Impact of endoscopic ultrasound on diagnosis and management of presumed mucinous neoplasms when done for pancreatic cyst morphology change on non-invasive surveillance imaging

Background and study aims Guidelines for management of presumed neoplastic pancreatic cysts have encouraged noninvasive imaging for low-risk surveillance, while reserving endoscopic ultrasound for worrisome features including morphologic change. We aim to study the impact of endoscopic ultrasound on diagnosis and management compared with non-invasive imaging. Patients and methods A single-institution pancreatic cyst database was retrospectively queried for patients who underwent endoscopic ultrasound for the indication of change in cyst morphology. Diagnoses were classified as presumed mucinous neoplasm with or without worrisome features or high-risk stigmata and non-mucinous lesions. Management decisions were defined a priori as surgical evaluation for patients with high-risk stigmata, positive cytology or mural nodule, or continued surveillance for all others. Results Between January 2013 and October 2016, 709 pancreas cyst endoscopic ultrasounds were performed of which 89 were for cyst morphology change seen on noninvasive imaging including 10 presumed pseudocysts, nine presumed serous cystadenomas, and 70 presumed mucinous cystic neoplasms. Cyst morphologic changes included increase in caliber of the main pancreatic duct (7 cases), increase in cyst size (68 cases), cyst ≥ 30 mm (10 cases), and presence of a solid nodule (1 case). Median cyst size increase was 5 mm with interquartile range of 4 mm over 2.1 ± 1.9 years. Endoscopic ultrasound done for morphologic change resulted in a change in diagnosis and management in 16 % and 13 % of cases, respectively. Conclusion Endoscopic ultrasound has a modest but clinically significant role in impacting diagnosis and management for presumed mucinous cystic neoplasms when performed for the indication of cyst morphology change.

Virulent T4 Acanthamoeba causing keratitis in a patient after swimming while wearing contact lenses in Southern Brazil

Several strains of free-living amoebae belonging to the genusAcanthamoebacan cause a painful sight-threatening disease of the cornea known asAcanthamoebakeratitis (AK). The numbers of AK cases keep rising worldwide mainly due to an increase in contact lens wearers and lack of hygiene in the maintenance of contact lenses and their cases. We report a case of AK in a healthy young woman admitted to the Hospital de Clinicas in Porto Alegre, southern Brazil. Corneal scrapings were examined for the presence ofAcanthamoebastrains. The initial isolate was characterized by morphological and genotypic properties. The isolate belonged to group III according to Pussard and Pons’ cyst morphology. Analysis of its 18S rDNA sequence identified the isolate as genotype T4. The T4 genotype is the most commonly reported among keratitis isolates and the most common in environmental samples.

Collyriclosis in Red-backed shrikes Lanius collurio from Israel and Czech Republic

Summary One juvenile Red-backed shrike (Lanius collurio) with a cutaneous cyst of Collyriclum faba under its beak was observed in Israel on 13 October 2016. Another Red-backed shrike (adult female) with multiple cutaneous cysts around the vent was observed in Průhonice, Czech Republic on 19 June 2017. A third Red-backed shrike (adult male) with three cutaneous cysts around the vent was observed in Mariánské Radčice, Czech Republic on 16 July 2017. In the Israeli case, two adult trematodes C. faba were found in the cutaneous cyst. In the two Czech cases, C. faba was identified indirectly by analysing the cutaneous cyst morphology. C. faba had never been recorded previously in Israel.

Cyst morphology of large branchiopod crustaceans (Anostraca, Notostraca, Laevicaudata, Spinicaudata) in western Poland

The morphology of resting eggs was studied in Polish populations of 7 large branchiopod species:Branchipus schaefferi,Chirocephalus shadini,Eubranchipus grubii(Anostraca),Lepidurus apus,Triops cancriformis(Notostraca),Lynceus brachyurus(Laevicaudata), andCyzicus tetracerus(Spinicaudata). Scanning electron microscope photographs for each species are also provided. In some species (especiallyE. grubii), the ornamentation and size of cysts from Polish populations significantly differ from literature data for populations from other parts of Europe. We also present a key to determination of the studied species based on cyst morphology and discuss whether those traits are useful in surveys of new localities of endangered large branchiopods.

Pathological and phylogenetic characterization ofAmphibiothecumsp. infection in an isolated amphibian (Lissotriton helveticus) population on the island of Rum (Scotland)

SUMMARYOutbreaks of cutaneous infectious disease in amphibians are increasingly being attributed to an overlooked group of fungal-like pathogens, the Dermocystids. During the last 10 years on the Isle of Rum, Scotland, palmate newts (Lissotriton helveticus) have been reportedly afflicted by unusual skin lesions. Here we present pathological and molecular findings confirming that the pathogen associated with these lesions is a novel organism of the order Dermocystida, and represents the first formally reported, and potentially lethal, case of amphibian Dermocystid infection in the UK. Whilst the gross pathology and the parasite cyst morphology were synonymous to those described in a study from infectedL. helveticusin France, we observed a more extreme clinical outcome on Rum involving severe subcutaneous oedema. Phylogenetic topologies supported synonymy between Dermocystid sequences from Rum and France and as well as their distinction fromAmphibiocystidiumspp. Phylogenetic analysis also suggested that the amphibian-infecting Dermocystids are not monophyletic. We conclude that theL. helveticus-infecting pathogen represents a single, novel species;Amphibiothecum meredithae.

Discovery of Heterodera filipjevi in Washington and Comparative Virulence with H. avenae on Wheat

The cereal cyst nematode Heterodera avenae suppresses wheat production in the western United States. A second species of cereal cyst nematode, H. filipjevi, was identified in eastern Oregon during 2008. This paper reports the discovery of H. filipjevi–infested fields in eastern Washington, thereby extending the known distribution of H. filipjevi in the United States. The identity of H. filipjevi was determined and confirmed by species-specific polymerase chain reaction (PCR), PCR-restriction fragment length polymorphism (RFLP), sequencing, and cyst morphology. Soils that were collected from naturally infested fields in Washington were used to compare the virulence of H. avenae and H. filipjevi on six spring wheat cultivars under controlled-environment conditions. Noninfested soils from nearby fields were used as controls. Cultivars Ouyen and WB Rockland were resistant to H. avenae and susceptible to H. filipjevi. Cultivars Sönmez and SY Steelhead were resistant to H. filipjevi and susceptible to H. avenae. Cultivars Louise and WB 936 were susceptible to both species. The resistance of SY Steelhead to ‘H. avenae’, reported in a previous paper, is corrected as resistance to H. filipjevi due to an earlier misidentification of H. filipjevi. Management guidelines that include crop rotations and resistant cultivars are presented. Discovery of additional infestations of H. filipjevi are anticipated when DNA-based tests become used routinely in commercial diagnostic laboratories.