Pancreatic mesothelial cyst.

A 60-year-old woman was investigated for abdominal pain and increasing asthenia. Abdominal CT revealed a 25 mm hypodense cystic lesion in the tail of the pancreas. MRI showed a multiloculated cystic lesion, T1-hypointense and T2-hyperintense lesion, without wall enhancement. Endoscopic ultrasound detected a 25 mm multi-loculated cystic lesion, with regular margin and without pancreatic duct communication. Diagnosis of pancreatic mucinous cystadenoma was discussed and the patient was referred to surgery. She underwent distal pancreatectomy with spleen preservation. Pathological examination revealed the diagnosis of pancreatic mesothelial cyst. Histologically, the cyst was multiloculated, lined by cuboidal epithelium, ovoid nuclei and amphophilic cytoplasm, without mucin deposition or cytological atypia. Immunohistochemistry examination revealed positive staining for cytokeratin 5/6, vimentin and calretinin. At 1-year follow-up, she is in her usual health, without any symptoms.

Pancreatic cysts or pancreatic cystic neoplasms? An analysis of 145 cases.

Introduction Frequency of detection of pancreatic cystic lesions increased recent years. The majorities are pseudocysts, the remaining cysts are mainly neoplasms. Proven risk of malignancy affects intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). Material and methods 145 patients operated on at the Department of General and Transplant Surgery in Barlicki Hospital in Lodz, Poland, in 2007-2016 due to pancreatic cystic lesion. The type of surgery, histopathological diagnosis and basic demographic data were analyzed. Results Nonneoplastic cyst (mainly pseudocysts) was found in 66.9% of patients, neoplasms were detected in 33.1%. The mean age was significantly higher in patients with neoplasms than without neoplasm (57.06 years vs. 50.88 years, p = 0.009). Neoplastic cyst occurred more frequently in women (68.75% of women, 31.25% of men, p = 0.001), Nonneoplastic cyst was found significantly more often in men (64.95% of men, 35.05% of women, p = 0.001). Malignant tumor was found in 14.58% of neoplasms cases. Pancreatic resections in neoplastic cysts were performed in 77,08%. In patients with nonneoplastic cysts drainage operations were performed most frequently (80.41%). Conclusions Neoplastic cysts are more common in women. The average age in the group of patients with neoplasms is higher than in the group with nonneoplastic cysts. In women with pancreatic cystic lesion without history for pancreatitis, the probability of neoplasms diagnosis is high. Discussion Pancreatic cystic tumors are treated radically due to the lack of sufficiently sensitive and specific pre-operative examinations. The natural history of mucinous neoplasms (IPMN and MCN) ranges from dysplasia to cancer. There are no guidelines that could be in satisfactory way used in follow up patients with pancreatic cysts.

Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions.

PURPOSE: To facilitate a better understanding of incidentally noted cystic pancreatic lesions, since these lesions often pose a challenge regarding appropriate management. METHODS: This article reviews pathophysiology, prevalence, significance, and recommendations for management of the various pancreatic cystic lesions. Illustrative cases are demonstrated. RESULTS: Diagnostic benign lesions can be left alone. Cross-sectional imaging can be used to follow-up benign appearing lesions and to stage more aggressive ones. Endoscopic ultrasound with fine needle aspiration and cyst fluid analysis can be performed on certain indeterminate lesions. Lesions with high malignant potential should undergo resection. CONCLUSIONS: A better understanding of the variety of incidentally detected pancreatic cystic lesions can help direct appropriate management.

[Methods of intraductal pancreatic hypertension elimination].

The study is devoted to the surgical treatment of benign pancreatic cysts. Results of the internal drainage of pancreatic duct ul system in 76 patients were analyzed. Pancreaticoenterostomy combined with partial pancreatic resection in 21 cases, was performed in 53 patients. The rest 23 patients required no enterostomy of the main pancreatic duct. The lateral pancreaticojejunostomy was performed in 48 patients, of whom 32 patients had an original reconstructive circulation of the intestinal loop applied. By the width of the pancreatic duct less then 5 mm, the original method of resection of the front surface of the pancreas was applied (n=5). The bilateral pancreaticojejunostomy was performed in 3 patients with the pancreatic duct width less then 5 mm and diastasis of the latter. There was no postoperative lethality; complicated postoperative period required reoperation in 5,3%. Long-term results were considered good in 74,6%, satisfactory in 16,4% and unsatisfactory in 9% of patients.

[Treatment of bleedings from cystic formations of the pancreas].

Treatment of 10 patients with bleedings from the pancreatic cysts was analyzed. Angiography with endovascular occlusion of the source of bleeding was used in 4 patients. Hemostasis was achieved in 2 patients. Emergency operations were made on 7 patients with continuing and repeated bleedings, and unsuccessful attempts of roentgen-endovascular treatment. Two patients after correction of anemia were subjected to planned operations according to the indications accepted for chronic cystic pancreatitis. The operation allows reliable liquidation of the source of bleeding and the symptoms of chonic pancreatitis.

Lesões císticas do pâncreas / Cystic lesions of the pancreas

As lesões císticas pancreáticas estão sendo reconhecidas com freqüência aumentada e tem se tornado um achado comum na prática clínica devido ao avanço nos métodos diagnósticos e terapêuticos, com conseqüente queda na mortalidade cirúrgica.O objetivo desta revisão é discutir a fisiopatogenia, achados clínicos, conduta diagnostica e bases de tratamento segundo os fatores etiológicos responsáveis pela formação das lesões císticas pancreáticas não-neoplásicas.

Natural course and outcome of cystic lesions in the pancreas.

BACKGROUND: The number of patients identified with cysts of the pancreas is increasing. The current study was undertaken to assess the natural course and malignant potential of pancreatic cysts. METHODS: From 1995 to 2008, radiology records were reviewed for the presence of cystic lesions of the pancreas (CLP) characteristics, patient demographics, and follow-up. RESULTS: Eighty-two patients met the study inclusion criteria, with a mean age at time of diagnosis of 64.4 +/- 16.7 years. Mean cyst size was 1.36 +/- 1.05 cm, with 75.6% of patients having a solitary cyst. Thirteen patients underwent surgery. Operative intervention was statistically related to symptomatic, loculated cysts with the presence of calcifications (all P <.05). Malignancy was statistically related to symptomatic (P <.05), loculated cysts (P <.01), and male gender (P <.05). CONCLUSIONS: Our data show that most pancreatic cysts found on radiographic imaging are asymptomatic, solitary, and small and can be followed safely radiographically.

Cystic and solid lesions of the pancreas.

More than 95% of malignant tumours of the pancreas are exocrine carcinomas. The exocrine carcinomas have to be distinguished from benign serous cystadenomas and tumours, the latter including mucinous cystic neoplasms, serous cysts, and solid pseudopapillary neoplasms. Cystic lesions have to be separated from pseudocysts, which are the most common cysts. Pseudocysts are due to extensive confluent autodigestive tissue necrosis caused by alcoholic, biliary, or traumatic acute pancreatitis. This review focuses on the classification of the different types of solid and cystic lesions based on histological criteria. The various imaging procedures are also discussed, along with their strengths and limitations.

Small cystic lesions of the pancreas: clinical significance and findings at follow-up.

BACKGROUND: Our purpose was to correlate the imaging findings of small cystic pancreatic lesions to the incidence of growth on follow-up imaging and their pathologic diagnoses. METHODS: CT images for 159 patients with cystic pancreatic lesions were retrospectively evaluated and lesions were assessed for size, number, connection to the main pancreatic duct (MPD), MPD dilatation, and any presence of loculation, wall irregularity, thick septations, or solid components. A total of 86 patients had follow-up imaging with time periods of less than 6 months (n = 21), 6-12 months (n = 22), 1-2 years (n = 14), and greater than 2 years (n = 29). Lesion histology was available in 20 patients. RESULTS: Lesions with pathologic correlation proved to be: side branch intraductal papillary mucinous neoplasm or tumor (IPMT) (n = 5), combined type IPMT (n = 4), nonmucinous cyst (n = 4), chronic pancreatitis (n = 2), and reactive atypia with nonmucinous fluid (n = 1), combined type IMPT with foci of adenocarcinoma (n = 1), mucinous adenocarcinoma (n = 2), and nonmucinous adenocarcinoma (n = 1). Lesions with solid components were significantly more likely to grow and be malignant (P < 0.05). The presence of MPD dilatation was more common in patients with combined type IPMTs or malignancies. No other factors were predictive of malignancy. CONCLUSIONS: Solid components are predictive of malignancy, and MPD dilatation should prompt consideration of surgery. Other cystic lesions can be followed.

Primary cilia deletion in pancreatic epithelial cells results in cyst formation and pancreatitis.

BACKGROUND & AIMS: Defects in cilia formation or function have been implicated in several human genetic diseases, including polycystic kidney disease (PKD), Bardet-Biedl syndrome, and primary ciliary dyskinesia. Pancreatic lesions are found in approximately 10% of PKD patients, suggesting a connection between cilia defects and pancreatic pathologies. Here, we investigate the role of cilia in pancreas formation and function by analyzing mice that lack cilia in pancreatic cells. METHODS: Using Cre/lox technology, we conditionally inactivated Kif3a, the gene encoding for a subunit of the kinesin-2 complex that is essential for cilia formation, in pancreatic epithelia. Kif3a mice were studied by immunohistochemical and biochemical methods to assess the morphology and differentiation status of pancreatic cells. RESULTS: Tissue-specific loss of Kif3a in pancreatic cells resulted in severe pancreatic abnormalities including acinar-to-ductal metaplasia, fibrosis, and lipomatosis. Ductal metaplasia appears to be due to expansion of ductal cells rather than transdifferentiation of acinar cells. Cyst formation, aberrant ductal morphology, and extensive fibrosis associated with severe adhesion to adjacent organs were commonly observed in aged Kif3a mutant mice. Deletion of Kif3a using different pancreas-specific Cre strains suggests that these pancreatic phenotypes might be caused by the absence of cilia in ductal cells. Activation of transforming growth factor beta and Mitogen-activated protein kinase kinase/extracellular signal-regulated kinase (MEK/ERK) pathways may play a role in these phenotypes. CONCLUSIONS: These results demonstrate that the absence of cilia in pancreatic cells produces pancreatic lesions that resemble those found in patients with chronic pancreatitis or cystic fibrosis.

Developmental and metabolic disorders of the pancreas.

The pancreas is an important exocrine and endocrine organ that develops from the dorsal and ventral anlagen during embryogenesis and arises from the endodermal lining of the duodenum within the first month of human embryonic life. A number of developmental disorders can either lead to anatomic abnormalities of the pancreas and its ducts, or can be part of complex disorders that affect multiorgan systems. Other genetic changes can lead to metabolic abnormalities that affect the pancreas exclusively or increase the lifetime risk for developing pancreatitis or pancreatic diabetes. This article reviews some of the developmental and metabolic disorders that can affect the endocrine and exocrine pancreas.

[Morphological characteristics of cystic pancreatic tumors]. / Morfologicheskaia kharakteristika kistoznykh opukholei podzheludochnoi zhelezy.

The results of 86 clinical observations of cystic pancreatic tumor are adduced. The expediency of the postoperative pathomorphological investigation conduction was substantiated because of high degree of the cystic pancreatic tumors polymorphism presence and low informativity of preoperative and intraoperative investigations.

Solid cystic tumor of the pancreas: report of six cases and a review of the Japanese literature.

Although many cases of solid cystic tumor of the pancreas (SCT) have been reported, its nature and histogenesis remain controversial. We herein report six cases of SCT, including three cases of noncystic type. A review of 22 cases of noncystic type SCT, including our 3 cases, was carried out to compare their features with those of 173 cases of classic SCT reported in Japan. Noncystic type SCTs tend to occur in male patients and are smaller in size and less frequently symptomatic, although they show histological characteristics similar to those of classic SCTs. The developmental process might be a cause of cyst formation. The accumulation and analysis of many, at present, "atypical" cases for clarification of its nature, will, it is hoped, lead to a new nomenclature for this condition that adequately describes its biological origin.

Duplicación gástrica en el adulto. Caso clínico / Gastric duplication in an adult. A case report

Presentamos un caso de duplicación quística gástrica en un paciente de 58 años de edad, de localización antral. Se analizan las características anatómicas de este tipo de malformaciones, los medios diagnósticos empleados y se revisa la bibliografía referente a dicha patología (AU)

Tumor sólido epitelial papilar-quístico del páncreas: reporte de un caso clínico y revisión de la literatura / Solid and papillary epithelial tumor of the pancreas

El tumor sólido epitelial papilar quístico del páncreas (SEPQ) es una infrecuente neoplasia de bajo grado de malignidad que ocurre principalmente en adolescentes y mujeres jóvenes. Reportamos un caso de SEPQ en una mujer de 17 años de edad, que ingresó por una tumoración abdominal, la cual fue diagnosticada mediante biopsia por aspiración. El tumor fué resecado totalmente. En el seguimiento a los 6 meses no hay evidencia de recidiva. Siendo una patología poco común, se hace una revisión de la literatura sobre los aspectos clínicos, histológicos, radiológicos y quirúrgicos

Simposio: enfermedades del páncreas. Pseudoquistes del páncreas: resultados del tratamiento quirúrgico / Symposium Diseases of pancreas: pseudocysts of pancreas: surgical treatment results

Objetivo: Evaluar los resultados del tratamiento quirúrgico de un grupo de pacientes con pseudoquistes pancreáticos. Sede: Departamentos de cirugía, gastroenterología y endoscopia del Instituto Nacional de la Nutrición "Salvador Zubirán", institución de tercer nivel de atención médica. Diseño: Análisis retrolectivo de una cohorte de pacientes. Pacientes y métodos: Se analizaron los datos demográficos, estudios diagnósticos, hallazgos transoperatorios, tipo de intervención con pseudoquistes pancreáticos que fueron atendidos en el período comprendido entre 1956 y 1994, estableciéndose el último estatus en 1994. Resultados: Hubo predominio de lesiones en pacientes del sexo masculino (63), con edad promedio de 41 años. La frecuencia de pseudoquistes secundarios a un brote de pancreatitis aguda o un episodio de agudización de pancreatitis crónica fue similar. De la misma forma, la etiología alcohólica y biliar como causas de la pancreatitis se presentaron con igual frecuencia. A 47 pacientes se les practicó drenaje externo y al resto drenaje interno o resección. La mortalidad operatoria fue del 7 por ciento. En un periodo promedio de seguimiento de 7 años, se observo desaparición definitiva del pseudoquiste en el 92 por ciento de los pacientes. Conclusiones: De acuerdo a los resultados se propone un esquema terapéutico basado en la relación del pseudoquiste con el conducto pancreático y las condiciones de este último

Simposio: enfermedades del páncreas. Análisis de la evolución clínica y por pancreatografía dinámica de las colecciones secundarias a pancreatitis aguda / Symposium Diseases of pancreas: secondary pancreatic fluid colections: clinical and CT scan assessment

Objetivo: Caracterizar, mediante pancreatografía dinámica, el origen, características, evolución clínica e imagenología de las colecciones secundarias (CS) a pancreatitis aguda, así como evaluar los resultados del tratamiento. Sede: Departamentos de Cirugía Gastrointestinal y Radiología del Hospital de Especialidades Siglo XXI del Centro Médico Nacional del IMSS, en México, D.F. Diseño: Estudio prospectivo, observacional, longitudinal. Análisis estadístico: Análisis univariado, análisis de varianza (Kruskal-Wallis), prueba de U de Mann-Whitney, t de Student, X², prueba exacta de Fisher. Valor significativo de p menor de 0.05. Pacientes y métodos: Durante un período de 36 meses, 216 pacientes con PA fueron admitidos en el Departamento de Cirugía Gastrointestinal. Se realizó PD en 175, excluímos 55 referimientos tardíos. Se analizaron los siguientes datos: Demografía, severidad, datos de la pancreatografía dinámica (número, lugar, tamaño, forma, densidad, necrosis y características asociadas), bacteriología, comunicación ductal, evoluación y tratamiento. Resultados: Un total de 82 (68 por ciento) desarrollaron una CS durante su evoluación: 16 con colección Líquida Aguda (CLA), 7 con Pseudoquiste Agudo (PsAg), 7 con Absceso Pancreático (Ab P) y 52 con Secuestro Pancreático (SP). No existieron diferencias demográficas. Las CLA fueron una reacción temprana exudativa, típicamente pequeña, múltiple, irregular, de densidad homogénea y baja, estéril, sin pared, necrosis o comunicación ductal. Todas presentaron regresión espontánea. Los PsAg fueron único, regulares, intrapancreáticos, relativamente grandres, con mayor densidad, pared gruesa no epitelizada, estériles y sin necrosis asociada. Se resolvieron con tratamiento médico dos, con drenajes percutáneo uno, con drenaje quirúrgico cutro; los operados fueron los de mayor tamaño, con densidad heterogénea y tuvieron mayor tiempo de estancia hospitalaria. Loas AbP fueron únicos, irregulares, de tamaño y distribución variable, con mayor densidad, con detritus y comunicacion ductal en forma ocasional e infección polimicrobiana siempre; con los PsAg, tuvieron el mayor inatervalo entre su inicio y el diagnóstico (casi 4 semanas), requirieron drenaje quirúrgico externo y presentaron la mayor estancia intrahospitalaria y morbilidad. Los SP constituyeron el grupo más ambigüo; tuvieron la mayor severidad y fueron los únicos con necrosis Asociada, múltiples, de localización y densidad variable, no de gran tamaño pero si muy irregulares (pared delgada en 10 por ciento); se realizó tratamiento conservador en 18 y quirúrgico en los restantes 34. Pueden progresar a la licuefacción total y desaparecer o complicarse y requerir cirugía, en especial cuando se infectan. Conslusión: El reconocer y clasificar, con la ayuda de la pancreatografía dinámica a cada una de las colecciones secundarias, como entidades diferentes de origen, evolución y pronóstico, nos permitirá unificar los criterios de diagnóstico y tomar medidas adecuadas en su tratamiento

Cystic tumors of the pancreas.

Cystic neoplasms of the pancreas are relatively uncommon lesions that should not be confused with pancreatic pseudocysts. Guidelines for this differential diagnosis, the characteristics of the more common varieties, and the authors' experience with 130 cystic tumors are described.