Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Mar 15, 2018; 10(3): 91-95
Published online Mar 15, 2018. doi: 10.4251/wjgo.v10.i3.91
Case of pancreatic metastasis from colon cancer in which cell block using the Trefle® endoscopic scraper enables differential diagnosis from pancreatic cancer
Akihisa Kato, Itaru Naitoh, Hiroyuki Kato, Kazuki Hayashi, Katsuyuki Miyabe, Michihiro Yoshida, Yasuki Hori, Makoto Natsume, Naruomi Jinno, Takeshi Yanagita, Shuji Takiguchi, Satoru Takahashi, Takashi Joh
Akihisa Kato, Itaru Naitoh, Kazuki Hayashi, Katsuyuki Miyabe, Michihiro Yoshida, Yasuki Hori, Makoto Natsume, Naruomi Jinno, Takashi Joh, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
Hiroyuki Kato, Satoru Takahashi, Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
Takeshi Yanagita, Shuji Takiguchi, Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
Author contributions: Kato A and Naitoh I mainly designed this concept and drafted the article; Miyabe K, Yoshida M, Hori Y, Natsume M, Jinno N and Yanagita T performed the treatment for the patient and provided data involved in clinical course; Kato H and Takahashi S performed histological evaluation and provided data involved in immunohistochemistry; Hayashi K and Takiguchi S revised the article for important intellectual content; Joh T gave a final approval of the article.
Informed consent statement: Written informed consent was obtained from the patient.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Itaru Naitoh, MD, PhD, Assistant Professor, Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan. inaito@med.nagoya-cu.ac.jp
Telephone: +81-52-8538211 Fax: +81-52-8520952
Received: December 5, 2017
Peer-review started: December 5, 2017
First decision: January 3, 2018
Revised: January 9, 2018
Accepted: February 3, 2018
Article in press: February 3, 2018
Published online: March 15, 2018
Abstract

Endoscopic transpapillary brush cytology and forceps biopsy during endoscopic retrograde cholangiopancreatology are generally used to obtain pathological evidence of biliary strictures. Recently, the new endoscopic scraper Trefle® has been reported and demonstrated high cancer detectability in malignant biliary strictures. This device is used to scrape the stricture over the guidewire, and, in the original method, the tissue and/or cell samples obtained are subjected to histological and/or cytological analysis separately. However, discrimination of chunks of tissue is hampered by the opacity of the surrounding fluid. We have developed a cell block technique for the Trefle® device without dividing obtained specimens into tissue and cellular components, which is the simplest method and enables immunohistochemical analysis. We present a case of obstructive jaundice diagnosed immunohistochemically as pancreatic metastasis from colon cancer using cell block sections obtained with the Trefle® device, which procedure is as easy as conventional brush cytology.

Keywords: Trefle®, Cell block, Endoscopic scraper, Pancreatic metastasis, Biliary strictures

Core tip: We described a case of pancreatic metastasis from colon cancer in which cell block technique with the specimens obtained by the new endoscopic device Trefle® was useful in the differential diagnosis from pancreatic cancer. The combination of cell block technique and Trefle® might be a promising method in the diagnosis of biliary strictures because this procedure is as easy as conventional brush cytology.