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World Journal of Gastrointestinal... Aug 2023Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas, resulting in recurrent abdominal pain, diabetes mellitus, and malnutrition. It may lead to... (Review)
Review
Chronic pancreatitis is a chronic fibro-inflammatory disorder of the pancreas, resulting in recurrent abdominal pain, diabetes mellitus, and malnutrition. It may lead to various other complications such as pseudocyst formation, benign biliary stricture, gastric outlet obstruction; and vascular complications like venous thrombosis, variceal and pseudoaneurysmal bleed. Development of varices is usually due to chronic venous thrombosis with collateral formation and variceal bleeding can easily be tackled by endoscopic therapy. Pseudoaneurysmal bleed can be catastrophic and requires radiological interventions including digital subtraction angiography followed by endovascular obliteration, or sometimes with a percutaneous or an endoscopic ultrasound-guided approach in technically difficult situations. Procedure-related bleed is usually venous and mostly managed conservatively. Procedure-related arterial bleed, however, may require radiological interventions.
PubMed: 37701688
DOI: 10.4240/wjgs.v15.i8.1574 -
Revista Espanola de Enfermedades... Mar 2024Ectopic pancreas (EP) is defined as pancreatic tissue that lacks anatomical or vascular connections to the normal pancreas. EP is generally asymptomatic and is detected...
Ectopic pancreas (EP) is defined as pancreatic tissue that lacks anatomical or vascular connections to the normal pancreas. EP is generally asymptomatic and is detected incidentally during endoscopy. However, due to pseudocyst formation, inflammation, or malignant transformation, it may cause non-specific gastrointestinal symptoms, such as abdominal pain, abdominal discomfort, nausea, vomiting, and bleeding. Pseudocyst formation in EP may result from the retention of exocrine secretions in the absence of connections between the glandular epithelium and gastric lumen. We herein report a case of EP with a pseudocyst associated with epigastric pain. EP with a pseudocyst, although rare, needs to be considered in a differential diagnosis of cystic lesions of the stomach.
PubMed: 38450507
DOI: 10.17235/reed.2024.10339/2024 -
Journal of Clinical Medicine Feb 2024Adrenal cysts are uncommon and usually asymptomatic, and therefore are usually incidentally discovered adrenal lesions. They have a broad pathohistological spectrum that... (Review)
Review
Adrenal cysts are uncommon and usually asymptomatic, and therefore are usually incidentally discovered adrenal lesions. They have a broad pathohistological spectrum that includes pseudocysts and endothelial (vascular), parasitic, and epithelial (mesothelial) cysts. Although most adrenal cysts are benign and hormonally non-functional lesions, some can have ambiguous imaging appearances and mimic malignant adrenal neoplasms. On the other hand, the actual malignant neoplasms could undergo cystic transformation. Additionally, immune cell infiltrations, thrombosis, or haemorrhage seen in sepsis can frequently cause adrenal cyst development, raising a question about the possible connection between severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and adrenal cystic lesions. Due to the disease's rarity, the likelihood of malignancy, and the lack of specific guidelines, the management of adrenal cysts is always challenging especially in a young person. This review discusses the important diagnostic and the current treatment possibilities for adrenal cystic lesions. Aiming to emphasize clinical dilemmas and help clinicians navigate the challenges when encountering a patient with an adrenal cyst in everyday practice, we based our review on a practical question-answer framework centred around the case of a young woman with an incidentally discovered large adrenal cyst.
PubMed: 38337539
DOI: 10.3390/jcm13030846 -
Journal of Voice : Official Journal of... Jul 2023Benign vocal fold masses (BVMs) include nodules, polyps, cysts, and other pathology. Nevertheless, some otolaryngologists and other physicians utilize "vocal fold...
INTRODUCTION
Benign vocal fold masses (BVMs) include nodules, polyps, cysts, and other pathology. Nevertheless, some otolaryngologists and other physicians utilize "vocal fold nodules" as an umbrella diagnosis for vocal fold masses. Patients subsequently evaluated by a laryngologist are found to have a different vocal fold mass, which often has a different prognosis and treatment plan compared to nodules.
OBJECTIVE
The purpose of this study was to investigate the rate at which vocal fold nodules are misdiagnosed.
METHODS
Adult voice patients who presented to our voice center having been evaluated elsewhere by an otolaryngologist and diagnosed with vocal fold nodules, or prenodules, were included in this retrospective study. Strobovideolaryngoscopy (SVL) footage from each patient's first visit or prior to any treatment at our center was compiled and de-identified. Three blinded physician raters evaluated the videos to determine if the mass(es) was/were nodules on a binary scale, with 1 indicating a nodule. If the mass was not a nodule (0), the raters were asked to identify it based on a list of five different mass types.
RESULTS
There were 56 cases (11 male and 45 female) included in the retrospective cohort. The average age was 38 ± 14.8 with a range of 11-65. Reliability between all raters was fair (κ = 0.3). Individually raters 1 and 2 had very good reliability (κ = 1) and rater 3 had good reliability (κ = 0.6). In 100% of cases, two raters agreed that none of the masses were nodules. Only one rater identified two masses as vocal fold nodules, indicating that at least 97% of cases were not vocal fold nodules and had been misdiagnosed. The most frequently identified mass and the most frequently agreed upon mass by all raters was vocal fold cyst or pseudocyst, followed by fibrous mass. Only one rater was unable to identify the mass type in some cases (n = 7).
CONCLUSION
Vocal fold nodules are frequently misdiagnosed. Proper identification of vocal fold masses requires high levels of expertise and SVL. Since treatment of BVMs varies with mass type, accurate diagnosis is essential.
PubMed: 37423793
DOI: 10.1016/j.jvoice.2023.06.008 -
Gastrointestinal Endoscopy Clinics of... Jul 2024Pancreatic fluid collections (PFCs) are commonly encountered complications of acute and chronic pancreatitis. With the advancement of endoscopic ultrasound (EUS)... (Review)
Review
Pancreatic fluid collections (PFCs) are commonly encountered complications of acute and chronic pancreatitis. With the advancement of endoscopic ultrasound (EUS) techniques and devices, EUS-directed transmural drainage of symptomatic or infected PFCs has become the standard of care. Traditionally, plastic stents have been used for drainage, although lumen-apposing metal stents (LAMSs) are now favored by most endoscopists due to ease of use and reduced procedure time. While safety has been repeatedly demonstrated, follow-up care for these patients is critical as delayed adverse events of indwelling drains are known to occur.
Topics: Humans; Drainage; Endosonography; Stents; Pancreatitis; Pancreatic Pseudocyst
PubMed: 38796299
DOI: 10.1016/j.giec.2024.02.008 -
Therapeutic Advances in Gastroenterology 2023Pancreatic fluid collection often occurs as a local complication of acute pancreatitis, and drainage is indicated in symptomatic patients. The drainage may be surgical,... (Review)
Review
Pancreatic fluid collection often occurs as a local complication of acute pancreatitis, and drainage is indicated in symptomatic patients. The drainage may be surgical, percutaneous, or endoscopic ultrasound (EUS) guided. In symptomatic collections older than 4 weeks and localized in the upper abdomen, EUS-guided drainage is the first choice of treatment. Lumen-apposing metal stents are useful in cases of walled-off necrosis, facilitating access to the cavity; however, they do not reduce the number of necrosectomy sessions required. In most pancreatic pseudocysts requiring drainage, plastic stents remain the first choice of treatment. This review aimed to summarize the principles and techniques of step-up therapy of pancreatic fluid collections, including preprocedural and postprocedural assessment and practical approaches of drainage and necrosectomy, making available evidence more accessible to endoscopists aiming to train for this procedure. Successful and safe EUS drainage connotes early recognition and treatment of complications and the presence of a multidisciplinary team for optimal patient management. However, the best time for necrosectomy, modality of drainage method (lumen-apposing metal stents or plastic stents), and duration of antibiotherapy are still under evaluation.
PubMed: 37485492
DOI: 10.1177/17562848231180047 -
Radiologie (Heidelberg, Germany) Dec 2023Cystic pancreatic lesions are detected incidentally at an increasing rate. Often, the patients present asymptomatically. Hence, the resulting clinical consequences... (Review)
Review
BACKGROUND
Cystic pancreatic lesions are detected incidentally at an increasing rate. Often, the patients present asymptomatically. Hence, the resulting clinical consequences remain challenging and unsettling for both physicians and patients.
OBJECTIVES
Status of current recommendations in handling cystic pancreatic lesions.
MATERIALS AND METHODS
Selective literature search of PubMed while taking current guidelines into account.
RESULTS
Correct diagnostic classification of the cystic lesion is crucial since further action depends on the type of cystic lesion. Resection is generally recommended for mucinous cystic neoplasms (MCN), solid pseudopapillary neoplasms (SPN), and intraductal papillary mucinous neoplasms (IPMN) with relevant risk criteria such as prominent main-duct dilation. Surveillance is recommended for IPMN without risk criteria, as long as comorbidities and life expectancy of the patient will allow preventive resection over the years. SCNs are benign and only symptomatic SCNs require resection. Inflammatory pancreatic cysts should only be treated under certain circumstances.
Topics: Humans; Pancreatic Cyst; Pancreatic Intraductal Neoplasms; Carcinoma, Pancreatic Ductal; Pancreas; Pancreatic Neoplasms; Neoplasms, Cystic, Mucinous, and Serous
PubMed: 37878017
DOI: 10.1007/s00117-023-01226-4 -
Annals of Diagnostic Pathology Dec 2023Ganglion cyst of the temporomandibular joint (TMJ) is an uncommon pathology with uncertain etiology. There is no consensus on their management. The current systematic... (Review)
Review
Ganglion cyst of the temporomandibular joint (TMJ) is an uncommon pathology with uncertain etiology. There is no consensus on their management. The current systematic review aimed to discuss the clinical and histopathological features of ganglion cysts of TMJ, to aid in appropriate treatment. A literature search was done and a total of 20 cases were retrieved from published databases such as PubMed, SCOPUS, and Google Scholar. The cyst presented with swelling in all the cases followed by pain (50 %) and trismus (35 %) as other common symptoms. Though CT and MRI proved helpful in determining the location of the cyst, a histopathological examination was essential in concluding its final diagnosis. It is a pseudocyst lined by dense fibro-connective tissue with myxoid tissue degeneration. Histologically, it is essential to distinguish them from the clinically and radiographically similar true cyst of TMJ, synovial cyst. The lining of ganglion cyst is devoid of epithelium and synovial cells. Surgical excision was found to be the treatment of choice with minimal recurrence (10 %) being reported.
Topics: Humans; Ganglion Cysts; Temporomandibular Joint Disorders; Synovial Cyst; Temporomandibular Joint; Magnetic Resonance Imaging
PubMed: 37748213
DOI: 10.1016/j.anndiagpath.2023.152212 -
ACG Case Reports Journal Jul 2023Pancreatic pseudocyst formation is a common complication of chronic pancreatitis. Rarely, a fistula develops between the pseudocyst and the portal venous system. We...
Pancreatic pseudocyst formation is a common complication of chronic pancreatitis. Rarely, a fistula develops between the pseudocyst and the portal venous system. We present a case of a 50-year-old man who was found to have a pancreatic pseudocyst-superior mesenteric vein fistula after being evaluated for several months of abdominal pain and weight loss. The patient was treated with endoscopic stenting of the pancreatic duct along with early enteral nutrition and suppressive antibiotics, which resulted in improvement in his condition. This case report highlights clinical presentation and the complexity of treatment of this rare diagnosis.
PubMed: 37441624
DOI: 10.14309/crj.0000000000001092 -
Andes Pediatrica : Revista Chilena de... Apr 2024Molluscum contagiosum (MC) is a common viral infection in children, immunocompromised, and sexually active adults. Its usual clinical presentation is 2-5 mm, whitish or... (Review)
Review
Molluscum contagiosum (MC) is a common viral infection in children, immunocompromised, and sexually active adults. Its usual clinical presentation is 2-5 mm, whitish or skin-colored papules, with a shiny surface and central umbilication, generally clustered and randomly distributed over the skin surface. Dermoscopy reveals yellowish-white polylobulated structures with peripheral telangiectasia. Diagnosis is usually clinical supported by dermoscopy. However, in some cases, inflammatory manifestations can be associated with this infection and can mimic other dermatological conditions, making the diagnosis difficult and leading to unnecessary treatments. The objective of this article is to describe the main skin reactions associated with MC infection in order to provide a diagnostic and initial management tool for clinicians dealing with these conditions. Reported manifestations include the BOTE sign, perilesional eczema, Gianotti-Crosti syndrome-like reaction, ID reaction, erythema annulare centrifugum, erythema multiforme, folliculitis, white halo, and atypical manifestations (giant, disseminated, necrotic, polypoidal, and nodular lesions, pseudocysts, abscesses). In pediatric patients with the clinical manifestations described above, infection by molluscum contagiosum pox virus should be considered among the differential diagnoses, and referral to a dermatologist should be made in selected cases.
Topics: Humans; Molluscum Contagiosum; Child; Diagnosis, Differential; Dermoscopy; Skin Diseases
PubMed: 38801360
DOI: 10.32641/andespediatr.v95i2.5034