, Tokyo). The aim of this study was to evaluate the usefulness of endoscopic observation methods using monochrome mode for vascular lesions compared with the current NBI system. Methods: From May 2009 to September 2012, 14 cases (VE: vascular ectasia, 8 cases; GAVE: gastric antral vascular ectasia, 2 cases; RC: radiation colitis, 4 cases) were enrolled in this study. For these cases, 28 images were taken (close view: 14 images, distant view: 14 images) in the same situation using each of normal mode, NBI mode and monochrome mode (MONO mode). Normal mode observation was defined at 5 points. A total of 84 images (28 images for each of three modes) were evaluated by 15 trainee doctors with little experience of endoscopy,

on a scale of one to ten, for each of a: Recognition of Selleck KU57788 the lesion, b: Observation of the vessel and c: Observation of the background mucosa. Results: The scores for NBI mode (a: 5.37, b: 5.50, c: 5.06) LY294002 cost and MONO mode (a: 5.33, b: 5.44, c: 5.02) showed almost the same evaluation results, and they were better than in normal mode. In the close view, the scores for NBI mode were better than with MONO mode for

recognition of the lesion (a: 5.72 vs. 5.43, p < 0.05) and observation of the background mucosa (c: 5.51 vs. 5.17, p < 0.05). However, although there was no significant difference in the distant view, better results were obtained for all factors with MONO mode (a: 5.23, b: 5.17, c: 4.86) compared with NBI mode (a: 5.03, b: 5.01, c: 4.62). The brightness of the field of view obtained using MONO mode, even in the

distant view, was considered to be a reason for the results. Moreover, MONO mode was effective for observation of remaining blood vessels after APC ablation for GAVE and RC, as an evaluation of endoscopic treatment. Conclusion: Monochrome mode is convenient and useful in endoscopy for observation of vascular lesions. Key Word(s): 1. monochrome mode; 2. vascular lesions; 3. NBI; Presenting Author: BIN CHENG 上海皓元 Additional Authors: YAN WANG, JINLIN WANG Corresponding Author: BIN CHENG Affiliations: Dept. of Gastroenterology, Tongji Hospital of Huazhong University of Science and Technology Objective: To evaluate significance of Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) in diagnosis extramural lesions of the upper gastrointestinal tract. Methods: EUS-FNA was performed in 71 patients with pancreatic lesions, mediastinal and retroperitoneal masses detected by ultrasonography, Computed Tomography (CT) or clinical suspected diagnosis, 33 of the 71 are pancreatic lesions, 25 are mediastinal masses, and 13 are retroperitoneal masses, cytological and pathological evaluation were performed, flow cytometry was performed when necessary. Results: (1) The overall diagnosis sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) accuracy of EUS-FNA were respectively 82.2%, 100%, 100%, 76.5%, 88.7%.

, Tokyo). The aim of this study was to evaluate the usefulness of endoscopic observation methods using monochrome mode for vascular lesions compared with the current NBI system. Methods: From May 2009 to September 2012, 14 cases (VE: vascular ectasia, 8 cases; GAVE: gastric antral vascular ectasia, 2 cases; RC: radiation colitis, 4 cases) were enrolled in this study. For these cases, 28 images were taken (close view: 14 images, distant view: 14 images) in the same situation using each of normal mode, NBI mode and monochrome mode (MONO mode). Normal mode observation was defined at 5 points. A total of 84 images (28 images for each of three modes) were evaluated by 15 trainee doctors with little experience of endoscopy,

on a scale of one to ten, for each of a: Recognition of buy Barasertib the lesion, b: Observation of the vessel and c: Observation of the background mucosa. Results: The scores for NBI mode (a: 5.37, b: 5.50, c: 5.06) Trichostatin A and MONO mode (a: 5.33, b: 5.44, c: 5.02) showed almost the same evaluation results, and they were better than in normal mode. In the close view, the scores for NBI mode were better than with MONO mode for

recognition of the lesion (a: 5.72 vs. 5.43, p < 0.05) and observation of the background mucosa (c: 5.51 vs. 5.17, p < 0.05). However, although there was no significant difference in the distant view, better results were obtained for all factors with MONO mode (a: 5.23, b: 5.17, c: 4.86) compared with NBI mode (a: 5.03, b: 5.01, c: 4.62). The brightness of the field of view obtained using MONO mode, even in the

distant view, was considered to be a reason for the results. Moreover, MONO mode was effective for observation of remaining blood vessels after APC ablation for GAVE and RC, as an evaluation of endoscopic treatment. Conclusion: Monochrome mode is convenient and useful in endoscopy for observation of vascular lesions. Key Word(s): 1. monochrome mode; 2. vascular lesions; 3. NBI; Presenting Author: BIN CHENG medchemexpress Additional Authors: YAN WANG, JINLIN WANG Corresponding Author: BIN CHENG Affiliations: Dept. of Gastroenterology, Tongji Hospital of Huazhong University of Science and Technology Objective: To evaluate significance of Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) in diagnosis extramural lesions of the upper gastrointestinal tract. Methods: EUS-FNA was performed in 71 patients with pancreatic lesions, mediastinal and retroperitoneal masses detected by ultrasonography, Computed Tomography (CT) or clinical suspected diagnosis, 33 of the 71 are pancreatic lesions, 25 are mediastinal masses, and 13 are retroperitoneal masses, cytological and pathological evaluation were performed, flow cytometry was performed when necessary. Results: (1) The overall diagnosis sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) accuracy of EUS-FNA were respectively 82.2%, 100%, 100%, 76.5%, 88.7%.

The specific diagnosis was also recorded. SPSS was used to analyze the data. Descriptive statistics were used to explore demographic data and survey responses. Chi-square tests of independence were conducted to examine associations among variables. A total of 72 patients completed surveys. Three (4.2%) patients were under the age of 25, 23 (31.9%)

were between the ages of 26 and 35, 18 (25%) were between the ages of 36 and 45, 17 (23.6%) were between the ages of 46 and 55, and 9 (12.5%) were over the age of 55. Two (2.7%) patients did not report their age. Out of the 72 patients, 32 (44%) reported that they had pelvic region pain brought on by sexual activity. Thirteen (18%) indicated they had pelvic region pain that prevented them from engaging in sexual activity. Of Caspase inhibitor the patients who reported pelvic pain, 1 (3.2%) indicated they had pain for less than 1 year, 12 (35.4%) reported they had

pain from 1 to 5 years, 9 (29%) indicated they had pain from 6 to 10 years, and 10 (32.3%) said the pain was present for over 10 years. A chi-square test of independence was conducted to examine whether there was an association between the frequency of pelvic region pain brought on by or preventing sexual activity, and the type of headache (chronic medication overuse headache, selleck compound chronic migraine, or a combination of the 2). There was no significant association

between pelvic pain brought on by sexual activity and the type of headache, χ2(2) = 0.65, P > .05. However, a pattern emerged suggesting that a greater percentage of patients reported pelvic pain brought on by sexual activity if they reported both chronic medication overuse headache and migraine (57.1%) compared with patients who reported either chronic medication overuse headache (41.7%) or chronic migraine (41.2%). There was no significant association between pelvic pain that prevents sexual activity and the type of headache, χ2(2) = 0.65, P > .05. When patients were asked whether they had discussed their pelvic region pain with an HCP, 16 (50%) indicated they had, while the remaining 16 (50%) did not. Of the patients MCE公司 who had discussed their pain with an HCP, 5 (31%) indicated they had not received treatment at all, 6 (37.5%) reported they were currently in treatment, 5 (31.2%) said they had received treatment in the past, and 1 (6.2%) did not give a response regarding whether they had treatment. Of those patients who had discussed their pain with a HCP but indicated that they did not receive treatment (n = 6), the reasons provided included: no treatment was offered (n = 2); pain went away on its own (n = 2); pain was not severe enough to warrant care (n = 1); and too embarrassed to pursue treatment (n = 1).

Incidence rates of ICC were 0.09 and 0.43 per 100,000 person-years, respectively, among women who were hepatitis B surface antigen (HBsAg)-seronegative and HBsAg-seropositive, showing an age-adjusted hazard ratio (HRadj) (95% confidence interval [CI]) of 4.80 (1.88-12.20). The incidence

rates of NHL overall for HBsAg-seronegative and HBsAg-seropositive women were 1.23 and 3.18 per 100,000 person-years, respectively, with an HRadj (95% CI) selleck products of 2.63 (1.95-3.54). Among NHL subtypes, HBsAg-seropositive women had an increased risk of DLBCL compared with those who were HBsAg-seronegative (incidence rates: 1.81 and 0.60 per 100,000 person-years, respectively; HRadj [95% CI]: 3.09 [2.06-4.64]). The significantly increased risk was not observed for other specific subtypes of NHL. Conclusions: Chronic HBV infection was associated with an increased risk of ICC and DLBCL in women. Our data suggested a possible etiological role of HBV in the development of ICC and specific subtypes of NHL. (HEPATOLOGY 2011;) T he association between chronic hepatitis B virus (HBV) infection and an increased risk of hepatocellular carcinoma

(HCC) has been well documented.1 However, whether HBV causes cancers other than HCC is uncertain. Recently, the International Agency for Research on Cancer (IARC) identified intrahepatic cholangiocarcinoma (ICC) and non-Hodgkin lymphoma (NHL) as likely to have positive links to HBV, Erlotinib manufacturer but the epidemiological evidence for the causal association is still limited and further evidence is needed.2 Several studies suggested that HBV may play a role in the etiology of ICC and NHL.3-13 In case-control studies, the estimated odds ratios for the association with hepatitis B surface antigen (HBsAg) seropositivity ranged from 2.3-8.9 for ICC3-5 and 1.8-4.1 for NHL.6-10 Likewise, the magnitude of the association of HBsAg seropositivity with ICC was larger than that with NHL in cohort studies; the risk of ICC was elevated 9-fold in Japanese blood donors with HBV infection,11 whereas

the excess risk of NHL in people with HBV infection 上海皓元医药股份有限公司 ranged from 1.7-2.8.12, 13 However, few studies have examined the association of HBV with NHL subtypes, and the results have been inconsistent.13-15 In addition, these studies have only used HBsAg as a marker for chronic HBV infection status, but the information on the marker of active HBV infection (i.e., hepatitis B e antigen [HBeAg]) was not available. We are not aware of previous studies examining the association of ICC and NHL with chronic HBV infection by both HBsAg and HBeAg serostatus. The national hepatitis B vaccination program in Taiwan provided free testing for chronic HBV seromarkers including HBsAg and HBeAg for pregnant women during their routine prenatal examinations.16 Newly diagnosed cancers occurring within this large cohort of parous women were identified by computerized linkage with the National Cancer Registry.

These findings are in line with the increase in MMP-2 activity reported in IL-6−/− mice upon CCl4 exposure, and the inhibitory effect of IL-6 on MMP-2 expression in hepatic myofibroblasts.31 Moreover, we also demonstrate that IL-6–dependent dysregulation of MMP-2 activity is responsible

for impaired liver regeneration, as shown by the beneficial effects of an MMP-2/MMP-9 inhibitor on cyclin D1 expression in CB2−/− mice. Taken together, these data further argue for a central role of IL-6 in the regenerative response promoted by CB2 receptors, and identify MMP-2 as a downstream target. Our data show that hepatocytes do not express CB2 receptors, indicating that paracrine interactions mediate the beneficial learn more impact of these receptors on hepatocyte injury and regeneration. It is well established that following acute liver injury, Kupffer cells rapidly release proinflammatory mediators, such as TNF-α and IL-6, that regulate hepatocyte death and proliferation. Accumulating evidence suggest that, apart from their fibrogenic properties, hepatic myofibroblasts click here are also central in the regulation of hepatocyte injury and regeneration.39-41 Indeed, at sites of injury, myofibroblasts produce bioactive mediators with antiapoptotic and mitogenic effects on hepatocytes, including TNF-α and IL-6.32 Macrophage culture experiments indicate that activation of CB2

receptors does not increase either TNF-α or IL-6 expression. These results suggest that macrophages are not responsible for the CB2-dependent production of these cytokines in the CCl4

model. In contrast, activation of CB2 receptors in cultured hepatic myofibroblasts leads to a concurrent increase in TNF-α and IL-6 expressions, associated with a down-regulation 上海皓元医药股份有限公司 of MMP-2 expression. These data therefore suggest that production of TNF-α by hepatic myofibroblasts may contribute to iNOS-dependent hepatoprotective effects mediated by CB2 receptors following acute liver injury. Similarly, and because hepatic myofibroblasts are the major source of MMP-2 during liver injury,32 our data also suggest that hepatic myofibroblasts may also be key contributors in the IL-6/MMP-2–dependent regenerative effects of CB2 receptors. Our results indicate that CB2 receptors expressed in hepatic myofibroblasts elicit dual beneficial properties, by producing hepatoprotective factors, and by triggering antifibrogenic effects following growth inhibition and apoptosis of hepatic myofibroblasts.17 In keeping with our results, hepatic myofibroblasts have been shown to display similar hepatoprotective and antifibrogenic effects following stimulation of IGF-1 receptors41 or neurotrophin p75NTR.39, 42 In conclusion, our data demonstrate that CB2 receptors reduce liver injury and promote liver regeneration following acute insult, by distinct paracrine mechanisms on hepatocytes originating from hepatic myofibroblasts.

Gomez et al.[9] have further contributed to our understanding of decompensation in cirrhosis. In particular, the group focused on patients from Latin America with the main objective to evaluate the 6-year cumulative incidence Forskolin supplier of overall mortality or transplantation, HCC, and major clinical outcomes of hepatic decompensation. The authors evaluated a large Cuban cohort of HCV patients with cirrhosis with two different

stages of compensated disease with the absence (stage 1) and presence of varices (stage 2). The study was conducted as a prospective longitudinal “inception cohort” study. Between 2004 and 2007, 402 patients were included in the study if they were >18 years of age, had confirmed

AZD2014 in vitro diagnosis of cirrhosis based on clinical, laboratory, and imaging findings, or histology, without a history of decompensation and absence of alcoholism. Patients were excluded if there was concurrent liver disease, concomitant diseases with reduced life expectancy, psychiatric disease, or HCC. Noninvasive studies were relied on to make the diagnoses of cirrhosis in some patients. This may influence the findings, as noninvasive testing can occasionally misdiagnose cirrhosis. The primary outcome of the study was overall mortality or liver transplantation. Secondary outcomes were diagnosis of HCC, variceal hemorrhage, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, jaundice, and development of varices in patients (in stage 1 patients only). Similar to previous studies, the authors found that patients with stage 2 disease with varices had poorer outcomes when compared to stage 1 disease without varices. The cumulative overall mortality or liver transplantation at 312 weeks was significantly lower in stage 1 cirrhosis without varices (15%) compared to stage 2 cirrhosis with varices (45%). Also consistent with previously published results, the incidence

of HCC at 312 weeks was significantly lower in patients with stage 1 cirrhosis (9%) compared to stage 2 cirrhosis (29%). Notably, MCE公司 patients were screened for HCC every 6 months with liver ultrasonography and α-fetoprotein determination throughout the study. Similar to previous findings, ascites was the most common first decompensating event, at 15%. Variceal hemorrhage and hepatic encephalopathy each occurred as the first decompensating event in 5% of patients. The occurrence of clinical decompensation was different in patients with stage 1 and 2 cirrhosis. One possible explanation is that patients both with (higher HVPG) and without varices (lower HVPG) were included. Patients with stage 2 cirrhosis with varices had a higher 6-year cumulative incidence of decompensation at 66% but stage 1 patients without varices had a significantly lower incidence, at 26%.

Results:  Among the 277 patients, the overall accuracy of EUS and MDCT for T staging was 74.7% and 76.9%, respectively. Among the 141 patients with visualized primary

lesions on MDCT, the overall accuracy of EUS and MDCT AP24534 in vivo for T staging was 61.7% and 63.8%, respectively. The overall accuracy for N staging was 66% and 62.8%, respectively. The performance of EUS and MDCT for large lesions and lesions at the cardia and angle had significantly lower accuracy than that of other groups. For EUS, the early gastric cancer lesions with ulcerative changes had significantly lower accuracy than those without ulcerative changes. Conclusions:  For the preoperative assessment of individual T and N staging in patients with gastric cancer, the accuracy of MDCT was close to that of EUS. Both EUS and MDCT are useful complementary modalities for the locoregional staging of gastric cancer. “
“Background and Aim:  Hepatocellular carcinoma (HCC) tends to metastasize to extrahepatic organs. Stomach involvement has been seldom reported and has always been considered as direct invasion. This study aims to propose a possible existing pathway for the hematogenous metastasis of HCC to the stomach. Methods:  Only seven cases with stomach involvement were found from 8267 HCC patients registered at our hospital between 2000 and 2007. Their laboratory data, the findings of computed

tomography and upper endoscopy, therapeutic procedures, such www.selleckchem.com/products/Sunitinib-Malate-(Sutent).html as esophageal variceal banding ligation (EVL), and transhepatic arterial embolization (TAE) were further studied.

Results:  All seven patients were male. Liver cirrhosis was found in six patients (6/7 = 85.7%), HCC with portal vein thrombosis (PVT) in six patients (6/7 = 85.7%), splenomegaly in five patients (5/7 = 71.4%) and esophageal varices in five patients (5/7 = 71.4%). Six patients underwent TAE and one patient underwent EVL before the development of HCC in the stomach. Four patients had HCC at the cardia, one patient at the anterior wall of the high body and two patients at the greater curvature of the high body, far away from the original HCC. 上海皓元医药股份有限公司 Six patients eventually developed distant metastasis. HCC with gastric metastasis developed 53–126 days after TAE in five patients and 74 days after EVL in one patient. Conclusions:  When cirrhotic patients with portal hypertension have HCC with PVT, a hematogenous pathway can exist for gastric metastasis of tumor thrombi involving hepatofugal flow to the stomach after TAE or EVL apart from the major pathway of direct invasion. “
“Idiopathic portal hypertension (IPH) is a rare cause of intrahepatic portal hypertension. Data on natural history and prognosis of IPH are limited. We sought to describe the complications and long-tem outcome of IPH by retrospectively studying 69 biopsy-proven cases of IPH. Mean duration of follow-up was 6.7 ± 4.6 years. All patients had evidence of portal hypertension (PH) at diagnosis, and 42% were symptomatic.

2 years. The Kaplan Meier 1- and 5-year post-LT survival was 92.8% and 72.1% for waiting time < 6 months, versus 93.1% and 78.6% for waiting time ≥ 6 months (p=0.02). Cumulative probabilities of HCC recurrence at 6 months, 1 and 5 years post-LT were 6.4%, 7.7% and 16.8% with waiting time < 6 months versus 2.0%, 4.6% and 10.9% with waiting time ≥ 6 months, respectively (p=0.048). Predictors of HCC recurrence in multivariate analysis included microvascular

invasion (HR 3.8, 95% CI 2.2-6.4, p<0.001), explant tumor > Milan criteria (HR 3.2, 95% CI 1.4-7.1, p=0.005), and alpha-fetopro-tein Bioactive Compound Library screening >100 at transplant (HR 2.6, 95% CI 1.6-4.3, p<0.001). Waiting time < 6 months was a predictor of HCC recurrence in univariate (HR 1.5, 95% CI 1.001-2.4, p=0.049) but not in multivariate analysis. However, waiting time < 6 months was the only pre-LT factor predicting early HCC recurrence within 6 months after LT in multivariate analysis (HR 3.0, 95% CI 1.2-7.0, p=0.015). In conclusion, this large multi-center study provides evidence of an association between short waiting time and early HCC recurrence after LT. A minimal observation of 6 months from HCC diagnosis and LRT to LT may select out patients at increased risk for early post-LT HCC recurrence, thus supporting the “ablate and wait” principle in candidate selection while on the LT waiting list. Disclosures: The following people have nothing to disclose: Neil Mehta, Julie

Heimbach, Denise M. Harnois, Jennifer L. Dodge, Justin M. Burns, David Cilomilast Lee, William Sanchez, John P. Roberts, Francis Y. Yao Background: HCC recurrence is a major impediment to effective treatment of HCC by LT. Despite using the Milan criteria for candidate selection, up to 20% of HCC patients develop recurrence after LT and consequently have poor survival. This limits the benefit/risk ratio of LT for HCC patients compared to patients with benign liver disease. In order to

optimize organ allocation strategies, other objective preoperative parameters that can reliably predict the risk for recurrence post-LT are needed. Aims: To determine the association between pre-LT alpha-fetoprotein (AFP), lens culinaris agglutinin-reactive AFP (AFP-L3) and des-gamma-carboxy prothrombin (DCP) alone, or in combination with other biomarkers or 上海皓元医药股份有限公司 Milan criteria and risk of HCC recurrence after LT Methods: A retrospective cohort study of HCC patients undergoing LT between 2000 and 2008 was conducted. Of the 313, 127 had available serum samples drawn before LT. Serum AFP, AFP-L3% and DCP were measured in a blinded fashion using the μTASWako i30 immunoanalyzer. The hazard ratio (HR) and 95% confidence interval (95%CI) were calculated using Cox Proportional Hazards analysis. Results: Of the variables examined, tumor size, the Milan criteria and high levels of biomarkers were significantly associated with HCC recurrence. HRs (95%CI) were 1.4 (1.1-1.7) for tumor size, 2.6 (1.4-4.7) for tumor stage outside Milan criteria, 2.8 (1.4-5.4) for AFP ≥250 ng/ mL, 3.2 (1.

The first studies to evaluate the use of fibrates for PBC appeared in the Japanese literature in the late 1990s and reports subsequently reached Western medical journals in 2000. There have now been approximately 20 small pilot studies/case series, 16 of which are from Japan, evaluating fibrate use either alone or in combination with UDCA

for PBC.6–25 In the largest trial reported to date, Iwasaki and colleagues first compared fibrate monotherapy with UDCA; 45 patients were randomized to receive either therapy and evaluated at 52 weeks.18 They found bezafibrate (400 mg/day) to be as effective in reducing ALP, GGT, IgM and ALT levels as UDCA (600 mg/day). In a second study, they gave 21 patients with UDCA refractory PBC (defined by ALP > 1.5 normal) combined bezafibrate and UDCA therapy and importantly demonstrated a Dinaciclib datasheet significant improvement in ALP levels.18 Overall, similar results to the work by Iwasaki have been reported in all fibrate studies in PBC. The great majority of these trials have used biochemical improvement alone as a measure of treatment success. In addition, no standardized criteria to define incomplete response to UDCA therapy have been applied, and all but a few studies have reported after a relatively short follow-up period of 3–12 months.16,26 Unfortunately, only two case series evaluating histological changes

with fibrate therapy have been performed in a combined total of five patients; results have been mixed with histological improvement in some and worsening in others, irrespective of changes in liver biochemistry.12,26

LY294002 price Clearly, for an insidiously MCE progressive disease like PBC, the conclusions that can be drawn from these small pilot trials are limited. In this issue of JGH, Takeuchi and colleagues report yet another small pilot study of fibrate therapy in PBC. Over an 8-year period they consecutively enrolled 37 patients with PBC to receive 600 mg of UDCA. After 6 months treatment, those patients who failed to achieve a biochemical response to UDCA (defined by a fall in ALP > 40% or into the normal range), had bezafibrate therapy added. Fifteen (41%) of the 37 patients enrolled fell into this non-responder group and after one year of combined therapy, 12 of 15 (80%) had normalized their ALP and IgM levels with combination therapy. In an attempt to translate these biochemical improvements into a clinical outcome, Mayo risk scores were evaluated at enrollment and study conclusion at 2 years follow-up. No significant difference was noted between groups; this is not surprising, given the relatively short period of follow-up and small numbers. The current study confirmed that at baseline, lower levels of ALP and early histological stage without PBC symptoms were both independent predictors of a “good response” to UDCA therapy.

Splenic pseudocyst are uncommon and thought to result from resolution and liquefaction

of hematoma of remote or recent trauma. GSK1120212 Here we represent a case of a huge splenic pseudocyst which is accompanied by a pancreatic pseudocyst. Methods: A 55-year-old man, who had a 30-year history of alcohol consumption and just discontinued 2 years ago, was admitted to our hospital for treatment of aching pain over left upper quadrant (LUQ) of the abdomen, which was worsening after meal without nausea or vomiting. He denied any medical or surgical history, but the patient mentioned a fracture of the left 10th rib eight years ago, without any medical observation after it. The physical examination was essentially normal. The patient’s complete blood count showed an elevated leukocyte count of 14.46×109/L with the neutrophil count of 12×109/L and a slightly decreased erythrocyte count of 3.6×1012/L with hemoglobin 106 g/L. Other blood tests were unremarkable. Ultrasonography (UG) revealed a complex cyst 11–12 cm in diameter on the lower part of the spleen, which contained thick echoes from tissue debris and was loculated

incompletely (Figure 1A). The consistency of the splenic inferior edge was interrupted and the shape of the spleen was irregular. The parenchyma of the spleen was compressed, displaced and found around the complex cyst. The main splenic artery and vein selleck compound and their branches could be demonstrated at the splenic hilum. The shape, size and echogenicity of pancreas (head, body and tail) seemed normal (Figure 1B). The abdominal computed tomography (CT) indicated the lesion in the spleen and splenic hilum, similar to what had beem found in UG. CT revealed an irregular, hypodense cystic lesion in the spleen and around the splenic hilum, part of which was not separated from the tail of pancreas and stomach. The head and body of pancreas were homogenous with the normal size and shape. The contour of the tail of pancreas was unclear (Figure 上海皓元医药股份有限公司 2A). Because of persistent LUQ pain, the patient underwent an exploratory laparotomy. During the operation,

surgeons found a huge cystic mass among the gastric fundus, pancreatic tail and spleen, which was encapsulated by greater omentum and indistinguishable from adjacent tissues, thus leading to the dilemma that it was impossible to remove the cyst integrally. Then the cystic content was aspirated to check amylase, which was black-brown and turbid and showed the level of amylase being as high as 86464 IU/L. Finally, a drainage catheter was placed in the cyst and abdomen was closed. Five days after operation, UG revealed distinctly decreased splenic pseudocyst (Figure 2B, the white arrow points towards the catheter). The pancreas echogenicity (including the tail) seemed as normal as preoperative examination.