Double-Balloon Enteroscopy–Assisted Diagnosis of Malignancy Arising From Meckel’s Diverticulum

Abstract

A computed tomography scan of a 42-year-old man showed enlarged mesenteric lymphadenopathy with dilated midileal small-bowel loop containing nodular wall thickening and mucosal hyperenhancement (Figure A). He was referred for antegrade double-balloon enteroscopy (DBE). Antegrade DBE showed a large diverticulum with prominent mucosal folds, focal thickening, and an area of ulceration (Figure B) at an insertion depth of 20 feet. Multiple biopsy specimens were taken. Histology discovered poorly differentiated carcinoma with extensive necrosis (Figure C). The tumor cells showed significant nuclear pleomorphism with an irregular nuclear membrane, clumpy chromatin, and brisk mitotic activity. Immunostaining-positive CAM5.2 confirmed the epithelial nature of the tumor. Positive stains for cytokeratin, GAT3, PLAP, and SALL4 with negative Oct34, CD17, AFP, and CD30 were interpreted as nonspecific, undifferentiated carcinoma. The stains for arginase, hepatocyte, albumin, glypin-3, CDX2, SF1, CK5/ 6, and TTF-1 were negative. The patient was diagnosed with undifferentiated carcinoma arising in ectopic gastric tissue in the small bowel. Based on our literature review, this is a case of DBEassisted diagnosis of malignancy arising from Meckel's diverticulum. Conflicts of interest The authors disclose no conflicts.

Bowel ultrasound enhances predictive value based on clinical indicators: a scoring system for moderate-to-severe endoscopic activities in patients with ulcerative colitis

“…In our model, stool frequency and hematochezia were respectively included. Although the discordance between patient’s subjective symptoms and endoscopic activities was reported, 13 it is obvious that stool abnormality is still the most intuitive and simple index representing disease activity for UC characterized by diffuse colonic mucosal lesions. Based on clinical applications, we believe that it is an acceptable choice to separate stool frequency and hematochezia into the model respectively with the proper p -value.…”

Secondary prevention for hepatocellular carcinoma in patients with chronic hepatitis B: are all the nucleos(t)ide analogues the same?

“…Serum HBV DNA level is less discriminative on HCC development after the initiation of antiviral therapy in CHB patients. This is reflected by the good performance of treated derived HCC risk scores in the absence of HBV DNA including the PAGE-B-related scores [ 24 – 26 ] and CAMD score [ 27 , 28 ]. The current first-line NA treatment has modified the natural history of CHB by a potent effect on HBV DNA suppression and a reduced risk of disease progression in both non-cirrhotic and cirrhotic patients [ 11 , 12 , 29 ].…”

Diagnosis and therapy using double-balloon endoscopy for small bowel disease: experience from a Chinese tertiary hospital

“…However, these studies have mainly focused on the efficacy of DBE in patients with different indications, such as suspected small bowel bleeding (SSBB), Crohn's disease (CD), and similar conditions. [6][7][8][9][10][11][12][13] Few reports in China have focused on SBD detection by DBE in patients of different ages. 14,15 In this study, we retrospectively analyzed the indications, insertion route/depth, diagnostic yield, therapeutic yield, and safety of more than 2000 retrograde and anterograde DBE procedures in our hospital during a 14-year period.…”

“…However, these studies have mainly focused on the efficacy of DBE in patients with different indications, such as suspected small bowel bleeding (SSBB), Crohn’s disease (CD), and similar conditions. 6–13 Few reports in China have focused on SBD detection by DBE in patients of different ages. 14,15…”