BackgroundThe aim of this study was to compare the diagnostic performances of the collagen proportionate area (CPA) and liver stiffness measurement (LSM) for liver fibrosis quantification in chronic hepatitis C (CHC).MethodsA total of 137 eligible consecutive Taiwanese patients (74 women and 63 men; age 21–80 years; median age 54 years), with CHC underwent LSM by using acoustic radiation force impulse (ARFI) elastography and an immediate percutaneous liver biopsy for METAVIR scoring. Liver tissue sections were stained using picrosirius red. Areas of the stained collagen and the tissue parenchyma were calculated in pixels. The ratio between the two areas was expressed as a CPA percentage. The result of LSM was presented as shear wave velocity (SWV).ResultsMETAVIR fibrosis (F) stages were dichotomized using the CPA (%) and SWV (m/s), and the optimal cut-off values were 7.47 and 1.59 for F1 versus F2–4; 12.56 and 1.73 for F1, 2 versus F3, 4; 15.32 and 1.96 for F1–3 versus F4. To dichotomize F1 versus F2–4, the areas under receiver operating characteristic curves for the CPA was 0.9349 (95% confidence interval: 0.8943–0.9755) and for SWV was 0.8434 (0.7762–0.9105) (CPA versus SWV, P = 0.0063). For F1, 2 versus F3, 4, the CPA was 0.9436 (0.9091–0.9781); SWV was 0.8997 (0.8444–0.9551) (P = 0.1587). For F1–3 versus F4, the CPA was 0.8647 (0.7944–0.9349); SWV was 0.9036 (0.8499–0.9573) (P = 0.2585). The CPA could be predicted in a linear regression formula by using SWV and platelet count (R2 = 0.524).ConclusionsThe CPA and ARFI elastography are promising tools for liver fibrosis evaluation. The CPA was superior to ARFI elastography in the diagnosis of significant fibrosis (≥ F2). The CPA may be independent of severe necroinflammation, which may augment liver stiffness.

Primary malignant melanoma of the esophagus (PMME) is a rare tumor with poor prognosis, rapid progression, and early metastasis. It often occurs in the middle to lower part of the esophagus. Endoscopic findings reveal various colors ranging from white, brown, and purple to black, and the lesions could be ulcerative, superficial, or protruding polypoid. Only a few reports about endoscopic findings of PMME are available in the literature. Here, we describe a case of a 77‐year‐old man who suffered from epigastric pain and acid regurgitation for 2 weeks. Endoscopic findings revealed an ulcerative lesion with purple‐black pigmentation in the lower part of the esophagus. Endoscopic biopsy was performed. Hematoxylin and eosin (H&E) staining showed a subepithelial nodule with melanocytosis and a high nuclear‐cytoplasmic (N/C) ratio and macronucleoli. Immunohistochemical staining revealed positive results for S‐100, HMB‐45, and melan‐A. Based on these pathologic and immunohistochemical examinations, the patient was diagnosed with PMME. However, the patient initially hesitated to undergo surgical intervention until he developed dysphagia 2 years later. We also present a series of endoscopic images of PMME of this patient in this paper.

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Gastric metastasis from renal cell carcinoma (RCC) after nephrectomy is unusual, and few cases have been reported, with a mean duration of 6.9 years from the diagnosis of RCC to gastric metastasis. We report a case of gastrointestinal bleeding in a patient who received right radical nephrectomy for RCC 12 years ago. Esophagogastroduodenoscopy found an ulcerative mass, and metastatic RCC was finally diagnosed via histopathological examination and immunohistochemistry staining. RCC usually metastasizes to the lung, lymph nodes, and bone. It rarely metastasizes to the stomach, and there is no specific symptom despite gastric metastasis. Early detection of gastric metastasis should be conducted due to a lack of effective systemic therapy for RCC. In conclusion, endoscopic survey is recommended for patients of RCC with any suspicious symptoms, including epigastric pain, dyspepsia, decreasing appetite, hematemesis, melena, or anemia.

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