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A new approach by investigating the intra-tumoral microbiome raised great interest because they may influence the host immune response and natural history of the disease. However, previous studies on the intra-tumoral microbiome of pancreatic ductal adenocarcinoma (PDAC) were mostly based on examining the formalin-fixed paraffin-embedded tumor specimens. This study aims to investigate the feasibility of using endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) as a complementary procedure of surgical biopsy to obtain adequate fresh pancreatic cancer tissue for intra-tumoral microbial research. This was a prospective pilot study performed at a single tertiary referral center. We obtained pancreatic cancer tissue by EUS-FNB and surgical biopsy, respectively. We amplified the V3-V4 hyper-variable region of bacterial 16S ribosomal ribonucleic acid (rRNA) genes, constructed a pair-end library, and performed high-throughput sequencing. From August 2020 to November 2020, nine eligible patients with PDAC were enrolled in this study. The intra-tumoral microbiome profile was successfully generated from the PDAC cancer tissue obtained by EUS-FNB as well as by surgical biopsy. There was no significant difference in intra-tumoral alpha-diversity or bacterial taxonomic composition between tissues obtained by EUS-FNB and by surgical biopsy. EUS-FNB can collect sufficient fresh cancer tissue for microbiome analyses without complication. The intra-tumoral microbiome profile in tissues obtained by EUS-FNB had similar alpha-diversity and taxonomic profiles with those obtained by surgical biopsy. It implicated, except for surgical biopsy, EUS-FNB can be another valid and valuable tool for studying intra-tumoral microbiome in patients with resectable and unresectable PDAC.

Primary malignant melanoma of the esophagus (PMME) is a rare tumor with poor prognosis, rapid progression, and early metastasis. It often occurs in the middle to lower part of the esophagus. Endoscopic findings reveal various colors ranging from white, brown, and purple to black, and the lesions could be ulcerative, superficial, or protruding polypoid. Only a few reports about endoscopic findings of PMME are available in the literature. Here, we describe a case of a 77‐year‐old man who suffered from epigastric pain and acid regurgitation for 2 weeks. Endoscopic findings revealed an ulcerative lesion with purple‐black pigmentation in the lower part of the esophagus. Endoscopic biopsy was performed. Hematoxylin and eosin (H&E) staining showed a subepithelial nodule with melanocytosis and a high nuclear‐cytoplasmic (N/C) ratio and macronucleoli. Immunohistochemical staining revealed positive results for S‐100, HMB‐45, and melan‐A. Based on these pathologic and immunohistochemical examinations, the patient was diagnosed with PMME. However, the patient initially hesitated to undergo surgical intervention until he developed dysphagia 2 years later. We also present a series of endoscopic images of PMME of this patient in this paper.

Gastric metastasis from renal cell carcinoma (RCC) after nephrectomy is unusual, and few cases have been reported, with a mean duration of 6.9 years from the diagnosis of RCC to gastric metastasis. We report a case of gastrointestinal bleeding in a patient who received right radical nephrectomy for RCC 12 years ago. Esophagogastroduodenoscopy found an ulcerative mass, and metastatic RCC was finally diagnosed via histopathological examination and immunohistochemistry staining. RCC usually metastasizes to the lung, lymph nodes, and bone. It rarely metastasizes to the stomach, and there is no specific symptom despite gastric metastasis. Early detection of gastric metastasis should be conducted due to a lack of effective systemic therapy for RCC. In conclusion, endoscopic survey is recommended for patients of RCC with any suspicious symptoms, including epigastric pain, dyspepsia, decreasing appetite, hematemesis, melena, or anemia.

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Introduction: A new approach by investigating the intra-tumoral microbiome raised great interest because they may influence the host immune response and natural history of the disease. However, previous studies on the intra-tumoral microbiome of pancreatic ductal adenocarcinoma (PDAC) were mostly based on examining the formalin-fixed paraffin-embedded tumor specimens. This study aims to investigate the feasibility of using endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) as a complementary procedure of surgical biopsy to obtain adequate fresh pancreatic cancer tissue for intra-tumoral microbial research. Materials and methods: This was a prospective pilot study performed at a single tertiary referral center. We obtained pancreatic cancer tissue by EUS-FNB and surgical biopsy, respectively. We amplified the V3-V4 hyper-variable region of bacterial 16S ribosomal ribonucleic acid (rRNA) genes, constructed a pair-end library, and performed high-throughput sequencing. Results: From August 2020 to November 2020, nine eligible patients with PDAC were enrolled in this study. The intra-tumoral microbiome profile was successfully generated from the PDAC cancer tissue obtained by EUS-FNB as well as by surgical biopsy. There was no significant difference in intra-tumoral alpha-diversity or bacterial taxonomic composition between tissues obtained by EUS-FNB and by surgical biopsy. Conclusion: EUS-FNB can collect sufficient fresh cancer tissue for microbiome analyses without complication. The intra-tumoral microbiome profile in tissues obtained by EUS-FNB had similar alpha-diversity and taxonomic profiles with those obtained by surgical biopsy. It implicated, except for surgical biopsy, EUS-FNB can be another valid and valuable tool for studying intra-tumoral microbiome in patients with resectable and unresectable PDAC.