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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e129
Material and methods:
A EUS-guided fine-needle biopsy (EUS-
FNB) of the lesion was performed using a 25 fenestrated needle in
a single pass changing the position of the echoendoscope to safely
target the solid tissue only without going through the gallbladder
lumen. Antibiotic prophylaxis was used. Procedure was uneventful.
Adequate tissue specimen was obtained for histopathological
assessment and proved to be metastatic melanoma with BRAF
mutation. Thus, the patient started on BRAF inhibitor Vemurafenib
with rapid response.
Results:
Metastases of melanoma to the gallbladder are rare and
generally associated with widespread multi-visceral disease where
prognosis is poor. In this case EUS-FNB consented to diagnose
a limited metastatic disease involving an unusual location and
provided tissue for repeated genetic test that was crucial to address
the following treatment.
Conclusions:
To our knowledge, this is the first case reported in
literature of metastatic melanoma of the gallbladder diagnosed by
EUS-FNB.
V.02.14
THE DIAGNOSIS OF AMOEBIC COLITIS IN NORTHERN ITALY: NOT
AN EASY TASK!
Rossi M.*, Fasoli R., Tieppo C., Tasini E., De Pretis G.
Gastroenterologia Ospedale Santa Chiara, Trento, Italy
Background and aim:
Amoebic colitis can mimic closely inflam
matory bowel disease from clinical and endoscopic point of views
and create severe management problems given a totally different
therapeutic approach.
Furthermore, the paucity of observed cases make its recognition
troublesome.
Material and methods:
We describe the case of a 42 years old
Albanian woman working as a caregiver of an old lady who had a
previous history of world-wide journeys.
She has been admitted in another hospital with a 9 months history
of chronic bloody diarrhea, with previous evidence of non-specific
proctitis.
The clinical picture had dramatically evolved in the week before
admission, with development of bloody diarrhoea, abdominal pain
and fever, mild anaemia, leukocytosis and elevation of C-reactive
protein. A standard search for stools parasites gave negative results.
She has been treated with a combination of iv. steroids and iv.
metronidazole.
Once trasferred to our ward a colonoscopy revealed flask-shaped
multiple ulcerations in the left colon, with histology suggesting
acute ulcerative colitis; the examination of fresh stool specimens
revealed trophozoites of Entamoeba histolytica.
Results:
Withdrawal of prednisone and continuation of
metronidazole allowed complete clinical recovery.
Conclusions:
The clinical case we report stresses :
-the importance of taking an accurate history, since the old lady has
probably been the source of the infection of the caregiver due to her
state of healthy carrier passing Entamoeba cysts in the stools.
-the possibility of an insidious course in patients with amoebic
colitis
-the necessity to examine fresh stools specimens to diagnose an
infestation by Entamoeba histolytica.
-the possibility to misinterpret colorectal flask-shaped ulcers, in
spite of their specificity.
-histology is not helpful.