Publications by authors named "Muslim Atiq"

52 Publications

Distinct Clinical Characteristics in Young-Onset Pancreatic Neuroendocrine Tumor.

Cancers (Basel) 2020 Sep 3;12(9). Epub 2020 Sep 3.

Division of Hematology and Oncology, UT Southwestern Medical Center, Dallas, TX 75390, USA.

Background: We aimed to study the effect of socioeconomic differences and molecular characteristics on survival in patients with young-onset pancreatic neuroendocrine tumors (YOPNET) and typical-onset PNET (TOPNET).

Methods: We identified the patients with YOPNET (<50 years) and TOPNET (≥50 years) who underwent definitive surgery diagnosed between 2004 and 2016 using the National Cancer Database. We evaluated overall survival (OS) using the Kaplan-Meier and Cox regression methods before and after propensity score matching. A publicly available genomic dataset was used to compare mutation frequencies among the two groups.

Results: A total of 6259 patients with PNET were included, of which 27% were YOPNET. Patients with YOPNET were more likely to be Black, Hispanic, female, and have private insurance versus patients with TOPNET (all < 0.001). Patients with YOPNET had a lower comorbidity score, but higher stage and tumor size (all < 0.001). YOPNET was associated with a greater improved OS than TOPNET before and after propensity score matching ( < 0.001). On multivariable analysis, this survival difference persisted for YOPNET as an independent prognostic factor (unmatched = 0.008; matched = 0.01). For genomic analysis, patients with YOPNET had a lower rate of multiple endocrine neoplasia type-1 (MEN-1) mutation than patients with TOPNET (26% vs. 56%, < 0.001).

Conclusions: YOPNET represents a disease with distinct clinical features. Patients with YOPNET who underwent definitive surgery had better OS than patients with TOPNET despite having higher stage and tumor size. YOPNET also had lower rate of MEN-1 mutation.
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http://dx.doi.org/10.3390/cancers12092501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563582PMC
September 2020

Extramedullary Myeloid Sarcoma with Symptoms of Acute Pancreatitis Mimicking Pancreatic Carcinoma.

S D Med 2020 Jul;73(7):305-307

Division of Gastroenterology and Hepatology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

Extramedullary myeloid sarcomas are extramedullary tumors of immature myeloid cells, often associated with acute myeloid leukemia (AML), chronic myeloid leukemia (CML), or other myeloproliferative diseases. They are usually found in connective/soft tissues, skin, breast and gastrointestinal system. Pancreas is an uncommon site to be involved. We present a case of pancreatic myeloid sarcoma presenting with symptoms of acute pancreatitis including epigastric pain associated with nausea and vomiting, with imaging findings (abdominal CT) suggestive of pancreatic carcinoma, both presenting as hypoattenuating mass. It is important to consider myeloid sarcoma as a differential for pancreatic mass, especially given the history of AML as in our patient, which would lead to timely diagnosis and initiation of chemotherapy.
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July 2020

Finding a needle in a haystack: Endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic masses in the setting of chronic pancreatitis.

Ann Gastroenterol 2020 Jul-Aug;33(4):418-425. Epub 2020 May 10.

Division of Gastroenterology and Hepatology (Bhaveshkumar Patel, Muslim Atiq).

Background: The mainstay for the definitive diagnosis of pancreatic lesions is endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). However, there is evidence that EUS-FNA has low sensitivity in the setting of chronic pancreatitis (CP). This single-center retrospective study aimed to compare and analyze the diagnostic yield of EUS-FNA for solid pancreatic lesions in the presence and absence of CP, and to further investigate strategies for overcoming the low diagnostic yield in the setting of CP.

Methods: This study identified patients who underwent EUS-FNA at Sanford USD Medical Center (SD, USA) for a solid pancreatic lesion between July 15, 2011, and November 30, 2017. Data on demographics, clinical features, cross-sectional imaging findings, EUS findings, cytology/pathology, and clinical follow up were collected.

Results: The final diagnosis was adenocarcinoma in 156 patients (67%), neuroendocrine tumor in 27 (12%), lymphoma in 6 (3%), metastatic malignancy in 8 (4%), and benign etiologies in 35 (15%). CP was identified in 44/234 (19%) patients. The overall diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for EUS-FNA were 92.9%, 97.1%, 99.5%, 70.8%, and 93.5%, respectively. The sensitivity (80% vs. 95%, P=0.020) and accuracy (86% vs. 95%, P=0.043) were significantly lower in patients with CP compared to those without CP.

Conclusion: CP can significantly affect the EUS-FNA diagnostic yield of solid pancreatic neoplasms. A high index of clinical suspicion is required in these cases to make a definitive diagnosis.
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http://dx.doi.org/10.20524/aog.2020.0484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315714PMC
May 2020

Utility of Endoscopic Ultrasound in the Work Up for Solitary Hepatobiliary Neuroendocrine Lesions.

S D Med 2020 Jun;73(6):270-274

Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

A 43-year-old woman, with an unremarkable past medical history, presented with a three-week history of generalized itching, jaundice, and abdominal pain. Initial workup showed amorphous, regionally invasive, and obstructing soft tissue mass in the region of the hepatic hilum. The middle third of the main bile duct was subsequently found to harbor a polypoid mass on endoscopic retrograde cholangiopancreatograph. Biopsy revealed nests of neoplastic cells that was subsequently identified as well-differentiated neuroendocrine tumor. A search for a possible primary neuroendocrine tumor was performed and included imaging of the chest, abdomen, and pelvis, a colonoscopy, capsule endoscopy, and an octreotide scan; however, no primary tumor outside of the liver was identified. Surgical debulking was performed, during which intraoperative exploration and ultrasound failed to reveal any extra-hepatic tumor sanctuaries. A few months later, patient underwent endoscopic ultrasound (EUS) for evaluation of recurrent abdominal pain which revealed a small lesion in the pancreas. It was unclear, however, whether it was primary or a metastatic lesion. This case represents a diagnostic challenge and emphasizes the potential utility of EUS in the preoperative work up for any presumable primary hepatobiliary neuroendocrine tumor.
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June 2020

Diagnostic Challenge With Auto-Immune Pancreatitis and IgG4-Related Disease.

S D Med 2020 Jun;73(6):266-269

Sanford Center for Digestive Health, Sioux Falls, South Dakota.

IgG4-related disease (IgG4RD) is a chronic immune mediated condition primarily affecting the hepato-pancreatico-biliary system. We report a case of IgG4RD with extensive pancreatic and hepatic involvement masquerading as metastatic pancreatic malignancy posing a diagnostic and therapeutic dilemma.
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June 2020

Use of lumen apposing metal stent for pyloric stenosis refractory to balloon dilatation.

J Dig Dis 2019 Dec 22;20(12):663-664. Epub 2019 Nov 22.

Department of Gastroenterology, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota, USA.

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http://dx.doi.org/10.1111/1751-2980.12828DOI Listing
December 2019

Squamous Papilloma After Endoscopic Ablation of Barrett's Esophagus: A Case Report and Review of Literature.

S D Med 2019 05;72(5):200-202

Department of Gastroenterology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

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May 2019

Percutaneous removal of a retained appendicolith causing recurrent perihepatic abscesses between the liver and diaphragm.

BMJ Case Rep 2019 Jul 18;12(7). Epub 2019 Jul 18.

Department of Interventional Radiology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA.

Many cases of appendicitis can be associated with appendicoliths. These may sometimes be lost during appendectomies and may be lodged in the body. Most of these cases lead to recurrent abscess formation, and these appendicoliths invariably need removal. Typically, this used to be done as an open surgery or laparoscopically. Here we describe the case of a transcutaneous removal of an appendicolith that was lodged between the liver and diaphragm that led to recurrent perihepatic abscess formation in a 24-year-old otherwise healthy man. The patient made a successful recovery without any recurrence. A transcutaneous approach to remove a retained appendicolith may be a feasible, a safe and an easy method to extract appendicoliths that are accessible for transcutaneous removal.
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http://dx.doi.org/10.1136/bcr-2019-230176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6663240PMC
July 2019

Clinical presentations, management, and outcomes of acute esophageal necrosis: a systemic review.

Expert Rev Gastroenterol Hepatol 2019 May 16;13(5):507-514. Epub 2019 Apr 16.

a Sanford School of Medicine , University of South Dakota , Sioux Falls , SD , USA.

Background: To review all the reported literature on acute esophageal necrosis.

Research Methods: Databases were searched using the special Medical Subject Heading (MeSH) terms. All the available reported cases of acute esophageal necrosis were analyzed.

Results: A total of 154 cases were identified and 130 cases were analyzed. The mean age of presentation was 61 years, and 70% of cases were males. The most common presenting symptoms were hematemesis in 66%, shock in 36%, melena in 33%, abdominal or substernal pain in 28%. The most common comorbidities reported were diabetes in 38%, hypertension in 37%, alcohol abuse in 25%, and chronic kidney disease in 16%. On upper endoscopy, 51% had a distal disease, 36% had pan esophageal, and only 2% had a proximal disease. 84% of patients were treated with IV Proton Pump Inhibitors, 22% received transfusions, 23% got antibiotics for underlying sepsis, 14% also received sucralfate, and 4% required surgery for treatment. The mortality rate was 32%, while perforation was reported in 5% and stricture formation reported in 9% of patients.

Conclusions: Patients with acute esophageal necrosis can have a favorable outcome if treated appropriately.
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http://dx.doi.org/10.1080/17474124.2019.1601555DOI Listing
May 2019

Spatial Epidemiology of Pancreatic Cancer in South Dakota.

J Gastrointest Cancer 2020 Mar;51(1):144-151

Department of Public Health, University of South Dakota, Vermillion, SD, USA.

Background: Pancreatic cancer is the fourth leading cause of cancer-related mortality in the United States. Descriptive epidemiology of pancreatic cancer in South Dakota has not been studied before.

Materials And Methods: All cases of pancreatic cancer reported to the SD Cancer Registry between January 2005 and December 2014 were included in the study. Variables collected included demographics, geographical location including county of residence and zip codes, date of diagnosis, date of last contact or follow-up, size and location of the tumor, grade of the tumor, diagnostic modality as well as therapeutic interventions. Log rank test was used to compare survival curves. Kaplan-Meier product limit estimates were provided. Data was analyzed using SAS 9.1.4 software.

Results: One thousand sixty-four cases of pancreatic cancer were reported. Median age was 73 years. Cumulative age-adjusted incidence rate for pancreatic cancer for 2005-2014 was 11.1. Cumulative age-adjusted mortality rate for pancreatic cancer for 2005-2014 was 10.2. Almost half of these patients had distant metastasis at the time of presentation (n = 536; 50.4%). Overall, median survival was 5 months. Median survival for patients under the age of 60 years was 9.5 months as opposed to median survival for patients 60 years or older which was 3.9 months. Median survival of patients with well-differentiated, moderately differentiated, and poorly differentiated tumors, was 20.8 months, 8.2 months and 6.3 months respectively (p value = 0.0017).

Conclusion: Incidence of pancreatic cancer in South Dakota is similar to the national trends in the United States. Age at presentation, location of tumor in pancreas, and biological behavior of tumor were all predictors of survival in patients with pancreatic cancer.
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http://dx.doi.org/10.1007/s12029-019-00214-zDOI Listing
March 2020

Management of Bouveret's syndrome.

J Dig Dis 2019 04 28;20(4):215-219. Epub 2019 Mar 28.

Division of Transplant Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.

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http://dx.doi.org/10.1111/1751-2980.12713DOI Listing
April 2019

The Impact of Repeating Endosonography with Confocal Endomicroscopy for the Diagnosis of Cystic Neuroendocrine Tumor.

Case Rep Gastrointest Med 2019 14;2019:5187874. Epub 2019 Jan 14.

Department of Gastroenterology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA.

Cystic pancreatic neuroendocrine tumors represent around 13% of all neuroendocrine tumors (Hurtado-Pardo 2017). There has been an increase in the incidence of cases due to improvement in imaging modalities. This is a case of a 68-year-old male with the incidental finding of a pancreatic cyst on CT. Initial Endoscopic Ultrasound with Fine Needle Aspiration (EUS-FNA) showed sonographic and cytology features suggestive of a pancreatic pseudocyst. However the cyst persisted with no change in size after aspiration leading to a follow-up EUS- FNA, which was combined with needle based confocal laser endomicroscopy (nCLE). The nCLE features were consistent with a cystic pancreatic neuroendocrine tumor, which was later confirmed on histology after surgical resection.
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http://dx.doi.org/10.1155/2019/5187874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6348892PMC
January 2019

Non-surgical management of Boerhaave's syndrome: a case series study and review of the literature.

Endosc Int Open 2018 Jan 16;6(1):E92-E97. Epub 2018 Jan 16.

Department of Gastroenterology, University of South Dakota - Sanford School of Medicine, Sioux Falls, South Dakota, United States.

Background And Study Aims:  Boerhaave's syndrome (BS) is a life-threatening condition with morbidity and mortality rates as high as 50 % in some reports. Until recently, surgical intervention has been the mainstay of management plans. With advances in therapeutic endoscopy, however, there has been increasing interest in non-surgical options including endoscopic esophageal stenting.

Patients And Methods:  We reviewed the medical records of all patients diagnosed with BS and managed with endoscopic interventions between November 2011 and November 2016. The following variables were collected: patient demographics, clinical presentations, locations of esophageal perforation, primary interventions, complications, and outcomes.

Results:  Six patients were found to be diagnosed with BS during the study period. The median age at presentation was 55. There were 4 males and 2 females. The most common site of perforation was in the distal esophagus. The most common presenting symptom was chest pain (67 %) following an episode of vomiting or retching. Four patients (66.7 %) developed septic shock. Endoscopic treatment with a fully covered esophageal stent was the primary intervention in all patients (100 %). Interventional radiology was consulted in all cases for fluid drainage and chest tube placements. Clinical resolution of the BS was achieved in all patients (100 %) without any subsequent surgical interventions. There were no deaths within the study group, and the average follow-up duration was 2 years.

Conclusion:  Endoscopic treatment seems to be an effective management strategy in patients with BS. We also noted satisfactory results in patients presenting with sepsis, presumably due to urgent, interventional radiology-guided fluid drainage.
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http://dx.doi.org/10.1055/s-0043-124075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770272PMC
January 2018

Indeterminate biliary strictures: a simplified approach.

Expert Rev Gastroenterol Hepatol 2018 Feb 23;12(2):189-199. Epub 2017 Oct 23.

b Surgery , University of South Dakota Sanford School of Medicine , Sioux Falls , SD , USA.

Introduction: Pre-operative evaluation of biliary strictures remains challenging. The dilemma that exists is how to balance the risk of failing to detect malignancy and the potential morbidity caused by unnecessary surgery in patients with benign etiologies. With emerging novel diagnostic modalities, this study aims to assess the efficacy of diagnostic techniques and facilitate a clinical approach to indeterminate biliary strictures. Areas covered: Conventional imaging modalities are crucial in identifying the location of a stricture and are helpful for choosing further diagnostic modalities. Utilization of endoscopic techniques, including endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS), is key in establishing a diagnosis. The emergence of novel diagnostic modalities, such as fluorescence in-situ hybridization (FISH), peroral cholangioscopy (POC), intraductal endoscopic ultrasound (IDUS) and confocal laser endomicroscopy (CLE), enhance the diagnostic yield in the evaluation of indeterminate biliary strictures. Expert commentary: More reliable and validated visual criteria for differentiating malignancy from benign biliary conditions, utilizing advanced imaging modalities such as POC and CLE, need to be established. It is of significance to further evaluate these novel diagnostic modalities through ongoing trials and to develop a diagnostic algorithm that reconciles cost-effectiveness with diagnostic accuracy.
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http://dx.doi.org/10.1080/17474124.2018.1391090DOI Listing
February 2018

Percutaneous Endoscopic Management for Oriental Cholangiohepatitis: A Case Report and a Brief Review of the Literature.

Case Rep Gastrointest Med 2017 27;2017:8575674. Epub 2017 Aug 27.

Department of Gastroenterology, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.

Oriental cholangiohepatitis (OCH) is a disease characterized by intrabiliary pigment stone formation, resulting in recurrent bouts of cholangitis. OCH is found mostly in Southeast Asia but it is occasionally recognized in Western societies. OCH etiology is largely unknown. We report our experience with a patient who presented with acute cholecystitis. Following laparoscopic cholecystectomy, she developed acute cholangitis due to multiple biliary tree stones. She underwent ERCP to clear the stones from common bile duct. For the intrahepatic stones, she underwent novel hybrid percutaneous endoscopic technique. The procedure resulted in complete clearance of biliary tree stones and resolution of her symptoms. The aim of this case is to increase awareness of this disease when patients from endemic areas present with biliary stones.
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http://dx.doi.org/10.1155/2017/8575674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5591995PMC
August 2017

Hybrid Percutaneous-Endoscopic Treatment for Acute Calculous Cholecystitis in a High-Risk Surgical Patient.

ACG Case Rep J 2017 19;4:e89. Epub 2017 Jul 19.

Department of Gastroenterology, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD.

Acute cholecystitis (AC) has long been treated with percutaneous cholecystostomy (PC) in patients who are poor surgical candidates, but it is associated with high recurrence rate. We report our experience with a hybrid percutaneous-endoscopic technique in an elderly patient with AC who had received a PC. In this technique, a pediatric endoscope was introduced through the PC opening to the gallbladder, and the stones were visualized, fragmented, and extracted using a retrieval basket. The patient's AC resolved, and within 2 weeks the PC tube was removed. The patient remained asymptomatic at the 6-month and 1-year follow-up visits. We believe that if this method is replicated in large scale, it could be an effective alternative to cholecystectomy in nonsurgical candidates.
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http://dx.doi.org/10.14309/crj.2017.89DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519400PMC
July 2017

Unusual Cutaneous Metastasis of Pancreatic Adenocarcinoma.

ACG Case Rep J 2017 12;4:e58. Epub 2017 Apr 12.

Department of Gastroenterology, University of South Dakota, Sioux Falls, SD.

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http://dx.doi.org/10.14309/crj.2017.58DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5404628PMC
April 2017

Intraductal cholangioscopy-guided electrohydraulic lithotripsy as a rescue therapy for impacted common bile duct stones within a Dormia basket.

Endoscopy 2016 0;48(S 01):E357-E358. Epub 2016 Nov 16.

Sanford USD Medical Center, Gastroenterology, Sioux Falls, South Dakota, USA.

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http://dx.doi.org/10.1055/s-0042-119039DOI Listing
August 2017

Diagnostic Differentiation of Pancreatic Neuroendocrine Tumor From Other Neoplastic Solid Pancreatic Lesions During Endoscopic Ultrasound-Guided Fine-Needle Aspiration.

Pancreas 2016 Mar;45(3):394-400

From the *Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX; †Department of Gastroenterology, Hepatology, and Nutrition, and ‡Department of Biostatistics, The Ohio State University, Columbus, OH.

Objectives: To identify factors differentiating pancreatic neuroendocrine tumors (PNETs) from non-PNET neoplastic solid pancreatic lesions (SPLs) and assess the accuracy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA).

Methods: This is a retrospective study at a tertiary center of consecutive patients referred for EUS from 2004 to 2011. The main outcomes were pretest predictors and accuracy of EUS-FNA for diagnosis of PNET.

Results: Among a total of 1108 EUS-FNAs for pancreatic lesions, 672 patients (PNET = 91, non-PNET neoplastic-SPLs = 581) had neoplastic-SPLs. The sensitivity, specificity, and accuracy of EUS-FNA for diagnosis of PNETs were 98.9%, 100%, and 99.9%, respectively. The mean needle-passes were 3.0/patient. The EUS volume (mean/year per endosonographer) in preceding 3 years significantly correlated with fewer needle passes (rs: [-0.26]; P = 0.02).Multivariate analysis demonstrated that patients with PNET when compared to non-PNET neoplastic-SPLs were younger (odds ratio [OR], 3.23; 95% confidence interval [95% CI], 1.19-9.09; P = 0.001), have 2 or more pancreatic lesions (OR, 5.63; 95% CI, 1.74-18.2; P = 0.005), and lower CA 19-9 values (OR, 10.0; 95% CI, 3.13-33.3; P = 0.001). Further, PNETs were less likely to have weight loss (OR, 0.40; 95% CI, 0.17-0.90; P = 0.03), current smoking (OR, 0.47; 95% CI, 0.22-0.98; P < 0.05), pancreatic ductal dilation (OR, 0.28; 95% CI, 0.13-0.60; P = 0.002), or imaging evidence of arterial invasion (OR, 0.22; 95% CI, 0.07-0.71; P = 0.01).

Conclusions: Although pre-FNA findings can reliably characterize, EUS-FNA is highly accurate for the diagnosis of PNETs.
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http://dx.doi.org/10.1097/MPA.0000000000000488DOI Listing
March 2016

Glycogenic Hepatopathy: Thinking Outside the Box.

Case Rep Gastroenterol 2015 May-Aug;9(2):221-6. Epub 2015 Jul 9.

Department of Internal Medicine, Sanford USD School of Medicine, Sioux Falls, S. Dak., USA.

Glycogenic hepatopathy (GH) remains underrecognized in adults as most clinicians mistake it for the more common hepatic abnormality associated with uncontrolled diabetes mellitus in this age group, non-alcoholic fatty liver disease. This is also complicated by the fact that both entities are indistinguishable on liver ultrasound. We herein describe a similar predicament in which a young adult female presented with bilateral upper quadrant abdominal pain, tender hepatomegaly, lactic acidosis and a >10-fold increase in liver enzymes, which worsened after the administration of high-dose steroids. Despite intravenous normal saline resuscitation, serum transaminitis persisted in a fluctuating manner. Ultimately, a liver biopsy confirmed GH. Biochemically, GH is driven by high amounts of both circulating glucose and insulin or by the administration of high-dose steroids. Improving glycemic control is the mainstay of treatment for GH. However, in our case, improvement in glycated hemoglobin of just 0.6% was enough to achieve symptomatic relief, supporting recent claims of the involvement of other identified factors in disease development.
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http://dx.doi.org/10.1159/000437048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520193PMC
August 2015

Retrieval of a sharp foreign body from the stomach: a novel approach.

Endoscopy 2014 27;46 Suppl 1 UCTN:E105-6. Epub 2014 Mar 27.

University of South Dakota - Sanford School of Medicine, Sioux Falls, South Dakota, USA.

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http://dx.doi.org/10.1055/s-0033-1359189DOI Listing
November 2014

Undifferentiated carcinoma of pancreas: a rare entity with aggressive behavior and possible genetic link.

S D Med 2014 Mar;67(3):97-9

Unlabelled: An aggressive undifferentiated carcinoma of pancreas is a rare tumor, especially with a strong personal and family history of malignant melanoma. Limited literature review and few case reports described a genetic association between distinct types of pancreatic cancer and malignant melanoma.

Case Report: We present an uncommon case of an aggressive undifferentiated carcinoma of the pancreas in a 50-year-old Caucasian female. Initially, she presented with intermittent epigastric postprandial pain and mild nausea. A computed tomography scan of the abdomen showed a 5 cm heterogenous pancreatic tail mass, which on biopsy was found to be a poorly differentiated non-small cell carcinoma. Past medical history included malignant melanoma, with extensive family history of pancreatic cancer and malignant melanoma. However, not genetically confirmed, a hereditary pancreatic linkage was highly suspected. A week later, repeat computed tomography demonstrated tremendous enlargement of the pancreatic tail mass. Within a few weeks, the patient developed aggressive metastasis in various organ systems, followed by multiple surgeries. An emergent first round of chemotherapy was started, followed by an intensive care unit stay, and she eventually died.

Conclusion: Our case exposes the aggressive behavior of undifferentiated carcinoma of pancreas, along with possible hereditary link between pancreatic cancer and malignant melanoma.
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March 2014

Verrucous carcinoma of the esophagus: a potential diagnostic dilemma.

Case Rep Gastroenterol 2013 Sep 28;7(3):498-502. Epub 2013 Nov 28.

Department of Gastroenterology, Sanford Medical Center, University of South Dakota, Sioux Falls, S. Dak., USA.

Verrucous carcinoma of the esophagus is a rare variant of squamous cell carcinoma associated with human papillomavirus. We report the case of a 58-year-old female who presented with ongoing symptoms of dysphagia. On previous endoscopies she had been noted to have a large polyp-like mass involving the esophagus, with negative biopsies for malignancy. Repeat endoscopy with concurrent endoscopic ultrasound showed a large semi-pedunculated polyp in the distal esophagus and a hypoechoic, irregular mass involving the gastroesophageal junction with esophageal thickening. Deep layer biopsies showed pseudoepitheliomatous hyperplasia with immunohistochemical staining positive for human papillomavirus. The patient was subsequently treated with chemo-radiation followed by esophagectomy.
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http://dx.doi.org/10.1159/000357303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901627PMC
September 2013

Giant hepatic hemangioma masquerading as a gastric subepithelial tumor.

Gastroenterol Hepatol (N Y) 2013 Jun;9(6):396-8

Department of Gastroenterology, Hematology, and Nutrition.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3736798PMC
June 2013

Clinical decision making in the management of pancreatic cystic neoplasms.

Expert Rev Gastroenterol Hepatol 2013 May;7(4):353-60

Sanford Digestive Health Center, University of South Dakota, Sioux Falls, SD, USA.

Pancreatic cystic lesions continue to pose diagnostic and management dilemmas for physicians. This may be related, in part, to the fact that these lesions represent a range of diagnostic possibilities, from inflammatory cysts and nonmucinous cysts to mucinous cysts, which may or may not have foci of invasive malignancy. Adequate characterization of cystic lesions is necessary to help devise a management plan. Moreover, patient-related factors such as comorbid conditions are often essential in deciding whether patients should be managed by a conservative approach of watchful waiting versus surgical resection, if so indicated. This review summarizes the recent advances in the management of pancreatic cystic neoplasms.
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http://dx.doi.org/10.1586/egh.13.23DOI Listing
May 2013

Role of endoscopic ultrasonography in evaluation of metastatic lesions to the pancreas: a tertiary cancer center experience.

Pancreas 2013 Apr;42(3):516-23

Department of Gastroenterology, University of Texas-MD Anderson Cancer Center, Houston, TX 77030, USA.

Objectives: Metastatic lesions to the pancreas pose diagnostic challenges with regards to their differentiation from primary pancreatic cancer. Data on the yield of endoscopic ultrasonography (EUS)-guided fine-needle aspiration in detection of these lesions are limited.

Methods: This is a retrospective review of 23 patients referred to a tertiary referral center for further evaluation of suspected pancreatic metastases. Main outcome measures were diagnostic yield of endoscopic ultrasonography-guided fine-needle aspiration in evaluation of metastatic lesions to the pancreas.

Results: Of 644 patients, 23 (3.6%) undergoing EUS of the pancreas were diagnosed to have metastatic disease to the pancreas based on clinical, radiological, and cytological results. Mean (SD) age was 64.3 (11.7) years. Of the 23 patients, 18 (78.3%) were asymptomatic. Mean (SD) size of lesion on EUS was 39.1 (19.9) mm. A diagnosis of malignant lesion was made in 21 of 23 cases, with a diagnostic accuracy of 91.3%.

Conclusions: Metastatic lesions to the pancreas present as incidental, solitary mass lesions on staging or surveillance imaging. Endoscopic ultrasonography-guided fine-needle aspiration is an important tool in the characterization and further differentiation of metastatic lesions to the pancreas from primary pancreatic cancer.
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http://dx.doi.org/10.1097/MPA.0b013e31826c276dDOI Listing
April 2013

First report of celiac plexus block for refractory abdominal pain secondary to peripancreatic colon cancer metastasis.

Gastrointest Endosc 2012 Sep 9;76(3):692-3. Epub 2012 Feb 9.

Department of Gastroenterology, Hepatology and Nutrition, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.

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http://dx.doi.org/10.1016/j.gie.2011.08.026DOI Listing
September 2012

EUS-FNA for pancreatic neuroendocrine tumors: a tertiary cancer center experience.

Dig Dis Sci 2012 Mar 1;57(3):791-800. Epub 2011 Oct 1.

Department of Gastroenterology, MD Anderson Cancer Center, 1515-Holcombe Blvd., Unit #1466, Houston, TX 77030, USA.

Objectives: Pancreatic neuroendocrine tumors (PNET) are fairly uncommon. Recent data highlight the importance of EUS in diagnosis of PNET. With this background, we decided to review our experience from a tertiary cancer center with regard to the presentation and clinical features of PNET and the diagnostic utility of EUS-FNA in this scenario.

Methods: We identified patients who underwent EUS at our institution between January 1st 2001 and December 31st 2009 for a suspected PNET. Data on clinical features, cross-sectional imaging findings, EUS findings, and cytology results were collected.

Results: A total of 81 patients were referred for EUS-FNA for a suspected PNET. Mean age was 58.1 years. There were 41 (50.6%) males. PNET was found incidentally in 38 (46.9%) patients. Computed tomography scanning identified a pancreatic mass in 72 out of 79 (91.1%) cases. Mean diameter of the largest lesion seen on EUS was 27.5 mm (range: 6.9-80 mm). The most common site (34; 42%) was the head of the pancreas. EUS-FNA correctly confirmed a PNET in 73 out of 81 cases with diagnostic accuracy of 90.1%. Seven (8.6%) out of 81 patients had functional lesions, including three gastrinomas and four insulinomas. Liver metastases were found in 31 out of 81 (38.3%) cases. Of the 31 patients with liver metastasis, the mean diameter of lesions on EUS was 33.9 mm compared with 23.5 mm in patients without liver metastasis (P = 0.005).

Conclusion: EUS-FNA is a reliable modality for further characterization of suspected lesions and for establishing a tissue diagnosis. The occurrence of complications of EUS-FNA in this setting is low. Non-functional PNET are more frequently encountered than functional PNET.
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http://dx.doi.org/10.1007/s10620-011-1912-7DOI Listing
March 2012

Giant gastric hyperplastic polyp: not always a benign lesion.

J Ark Med Soc 2010 Oct;107(5):89-92

Giant gastric hyperplastic polyps constitute of around 76% of all gastric polyps found. They are often found incidentally on upper GI endoscopy. They often present with occult GI bleeding causing iron deficiency anemia or partial gastric outlet obstruction. Although mostly benign, they do have potential for malignant transformation and hence must be excised endoscopically or surgically, whichever may be feasible. We hereby present a couple of cases of gastric hyperplastic polyps in an attempt to add to the current literature on this rather rare entity.
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October 2010