ABSTRACT
Las neoplasias quísticas pancreáticas se observan en cuerpo y cola del páncreas en mujeres de mediana edad. Son consideradas lesiones premalignas y requieren extirpación quirúrgica según tamaño y características imagenológicas. El cistoadenoma mucinoso es una neoplasia epitelial que produce mucina, forma quistes que surgen del páncreas y puede progresar a carcinoma invasivo. Representan la mitad de las neoplasias quísticas del páncreas. Lesiones sintomáticas en pacientes operables deben resecarse. En caso de lesiones asintomáticas, es importante diferenciar su estirpe (serosa o mucinosa) y su riesgo de degeneración. Una vez valorado el paciente, se indica tratamiento quirúrgico u observación. Caso clínico: Paciente femenina de 43 años con antecedentes de hipertensión arterial sistémica e hipotiroidismo controlados, quien presenta cuadro clínico caracterizado por distensión abdominal y síntomas dispépticos. Se realiza ultrasonografía abdominal y tomografía de abdomen y pelvis con doble contraste evidenciándose lesión redondeada hipodensa en rango líquido con septos finos en su interior, definida, que impresiona formar parte de cuerpo y cola de páncreas. Se decide resolución quirúrgica mediante laparotomía exploradora. Informe histopatológico: cistoadenoma mucinoso cuerpo y cola de páncreas. Conclusión: Las neoplasias quísticas del páncreas son tumoraciones que en la actualidad gracias al desarrollo de nuevas tecnologías se observan en nuestra práctica médica con más frecuencia. Al sospechar una neoplasia quística del páncreas, el tratamiento adecuado es la resección quirúrgica adaptada a la localización del tumor. El manejo de esta patología debe ser individualizado de acuerdo a las características clínicas, imagenológicas e histopatológicas del mismo(AU)
Pancreatic cystic neoplasms are observed in the body and tail of the pancreas in middle-aged women. They are considered premalignant lesions and require surgical removal depending on their size and imaging characteristics. Mucinous cystadenoma is an epithelial neoplasm that produces mucin, forms cysts that arise from the pancreas, and can progress to invasive carcinoma. They represent half of the cystic neoplasms of the pancreas. Symptomatic lesions in operable patients should be resected. In the case of asymptomatic lesions, it is important to differentiate their type (serous or mucinous) and their risk of degeneration. Once the patient has been assessed, surgical treatment or observation is indicated. Clinical case: A 43-year-old female patient with a history of controlled systemic arterial hypertension and hypothyroidism, who presented a clinical picture characterized by abdominal distension and dyspeptic symptoms. Abdominal ultrasonography and tomography of the abdomen and pelvis with double contrast were performed, a rounded, hypodense lesion in the liquid range with fine septa inside, defined, which appears to be part of the body and tail of the pancreas. Surgical resolution was decided by exploratory laparotomy. Histopathological report: mucinous cystadenoma of the body and tail of the pancreas. Conclusion: Cystic neoplasms of the pancreas are tumors that today, thanks to the development of new technologies, are observed more frequently in our medical practice. When suspecting a cystic neoplasm of the pancreas, the appropriate treatment is surgical resection adapted to the location of the tumor. The management of this pathology must be individualized according to its clinical, imaging and histopathological characteristics(AU)
Subject(s)
Humans , Female , Adult , Pancreas , Pancreatic Neoplasms , Cystadenoma, Mucinous , Pancreatectomy , Hypertension , Hypothyroidism , LaparotomyABSTRACT
Objective:To evaluate the efficacy and safety of the second session of endoscopic ultrasound-guided lauromacrogol ablation (EUS-LA) for pancreatic cystic neoplasms (PCNs).Methods:A total of 74 patients with suspected of PCNs who underwent EUS-LA in the First Medical Center of Chinese PLA General Hospital from April 2015 to December 2020 were enrolled in the study. Fifteen of them underwent the second ablation. The efficiency of EUS-LA was determined based on the change of lesion volume during the imaging follow-up, categorized into complete resolution (CR), partial resolution (PR) and stable disease (SD). The safety was determined by the complication incidence.Results:Among the 15 patients undergoing the second EUS-LA, there were 9 males and 6 females with age of 51.5±17.6 years. Thirteen patients completed imaging follow-up after the second EUS-LA, CR was achieved in 8 patients, PR in 2 patients and 3 in SD. The CR rate increased from 0 after the first ablation to 8/13 after the second ablation ( P=0.002). The median cyst diameter decreased from 22.0 mm before the second ablation to 15.0 mm after the second ablation ( Z=-2.666, P=0.008) and the median cyst volume reduced from 2 419.7 mm 3 to 1 099.5 mm 3 ( Z=-2.134, P=0.033). The complication incidence of the second ablation was 2/15, similar to that of the first ablation. Conclusion:The second ablation is effective and safe without increasing the complication incidence in patients without achieving CR after the first EUS-LA.
ABSTRACT
As the detection rate of pancreatic cystic neoplasms (PCN) increases,recommendations or guidelines for the diagnosis and treatment of PCN have been released from professional organizations.From the perspective of radiology,we compared seven guidelines in terms of general introduction,preoperative monitoring methods and strategies,stratification of risk factors,surgical indications,and postoperative follow-ups,aiming to provide references for the evaluation of images and the formulation of individualized approach for the treatment of PCN.
Subject(s)
Humans , Pancreatic Cyst/therapy , Pancreatic Neoplasms/therapy , Pregnenolone Carbonitrile , Radiography , RadiologyABSTRACT
The diagnostic rate of pancreatic cystic lesions (PCLs) is increasing year by year with the development of radiological techniques. PCLs are a group of heterogeneous diseases, mainly including intraductal papillary mucinous neoplasms, mucinous cystic neoplasm, serous cystic neoplasm, and other rare cystic lesions, and different types of pancreatic cystic neoplasms have different biological behaviors and rates of malignant transformation. A precise diagnosis of patients with pancreatic cystic neoplasms helps to select surgical treatment for some patients and perform follow-up observation for other patients. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle aspiration play an important role in the diagnosis and differential diagnosis of PCLs. Endoscopic ultrasound-guided ablation therapy for PCLs is still in the early stage although it has been performed for more than a decade; however, it is safe and effective and can be used as an substitutive therapy for surgical operation, and therefore, it holds promise for clinical application.
ABSTRACT
Resumen Los quistes pancreáticos comprenden una amplia variedad de lesiones cada vez más frecuentemente diagnosticadas debido tanto al empleo creciente de técnicas de imagen como al envejecimiento de la población. Entre ellas, las neoplasias quísticas mucinosas son especialmente relevantes por su potencial de malignización. Aunque la ecografía abdominal, la tomografía axial computarizada y la resonancia magnética suelen ser las pruebas diagnósticas de imagen iniciales, muchas veces los hallazgos morfológicos no son suficientes para su diferenciación. La ecoendoscopia se ha convertido en la mejor prueba para su caracterización ya que permite realizar estudio morfológico y también del líquido obtenido mediante punción, aunque su precisión diagnóstica para la detección de quistes de estirpe mucinosa y de malignidad sigue siendo baja. La importancia de la adecuada caracterización radica tanto en la detección precoz de las lesiones preneoplásicas y malignas como en evitar cirugías innecesarias. La indicación de ecoendoscopia, de tratamiento quirúrgico y de seguimiento varía entre las distintas guías de práctica clínica estando actualmente en duda especialmente el tratamiento y seguimiento de las neoplasias quísticas mucinosas papilares intraductales de rama lateral por el menor riesgo de degeneración y su asociación con el cáncer de páncreas.
Abstract Cystic pancreatic lesions comprise a wide variety of lesions that are being increasingly diagnosed due to the more frequent use of imaging techniques and the aging of the population. Among these lesions, mucinous cystic neoplasms are especially relevant because of their malignant potential. Although abdominal ultrasound, computerized tomography and magnetic resonance imaging are usually the initial diagnostic imaging tests, morphological findings are often not enough for their differentiation. Endoscopic ultrasound has become the best test for their characterization because it allows morphological study and fluid analysis obtained by puncture of the lesion, although its diagnostic accuracy for the detection of mucinous and malignant cysts remains low. The importance of proper characterization is the early detection of preneoplastic as well as malignant lesions and to avoid unnecessary surgery. Clinical practice guidelines differ about the indications for endoscopic ultrasound, surgical treatment and follow-up of these lesions. Questions specially remains in the management of side-branch intraductal papillary neoplasm because of their lower risk of degeneration and their association with pancreatic cancer.
Subject(s)
Humans , Pancreatic Neoplasms , Cysts , Diagnosis , Magnetic Resonance Imaging , Magnetic Resonance SpectroscopyABSTRACT
This study aims to predict expression of Ki67 molecular marker in pancreatic cystic neoplasm using radiomics. We firstly manually segmented tumor area in multi-detector computed tomography (MDCT) images. Then 409 high-throughput features were automatically extracted and the least absolute shrinkage selection operator (LASSO) regression model was used for feature selection. After 200 bootstrapping repetitions of LASSO, 20 most frequently selected features made up the optimal feature set. Then 200 bootstrapping repetitions of support vector machine (SVM) classifier with 10-fold cross-validation were used to avoid overfitting and accurately predict the Ki67 expression. The highest prediction accuracy could achieve 85.29% and the highest area under the receiver operating characteristic curve (AUC) was 91.54% with a sensitivity (SENS) of 81.88% and a specificity (SPEC) of 86.75%. According to the results of experiment, the feasibility of predicting expression of Ki67 in pancreatic cystic neoplasm based on radiomics was verified.
ABSTRACT
The increasing discovery of pancreatic cystic neoplasm is a recent trend because of the widespread use and development of imaging techniques. Physicians have to recognize the different characteristics of the cystic neoplasms so that a determination may be selected regarding the potential for malignancy. Appropriate evaluation of pancreatic cystic lesion includes a multidisciplinary approach involving gastroenterologists with experience in endoscopic ultrasound, radiologist, and pancreatic surgeons. The selective approach is important in management of this neoplasm with minimizing incorrect diagnosis and unnecessary surgery. Considering the characteristic features of pancreatic cystic neoplasm, the clinical decision should be tailored according to needs and conditions of the individual patients.
Subject(s)
Humans , Diagnosis , Follow-Up Studies , Pancreatic Cyst , Surgeons , Ultrasonography , Unnecessary ProceduresABSTRACT
With the popularization of the aging population and imaging examination,detection rate of the pancreatic cystic neoplasm are increasing in recent years,which commonly includes intraductal papillary mucinous neoplasm (IPMN),mucinous cystic neoplasm (MCN),serous cystic neoplasm (SCN) and solid pesudopapillary tumor (SPT).The differential diagnosis is essential to decide surgical resection or observation.The diagnosis of pancreatic cystic tumor relies primarily on imaging examination.For patients who need to long-term follow-up,the MRI should be recommended.The preoperative precision diagnosis that is performed by traditional imaging,tumor markers,endoscopic ultrasonography and contribute to make the individualized therapy plan.The follow-up strategy is optimal for majority of patients with SCN.According to patients' condition,the surgical resection or observation will be selected for patients with IPMN or MCN after finding malignant transformation-related high risk factors.SPT has been classified as the malignant tumor,and if patients are suspected to have SPT by imaging examination,surgical resection should be recommended.
ABSTRACT
Pancreatic cystic neoplasm is a general term for a large class of pancreatic tumors,including mucinous cystic neoplasm,serous cystic neoplasm,and pancreatic intraductal papillary mucinous neoplasm.Due to the limitations of the current techniques in differential diagnosis and disease staging,different centers have great discrepancies in their treatment.The 103rd annual meeting of American College of Surgeons (ACS)as a grand meeting in the field of surgery bringed together a large number of clinical research results every year.Therefore,authors selected and reviewed contents about pancreatic cystic neoplasm,with a view to provide new ideas in terms of its management and further research.
ABSTRACT
With the development of abdominal imaging examination,detection rate of pancreatic cystic neoplasms is increasing in recent years.Misdiagnosis and unreasonable treatment sometimes are unavoidable since the variable subtype,pathology and natural history.Multidisciplinary team (MDT)including surgeons,radiologists,gastro-enterologists and pathologists is very helpful to make an exact diagnosis and appropriate treatment for pancreatic cystic neoplasms.However,because of the complexities of pancreatic cystic neoplasms,challenges and difficulties of MDT always exist.In this article,authors summarized the newest advancement of pancreatic cystic neoplasms and highlighted the experiences in the management of pancreatic cystic neoplasms from MDT,aiming to seek the optimal strategy.
ABSTRACT
With the development of abdominal imaging examination,detection rate of pancreatic cystic neoplasms is increasing in recent years.Misdiagnosis and unreasonable treatment sometimes are unavoidable since the variable subtype,pathology and natural history.Multidisciplinary team (MDT)including surgeons,radiologists,gastro-enterologists and pathologists is very helpful to make an exact diagnosis and appropriate treatment for pancreatic cystic neoplasms.However,because of the complexities of pancreatic cystic neoplasms,challenges and difficulties of MDT always exist.In this article,authors summarized the newest advancement of pancreatic cystic neoplasms and highlighted the experiences in the management of pancreatic cystic neoplasms from MDT,aiming to seek the optimal strategy.
ABSTRACT
Objective To evaluate the safety and feasibility of endoscopic ultrasonography(EUS)-guided dehydrated ethanol lavage on treatment of pancreatic cystic neoplasms(PCN). Methods The data of 15 patients with PCN treated by EUS-guided dehydrated ethanol lavage in Nanjing Drum Tower Hospital from April 2014 to December 2016 were retrospectively analyzed. All the patients underwent EUS-guided fine needle aspiration, and then the cyst cavity was lavaged with dehydrated ethanol. The curative effects and complications were evaluated after the procedure. Results Each patient had one operation and all the operations were successful. No operation-related intraoperative or postoperative complications occurred. Patients were followed up for a median time of 15 months(range from 3-30 months).Twelve patients finished a long term follow-up,including 6 cases of complete remission and 6 cases of partly remission. None of the patients underwent surgical resection. Conclusion Dehydrated ethanol lavage is safe and feasible for treatment of PCN.
ABSTRACT
Pancreatic cystic and neoplasms are being diagnosed with increasing frequency. Accurate diagnosis and determination of benign versus malignant lesions is crucial for determining need for surveillance versus surgery or endoscopic therapy as well as avoiding unnecessary surgery in cysts with no malignant potential. Tumor markers such as KRAS and GNAS hold promise, but which molecular marker or a combination of markers is most useful and cost effective remains to be seen. Advanced imaging with confocal laser endomicroscopy can serve as an optical biopsy and play a part in the diagnostic algorithm. Microforceps aided biopsy of pancreatic cyst wall and tumor contents hold great promise as they allow direct tissue acquisition. Much progress has been made in the role of EUS guided evaluation of pancreatic cystic neoplasms over the last several years, and with the advances enumerated above, the future is more than just a few shades of gray. Future studies should include prospective multi-arm trials of microforceps biopsy versus conventional EUS-FNA and use of biochemical and molecular markers, confocal laser endomicroscopy or a combination thereof to determine best approach to pancreatic cystic neoplasms. In Osler's words, 'Medicine is a science of uncertainty and an art of probability'. Incorporation of advanced imaging and molecular markers into a new diagnostic algorithm with subsequent validation through retrospective and prospective studies has the potential to increase diagnostic accuracy and guide optimal management of patients and improve outcomes.
ABSTRACT
Pancreatic cystic and neoplasms are being diagnosed with increasing frequency. Accurate diagnosis and determination of benign versus malignant lesions is crucial for determining need for surveillance versus surgery or endoscopic therapy as well as avoiding unnecessary surgery in cysts with no malignant potential. Tumor markers such as KRAS and GNAS hold promise, but which molecular marker or a combination of markers is most useful and cost effective remains to be seen. Advanced imaging with confocal laser endomicroscopy can serve as an optical biopsy and play a part in the diagnostic algorithm. Microforceps aided biopsy of pancreatic cyst wall and tumor contents hold great promise as they allow direct tissue acquisition. Much progress has been made in the role of EUS guided evaluation of pancreatic cystic neoplasms over the last several years, and with the advances enumerated above, the future is more than just a few shades of gray. Future studies should include prospective multi-arm trials of microforceps biopsy versus conventional EUS-FNA and use of biochemical and molecular markers, confocal laser endomicroscopy or a combination thereof to determine best approach to pancreatic cystic neoplasms. In Osler's words, ‘Medicine is a science of uncertainty and an art of probability’. Incorporation of advanced imaging and molecular markers into a new diagnostic algorithm with subsequent validation through retrospective and prospective studies has the potential to increase diagnostic accuracy and guide optimal management of patients and improve outcomes.
ABSTRACT
Nowadays, increasing use of cross sectional imaging especially multi-detector computed tomography causes greater detection of pancreatic cysts. The differentiation between pancreatic pseudocyst and cystic pancreatic neoplasm is essential in determining the proper treatment and prognosis. Typical imaging findings of benign pancreatic cystic lesion, especially in the asymptomatic patient, can be refined through imaging follow up. Fast scanning time and the thin slice of multidetector computed tomography provides a high resolution of image quality, less motion artifact and multi-planar reformation. It is a non invasive technique and entails few complications. However, in an atypical imaging pattern or if suggestive of malignant in nature, further investigation with endoscopic retrograde cholangiopancreatography (ERCP) with fine needle aspiration (FNA) for tissue diagnosis or cytology can aid in definite diagnosis.