25G FNB needles (P ¼ 0.197). The diagnostic rates of histology were 23.5% (8/34) with 22G FNA needles and 41.2% (14/34) with 25G FNB needles (P ¼ 0.194). There was no significant differences in the mean number of needle passes (5.09 vs 5.76, P ¼ 0.089) or needle malfunctions (2.9% vs 11.8%, P ¼ 0.356) between 22G FNA and 25G FNB needles, respectively. No complications were identified in either group. Conclusion: The 25G FNB needle was not superior to the 22G FNA needle in the diagnostic yield of histology for EUS-guided sampling of pancreatic mass lesions, as the diagnostic yield, technical performance, and safety profiles were comparable between both of them.
W-021. The role of obesity as a risk factor for a hyperechogenic pancreas on endoscopic ultrasound
a Hospital Santa Maria, Serviço Gastrenterologia e Hepatologia, Portugal b Hospital Santa Maria, Serviço Cirurgia, Portugal c Hospital Santa Maria, Serviço Imagiologia, Portugal
Background: Intraductal papillary mucinous neoplasms (IPMN) are rare pancreatic neoplasms (7.5%) characterized by cystic dilation of the main pancreatic duct or its branches. IPMN are often mistaken with other causes of chronic pancreatitis. Aims: We report a patient with occult IPMN manifested as chronic idiopathic pancreatitis. Patients & methods: A 67-year old man, with no alcohol consumption, and a history of recurrent pancreatitis of unknown etiology since age 37, pancreatic-jejunal bypass at age 40 for pain relief and radiological evidence of chronic pancreatic since age 48 was admitted with abdominal pain, melaena and asthenia. Results: Endoscopy revealed a lesion below D2 occupying half the circumference and a third of the lumen with histology of high-grade epithelial papillary neoplasm. Computed tomography showed enlargement and heterogeneity of the pancreatic head with calcifications. We assumed the diagnosis of pancreatic cancer and the patient was submitted to a Whipple procedure. Histology revealed IPMN with foci of invasive adenocarcinoma with negative margins of resection. Conclusion: Our report illustrates the difficulty in diagnosing IPMN. Over three decades the patient’s findings were interpreted in the context of the natural history of chronic pancreatic, with a correct diagnosis only after established disease. Changes in regional morphology following surgical bypass may have contributed to the delay in diagnosis. Surgery remains the treatment of choice owing to its malignant potential, with excellent survival at 5 years in local disease (90%). Although uncommon, IPMN should be considered in the differential diagnosis of idiopathic pancreatitis.
Hyeongseok Nam, Daehwan Kang, Cheolwoong Choi, Byeongjun Song, Su Bum Park, Su Jin Kim
W-023.
Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, South Korea
Intraductal papillary mucinous neoplasm associated with pancreatic calcification. Case report and review of the literature
Background: Identification of hyperechogenic pancreas (HP) is not uncommon during endoscopic ultrasound (EUS). However, the clinical significance of HP is still unclear. We hypothesized that HP is related to obesity in a similar way to its relationship with fatty liver. Aims: The aim of this study was determine the incidence of HP in patients undergoing EUS and to assess the relationship between HP and obesity. Patients & methods: 524 adults who underwent EUS were included. 240 patients with a history of pancreatic disease or with hepatobiliary or advanced gastrointestinal cancer were excluded. 284 patients were included in the analyses. We performed subgroup analyses according to visceral adipose tissue (VAT) in 132 patients who underwent abdominal computed tomography scans. Results: On univariate analysis, obesity (body mass index > 5m kg/m2), fatty liver, diabetes mellitus, hypercholesterolemia, age older than 60 years were identified as risk factors associated with HP (P < 0.05). On multivariate analysis, fatty liver (p ¼ 0.008, odds ratio ¼ 2.219) and age older
Vyacheslav Egorov, Natalia Starostina, Tatiana Silina, Natalia Ratnikova, Olga Kosheleva, Roman Petrov 5th Moscow City Hospital, Moscow, Russia, Russia Background: Intraductal papillary mucinous neoplasm (IPMN) associated with pancreatic calcification is a rare and important event because of the different therapy for the diseases. Aims: To show the difficulties in diagnostics of two pancreatic conditions, which can lead to wrong treatment Patients & methods: A 50-year old woman suffering with recurrent abdominal pain and diabetes mellitus was admitted to our hospital after endoscopic, CT and EUS examinations. There was no previous history of acute pancreatitis and patient was treated for chronic calcific pancreatitis. Radiologically, calcifications were seen diffusely throughout the gland and there were no mucus entry through the major papilla. Results: After work up the diagnosis was unclear, but the dilation of the main pancreatic duct and abdominal pain syndrome made surgery the best