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Background/Aims@#Endoscopic ultrasound (EUS)-guided fine-needle aspiration is very effective for providing specimens for cytological evaluation. However, the ability to provide sufficient tissue for histological evaluation has been challenging due to the technical limitations of dedicated core biopsy needles. Recently, a modified EUS needle has been introduced to obtain tissue core samples for histological analysis. We aimed to determine (1) its ability to obtain specimens for histological assessment and (2) the diagnostic accuracy of EUS-guided fine-needle biopsy (EUS-FNB) using this needle. @*Methods@#We retrospectively analyzed consecutive cases of FNB using modified EUS needles for 342 lesions in 303 patients. The cytology and histological specimens were analyzed. Diagnostic accuracy was calculated. @*Results@#Adequate cytological and histological assessment was possible in 293/342 (86%) and 264/342 (77%) lesions, respectively. Diagnostic accuracy of the cytological specimen was 294/342 (86%) versus 254/342 (74%) for the histological specimen (p<0.01). Diagnostic accuracy of the combined cytological and histological assessment was 323/342 (94.4%), which was significantly higher than that of both histology alone (p<0.001) and cytology alone (p=0.001). @*Conclusions@#EUS-FNB with the modified EUS needle provided histologic tissue cores in the majority of cases and achieved excellent diagnostic accuracy with few needle passes.
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UNLABELLED: Doppler measurement provides information on the hemodynamics in the hepatic artery and the portal venous system. AIM: To study the hepatic artery hemodynamics in children with extra hepatic portal vein obstruction. MATERIALS AND METHODS: Hepatic artery indices were studied using Doppler indices in 15 children (<12 years) with extra hepatic portal hypertension (EHPVO) and obliterated esophageal varices. The hepatic artery resistive index, the arterial acceleration time and the acceleration index were used to determine the flow pattern within the hepatic artery. Controls were 15 healthy age-sex matched children, belonging to the same socioeconomic strata in absence of liver disease. RESULTS: The mean age of the children was 8.43 ± 3.2 years and male female ratio was 4:1. All the children had obliterated esophageal varices. The hepatic artery resistive index in the children with EHPVO was normal and similar to controls. The hepatic arterial early systolic acceleration index was significantly higher in cases compared to controls (436 ± 290 vs 214 ± 100; P value <0.004). The hepatic arterial acceleration time though low in the cases (86 ± 35 cm/s) was not statistically different from the controls (128 ± 14 cm/s). CONCLUSION: There was a significant increase in hepatic arterial early systolic acceleration in children with chronic EHPVO. The latter may be responsible for an increase in hepatic arterial in flow velocity in a slow flow system despite a normal resistive index.
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Primary lymphoma of the pancreas is a rare form of extranodal lymphoma accounting for less than 0.5% of pancreatic tumors. Percutaneous fine-needle aspiration of the pancreas with histopathological examination and immunohistochemical assay confirm the diagnosis. A 73 year old male presented with recurrent pancreatic type abdominal pain with significant weight loss over 1 year. He was pale with ill defined epigastric mass. Contrast enhanced CT showed an ill defined poorly marginated non enhancing hypodense mass lesion involving the body of the pancreas. CA 19-9 was normal. CT guided aspiration cytology was suggestive of hemolymphoid malignancy. Immunohistochemistry was positive for Leukocyte Common Antigen and CD 34. It was negative for CD3 and CD 20 indicating an undifferentiated lymphoma. Patient received two sessions of chemotherapy and was followed-up.
