Accuracy of endoscopic ultrasound-guided fine-needle aspiration in the suspicion of pancreatic metastases

Abstract\ud \ud \ud \ud Background\ud \ud Metastases to the pancreas are rare, and usually mistaken for primary pancreatic cancers. This study aimed to describe the histology results of solid pancreatic tumours obtained by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for diagnosis of metastases to the pancreas.\ud \ud \ud \ud Methods\ud \ud In a retrospective review, patients with pancreatic solid tumours and history of previous extrapancreatic cancer underwent EUS-FNA from January/1997 to December/2010. Most patients were followed-up until death and some of them were still alive at the end of the study. The performance of EUS-FNA for diagnosis of pancreatic metastases was analyzed. Symptoms, time frame between primary tumour diagnosis and the finding of metastases, and survival after diagnosis were also analyzed.\ud \ud \ud \ud Results\ud \ud 37 patients underwent EUS-FNA for probable pancreas metastases. Most cases (65%) presented with symptoms, especially upper abdominal pain (46%). Median time between detection of the first tumour and the finding of pancreatic metastases was 36 months. Metastases were confirmed in 32 (1.6%) cases, 30 of them by EUS-FNA, and 2 by surgery. Other 5 cases were non-metastatic. Most metastases were from lymphoma, colon, lung, and kidney. Twelve (32%) patients were submitted to surgery. Median survival after diagnosis of pancreatic metastases was 9 months, with no difference of survival between surgical and non-surgical cases. Sensitivity, specificity, positive and negative predictive values, and accuracy of EUS-FNA with histology analysis of the specimens for diagnosis of pancreatic metastases were, respectively, 93.8%, 60%, 93.8%, 60% and 89%.\ud \ud \ud \ud Conclusion\ud \ud EUS-FNA with histology of the specimens is a sensitive and accurate method for definitive diagnosis of metastatic disease in patients with a previous history of extrapancreatic malignancies.The authors are in debt with the Foundation Waldemar Barmley Pessoa, which was responsible for the acquisition of the needles for the patients of this study

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Different clinical aspects of Wirsungocele: case series of three patients and review of literature

Se ha descrito la asociación de Santorinicele con páncreas divisum. Esta característica anatómica crea condiciones ideales para los episodios de pancreatitis aguda y dolor abdominal crónico. La dilatación sacular del conducto pancreático principal también ha sido descrita como hallazgo incidental y como causa de episodios de pancreatitis aguda. Sin embargo, no hay una descripción del dolor abdominal crónico asociado. Se presentan tres casos detallados de Wirsungocele demostrados por colangipancreatografía retrógrada endoscópica. Dos pacientes tuvieron episodios de pancreatitis aguda y uno de dolor abdominal crónico. Fueron tratados con esfinterotomía endoscópica biliopancreática. Después de más de dos años de seguimiento ningún paciente presenta recurrencia clínica. La esfinterotomía endoscópica biliopancreática parece segura y efectiva para los pacientes sintomáticos con esta condición anatómica

PANCREATIC SPLENOSIS MIMICKING NEUROENDOCRINE TUMORS: microhistological diagnosis by endoscopic ultrasound guided fine needle aspiration

Context Pancreatic splenosis is a benign condition which can mimic a pancreatic neoplasm. Objective To describe the role of the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic nodules suspicious for pancreatic splenosis. Method From 1997 to 2011, patients with pancreatic solid tumors suspicious for splenosis by computed tomography and/or magnetic resonance imaging were referred to EUS-FNA. Those cases with pancreatic splenosis confirmed by EUS-FNA or surgery were included. Endosonographic findings and clinicopathologic features were also analysed. Results A total of 2,060 patients with pancreatic solid tumors underwent EUS-FNA. Fourteen (0.6%) cases with pancreatic splenosis were found. After applying exclusion criteria, 11 patients were selected. Most patients were male (7), young (mean age: 42 years) and asymptomatic (8). Endoscopic ultrasound imaging alone suspected pancreatic splenosis in 6 cases, and neuroendocrine tumors in 5 cases. Pancreatic splenosis was found most commonly in the tail, was round, hypoechoic, with homogeneous pattern, regular borders, and with scintigraphy negative for somatostatin receptors. The average diameter of these nodules identified by endoscopic ultrasound was 2.15&#8197;cm. Microhistology obtained by EUS-FNA confirmed the diagnosis in 9/10 patients. Conclusion Pancreatic splenosis can be diagnosed by EUS-FNA. Microhistology prevents unnecessary surgeries, and reassures asymptomatic patients with hypoechoic, homogeneous, and well circumscribed pancreatic nodules.<br> Contexto A esplenose pancre&#225;tica &#233; uma afec&#231;&#227;o benigna que pode mimetizar uma neoplasia pancre&#225;tica. Objetivo Descrever o papel da ecoendoscopia associada &#224; pun&#231;&#227;o aspirativa com agulha fina ecoguiada (EE-PAAF) dos n&#243;dulos de p&#226;ncreas suspeitos de esplenose pancre&#225;tica. M&#233;todo De 1997 a 2011, pacientes com tumores s&#243;lidos de p&#226;ncreas sugestivos de esplenose pancre&#225;tica, conforme achados de exames de imagem por tomografia computadorizada e/ou resson&#226;ncia magn&#233;tica foram encaminhados para EE-PAAF. Os casos com esplenose pancre&#225;tica confirmada pela ecoendoscopia ou pela cirurgia foram inclu&#237;dos. Os achados endossonogr&#225;ficos e os aspectos clinicopatol&#243;gicos foram analisados. Resultados Dois mil e sessenta pacientes com tumores s&#243;lidos do p&#226;ncreas foram submetidos a EE-PAAF. Quatorze (0,6%) casos com esplenose pancre&#225;tica foram encontrados. Ap&#243;s emprego dos crit&#233;rios de exclus&#227;o, 11 pacientes foram selecionados. A maioria dos pacientes era do sexo masculino (7), jovens (idade m&#233;dia: 42 anos) e assintom&#225;ticos (8). A imagem ecoendosc&#243;pica isolada suspeitou de esplenose pancre&#225;tica em 6 casos, e tumores neuroend&#243;crinos em outros 5 casos. A esplenose pancre&#225;tica foi detectada mais comumente na cauda do p&#226;ncreas, era redonda, hipoecog&#234;nica, com padr&#227;o homog&#234;neo, bordos regulares bem delimitados e com cintilografia negativa para os receptores de somatostatina. O di&#226;metro m&#233;dio dos n&#243;dulos foi de 2,15&#8197;cm. A microhistologia obtida pela EE-PAAF confirmou o diagn&#243;stico em 9/10 pacientes. Conclus&#227;o A esplenose pancre&#225;tica pode ser diagnosticada pela pun&#231;&#227;o aspirativa com agulha fina ecoguiada. A microhistologia evita cirurgias desnecess&#225;rias e tranquiliza pacientes assintom&#225;ticos com n&#243;dulos pancre&#225;ticos hipoecog&#234;nicos, homog&#234;neos e com bordos bem definidos