constipation without other related clinical symptoms at the present time. Colonoscopic examination showed marked melanosis coli of the entire mucosa. In the.
Letters to the editor
Figure 1. A, CT image of 8.5 7.5 7.5 cm heterogeneous solid pancreatic lesion involving the head and uncinated process with mass effect; no vascular invasion. B, EUS image from the duodenal bulb; heterogeneous mass with necrotic center invading duodenal wall. C, EUS-FNA specimen showing numerous malignant-appearing cells, singly and in acinar arrangements, with macronucleoli (Diff-Quik stain, orig. mag. 400). D, Positive reactivity to SMAD4 (immunohistochemical stain, orig. mag. 200).
and client satisfaction. ROSE is a great support to the endosonographer and may pin down the diagnosis even in challenging cases like ACC, thereby increasing the effectiveness of EUS-FNA. Benjamin Tharian, MBBS, MD, MRCP, FRACP Ashley L. Canipe, MBBS, MD Konrad Krall, CT (ASCP) Center for Interventional Endoscopy Florida Hospital Robert H. Hawes, MBBS, MD, FASGE Institute for Minimally Invasive Therapy Center for Interventional Endoscopy Florida Hospital University of Central Florida College of Medicine Shantel Hébert-Magee, MBBS, MD Center for Interventional Endoscopy Florida Hospital Orlando, Florida, USA REFERENCES 1. Wisnoski NC, Townsend CM, Nealon WH, et al. 672 patients with acinar cell carcinoma of the pancreas: a population-based comparison to pancreatic adenocarcinoma. Surgery 2008;144:141-8. 2. La Rosa S, Adsay V, Albarello L, et al. Clinicopathologic study of 62 acinar cell carcinomas of the pancreas: insights into the morphology and immunophenotype and search for prognostic markers. Am J Surg Pathol 2012;36:1782-95. http://dx.doi.org/10.1016/j.gie.2014.10.016
1050 GASTROINTESTINAL ENDOSCOPY Volume 81, No. 4 : 2015
An unusual presentation of anisakiasis in the colon (with video) To the Editor: Anisakiasis is a zoonotic disease that was first described in 1960.1 Since then, its prevalence has increased during the past few decades from countries with traditions of consuming raw, undercooked, or marinated fish, such as Japan, European countries, Latin America, and North America. The symptoms of intestinal anisakiasis are nonspecific: sometimes colicky and diffuse abdominal pain, nausea, and vomiting, or even allergic manifestations. The most common sites of involvement are the stomach and the small intestine. Here we report an unusual case of anisakiasis involving the colon. A 54-year-old woman was admitted to our hospital for colorectal cancer screening. She had a history of mild constipation without other related clinical symptoms at the present time. Colonoscopic examination showed marked melanosis coli of the entire mucosa. In the ascending colon there was a 12-mm nodular submucosal lesion. Because of its resemblance to a polypoid tumor, an en bloc EMR was performed with the use of submucosal saline solution injection (Fig. 1A and B). Histopathologic examination of the sample revealed an eosinophilic abscess in the colonic submucosal layer, with occasional foreign body giant cells, and containing an unsuspected parasitic nematode. The size and some morphologic www.giejournal.org
Letters to the editor
Figure 1. A and B, Endoscopic view of lesion before and after EMR. C, Melanosis coli and submucosal eosinophilic abscess containing the Anisakis nematode (H&E, orig. mag. 4). D, Anisakis simplex showing Y-shaped lateral cords and surrounded by eosinophils (H&E, orig. mag. 20).
features of the parasite (Y-shaped lateral cords) were consistent with Anisakis simplex (Fig. 1C and D). The results of serologic and other laboratory tests were within normal limits. At a guided interview later, she confirmed having eaten assiduously “boquerones en vinagre,” or raw anchovies (Engraulis encrasicolus) pickled in vinegar, a typical Mediterranean food. The patient has remained asymptomatic. This case depicts a rare presentation of colon anisakiasis in which endoscopic resection was both diagnostic and therapeutic. Anisakiasis is rarely located in the colon, with less than 1% in the reported medical literature among all cases of GI anisakiasis.2 More than half of these cases were on the right side of the colon. It is believed that the large distance to the colon is too far for the ingested larvae to travel. The clinical features in symptomatic patients are often similar to those of acute appendicitis, or intestinal occlusion simulating a tumor of the colon. Prior preventive measures or any suspicion of the invasion of larvae are important clues to be determined beforehand. Otherwise, colonoscopy may be used to diagnose and treat the cause, avoiding unnecessary surgery. Fausto Riu Pons, MD Department of Gastroenterology Javier Gimeno Beltran, MD Raquel Albero Gonzalez, MD Department of Pathology Marco Antonio Álvarez Gonzalez, MD, PhD www.giejournal.org
Josep M. Dedeu Cusco, MD, PhD Luis Barranco Priego, MD Agustín Seoane Urgorri, MD Department of Gastroenterology Hospital del Mar Barcelona, Spain REFERENCES 1. Van Thiel P, Kuipers FC, Roskam RT. A nematode parasitic to herring, causing acute abdominal syndromes in man. Trop Geogr Med 1960;12:97-113. 2. Mineta S, Shimanuki K, Sugiura A, et al. Chronic anisakiasis of the ascending colon associated with carcinoma. J Nippon Med Sch 2006;73:169-74. http://dx.doi.org/10.1016/j.gie.2014.10.017
Chasing zebras: large hyperplastic gastric polyp with inflammatory fibroid changes To the Editor: A 47-year-old Hispanic man had experienced epigastric pain for 2 years. A 1.7 cm mass was seen in the gastric body on abdominal CT (Fig. 1A). EGD revealed a 2-cm polyp near the incisura with a central nipple-like protrusion draining clear fluid (Fig. 1B). EUS showed a 2 1.5 cm lesion in the first and second sonographic layers with indistinct margins. The fourth sonographic layer was intact. The Volume 81, No. 4 : 2015 GASTROINTESTINAL ENDOSCOPY 1051
