e-Posters - Euro Gastro 2018
ASST Rhodense Garbagnate Milanese,Milan Italy.
SECONDARY PANCREATIC DIFFUSE LARGE B-CELL LYMPHOMA: AN EUS DIAGNOSIS OF A RARE CAUSE OF PANCREATIC MASS
G. De Nucci(Biography)
G. De Nucci(Abstract)
Background:\r\nPancreatic lymphomatous involvement is a rather unusual event: primary pancreatic lymphoma represents a rarity, accounting for less than 2% of all lymphomas. Secondary pancreatic involvement during systemic disease can occur but cytological diagnosis is very\r\nrarely performed considering the multiorgan dissemination. Pancreatic involvement may be misdiagnosed as pancreatic cancer thus leading to incorrect therapeutic management.In the last decade the Endoscopic Ultrasound (EUS) has emerged as the most cost-effective and safe procedure, a gold standard to\r\nobtain the diagnosis of pancreatic lesions. Lymphomas can show different pattern of pancreatic involvement, the most common one being, at radiological investigations, the nodular, hypodense one. Lymphomatous involvement of the pancreas is usually of the non Hodgkinâ€™s or B-cell type with diffuse large B-cell lymphoma being the most common hystotype.!\r\nWe report an unusual case of secondary, pancreatic, nodular involvement diagnosed by EUS-FNA in patient suffering from a diffuse large B-cell lymphoma.\r\n\r\nMaterials and methods:\r\nAn asymptomatic 68-ys-old male patient was referred to our hospital for radiological follow-up for lymphoma. A Ct scan showed a doubtful enlargement of the pancreatic head. An Eus was performed showing a hypoechoic mass measuring 17 mm in diameter\r\ncharacterized by infiltrative margins, with a central area of necrosis and ipoenhancement on evaluation using ev mdc(Sonovue).\r\nMoreover, a peripheral rim of oedematous pancreatic parenchyma was detected. The Endoscopist performed FNA (3 passes, 25 G\r\nneedle for direct smears and 3 passes,22 G needleforcell block) in order to rule out pancreatic involvement by the known lympho\r\ndisease. In the Pathological Unitd direct smears were stained with May-Gruenwald-Giemsa and with Papanicolaou stain. The 22 G\r\nneedle and syringe were rinsed and the liquid obtained was later centrifugated. The sediment obtained was fixed in 10% buffered formaldehyde, routinely processed and paraffin-embedded as a cell block. Twoâ€“micrometerâ€“thick sections were cut, stained with hematoxylin and eosin (H&E). Other sections were cut and used for ancillary studies. Immunophenotypic profiles were determined according to standard immunoperoxidase methods. The panel of antisera for the cell block sections included CD20, CD79a, CD3,cytokeratin AE1/AE3.\r\n\r\nResults:\r\n\r\nBoth the direct smears and the cell block sections displayed an abundant, scattered population composed by monomorphous large cells with round nuclei, with multiple nucleoli acting as lymphoid centroblasts. The immunocytochemistry analysis confirmed the cytological\r\nhypothesis showing expression of CD20 and CD79a and negativity for CD3 and cytokeratinAE1/AE3. Moreover necrotic background was\r\ndetected.\r\n\r\nConclusions:\r\n\r\nPancreatic malignant lymphomas are unusual, solid tumors categorized as non-epitehelial neoplasms. Primary pancreatic lymphoma is an extremely rare entity but secondary pancreati involvement can occur in up to 30% of patients. EUS + FNA is a safe, useful and concrete tool to achieve pancreatic involvement in this setting of lymphomatous diseases and it\'s fundamental for the therapeutic patient\r\nmanagement. Moreover an important role is played by the cytopathologist\'s expertise to achieve an accurate diagnosis applying ancillary techniques too,such as immunocytochemistry especially in deceiving cases.\r\n
Moscow Clinical Scientific Center, Russia
The treatment results of rectal fistulas in Crohn's disease - VAAFT
Danilov Mikhail has completed his PhD at the age of 28 years from Center of Surgery named after acad. B.V.Petrovsky, and postdoctoral studies from Sechenov University. He is the senior researcher of department of colorectal surgery. He has published more than 40 papers in reputed journals.
Treatment of fistulas of the rectum in Crohn\'s disease is a difficult task for both gastroenterologists and surgeons. Medicamental treatment of this pathology is recommended as the first line of therapy, and surgical treatment serves to control severe septic complications. The frequency of relapse in the surgical treatment of rectal fistula with the use of various methods can reach up to 55%, and 70% if there is also Crohn\'s disease. Surgical interventions with the plastic component and the excision of the fistula show good results, but they practically do not make sense in case of Crohn\'s disease. Mini-invasive interventions (VAAFT) are becoming increasingly popular, in the treatment of rectal fistulas in Crohn\'s disease in particular.\r\nOur clinic performed 12 procedures using video-endoscopic technologies (VAAFT) in patients with Crohn\'s disease, the comparison group included patients who underwent ligation of the fistula in the inter-sphinctercic space (LIFT) -18. In the first stage setons were put into all the patients, followed by operation in the period from 1 to 3 months. Patients of both groups did not differ in age and sex (p =34), as well as in fistula types: trans-sphincteric - VAAFT = 8, LIFT = 14, extra- sphincteric - VAAFT = 4, LIFT = 6 (p = 45).\r\nThe groups did not significantly differ in the duration of the surgical intervention: VAAFT - 28Â±5.2 min, LIFT - 26Â±5.8 min (Ñ€=.12), pain syndrome in the postoperative period (VAS scale) (p=.07), postoperative bed-day (4Â±1.2 and 4Â±1.4, p=.24). All patients in VAAFT-group underwent the first stage of fistuloscopy, then the fistula was cleared from fibrin overlap, fistula ablation was performed in the direction from the inner to the external opening, the internal opening was excised and sutured. According to the preoperative examination (transanal US, MRI) there was an ischio-rectal lag associated with the fistula in two patients in the VAAFT group and one in the LIFT group, and surgical intervention was supplemented by sanitation and drainage through the external fistula opening. The median follow-up of the total sample of patients was 12.6 months. In 2 patients of the LIFT group (10%) and the 1st group VAAFT (8.3%), the relapse of the disease was detected at different times: 6, 7 and 3 months, respectively (p=.18), the setons were put into the patients once again, medicamentous therapy was continued (preparations of 5-ASA, hormones, biological therapy).\r\nVideo-endoscopic treatment of rectum fistulas (VAAFT) in Crohn\'s disease is quite new and promising surgical technique that demonstrates satisfactory results in both early postoperative and distant period. The small-traumatic nature of the technique makes it possible to perform it in multiple and recurrent fistula of the rectum.