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DEN Open Apr 2024Pancreatic and biliary diseases encompass a range of conditions requiring accurate diagnosis for appropriate treatment strategies. This diagnosis relies heavily on... (Review)
Review
Current status of artificial intelligence analysis for the treatment of pancreaticobiliary diseases using endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography.
Pancreatic and biliary diseases encompass a range of conditions requiring accurate diagnosis for appropriate treatment strategies. This diagnosis relies heavily on imaging techniques like endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography. Artificial intelligence (AI), including machine learning and deep learning, is becoming integral in medical imaging and diagnostics, such as the detection of colorectal polyps. AI shows great potential in diagnosing pancreatobiliary diseases. Unlike machine learning, which requires feature extraction and selection, deep learning can utilize images directly as input. Accurate evaluation of AI performance is a complex task due to varied terminologies, evaluation methods, and development stages. Essential aspects of AI evaluation involve defining the AI's purpose, choosing appropriate gold standards, deciding on the validation phase, and selecting reliable validation methods. AI, particularly deep learning, is increasingly employed in endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography diagnostics, achieving high accuracy levels in detecting and classifying various pancreatobiliary diseases. The AI often performs better than doctors, even in tasks like differentiating benign from malignant pancreatic tumors, cysts, and subepithelial lesions, identifying gallbladder lesions, assessing endoscopic retrograde cholangiopancreatography difficulty, and evaluating the biliary strictures. The potential for AI in diagnosing pancreatobiliary diseases, especially where other modalities have limitations, is considerable. However, a crucial constraint is the need for extensive, high-quality annotated data for AI training. Future advances in AI, such as large language models, promise further applications in the medical field.
PubMed: 37397344
DOI: 10.1002/deo2.267 -
World Journal of Surgical Oncology Oct 2023Follicular dendritic cell sarcoma (FDCS) is a rare, low-to-moderate-grade malignant tumor, which occurs in the dendritic cells of the germinal center. Pancreatic FDCS...
BACKGROUND
Follicular dendritic cell sarcoma (FDCS) is a rare, low-to-moderate-grade malignant tumor, which occurs in the dendritic cells of the germinal center. Pancreatic FDCS (PFDCS) is extremely rare, with only a few reported cases. Presently, the etiology and pathogenesis of pancreatic FDCS are still unclear, and the clinical symptoms and signs as well as the laboratory diagnosis lack specificity. Although PFDCS presents better histological and morphological characteristics and a distinct immunophenotype, it can be easily missed and/or misdiagnosed if it occurs outside the node. Lymph node FDCS are easier to diagnose because of the rarity of fusiform cell tumors in lymph nodes.
CASE DEMONSTRATION
Herein, we reported a 67-year-old female patient with upper-left abdominal pain without obvious cause and was admitted for treatment. A computed tomography (CT) scan revealed a cystic solid mass in the pancreatic tail toward the greater curvature of the stomach, with an obvious enhancement of the cyst wall in enhanced scanning. Subsequently, the patient underwent surgical resection and the resected sample was sent for pathological biopsy. According to the results, the pathology was consistent with the histological morphology and immunohistochemical characteristics of FDCS, and the Epstein-Barr virus (EBV)-encoded RNA was negative for in situ hybridization. Three months post-resection, the patient returned to the hospital for chemotherapy. This case report is aimed to improve the clinical recognition of FDCS.
CONCLUSION
Pancreatic FDCS is a rare disease. Herein, we have reported a case of pancreatic FDCS and analyzed its clinical and pathological features and differential diagnosis to improve the understanding of FDCS.
Topics: Female; Humans; Aged; Dendritic Cell Sarcoma, Follicular; Epstein-Barr Virus Infections; Herpesvirus 4, Human; Pancreas; Lymph Nodes
PubMed: 37833728
DOI: 10.1186/s12957-023-03213-4 -
Cancers Mar 2024The malignant progression of pancreatic cystic lesions (PCLs) remains understudied with a knowledge gap, yet its exploration is pivotal for effectively stratifying... (Review)
Review
The malignant progression of pancreatic cystic lesions (PCLs) remains understudied with a knowledge gap, yet its exploration is pivotal for effectively stratifying patient risk and detecting cancer at its earliest stages. Within this review, we delve into the latest discoveries on the molecular level, revealing insights into the IPMN molecular landscape and revised progression model, associated histologic subtypes, and the role of inflammation in the pathogenesis and malignant progression of IPMN. Low-grade PCLs, particularly IPMNs, can develop into high-grade lesions or invasive carcinoma, underscoring the need for long-term surveillance of these lesions if they are not resected. Although and remain the primary oncogenic drivers of neoplastic development in IPMNs, additional genes that are important in tumorigenesis have been recently identified by whole exome sequencing. A more complete understanding of the genes involved in the molecular progression of IPMN is critical for effective monitoring to minimize the risk of malignant progression. Complicating these strategies, IPMNs are also frequently multifocal and multiclonal, as demonstrated by comparative molecular analysis. Algorithms for preoperative cyst sampling and improved radiomic techniques are emerging to model this spatial and temporal genetic heterogeneity better. Here, we review the molecular pathology of PCLs, focusing on changes associated with malignant progression. Developing models of molecular risk stratification in PCLs which can complement radiologic and clinical features, facilitate the early detection of pancreatic cancer, and enable the development of more personalized surveillance and management strategies are summarized.
PubMed: 38539517
DOI: 10.3390/cancers16061183 -
Radiology Case Reports Nov 2023Pancreatic pseudocysts are fluid-filled masses with a pseudo-capsule that appear following a pancreatic injury. Pseudocysts are the most frequent cystic lesions of the...
Pancreatic pseudocysts are fluid-filled masses with a pseudo-capsule that appear following a pancreatic injury. Pseudocysts are the most frequent cystic lesions of the pancreas, representing about 85% of all pancreatic cysts. The possible complications of pancreatic pseudocysts include infections, hemorrhage, intestinal stenosis or obstruction, and rupture into nearby organs or the peritoneal/retroperitoneal cavity. However, mediastinal extension of pancreatic pseudocysts with portal hypertension is rare. We present a case of an 18-year-old male with a history of weight loss over a 10-month period, presenting with an abdominal lump, hemoptysis, abdominal pain, and dyspnea. He was diagnosed with large pancreatic pseudocysts that extended into the mediastinum by ultrasonography (US) and contrast-enhanced computed tomography (CT) examination. Portal hypertension occurs as a result of portal vein compression. A histopathological examination proved conclusive of pancreatic pseudocysts. The patient was treated with surgery, where the cyst was drained.
PubMed: 37745761
DOI: 10.1016/j.radcr.2023.08.088 -
Archives of Pathology & Laboratory... Feb 2024Macroscopic precursor lesions of the pancreas represent a complex clinical management problem. Molecular characterization of pancreatic cysts has helped to confirm and...
CONTEXT.—
Macroscopic precursor lesions of the pancreas represent a complex clinical management problem. Molecular characterization of pancreatic cysts has helped to confirm and refine clinical and pathologic classifications of these lesions, inform our understanding of tumorigenesis in the pancreas, and provide opportunities for preoperative diagnosis.
OBJECTIVE.—
To review the pathologic classification of macroscopic cystic lesions of the pancreas: intraductal papillary mucinous neoplasms (IPMNs), mucinous cystic neoplasms (MCNs), intraductal oncocytic papillary neoplasms (IOPNs), and intraductal tubulopapillary neoplasms (ITPNs), and to describe our current state of understanding of their molecular underpinnings, relationship to invasive carcinomas, and implications for diagnosis and prognostication.
DATA SOURCES.—
We assessed the current primary literature and current World Health Organization Classification of Digestive System Tumours.
CONCLUSIONS.—
Macroscopic cystic lesions of the pancreas are morphologically and molecularly diverse. IPMNs and MCNs share mucinous cytoplasm with papillae. MCNs are defined by ovarian-type stroma. IOPNs have granular eosinophilic cytoplasm, prominent nucleoli, and complex, arborizing papillae. ITPNs demonstrate complex, back-to-back tubules and anastomosing papillae and lack prominent intracellular mucin. IPMNs and MCNs are characterized by driver mutations in KRAS/GNAS (IPMNs) and KRAS (MCNs), with later driver events in RNF43, CDKN2A, SMAD4, and TP53. In contrast, IOPNs and ITPNs have recurrent rearrangements in PRKACA/PRKACB and MAPK-associated genes, respectively. The recurrent alterations described in cysts provide an opportunity for diagnosis using aspirated cyst fluid. Molecular characterization of IPMNs shows a striking spatial and mutational heterogeneity, challenging traditional models of neoplastic development and creating challenges to interpretation of cyst fluid sequencing results.
PubMed: 38386006
DOI: 10.5858/arpa.2023-0358-RA -
Cureus Sep 2023, a Gram-negative spiral bacterium, is a rare cause of bacteremia in humans. Unfortunately, little is known about infections in emergency departments (EDs). We aimed to...
AIM
, a Gram-negative spiral bacterium, is a rare cause of bacteremia in humans. Unfortunately, little is known about infections in emergency departments (EDs). We aimed to describe the clinical features of infections in the ED.
METHODS
We conducted a descriptive study at the ED of Kobe City General Hospital (KCGH) in Japan between November 2011 and December 2020. We included all ED patients with infections. We retrospectively obtained the patient data from electronic medical records and described the patient characteristics, clinical course, and management of infections.
RESULTS
A total of 22 patients in the ED were diagnosed with infections, and all of them were detected through blood cultures. The chief complaints were vague: fever (18/22, 81.8%), chills (10/22, 45.5%), and localized pain or tenderness (8/22, 36.4%). Patients with complicated cases were also reported in the ED; three patients had vertebral osteomyelitis, two had infected aortic aneurysms, and another two had infected cysts (renal cyst and pancreatic cyst with concomitant empyema). Tetracycline (minocycline) was primarily prescribed and administered intravenously in five of 15 (33.3%) and orally in nine of 20 (45.0%) patients. Only one (4.5%) patient required surgical interventions. None of the patients died in the hospital.
CONCLUSIONS
We reported the clinical features of infections in the ED. Although some patients developed complicated infections, the prognosis was not poor under appropriate treatment, and most of them were successfully treated with antibiotics, primarily tetracycline.
PubMed: 37799212
DOI: 10.7759/cureus.44650 -
Cureus Dec 2023This technical report serves as a comprehensive guide for conducting a phenome-wide association study (PheWAS) utilizing data extracted from the Nationwide Inpatient...
Technical Report: Protocol for Characterizing Phenotype Variants Using Phenome-Wide Association Study (PheWAS) Utilizing the Nationwide Inpatient Sample 2020 in Individuals With Pancreatic Cysts and Lung Cancer.
This technical report serves as a comprehensive guide for conducting a phenome-wide association study (PheWAS) utilizing data extracted from the Nationwide Inpatient Sample 2020. Specifically tailored to individuals diagnosed with pancreatic cysts and lung cancer, the report establishes a step-by-step workflow designed to assist researchers in uncovering potential associations within this specific cohort. The methodology outlined in the report ensures clarity and reproducibility by employing a curated cohort sourced from the GitHub repository and executed using R for robust data analysis. The code encompasses pivotal steps, including the utilization of a QQ plot as a crucial diagnostic tool aimed at identifying systematic biases or associations. Additionally, the report incorporates the creation of a Manhattan plot, delving into essential mathematical considerations to enhance the interpretability of the results. Notably, the report elucidates the handling of the International Classification of Disease version 10 (ICD-10) codes, providing a sample approach for their segmentation to analyze associations by diagnostic categories. The segmentation aligns with the guidelines outlined in the American Medical Association's ICD-10-CM 2022, the Complete Official Codebook with Guidelines (American Medical Association Press, 2021), ensuring a standardized and rigorous analytical process. This comprehensive guide equips researchers with the tools and insights needed to navigate the complexities of PheWAS within the context of pancreatic cysts and lung cancer, fostering transparency, reproducibility, and meaningful scientific exploration.
PubMed: 38259398
DOI: 10.7759/cureus.50982 -
Respirology Case Reports Aug 2023Mediastinal pancreatic pseudocysts are rare complications of pancreatitis associated with alcohol consumption. Here, we report a case of mediastinal pancreatic...
Mediastinal pancreatic pseudocysts are rare complications of pancreatitis associated with alcohol consumption. Here, we report a case of mediastinal pancreatic pseudocyst. A 61-year-old Japanese woman presented to our hospital with epigastric pain and dyspnea. A chest radiograph revealed right-sided massive pleural effusion. Thoracentesis retrieved black pleural fluid with remarkably high fluid amylase levels were. Thoracic computed tomography (CT) after drainage revealed encapsulated fluid. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) were performed because abdominal CT and ultrasonography did not reveal any pancreatic problems. MRCP showed cystic masses and pancreatic tail cysts extending to the stomach and lower oesophagus. ERCP confirmed leakage of contrast medium from the pancreatic tail into the retroperitoneum. We diagnosed the patient with a pancreatic pseudocyst extending to the mediastinum. A mediastinal pancreatic pseudocyst should be considered a differential diagnosis in patients with black pleural fluid with a high amylase level.
PubMed: 37497338
DOI: 10.1002/rcr2.1195 -
Medicine Feb 2024Main pancreatic duct (MPD) dilatation is reported to be a risk factor for pancreatic cancer (PC). Although magnetic resonance cholangiopancreatography (MRCP) and...
Main pancreatic duct (MPD) dilatation is reported to be a risk factor for pancreatic cancer (PC). Although magnetic resonance cholangiopancreatography (MRCP) and ultrasonographic modalities are valuable for monitoring the pancreas, there is limited information on the efficacy of different imaging modalities in measuring MPD diameter. To improve pancreatic imaging, we developed a specialized ultrasound approach focusing on the pancreas (special pancreatic US). We aimed to examine the correlation between MPD diameter measurements using special pancreatic US versus MRCP. We retrospectively reviewed the clinical data of patients with MPD dilation (≥2.5 mm) via special pancreatic US used for screening at our institution between January 2020 and October 2022 and included patients who underwent magnetic resonance imaging 2 months before and after pancreatic US. The MPD diameter on MRCP was measured at the pancreatic locus, where the maximum MPD diameter was obtained on special pancreatic US. This study included 96 patients, with a median interval of 8.5 days between the date of special pancreatic US and the date of undergoing MRCP. MPD dilatation and/or pancreatic cysts were diagnosed in 86 patients, PC in 5 patients, and other diseases in 5 patients. The median MPD diameter, measured using special pancreatic US, was 3.4 mm (interquartile range: 2.9-4.9 mm), whereas it was 3.5 mm using MRCP (interquartile range: 2.8-4.5 mm). There were strong positive correlations between MPD diameter measured on special pancreatic US and that measured on MRCP (R = 0.925, P < .001). This study revealed strong positive correlations between the MPD diameter measurements using special pancreatic US and MRCP. MPD diameter measurements from each imaging method can be helpful during follow-up in individuals at a high risk of PC.
Topics: Humans; Cholangiopancreatography, Magnetic Resonance; Retrospective Studies; Pancreas; Pancreatic Ducts; Magnetic Resonance Imaging; Pancreatic Neoplasms; Ultrasonography
PubMed: 38394509
DOI: 10.1097/MD.0000000000037283