Mariângela Ottoboni Brunaldi

Introduction: Focal myositis (FM) is an uncommon, localized inflammatory process that affects a single muscle, with unknown aetiology. In the head and neck region, involvement of perioral musculature, floor of the mouth, and sternocleidomastoid muscle have been reported. FM affecting the tongue is very rare, with only four cases previously published to date.Aim: This report describes five additional cases of tongue FM.Case Report: Three patients were male and two were female (mean age, 56 years), and three had symptomatic short‐term nodular swelling.Results: By immunohistochemistry, M2 macrophages and CD4+ T cells were predominant. Focally, CD15+ granulocytes and CD20+ B cells were visualized. Polyclonal CD138+ plasma cells, with a predominance of IgG+ cells (rarely IgG4+), were detected. All patients evolved with complete resolution after biopsy and no signs of clinical or systemic progression were observed during the follow‐up.Conclusions: FM should be considered in the differential diagnosis of rapidly growing nodular lingual lesions. By immunohistochemistry, a predominance of M2 macrophages and CD4+ T cells is typical, and it can help in the differential diagnosis with myositis of other origins.

We report the case of a 31-year-old woman with an episode of epigastric pain of strong intensity 9 months ago, accompanied by nausea and vomiting, initially treated as dyspepsia. An abdominal ultrasound revealed cholecystolithiasis and a solid mass in the duodenum (5.0 x 4.9 x 2.6 cm) (Figure 1.A). Contrast examination of the duodenum revealed a filling defect occupying almost 90% of the intestinal lumen (Figure 1.B) and duodenoscopy revealed a subepithelial tumoral mass (Figure 1.C). The diagnosis of a DDC with an anechoic area filled with enteroliths was based on the findings of endoscopic ultrasound (EUS) (Figure 1.D).

Background: It is important to obtain representative histological samples of solid biliopancreatic lesions without a clear indication for resection. The role of new needles in such task is yet to be determined. Aim: To compare performance assessment between 20G double fine needle biopsy (FNB) and conventional 22G fine needle aspiration (FNA) needles for endoscopic ultrasound (EUS)-guided biopsy. Methods: This prospective study examined 20 patients who underwent the random puncture of solid pancreatic lesions with both needles and the analysis of tissue samples by a single pathologist. Results: The ProCore 20G FNB needle provided more adequate tissue samples (16 vs. 9, p=0.039) with better cellularity quantitative scores (11 vs. 5, p=0.002) and larger diameter of the histological sample (1.51±1.3 mm vs. 0.94±0.55 mm, p=0.032) than the 22G needle. The technical success, puncture difficulty, and sample bleeding were similar between groups. The sensitivity, specificity, and diagnostic accuracy were 88.9%, 100%, and 90% and 77.8%, 100%, and 78.9% for the 20G and 22G needles, respectively. Conclusions: The samples obtained with the ProCore 20G FNB showed better histological parameters; although there was no difference in the diagnostic performance between the two needles, these findings may improve pathologist performance.

Background: Cholangiocarcinoma is an aggressive neoplasm that usually requires palliative biliary drainage. Photodynamic therapy (PDT) has been described as a successful adjunct treatment to malignant biliary obstruction. Aim: To describe the use of digital cholangioscope to help provide laser light during biliary PDT session using locally developed light source. Method: Patient receives intravenous photosensitizer 24 h before the procedure. It starts with a regular duodenoscopy. After identification of the major papilla and retrograde cannulation, the digital cholangioscope is introduced into the common bile duct. Then, the cholangioscopic examination helps to identify the neoplastic stricture. Under direct visualization lighting catheter is advanced through the cholangioscope. Repositioning is recommended every centimeter to cover all strictured area. At the end of the procedure, a final cholangioscopy assesses the bile duct for the immediate result and adverse events. Result: This procedure was applied in one 82-year-old male due to obstructive jaundice in the last two months. EUS and ERCP revealed a severe dilation of the common bile duct associated with choledocholithiasis. Besides, was revealed dilation of hepatic duct up to a well-circumscribed hypoechoic solid mass measuring 1.8x2 cm compressing the common hepatic duct. The mass was deemed unresectable and the patient was referred for palliative treatment with PDT. He remained asymptomatic for three months. He perished due to complications 15 months after the PDT session. Conclusion: Digital cholangioscopy-guided biliary PDT is feasible and seems safe and effective as an adjunct modality in the palliation of extrahepatic cholangiocarcinoma.

The ampulla of Vater represents the epithelial junction of the main pancreatic duct and the distal bile duct, surrounded by the pancreatic head and duodenum parenchyma. Ampullary carcinoma can arise either from the intestinal epithelium or the epithelium covering the pancreatobiliary ducts. Many tumors develop from pre-existing adenomas, others evolve from precursor intraepithelial neoplasia supporting that two histological subtypes have different carcinogenesis. Thus, the question arises of classifying ampullary adenocarcinomas as the immunophenotypic pattern allowing a better understanding of the clinical implications of this neoplasm.