Duodenal Adenocarcinoma Diagnosed from a Biopsy Specimen of a Depressed Lesion Obtained by Magnifying Endoscopy

Biopsies are necessary for the management of duodenal tumors. However, the most suitable targets for biopsy are not known. An 82-year-old woman who regularly visited our hospital for rheumatoid arthritis underwent abdominal ultrasonography. This screening revealed a dilated pancreatic duct. Magnetic resonance cholangiopancreatography was performed, and dilatation of the pancreatic duct was confirmed. The patient underwent duodenoscopy to investigate the possibility of obstruction of the papilla of Vater. The examination revealed an elevated lesion around the papilla of Vater. Endoscopic ultrasonography and a 20-MHz mini-probe were used to investigate the depth of the invasion. The common bile and pancreatic ducts were intact. The mucosal and submucosal borders were indistinct; however, the border between the submucosa and muscularis propria was clear, suggesting that the muscularis propria was intact. Magnifying endoscopy was used to examine the surface of the elevated lesion, which revealed a depressed lesion. A biopsy specimen of the depressed lesion was taken, and the tumor was diagnosed as an adenocarcinoma. Another biopsy specimen from a non-depressed lesion was diagnosed as an adenoma. The patient was diagnosed with duodenal adenocarcinoma, and was recommended surgery. She declined surgery and was followed up for 34 months. Because it is possible for depressed lesions of duodenal tumors to be adenocarcinomas, biopsy specimens should be obtained from depressed lesions of duodenal tumors.

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Obstructive pancreatolithiasis in a cat with triaditis and concurrent hypercalcaemia

Journal of Feline Medicine and Surgery Open Reports ◽

10.1177/2055116921998494 ◽

2021 ◽

Vol 7 (1) ◽

pp. 205511692199849

Author(s):

Frederik Allan ◽

Anne-Lorraine Peschard ◽

Luca Schiavo ◽

Will Bayton ◽

Davide Corbetta ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Rare Condition ◽

Evidence Base ◽

Human Medicine ◽

Pancreatic Ducts ◽

Abdominal Ultrasonography ◽

Case Summary ◽

Pancreatic Duct Obstruction ◽

Amoxicillin Clavulanate

Case summary A 7-year-old neutered female domestic longhair cat was presented for further investigation of suspected hepatobiliary disease. Increases in serum 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester lipase and hepatobiliary enzymes, with concurrent hypoalbuminaemia, were documented on blood biochemistry. Abdominal ultrasonography findings were consistent with acute pancreatitis with multiple pancreatoliths visualised within the pancreatic duct. Treatment for suspected triaditis was initiated with a hydrolysed protein diet, amoxicillin–clavulanate, hepatoprotectants and buprenorphine. Fifty-three days later, the patient presented with hypercalcaemia and obstructive pancreatolithiasis, and was euthanased. Post-mortem examination revealed severe chronic active pancreatitis with moderate chronic lymphocytic, plasmacytic cholangiohepatitis and mild chronic lymphocytic–plasmacytic duodenal enteritis (triaditis). Multiple calcium carbonate pancreatoliths present within the pancreatic ducts had resulted in pancreatic duct obstruction. Relevance and novel information Pancreatolithiasis is a very rare condition in cats, with only five reports to date. In human medicine, pancreatolithiasis is often a sequala to chronic pancreatitis, seen in up to 50–90% of patients. However, in cats the aetiology of pancreatolithiasis, and indeed chronic pancreatitis, is poorly understood. This report describes a case of obstructive pancreatolithiasis in a cat with histopathological confirmation of triaditis and is the first report of hypercalcaemia in a cat with obstructive pancreatolithiasis. This further adds to the evidence base that pancreatolithiasis may have a similar pathogenesis to humans and can develop secondarily to chronic pancreatitis in cats.

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Pre-Operative Imaging and Pathological Diagnosis of Localized High-Grade Pancreatic Intra-Epithelial Neoplasia without Invasive Carcinoma

Cancers ◽

10.3390/cancers13050945 ◽

2021 ◽

Vol 13 (5) ◽

pp. 945

Author(s):

Ryota Sagami ◽

Kentaro Yamao ◽

Jun Nakahodo ◽

Ryuki Minami ◽

Masakatsu Tsurusaki ◽

...

Keyword(s):

Pancreatic Duct ◽

Invasive Carcinoma ◽

Current Knowledge ◽

Precancerous Lesions ◽

Ductal Adenocarcinoma ◽

Pancreatic Ducts ◽

High Grade ◽

Cytologic Examination ◽

Imaging Characteristics ◽

Retention Cysts

Pancreatic ductal adenocarcinoma (PDAC) arises from precursor lesions, such as pancreatic intra-epithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasm (IPMN). The prognosis of high-grade precancerous lesions, including high-grade PanIN and high-grade IPMN, without invasive carcinoma is good, despite the overall poor prognosis of PDAC. High-grade PanIN, as a lesion preceding invasive PDAC, is therefore a primary target for intervention. However, detection of localized high-grade PanIN is difficult when using standard radiological approaches. Therefore, most studies of high-grade PanIN have been conducted using specimens that harbor invasive PDAC. Recently, imaging characteristics of high-grade PanIN have been revealed. Obstruction of the pancreatic duct due to high-grade PanIN may induce a loss of acinar cells replaced by fibrosis and lobular parenchymal atrophy. These changes and additional inflammation around the branch pancreatic ducts (BPDs) result in main pancreatic duct (MPD) stenosis, dilation, retention cysts (BPD dilation), focal pancreatic parenchymal atrophy, and/or hypoechoic changes around the MPD. These indirect imaging findings have become important clues for localized, high-grade PanIN detection. To obtain pre-operative histopathological confirmation of suspected cases, serial pancreatic-juice aspiration cytologic examination is effective. In this review, we outline current knowledge on imaging characteristics of high-grade PanIN.

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A Case of Esophageal Xanthoma with Epithelial Reactive Inflammation with a Characteristic Finding of Narrow-Band Imaging Magnifying Endoscopy

Digestive Diseases ◽

10.1159/000501448 ◽

2019 ◽

Vol 38 (1) ◽

pp. 85-88

Author(s):

Hideki Mori ◽

Motohiko Kato ◽

Toshio Uraoka

Keyword(s):

Biopsy Specimen ◽

Narrow Band ◽

Narrow Band Imaging ◽

Basal Layer ◽

Excisional Biopsy ◽

Magnifying Endoscopy ◽

Thoracic Esophagus ◽

Characteristic Finding ◽

Capillary Loop ◽

White Substance

A 75-year-old woman had a 5 mm slightly elevated yellowish lesion in her thoracic esophagus. Narrow-band imaging magnifying endoscopy (NBI-ME) revealed aggregations of a tiny white substance beneath each intrapapillary capillary loop with weaving, dilatation, and a different shape. In this case, an irregular caliber was absent. The biopsy specimen taken from the lesion showed cells with large nuclei and increased chromatin clumping in the basal layer. These cells were positive for p53. Endoscopic submucosal dissection was performed for the purpose of excisional biopsy. Finally, it was diagnosed as an esophageal xanthoma with a benign epithelial reactive inflammation. This is the first report of esophageal xanthoma showing the characteristic NBI-ME finding of esophageal xanthoma. Further studies are required to determine whether the characteristic finding of NBI-ME is generally found in esophageal xanthomas.

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Combined minimaly invasive surgery of pancreaticolithiasis in combination with congenital stricture of the terminal sections of the pancreatic ducts

Pediatrician (St Petersburg) ◽

10.17816/ped8596-102 ◽

2017 ◽

Vol 8 (5) ◽

pp. 96-102

Author(s):

Mikhail P. Korolev ◽

Leonid E. Fedotov ◽

Ruben G. Avanesyan ◽

Elena A. Mikhailova ◽

Georgiy M. Lepekhin ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Magnetic Resonance ◽

Minimally Invasive ◽

Pancreatic Duct ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Pancreatic Ducts ◽

Invasive Treatment ◽

Percutaneous Access ◽

Joint Application

Chronic pancreatitis with pancreatic hypertension is extremely rare in childhood. Chronic pancreatitis in this age is usually always associated with a сongenital defect of the pancreatic duct system. The article describes the case of long-term clinical observation and minimally invasive treatment of chronic calculous pancreatitis, first diagnosed in a girl at the age of 16 years. Despite the fact that clinical manifestations were observed from the age of 3 years, the correct diagnosis could be made only at the age of 16, by joint application of ultrasound, Magnetic Resonance Imaging (MRI) and Magnetic Resonance Cholangiopancreatography (MRCP). The cause of chronic pancreatitis were concrements and strictures of the main and additional pancreatic ducts that caused pancreatic hypertension. Attempt of endoscopic retrograde lithoextraction from the pancreatic ducts was impossible because of the presence of severe stricture. Therefore, it was decided to apply a combined approach using percutaneous access under ultrasound navigation. The patient underwent series of minimally invasive combined procedures including the lithoextraction, balloon dilatation and transcutaneous drainage of the pancreatic ducts with the endoscopic and percutaneous access with ultrasound and radiologic control. For the prevention of restenosis, the antegrade stenting of the main pancreatic duct with self-expanding coated nitinol stent was used with further removal of the stent. Due to the treatment, there was no pancreatitis within 5 years after stent removal.

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Motion - Pancreatic Endoscopy is Useful for the Pain of Chronic Pancreatitis: Arguments for the Motion

Canadian Journal of Gastroenterology ◽

10.1155/2003/518084 ◽

2003 ◽

Vol 17 (1) ◽

pp. 57-59

Author(s):

Stanley M Branch

Keyword(s):

Chronic Pancreatitis ◽

Pancreatic Duct ◽

Endoscopic Therapy ◽

Clinical Problem ◽

Pancreatic Pseudocysts ◽

Pancreatic Ducts ◽

Success Rates ◽

Long Term Follow Up

Pain is the dominant clinical problem in patients with chronic pancreatitis. It can be due to pseudocysts, as well as strictures and stones in the pancreatic ducts. Most experts agree that obstruction could cause increased pressure within the main pancreatic duct or its branches, resulting in pain. Endoscopic therapy aims to alleviate pain by reducing the pressure within the ductal system and draining pseudocysts. Approaches vary according to the specific nature of the problem, and include transgastric, transduodenal and transpapillary stenting and drainage. Additional techniques for the removal of stones from the pancreatic duct include extracorporeal shockwave lithotripsy. Success rates for stone extraction and stenting of strictures are high in specialized centres that employ experienced endoscopists, but pain often recurs during long term follow-up. Complications include pancreatitis, bleeding, infection and perforation. In the case of pancreatic pseudocysts, percutaneous or even surgical drainage should be considered if septae or large amounts of debris are present within the lesion. This article describes the techniques, indications and results of endoscopic therapy of pancreatic lesions.

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Effect of Slc26a6 deletion on apical Cl−/HCO3− exchanger activity and cAMP-stimulated bicarbonate secretion in pancreatic duct

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00286.2006 ◽

2007 ◽

Vol 292 (1) ◽

pp. G447-G455 ◽

Cited By ~ 41

Author(s):

Hiroshi Ishiguro ◽

Wan Namkung ◽

Akiko Yamamoto ◽

Zhaohui Wang ◽

Roger T. Worrell ◽

...

Keyword(s):

Pancreatic Duct ◽

Apical Membrane ◽

Pancreatic Ducts ◽

Bicarbonate Secretion ◽

Wild Type ◽

Rt Pcr ◽

Secretory Rate ◽

Transport Fluid ◽

Exchange Activity

The role of Slc26a6 (PAT1) on apical Cl−/HCO3− exchange and bicarbonate secretion in pancreatic duct cells was investigated using Slc26a6 null and wild-type (WT) mice. Apical Cl−/HCO3− exchange activity was measured with the pH-sensitive dye BCECF in microperfused interlobular ducts. The HCO3−-influx mode of apical [Cl−]i/[HCO3−]o exchange (where brackets denote concentration and subscripts i and o denote intra- and extracellular, respectively) was dramatically upregulated in Slc26a6 null mice ( P < 0.01 vs. WT), whereas the HCO3−-efflux mode of apical [Cl−]o/[HCO3−]i exchange was decreased in Slc26a6 null mice ( P < 0.05 vs. WT), suggesting the unidirectionality of the Slc26a6-mediated HCO3− transport. Fluid secretory rate in interlobular ducts were comparable in WT and Slc26a6 null mice ( P > 0.05). In addition, when pancreatic juice was collected from whole animal in basal and secretin-stimulated conditions, neither juice volume nor its pH showed differences between WT and Slc26a6 null mice. Semiquantitative RT-PCR demonstrated more than fivefold upregulation in Slc26a3 (DRA) expression in Slc26a6 knockout pancreas. In conclusion, these results point to the role of Slc26a6 in HCO3− efflux at the apical membrane and also suggest the presence of a robust Slc26a3 compensatory upregulation, which can replace the function of Slc26a6 in pancreatic ducts.

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Deletion of Slc26a6 alters the stoichiometry of apical Cl−/HCO3− exchange in mouse pancreatic duct

AJP Cell Physiology ◽

10.1152/ajpcell.00151.2012 ◽

2012 ◽

Vol 303 (8) ◽

pp. C815-C824 ◽

Cited By ~ 15

Author(s):

Ying Song ◽

Akiko Yamamoto ◽

Martin C. Steward ◽

Shigeru B. H. Ko ◽

Andrew K. Stewart ◽

...

Keyword(s):

Pancreatic Duct ◽

Apical Membrane ◽

Flux Ratio ◽

Pancreatic Ducts ◽

Transmembrane Conductance Regulator ◽

Wild Type ◽

Transmembrane Conductance ◽

Membrane Hyperpolarization ◽

Disulphonic Acid ◽

Cystic Fibrosis Transmembrane

To define the stoichiometry and molecular identity of the Cl−/HCO3− exchanger in the apical membrane of pancreatic duct cells, changes in luminal pH and volume were measured simultaneously in interlobular pancreatic ducts isolated from wild-type and Slc26a6-null mice. Transepithelial fluxes of HCO3− and Cl− were measured in the presence of anion gradients favoring rapid exchange of intracellular HCO3− with luminal Cl− in cAMP-stimulated ducts. The flux ratio of Cl− absorption/HCO3− secretion was ∼0.7 in wild-type ducts and ∼1.4 in Slc26a6−/− ducts where a different Cl−/HCO3− exchanger, most likely SLC26A3, was found to be active. Interactions between Cl−/HCO3− exchange and cystic fibrosis transmembrane conductance regulator (CFTR) in cAMP-stimulated ducts were examined by measuring the recovery of intracellular pH after alkali-loading by acetate prepulse. Hyperpolarization induced by luminal application of CFTRinh-172 enhanced HCO3− efflux across the apical membrane via SLC26A6 in wild-type ducts but significantly reduced HCO3− efflux in Slc26a6−/− ducts. In microperfused wild-type ducts, removal of luminal Cl−, or luminal application of dihydro-4,4′-diisothiocyanatostilbene-2,2′-disulphonic acid to inhibit SLC26A6, caused membrane hyperpolarization, which was abolished in Slc26a6−/− ducts. In conclusion, we have demonstrated that deletion of Slc26a6 alters the apparent stoichiometry of apical Cl−/HCO3− exchange in native pancreatic duct. Our results are consistent with SLC26A6 mediating 1:2 Cl−/HCO3− exchange, and the exchanger upregulated in its absence, most probably SLC26A3, mediating 2:1 exchange.

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Endoscopic treatment for complex biliary and pancreatic duct injuries

Journal of Digestive Endoscopy ◽

10.4103/0976-5042.141926 ◽

2014 ◽

Vol 05 (01) ◽

pp. 002-012 ◽

Cited By ~ 1

Author(s):

Simon Bouchard ◽

Jacques Devière

Keyword(s):

Bile Duct ◽

Pancreatic Duct ◽

Percutaneous Treatment ◽

Severe Form ◽

Pancreatic Ducts ◽

Severe Injuries ◽

Percutaneous Approach ◽

The Past ◽

Bile Duct Injuries ◽

Complete Transection

AbstractSevere injuries of biliary or pancreatic ducts are associated with significant morbidity and mortality. Severe bile duct injuries such as major biliary leaks, complete transection, or complete occlusion of bile ducts can be grouped under the term complex bile duct injuries (CBDI). In the spectrum of pancreatic duct injuries, disconnected pancreatic duct syndrome (DPDS) represents the most severe form and most often occurs after a severe episode of acute pancreatitis. Treatment of these complex injuries is quite challenging and for many years surgical management has been considered the treatment of choice. However, in the past few years, some studies have reported the successful management of CBDI or DPDS using endoscopic procedures alone or in combination with a percutaneous approach. In this review, we detail the endoscopic or combined endoscopic/percutaneous treatment possibilities for CBDI and DPDS.

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Double plastic stent implantation for recurrent acute pancreatitis with incomplete pancreas divisum: a case report and literature review

Journal of International Medical Research ◽

10.1177/03000605211060142 ◽

2021 ◽

Vol 49 (11) ◽

pp. 030006052110601

Author(s):

Kunyi Liu ◽

Xuechen Liu ◽

Chengyi Shi ◽

Siqi Liu ◽

Hongwei Du ◽

...

Keyword(s):

Pancreatic Duct ◽

Stent Implantation ◽

Pancreas Divisum ◽

Guide Wire ◽

Pancreatic Ducts ◽

Recurrent Acute Pancreatitis ◽

Plastic Stent ◽

Minor Papilla ◽

Small Branch ◽

Pancréas Divisum

Pancreas divisum (PD) is a common pancreatic malformation caused by the failure of fusion between ventral and dorsal pancreatic ducts. There is a small branch of communication between the two systems in incomplete PD, and this variation has an incidence of 15%. A 43-year-old female patient presented to our department with recurrent abdominal pain. Magnetic resonance cholangiopancreatography (MRCP) showed that the ventral pancreatic duct was curved, with a local pouchlike dilatation. Endoscopic ultrasonography supported the diagnosis of incomplete PD and showed a thin branch of communication between ventral and dorsal pancreatic ducts. Endoscopic retrograde cholangiopancreatography (ERCP) and papillotomy of the minor papilla with double plastic stent implantation were performed. One pancreatic plastic stent was inserted across the minor and major papilla over the guide wire, creating a U-shape. The other wire-guided plastic stent was inserted through the minor papilla into the dorsal pancreatic duct. The pancreatic fluid drained smoothly after stent placement. During the 6-month follow-up, the patient remained well, without recurrence of pancreatitis.

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