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Revista Espanola de Patologia :... 2024This is the second article in a two-part series published in this journal, in which we examine the histopathological characteristics, as well as the differential... (Review)
Review
This is the second article in a two-part series published in this journal, in which we examine the histopathological characteristics, as well as the differential diagnosis, of the main entities that present as cystic and pseudocystic structures in cutaneous biopsy. In this second article, we address ciliated cutaneous cysts, branchial cysts, Bartholin's cysts, omphalomesenteric cysts, thymic cysts, thyroglossal duct cysts, synovial cysts, and median raphe cysts, as well as mucocele, ganglion, and auricular and digital myxoid pseudocysts.
Topics: Female; Humans; Cysts; Diagnosis, Differential; Bartholin's Glands
PubMed: 38599743
DOI: 10.1016/j.patol.2023.11.007 -
Polish Archives of Internal Medicine Aug 2023
Topics: Humans; Pancreatic Pseudocyst; Gastrointestinal Hemorrhage
PubMed: 37416974
DOI: 10.20452/pamw.16529 -
Children (Basel, Switzerland) Jan 2024Paediatric chronic pancreatitis (CP) is a rare and debilitating pathology that often requires invasive diagnostics and therapeutic interventions either to address a... (Review)
Review
Paediatric chronic pancreatitis (CP) is a rare and debilitating pathology that often requires invasive diagnostics and therapeutic interventions either to address a primary cause such as a pancreaticobiliary malunion or to deal with secondary complications such as chronic pain. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are two endoscopic modalities that have an established diagnostic role in paediatric CP, and their therapeutic utilisation is increasing in popularity. Surgical decompression of the obstructed and dilated pancreatic duct plays a role in alleviating pancreatic duct hypertension, a common association in CP. Surgery equally has a role in certain anatomical abnormalities of the pancreaticobiliary draining system, or occasionally in some CP complications such as drainage of a symptomatic pancreatic pseudocyst.
PubMed: 38255387
DOI: 10.3390/children11010074 -
World Journal of Surgery Sep 2023Pancreatic injury is rare, but it has a high mortality rate and its optimal treatment remains controversial. This study aimed to evaluate the clinical characteristics,...
BACKGROUND
Pancreatic injury is rare, but it has a high mortality rate and its optimal treatment remains controversial. This study aimed to evaluate the clinical characteristics, management strategies, and outcomes of patients with blunt pancreatic injury.
METHODS
This retrospective cohort study was performed on patients with a confirmed blunt pancreatic injury who were admitted to our hospital from March 2008 to December 2020. The clinical characteristics and outcomes of patients receiving different management strategies were compared. The risk factors for in-hospital mortality were evaluated by performing a multivariate regression analysis.
RESULTS
A total of 98 patients diagnosed with blunt pancreatic injury were identified, with 40 patients having undergone nonoperative treatment (NOT) and 58 patients having undergone surgical treatment (ST). The overall in-hospital deaths were 6 (6.1%), including 2 (5.0%) and 4 (6.9%) in the NOT and ST groups, respectively. Pancreatic pseudocysts occurred in 15 (37.5%) and 3 (5.2%) of the NOT and ST groups, respectively, showing a significant difference between the two groups (P < 0.001). In the multivariate regression analysis, concomitant duodenal injury (OR = 14.42, 95% CI 1.27-163.52; P = 0.031) and sepsis (OR = 43.47, 95% CI, 4.15-455.75; P = 0.002) were independently associated with in-hospital mortality.
CONCLUSIONS
Except for the higher incidence of pancreatic pseudocysts in the NOT group than in the ST group, there were no significant differences in the other clinical outcomes between the two groups. Concomitant duodenal injury and sepsis were the risk factors for in-hospital mortality.
Topics: Humans; Pancreatic Pseudocyst; Retrospective Studies; Pancreas; Wounds, Nonpenetrating; Abdominal Injuries; Thoracic Injuries; Treatment Outcome; Injury Severity Score
PubMed: 37227485
DOI: 10.1007/s00268-023-07026-0 -
Revista Espanola de Patologia :... 2024Cystic structures represent one of the most common findings in dermatopathology. These encompass both cystic tumors and pseudocysts resulting from the accumulation of... (Review)
Review
Cystic structures represent one of the most common findings in dermatopathology. These encompass both cystic tumors and pseudocysts resulting from the accumulation of certain substances, such as mucin. In a two-part series (of which this is the first part), we have reviewed the principal types of cysts and pseudocysts that may be observed in cutaneous biopsies, examining their histopathological features and primary differential diagnoses. This first part encompasses infundibular cysts, eruptive dermoid cysts, pigmented follicular cysts, pilonidal cysts, tricholemmal cysts, milium cysts, hybrid cysts, bronchogenic cysts, as well as steatocystoma, hydrocystoma, and comedones.
Topics: Humans; Epidermal Cyst; Bronchogenic Cyst; Biopsy; Diagnosis, Differential
PubMed: 38246707
DOI: 10.1016/j.patol.2023.11.006 -
Cureus Nov 2023Pancreatic pseudocysts are fluid-filled collections that can arise from acute or chronic pancreatitis and may lead to a range of complications, like rupture, infection,...
Pancreatic pseudocysts are fluid-filled collections that can arise from acute or chronic pancreatitis and may lead to a range of complications, like rupture, infection, hemorrhage, etc. Morbid obesity may further complicate the diagnosis and management of such cases. The present report describes the case of a 26-year-old superobese female (BMI: 58 kg/m²) with a pancreatic pseudocyst that presented diagnostic challenges and mimicked pulmonary embolism when the pseudocyst had ruptured. The patient initially presented with persistent biliary colic due to gallstones. Despite undergoing laparoscopic cholecystectomy, she continued to experience symptoms, including nausea, bloating, and inability to tolerate food, and lab tests showed progressive elevation of serum bilirubin levels. A huge pancreatic pseudocyst was found to be obliterating the gastric cavity and compressing the common bile duct after the patient was subjected to further radiological imaging. While waiting to be transferred to a tertiary center with endoscopic retrograde cholangiopancreatography (ERCP), endoscopic stenting, and other facilities, she suddenly experienced severe symptoms, like shortness of breath, upper abdominal/chest pain, tachycardia (heart rate: 140 beats per min), dizziness, and low oxygen saturation. The likelihood of pulmonary embolism (PE) was very high in the differential diagnoses, but computer tomography pulmonary angiography (CTPA) ruled out PE. Based on imaging and clinical assessment, rupture of the pancreatic pseudocyst was diagnosed. The patient was subsequently managed in a tertiary hospital endoscopically. This case highlights the challenges of diagnosing and managing pancreatic pseudocysts in extremely obese patients. It also underscores the role of a multidisciplinary approach and vigilant clinical attention to prevent misdiagnosis and optimize outcomes.
PubMed: 38161865
DOI: 10.7759/cureus.49643 -
Endoscopy Dec 2023
Topics: Humans; Pancreatic Pseudocyst; Mediastinum; Endosonography; Pancreatic Cyst
PubMed: 36400044
DOI: 10.1055/a-1966-0302 -
Alcohol (Fayetteville, N.Y.) Nov 2023Alcohol and nicotine are the two most important risk factors of chronic pancreatitis, and they often occur together. It is still unclear how much they influence the...
OBJECTIVES
Alcohol and nicotine are the two most important risk factors of chronic pancreatitis, and they often occur together. It is still unclear how much they influence the severity of the disease and which of the two addictions should be treated with priority.
METHODS
We performed a single-center, retrospective, cross-sectional study in a mixed medicosurgical cohort of 870 patients diagnosed with chronic pancreatitis (CP). We analyzed the impact of the drinking pattern and abstinence for alcohol and nicotine on the course of the disease. Patients with alcoholic CP were subdivided into 1) patients with "life-time drinking history" (LTDH), 2) "current drinkers" with current alcohol abuse without signs of LTDH, and 3) "former drinkers" who stopped or reduced alcohol intake dramatically.
RESULTS
Compared to patients with LTDH, "former drinkers" had a lower rate of exocrine insufficiency (29% vs. 59%) and pseudocysts (33% vs. 49%), were more often relapse-free (37% vs. 5%), and had less abdominal pain. There was no correlation detected between the quantity of alcohol consumption and the severity or progression of the disease. Regarding nicotine, 29 pack-years are the threshold for developing the early stage of CP. Under nicotine abstinence, only slightly more patients were relapse-free (37% vs. 22%). In contrast, the cumulative amount of nicotine consumed correlated with overall disease severity and the development of pseudocysts. The need for surgery was increased, with odds ratios of 1.8, for both alcohol and nicotine abuse.
CONCLUSIONS
Alcohol cessation in chronic pancreatitis reduces exocrine insufficiency, abdominal pain, and local complications. The effect of nicotine cessation is less pronounced in our cohort. However, nicotine abuse represents an important factor for the development of the disease.
PubMed: 38013125
DOI: 10.1016/j.alcohol.2023.11.006 -
Acta Neurochirurgica Jan 2024This study evaluates the safety of laparoscopic procedures in patients with cerebrospinal fluid (CSF) catheters draining distally into the abdomen. (Review)
Review
PURPOSE
This study evaluates the safety of laparoscopic procedures in patients with cerebrospinal fluid (CSF) catheters draining distally into the abdomen.
METHODS
A systematic search across PubMed, Scopus, and Ovid databases using pertinent keywords yielded 47 relevant papers, encompassing 197 cases, for analysis.
RESULTS
In the pediatric cohort (n = 129), male (49.6%) and female (34.1%) cases were reported, while gender remained unspecified in 16.3%. Shunt indications included unspecified (126 cases) and Meningomyelocele (3 cases). Laparoscopic procedures encompassed gastric (72.1%), urologic (21.7%), and other (6.2%) indications. Peri-operative shunt management included subcostal incision and clamping (1), ICP monitoring and drainage (2), and distal shunt flow confirmation (1). The prevalent complication was mechanical obstruction (10.1%), followed by pseudocyst formation (1.5%) and infection (2.3%). In the adult cohort (n = 61), males (60.6%) and females (39.3%) with a median age of 55 years were observed. Management strategies encompassed sponge packing and mobilization (11), distal shunt flow confirmation (2), shunt clamping (3), Transcranial Doppler monitoring (2), and no manipulation (30). Shunt infection emerged as the primary complication (2). Overall, 24 patients encountered VP shunt-related complications post-laparoscopy.
CONCLUSION
This study underscores the safety of laparoscopic interventions in patients with ventriculoperitoneal or lumboperitoneal shunts when facilitated by interdisciplinary cooperation. A meticulous preoperative assessment for shunt track localization, intraoperative visualization of shunt tip with CSF flow, vigilant perioperative anesthetic monitoring, and shunt dysfunction surveillance are crucial for favorable outcomes in laparoscopic procedures for these patients.
Topics: Adult; Child; Female; Humans; Male; Middle Aged; Abdomen; Catheters; Drainage; Laparoscopy; Retrospective Studies; Ventriculoperitoneal Shunt
PubMed: 38214791
DOI: 10.1007/s00701-024-05898-2 -
Scientific Reports Nov 2023Extracellular vesicles (EV) carry their cargo in a membrane protected form, however, their value in early diagnostics is not well known. Although pancreatic cysts are...
Extracellular vesicles (EV) carry their cargo in a membrane protected form, however, their value in early diagnostics is not well known. Although pancreatic cysts are heterogeneous, they can be clustered into the larger groups of pseudocysts (PC), and serous and mucinous pancreatic cystic neoplasms (S-PCN and M-PCN, respectively). In contrast to PCs and S-PCNs, M-PCNs may progress to malignant pancreatic cancers. Since current diagnostic tools do not meet the criteria of high sensitivity and specificity, novel methods are urgently needed to differentiate M-PCNs from other cysts. We show that cyst fluid is a rich source of EVs that are positive and negative for the EV markers CD63 and CD81, respectively. Whereas we found no difference in the EV number when comparing M-PCN with other pancreatic cysts, our EV-based biomarker identification showed that EVs from M-PCNs had a higher level of miR-200b. We also prove that not only EV-derived, but also total cyst fluid miR-200b discriminates patients with M-PCN from other pancreatic cysts with a higher sensitivity and specificity compared to other diagnostic methods, providing the possibility for clinical applications. Our results show that measuring miR-200b in cyst fluid-derived EVs or from cyst fluid may be clinically important in categorizing patients.
Topics: Humans; Biomarkers; MicroRNAs; Pancreas; Pancreatic Cyst; Pancreatic Neoplasms
PubMed: 37963969
DOI: 10.1038/s41598-023-47129-1