WEO Newsletter
2016; Wiley; Volume: 28; Issue: 6 Linguagem: Norueguês
10.1111/den.12699
ISSN1443-1661
Tópico(s)Esophageal and GI Pathology
ResumoDigestive EndoscopyVolume 28, Issue 6 p. 694-698 WEO NewsletterFree Access WEO Newsletter First published: 01 September 2016 https://doi.org/10.1111/den.12699AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat From the Editor By Dr Nalini Guda Dr Nalini Guda, WEO newsletter editor It gives me great pleasure and honor to write to you as the new editor of the WEO newsletter. It is hard to follow on the footsteps and leadership of former editors, Dr Jerome Waye, Dr Mostafa Ibrahim and Dr John Baillie. As we transition, the editorial team and I will be doing our best to continue the tradition of bringing the news of WEO and its partner societies and members in a timely fashion, combined with some educational information regarding the practice of gastrointestinal endoscopy. The WEO executive has recently met during the Digestive Disease Week (DDW) in San Diego. The Executive and Governing Council reviewed several of the programs and initiatives undertaken by WEO and its members. We will highlight these one at a time in our future newsletters. In keeping with the tradition, we will also continue to bring interesting cases and videos of live demonstrations from the WEO Centers of Excellence. Preparations are underway for ENDO 2017 – the first World Congress of GI Endoscopy, which will take place February 2017 in Hyderabad, India, under the leadership of the WEO President Dr Nageshwar Reddy. Details of the program are included in this newsletter. In this issue you will also find an interesting case presentation - we are thankful to Dr. Gomez, from the Mayo Clinic in the US, for submitting it. The Emerging Stars program is also included in this issue, and you can read more about their recent Chicago meeting. Finally, if you are attending UEG Week this October, please make sure to stop by the WEO booth The editorial team solicits your comments and suggestions to improve the newsletter, so that we can be your source for information, both for WEO activities and other gastrointestinal endoscopy news. To submit a news item or any suggestions, please contact us at secretariat@worldendo.org. With very best regards, Nalini M Guda MD, FASGE, AGAF. Section Chief, Gastroenterology Aurora St.Luke's Medical Center, Milwaukee. Clinical Adjunct Professor of Medicine University of Wisconsin, School of Medicine and Public Health. Milwaukee, Wisconsin, USA ENDO 2017 congress: join the first global endoscopy meeting hosted by WEO The World Endoscopy Organization (WEO) is proud to host ENDO 2017 – the first World Congress of GI Endoscopy, taking place February 16-19, 2017 in Hyderabad, India ENDO 2017 is the first comprehensive conference entirely devoted to gastrointestinal endoscopy and features world-renowned endoscopists. It is an exciting event aimed at addressing gaps and fostering dialogue for greater quality in endoscopy. The faculty and scientific committee include eminent endoscopists from all over world, including Dr Nageshwar Reddy (India), Professor Horst Neuhaus (Germany), Dr Jean-Francois Rey (France), Dr Douglas Faigel (USA), Dr Jacques Devière (Belgium) and Professor Hisao Tajiri (Japan), among many others. The program combines three and a half days of live demonstrations, symposia and a postgraduate program. There is a dedicated learning center with hands-on training and small group lectures, with focus on interaction between participants and experts. Registration is now open via the ENDO 2017 official website (www.endo-2017.org), with rates starting at USD 150. WEO is also pleased to announce up to 20% discount on tickets booked with airlines of the Star Alliance, the official airline network partner of ENDO 2017. To obtain the discount, use the code AI01S17 at the time of booking. All details are available at the ENDO 2017 website, under “travel and visa information”. NOW AVAILABLE: ENDO 2017 is excited to announce that the Journal of Gastroenterology and Hepatology Foundation (JGHF) will provide travel grants for young doctors age 40 years and below to attend ENDO 2017. The grant awards 15 selected recipients with a USD 1,000 travel stipend and waived registration fees. All applicants must submit an abstract in order to be eligible for the travel grant – the abstract submission process can be done online at the event website. In addition to the exciting program, the host city of ENDO 2017, Hyderabad, is the perfect opportunity to learn more about the Indian culture. Hyderabad is the perfect blend of traditional and modern – a city where sleek skyscrapers share space with heritage monuments and an eclectic mix of communities ensures a vibrant culture. Within 30-minutes driving distance from the congress center, you can visit tourist attractions such as the KBR National Park and the Golconda Fort. Pre- or post- congress tours to Goa and Kerala, as well as day-tours in Hyderabad, can be booked when registering for the event. Do not miss such an enriching experience in and around Hyderabad! For the detailed scientific program and to register, visit www.endo-2017.org. Follicular lymphoma of the ampulla: case report By Dr Victoria Gomez & Dr Katherine Mejia-Perez A 65-year-old man with long-standing symptoms of gastroesophageal reflux disease was referred for a diagnostic EGD. Endoscopy was unrevealing with the exception of a mucosal abnormality that appeared to arise from the periampullary region detected upon slow withdrawal within the duodenum. A diagnostic duodenoscope was inserted, with findings of a distorted major papilla with diffuse whitish nodularity, with extension to the periampullary area (Fig. 1A). The differential diagnosis of the lesion at that time included primary ampullary adenoma/carcinoma versus a pancreatic lesion. The patient was referred for EUS for further evaluation. A linear array endoscopic ultrasound (EUS) demonstrated an 18 mm polypoid mucosal lesion in the major papilla, without involvement of the muscularis propria or pancreas parenchyma (Fig. 1B). The bile and pancreatic ducts were spared. Mucosal biopsies were obtained. Histopathological and immunohistochemical evaluation showed nodular and diffuse proliferation of atypical lymphocytes in the submucosa and lamina propria, which stained positive for CD20, BCL-6, BCL-2, and CD10 (Fig. 1C); with a low proliferative rate by Ki-67 (5–20 %). The diagnosis of follicular lymphoma, World Health Organization (WHO) grade 1 of 3 of the periampullary region was made. Figure 1Open in figure viewerPowerPoint A, Whitish nodular lesion of the ampulla detected on upper endoscopic evaluation. B, Linear array EUS view, showing 18-mm polypoid lesion involving the major papilla, confined to the mucosa. C, Pathologic specimen stained with H&E, showing neoplastic follicles in the duodenal lamina propria and submucosa, (blue arrow, orig. Mag. ×10). D. Repeat upper endoscopy with duodenoscope post-chemotherapy, showing complete resolution of the lesion. The patient was referred for an oncologic consultation. NM PET/CT demonstrated no foci of abnormal metabolic activity. Five weekly sessions of induction chemotherapy with rituximab were administered. A surveillance EGD post-treatment was performed and demonstrated complete resolution of the lesion (Fig. 1D). Biopsies of the ampulla and periampullary region were obtained, showing no evidence of lymphoma. Discussion Primary follicular lymphoma is the rarest histologic subtype of the lymphomas affecting the gastrointestinal tract, with a frequency of 1–3.6 %. The duodenum is the most commonly affected location (1–4). It is mainly an asymptomatic condition, which usually represents an incidental diagnosis during GI endoscopy (5). The most common reported finding consists of multiple small mucosal whitish nodules or polyps. Endoscopic ultrasound most often reveals mucosal and submucosal thickening, with multiple hypoechogenic nodules, which represent lymphocyte proliferation (1,4). We decided not to perform biopsies on first upper endoscopic evaluation because the primary origin of the lesion, as well as its extent into the intestinal wall, was unknown. Diagnosis is confirmed with microscopic examination and immunostaining (5). Microscopy reveals neoplastic cells invading the lamina propria, being confined to the submucosal layer. Within the GI tract, immunostaining of follicular lymphoma shows expression of pan B cell markers, such as CD19 and CD20, and, the anti-apoptotic protein, BCL-2. They are also positive for BCL-6 and CD10 (2,5). Due to its low prevalence and absence of guidelines, treatment of ampullary lymphomas is very heterogenous: watch and wait, monotherapy with rituximab, chemotherapy with R-CHOP and R-CHOP-like regimens, surgery, radiotherapy and Helicobacter pylori eradication. Regarding prognosis, which tends to be favorable, some reports have shown no difference in prognosis among the different types of therapy strategies, (2,4,6). In our particular case, monotherapy with a biologic agent was successful. In conclusion, primary gastrointestinal lymphoma is a rare tumor, mostly asymptomatic and incidentally diagnosed on upper gastrointestinal examination. Endoscopists play an important role in its detection, diagnosis and initial management. Careful examination of the major papilla during routine upper endoscopy should always be performed with a careful, meticulous withdrawal. Subtle lesions can often times be properly recognized and further evaluated. References 1Franco DL, Islam S, Ruff K. Endoscopic findings of primary follicular lymphoma. Biomedica 2015; 35: 21– 3. 2Yoshino T, Miyake K, Ichimura K, Mannami T, Ohara N, Hamazaki S, et al. Increased incidence of folicular lymphoma in the duodenum. Am. J. Surg. Pathol. 2000; 24(5): 688– 693. 3Graham RL, Mardones MA, Krause JR. Primary follicular lymphoma of the duodenum. Proc (Bayl Univ Med Cent) 2015; 28(3): 381– 3. 4Yamamoto S, Nakase H, Yamashita K, Matsuura M, Takada M, Kawanami C, et al. Gastrointestinal follicular lymphoma: review of the literature. J. Gastroenterol. 2010 Apr; 45(4): 370– 88. 5Suzuki S, Tanioka F, Inaba K, Takatori S, Ochiai H, Suzuki S. A rare collision tumor composed of follicular lymphoma and adenocarcinoma in the ampulla of vater: a case report. Case Rep Pathol [Internet]. Hindawi Publishing Corporation; 2014 Jan; 2014: 530727. 6Takata K, Okada H, Ohmiya N, Nakamura S, Kitadai Y, Tari A, et al. Primary gastrointestinal follicular lymphoma involving the duodenal second portion is a distinct entity: a multicenter, retrospective analysis in Japan. Cancer Sci. 2011 Aug; 102(8): 1532– 6. ASGE Institute for Training & Technology receives WEO Emerging Stars Emerging Stars is a unique program by WEO aimed at selectively training emerging endoscopy leaders from around the world to help develop them into future leaders of endoscopy. The program includes three face-to-face training modules over the span of twelve to eighteen months. The first class of 19 “Emerging Stars” was selected from applicants from around the globe. The Emerging Stars program was developed by the initiative of Professor Ibrahim Mostafa (Egypt), Program Director and WEO's Education Committee Chair. The program is supported by grants from PENTAX Medical and Boston Scientific. Module 1 of the program took place in November 2015. The Emerging Stars class rejoined for the second module during April 3–8 2016, in Chicago, USA, at the ASGE Institute for Training & Technology (IT&T). This program was conducted in partnership with the American Society of Gastrointestinal Endoscopy (ASGE). The program offered interaction and training with several endoscopy teachers and researchers from the United States and other countries. The topics included teaching endoscopy, conducting research in the field of GI endoscopy, working with models and integrating them in endoscopy training, as well medico-legal aspects in endoscopy. A highlight of the program was the live demonstration “New techniques in endoscopy”, held at the University of Illinois at Chicago (UIC). The third and final module of the Emerging Stars Class of 2015 will take place in March 2017 in Cairo, Egypt. . The Emerging Stars class 2015 and some of the faculty at the IT&T. . Professor Mostafa (3rd from right) with participants during hands-on training. . UEG Week Vienna 2016 October 15–19, 2016. Vienna, Austria. www.ueg.eu/week UEG Week – the largest and most prestigious meeting of its kind in Europe attracting more than 13,000 specialists in Gastroenterology & Hepatology from 100+ countries. The United European Gastroenterology Week is an opportunity to present new research and thinking across a wide range of digestive disease areas, cutting-edge post-graduate teaching sessions, some of the best GI abstracts and posters and simultaneous live streams to a global audience and endoscopic, ultrasound and surgical hand-on training. The focus for UEG Week 2016 in Vienna will be to advance science and link people in the global GI community. UEG's mission is to continuously improve standards of care in gastroenterology, and promote ever greater understanding of digestive and liver disease – among the public and medical experts alike. . Hands-on training at the ESGE Learning Area. During the week, endoscopy enthusiasts are encouraged to visit the ESGE Learning Area to experience different types of interactive learning modalities. Hands-on training is offered from Saturday to Wednesday and the schedule is now available online at www.esge.com. WEO will also be present during UEG Week, holding several committee meetings, as well as having a booth at the scientific exhibition. Make sure to visit to learn more about the organization. WEO upcoming events For more information on these and other events, visit worldendo.org/events. Colorectal Cancer Screening Committee (CRCSC) meeting Cartagena September 10, 2016 – Cartagena, Colombia. Done in partnership with SIED, as part of the Pan-American Digestive Week 2016 program. Advanced Endoscopy Diagnosis Course (ADEC) Seoul September 10, 2016 – Seoul, Republic of Korea Advanced Endoscopy Diagnosis Course (ADEC) Cartagena September 13, 2016 – Cartagena, Colombia. Done in partnership with SIED, as part of the Pan-American Digestive Week 2016 program. Advanced Endoscopy Diagnosis Course (ADEC) Rio September 15, 2016 – Rio de Janeiro, Brazil Colorectal Cancer Screening Committee (CRCSC) meeting Vienna October 14, 2016 – Vienna, Austria Advanced Endoscopy Diagnosis Course (ADEC) Kobe November 2, 2016 - Kobe, Japan. Done in partnership with JGES and APDW, as part of APDW 2016 official program. Colorectal Cancer Screening Committee (CRCSC) meeting Kobe November 2, 2016 - Kobe, Japan. Done in partnership with JGES and APDW, as part of APDW 2016 official program. Better Endoscopic Service Training (BEST) Kobe November 4, 2016 - Kobe, Japan. Done in partnership with JGES and APDW, as part of APDW 2016 official program. Program for Endoscopic Teachers (PET) Bangkok November 30 – December 1, 2016 – Bangkok, Thailand ENDO 2017 - World Congress of GI Endoscopy February 16–19, 2017 - Hyderabad, India. www.endo-2017.org WEO endorsed events For more information on these and other events, visit worldendo.org/events. Seoul International Digestive Disease Symposium (SIDDS 2016) November 24–25, 2016 - Seoul, Korea 18th Egyptian Workshop on Therapeutic Endoscopy December 11–12, 2016 - Cairo, Egypt IsraeLive Endoscopy International 2017 March 27–28, 2017 - Haifa, Israel 5th International Symposium on Complications in GI Endoscopy November 2, 2017 - Hamburg, Germany. Volume28, Issue6September 2016Pages 694-698 FiguresReferencesRelatedInformation
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