Browsing by Author "Bulajic, M. (7003421660)"

It has been well established that chronic pancreatitis, initially localized to small ducts, evolves later to the main duct and the whole gland. The aim of this study was to give a morphologically based insight on borderline cases of incipient pancreatitis. A total of 95 human autopsy specimens were suspected for chronic pancreatitis on basis of positive history and macroscopic appearance. They were studied by standard anatomical methodology: H and E staining, postmortem pancreatography, corrosion casting, Spalteholz diaphanoscopy, macro- and microdissection. Various stages of chronic pancreatitis were verified in 87 specimens (91.6%). The initial (incipient, or 'equivocal') pancreatitis, based on Marseilles and Cambridge criteria, were detected in 16 cases (18.4%). The ductal abnormalities were found in only one (11 specimens) or in two (5 specimens) main pancreatic duct primary tributaries, without any involvement of the surrounding ducts and parenchyma. The pathological ducts were most frequently situated in the head, and to a lesser extent, in the body and tail of pancreas (10, 4 and 2 cases, respectively). These ducts were significantly both dilated and elongated (mean calibre 1.21 mm, mean length 15.7 mm). In conclusion, a precise diagnosis of the initial chronic pancreatitis has to be based on a full visualization and adequate morphometry of all the main pancreatic duet's tributaries, with clear-cut values of their normal dimension range.

Purpose: Duodenal tumors are rare and require a different management from that of esophagogastric neoplasia. The present study retrospectively analyses the endoscopic ultrasound (EUS) features of duodenal tumors of both epithelial and subepithelial origin. Materials and Methods: During a 12 year period, all duodenal tumors with histologic confirmation by surgery or biopsy were collected including endoscopic and endosonographic images. EUS images were analyzed for specific features (echogenicity, wall layer structure and relation, outer margins) to possibly distinguish epithelial (polyps and carcinoma versus lymphoma) and subepithelial (tumor type) tumors. Results: 53/80 cases had histologic confirmation(mean age 53.1±11.4 years, m:f=33:20), 31 were epithelial (13 adenomas, 12 carcinomas, 6lymphomas) and 22 subepithelial (11 GISTs, 7Brunneromas, 1 lipoma, 3 NETs). EUS did not recognize carcinomas in 2/13 adenomas. EUS features suggesting carcinoma were loss of wall layers and irregular margins. 5/6 lymphomas showed inhomogeneous thickening with layers partially recognizable. Tumor type of subepithelial lesions correlated with echogenicity: GIST tumors were mostly (62.5%) hypocheoic with the 3 malignant cases being characterized by heterogeneous echopattern with irregular outer margins. Of the hyperechoic lesions, lipomas had a homogeneous whitish appearance, while NET and Brunneromas were less hyperechoic. In the latter, the endoscopic aspect was also helpful for differential diagnosis. Accuracy of combined endoscopic/EUS imaging for all duodenal lesions was 84.9% (45/53). No procedural complications occurred among all patients that received EUS examinations. Conclusion: EUS contributes to the differential diagnosis of epithelial lesions known to be malignant; in subepithelial tumors, tissue confirmation is still required. © Georg Thieme Verlag KG Stuttgart - New York.

[No abstract available]

The case of a female patient with a symptomatic duodenal duplication cyst diagnosed on endoscopy is reported. It is very important to discriminate between this rare anomaly and choledochocele as the treatment differs. Ultrasonography and ERCP are useful for the differential diagnosis. This rare anomaly is more often diagnosed in children. In adults duodenal duplication cysts may cause obstructive jaundice. The endoscopic finding of a cystic lesion in the medial wall of the second duodenal section at the papilla Vateri should be interpreted as a sign of the disease.

An analysis of 119 autopsy specimens of human pancreas revealed two cases of specific embryonic anomaly, which we named ventral pancreas pseudoagenesis. Both glands underwent ductography and ductal morphometry, with subsequent histological assessment. They were of usual shape, contours and topographic regions. In both cases global gland drainage was via the minor papilla, while the major papilla was the outlet of common bile duct only. The morphological analysis revealed ductal indices to be similar to those found in dorsal pancreas divisum. One of the specimens had mild and the other marked chronic pancreatitis, which was probably due to the difference in age. In conclusion, ventral pancreas pseudoagenesis is another variant of pancreatic malformation which has to be taken into account in interpreting ERCPs of patients with chronic pancreatitis of unknown origin.