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Modern Pathology : An Official Journal... Jan 2022The literature is highly conflicted on what percentage of pancreatic ductal adenocarcinomas (PDACs) arise in association with intraductal papillary mucinous neoplasms... (Comparative Study)
Comparative Study
Pancreatic ductal adenocarcinomas associated with intraductal papillary mucinous neoplasms (IPMNs) versus pseudo-IPMNs: relative frequency, clinicopathologic characteristics and differential diagnosis.
The literature is highly conflicted on what percentage of pancreatic ductal adenocarcinomas (PDACs) arise in association with intraductal papillary mucinous neoplasms (IPMNs). Some studies have claimed that even small (Sendai-negative) IPMNs frequently lead to PDAC. Recently, more refined pathologic definitions for mucin-lined cysts were provided in consensus manuscripts, but so far there is no systematic analysis regarding the frequency and clinicopathologic characteristics of IPMN-mimickers, i.e., pseudo-IPMNs. In this study, as the first step in establishing frequency, we performed a systematic review of the pathologic findings in 501 consecutive ordinary PDACs, which disclosed that 10% of PDACs had associated cysts ≥1 cm. While 31 (6.2%) of these were IPMN or mucinous cystic neoplasm (MCN), 19 (3.8%) were other cyst types that mimicked IPMN (pseudo-IPMNs) per recent WHO/consensus criteria. As the second step of the study, we performed a comparative clinicopathologic analysis by also including our entire surgical pathology/consultation databases that was comprised of 60 IPMN-associated PDACs, 30 MCN-associated PDACs and 40 pseudo-IPMN-associated PDACs. We found that 84% of true IPMNs were pre-operatively recognized, whereas IPMN was considered in differential diagnosis of 33% of pseudo-IPMNs. Of the 40 pseudo-IPMNs, there were 15 secondary duct ectasias; 6 large-duct-type PDACs; 5 pseudocysts; 5 cystic tumor necrosis; 4 simple mucinous cysts; 3 groove pancreatitis-associated paraduodenal wall cysts; and 2 congenital cysts. Microscopically, pseudo-IPMNs had at least partial mucinous-lining mimicking IPMN but had smaller cystic (mean = 1.9 cm) and larger PDAC (mean = 3.8 cm) components compared to true IPMNs (cyst = 5.7 cm; PDAC = 2.0 cm). In summary, in this pathologically verified analysis that utilized refined criteria, 10% of PDACs were discovered to have cysts ≥1 cm, about two-thirds of which were IPMN/MCN but about one-third were pseudo-IPMNs. True IPMNs underlying the PDACs are often large and are already diagnosed pre-operatively as having an IPMN component, whereas only a third of the pseudo-IPMNs receive IPMN diagnosis by imaging and their cysts are smaller. At the histopathologic level, pseudo-IPMNs are highly prone to misdiagnosis as IPMN, which presumably accounts for much higher association of IPMNs with PDAC as reported in some studies. The subtle but salient characteristics of pseudo-IPMNs elucidated in this study should be combined with careful radiological/clinical correlation in order to exclude pseudo-IPMNs.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Carcinoma, Pancreatic Ductal; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pancreatic Intraductal Neoplasms; Pancreatic Neoplasms
PubMed: 34518632
DOI: 10.1038/s41379-021-00902-x -
International Journal of Dermatology Jan 2022Auricular pseudocysts are benign fluid accumulations of the ear of uncertain etiology. Little is known about the optimal modality to successfully treat these lesions. No...
BACKGROUND
Auricular pseudocysts are benign fluid accumulations of the ear of uncertain etiology. Little is known about the optimal modality to successfully treat these lesions. No systematic review addressing auricular pseudocysts have been published to date.
OBJECTIVES
The aim of this study is to summarize all the published data regarding diagnostic and therapeutic challenges of auricular pseudocysts.
METHODS
On May 28, 2020, a systematic search of Medline, Embase, and Cochrane databases was conducted. All the studies describing treatment of auricular pseudocysts, procedure description, outcome, and follow-up period were included in this review.
RESULTS
After full-text article review, 74 articles were included, representing a total of 1,011 lesions. The commonly used treatments for auricular pseudocysts were deroofing (493 lesions), aspiration (284 lesions), incision and drainage (171 lesions), intralesional steroids (53 lesions), and observation (10 lesions). The highest cure rate was found with the deroofing procedure (97.2%) followed by incision and drainage (95.9%). The mean follow-up period was 6.7 months.
CONCLUSION
Surgical procedures (anterior deroofing or incision and drainage) showed the highest cure rates and should be considered as first-line treatment for auricular pseudocysts. Future adequately designed randomized controlled trials are warranted to compare the efficacy of the techniques described.
Topics: Cysts; Drainage; Ear Diseases; Humans; Surgical Wound
PubMed: 34348416
DOI: 10.1111/ijd.15816 -
Pancreas Jul 2021The aim of the study was to evaluate the efficacy and safety of endoscopic treatment for pancreatic pseudocysts (PPCs) compared with laparoscopic treatment. (Comparative Study)
Comparative Study Meta-Analysis
OBJECTIVE
The aim of the study was to evaluate the efficacy and safety of endoscopic treatment for pancreatic pseudocysts (PPCs) compared with laparoscopic treatment.
METHODS
The Embase, Medline, Cochrane Library, Web of Science databases, China National Knowledge Infrastructure Chinese citation database, and WANFANG database were systematically searched to identify all comparative trials investigating endoscopic versus laparoscopic treatment for PPC. The main outcome measures included treatment success rate, adverse events, recurrence rate, operation time, intraoperative blood loss, and hospital stay.
RESULTS
Six studies with 301 participants were included. The results suggested that there was no difference in rates of treatment success (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.40-2.01; P = 0.79), adverse events (OR, 0.80, 95% CI, 0.38-1.70; P = 0.57), or recurrence (OR, 0.55, 95% CI, 0.22-1.40; P = 0.21) between endoscopic and laparoscopic treatments. However, the endoscopic group exhibited reduced operation time (weighted mean difference [WMD], -67.11; 95% CI, -77.27 to -56.96; P < 0.001), intraoperative blood loss (WMD, -65.23; 95% CI, -103.38 to -27.08; P < 0.001), and hospital stay (WMD, -2.45; 95% CI, -4.74 to -0.16; P = 0.04).
CONCLUSIONS
Endoscopic treatment might be suitable for PPC patients.
Topics: Blood Loss, Surgical; Endoscopy; Humans; Laparoscopy; Length of Stay; Outcome Assessment, Health Care; Pancreatic Pseudocyst; Postoperative Complications; Recurrence; Reproducibility of Results
PubMed: 34347721
DOI: 10.1097/MPA.0000000000001863 -
Evidence-based Complementary and... 2021PubMed Medline, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc, VIP, and Wanfang databases were searched. The primary... (Review)
Review
METHODS
PubMed Medline, Embase, Cochrane Library, China National Knowledge Infrastructure, China Biology Medicine disc, VIP, and Wanfang databases were searched. The primary outcome was treatment response. The secondary outcomes included changes in clinical and laboratory indicators and incidence of AP-related complications. Meta-analyses were performed by using a random-effect model. Risk ratios (RRs) with 95% confidence intervals (CIs) or weighted mean differences (WMDs) with 95% CIs were calculated.
RESULTS
Overall, 23 RCTs were included. The rates of overall (RR = 1.16; 95% CI = 1.12 to 1.20; < 0.00001) and complete (RR = 1.40; 95% CI = 1.30 to 1.50; < 0.00001) responses were significantly higher in the Xuebijing injection group. After treatment, the levels of interleukin-6 (WMD = -18.22; 95% CI = -23.36 to -13.08; < 0.00001), tumor necrosis factor- (WMD = -16.44; 95% CI = -20.49 to -12.40; < 0.00001), serum amylase (WMD = -105.61; 95% CI = -173.77 to -37.46; =0.002), white blood cell (WMD = -1.51; 95% CI = -1.66 to -1.36; < 0.00001), and C-reactive protein (WMD = -11.05; 95% CI = -14.32 to -7.78; < 0.00001) were significantly lower in the Xuebijing injection group. Abdominal pain (WMD = -1.74; 95% CI = -1.96 to -1.52; < 0.00001), abdominal distension (WMD = -1.56; 95% CI = -2.07 to -1.04; < 0.00001), gastrointestinal function (WMD = -2.60; 95% CI = -3.07 to -2.13; < 0.00001), body temperature (WMD = -2.16; 95% CI = -2.83 to -1.49; < 0.00001), serum amylase level (WMD = -1.81; 95% CI = -2.66 to -0.96; < 0.0001), and white blood cell (WMD = -2.16; 95% CI = -2.99 to -1.32; < 0.00001) recovered more rapidly in the Xuebijing injection group. The incidence of multiple organ dysfunction syndrome (RR = 0.18; 95% CI = 0.05 to 0.62; =0.006), pancreatic pseudocyst (RR = 0.17; 95% CI = 0.04 to 0.77; =0.02), and renal failure (RR = 0.16; 95% CI = 0.05 to 0.60; =0.006) was significantly lower in the Xuebijing injection group.
CONCLUSIONS
Xuebijing injection added on the basis of conventional treatment has a potential benefit for improving the outcomes of AP.
PubMed: 34221082
DOI: 10.1155/2021/6621368 -
Clinical Case Reports Jun 2021Alopecic and aseptic nodule of the scalp/Pseudocyst of the scalp is a rare but probably underdiagnosed nonscarring alopecia with good prognosis and doxycycline is a safe...
Alopecic and aseptic nodule of the scalp/Pseudocyst of the scalp is a rare but probably underdiagnosed nonscarring alopecia with good prognosis and doxycycline is a safe and effective option treatment.
PubMed: 34194753
DOI: 10.1002/ccr3.4153 -
Journal of Hepato-biliary-pancreatic... Feb 2022Peripancreatic fluid collections (PFCs) result from acute or chronic pancreatic inflammation that suffers a rupture of its ducts. Currently, there exists three options... (Meta-Analysis)
Meta-Analysis Review
Head-to-head comparison between endoscopic ultrasound guided lumen apposing metal stent and plastic stents for the treatment of pancreatic fluid collections: A systematic review and meta-analysis.
BACKGROUND/AIMS
Peripancreatic fluid collections (PFCs) result from acute or chronic pancreatic inflammation that suffers a rupture of its ducts. Currently, there exists three options for drainage or debridement of pancreatic pseudocysts and walled-off necrosis (WON). The traditional procedure is drainage by placing double pigtail plastic stents (DPPS); lumen-apposing metal stent (LAMS) has a biflanged design with a wide lumen that avoids occlusion with necrotic tissue, which is more common with DPPS and reduces the possibility of migration. We performed a systematic review and meta-analyses head-to-head, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS.
METHODS
We conducted a systematic review in different databases, such as PubMed, OVID, Medline, and Cochrane Databases. This meta-analysis considers studies published from 2014 to 2020, including only studies that compare the two main techniques to drainage of PFCs: LAMS vs DPPS.
RESULTS
Thirteen studies were included in the meta-analyses. Only one of all studies was a randomized controlled trial. These studies comprise 1584 patients; 68.2% were male, and 31.8% were female. Six hundred sixty-three patients (41.9%) were treated with LAMS, and 921 (58.1%) were treated with DPPS. Six studies included only WON in their analysis, two included only pancreatic pseudocysts, and five studies included both pancreatic pseudocysts and WON. The technical success was similar in patients treated with LAMS and DPPS (97.6% vs 97.5%, respectively, P = .986, RR = 1.00 [95% CI 0.93-1.08]). The clinical success was similar in both groups (LAMS: 90.1% vs DPPS: 84.2%, P = .139, RR = 1.063 [95% CI 0.98-1.15]). Patients treated with LAMS had a lower complication rate than the DPPS groups, with a significant statistical difference (LAMS: 16.0% vs DPPS: 20.2%, P = .009, RR = 0.746 [95% CI 0.60-0.93]). Bleeding was the most common complication in the LAMS group (33 patients, [5.0%]), whereas infection was the most common complication in the DPPS group (56 patients, [6.1%]). The LAMS migration rate was lower than in the DPPS (0.9% vs 2.2%, respectively, P = .05). The mortality rate was similar in both groups, 0.6% in the LAMS group (four patients) and 0.4% in the DPPS group (four patients; P = .640).
CONCLUSION
The PFCs drainage is an indication when persistent symptoms or PFCs-related complications exist. EUS guided drainage with LAMS has similar technical and clinical success to DPPS drainage for the management of PFCs. The technical and clinical success rates are high in both groups. However, LAMS drainage has a lower adverse events rate than DPPS drainage. More randomized controlled trials are needed to confirm the real advantage of LAMS drainage over DPPS drainage.
Topics: Drainage; Endosonography; Female; Humans; Male; Metals; Pancreatic Pseudocyst; Plastics; Randomized Controlled Trials as Topic; Stents; Treatment Outcome; Ultrasonography, Interventional
PubMed: 34107170
DOI: 10.1002/jhbp.1008 -
Otology & Neurotology : Official... Jun 2021Auricular pseudocyst (AP: intracartilaginous cyst, endochondral AP, cystic chondromalacia, and benign idiopathic cystic chondromalacia) is a benign condition of unknown...
OBJECTIVE
Auricular pseudocyst (AP: intracartilaginous cyst, endochondral AP, cystic chondromalacia, and benign idiopathic cystic chondromalacia) is a benign condition of unknown etiology. This report systematically reviews the published demographics, treatment protocols, and outcomes of AP between the various medical disciplines, and compares the findings to a theretofore-unreported 12-patient cohort. Primary outcome measure was AP complete resolution without recurrence.
DATA SOURCE
A systematic literature search of "MEDLINE" via "PubMed" and "Google Scholar" was performed in June, 2020. The 12 new patients were enrolled between January 2016 and December 2020.
STUDY SELECTION
Seventy-four papers met the study inclusion criteria and provided data on sex distribution, surgical approach and outcome, performance of approaches according to medical specialty, and recurrence rates of the reported AP populations.
DATA EXTRACTION
The appropriateness and study design quality were independently assessed by two reviewers.
DATA SYNTHESIS
The primary outcome was therapeutic success. A comparative analysis was also performed on the same extracted information that was retrieved from the medical files of the 12 new patients (10 men, 2 women, average age 24 yrs, range, 17-38).
CONCLUSIONS
AP is not uncommon. In line with the published literature, incision and curettage with excision of the anterior pseudocystic wall (deroofing) resulted in a recurrence rate of less than 17% with good cosmetic outcome among all 12 patients. Aspiration alone was associated with increased recurrence rates. Deroofing emerged as the preferred modality, with good cosmetic outcome and reduced recurrence rate. It was usually performed by otolaryngologists, while dermatologists used more conservative approach more frequently. Incision and drainage combined with compression reduces risk of recurrence.
Topics: Adult; Cysts; Drainage; Ear Diseases; Female; Humans; Male; Neoplasm Recurrence, Local; Treatment Outcome; Young Adult
PubMed: 33687172
DOI: 10.1097/MAO.0000000000003036 -
Pathology, Research and Practice Apr 2021To address the diagnostic accuracy of endoscopic ultrasound guided through-the-needle-biopsies (TTNBs) and simultaneously obtained cytology samples from pancreatic cysts... (Meta-Analysis)
Meta-Analysis
Diagnostic accuracy of EUS-guided through-the-needle-biopsies and simultaneously obtained fine needle aspiration for cytology from pancreatic cysts: A systematic review and meta-analysis.
OBJECTIVES
To address the diagnostic accuracy of endoscopic ultrasound guided through-the-needle-biopsies (TTNBs) and simultaneously obtained cytology samples from pancreatic cysts compared to the final histopathological diagnosis of the surgical specimen, and to give an overview of ancillary tests performed on TTNBs.
METHODS
A literature search was conducted in MEDLINE, Embase and Scopus. Studies were included in the meta-analysis, if they had data for TTNB, cytology and a surgical specimen of pancreatic cysts as reference standard. The assessment of the risk of bias and quality of the included studies was conducted using the modified QUADAS-2 tool.
RESULTS
Ten studies with 99 patients were included in the meta-analysis. Data regarding study design and clinicopathological features were extracted systematically. For TTNB, pooled sensitivity was 0.86 (95 % CI 0.62-0.96), specificity 0.95 (95 % CI 0.79-0.99) and area under the curve (AUC) 0.86 for the diagnosis of a mucinous cyst and pooled sensitivity was 0.78 (95 % CI 0.61-0.89), specificity 0.99 (95 % CI 0.90-0.99) and AUC 0.92 for the diagnosis of a high-risk cyst. For a specific diagnosis, pooled sensitivity was 0.69 (95 % CI 0.50-0.83), specificity 0.47 (95 % CI 0.28-0.68) and AUC 0.49. For cytology performed simultaneously, pooled sensitivity was 0.46 (95 % CI 0.35-0.57), specificity 0.90 (95 % CI 0.46-0.99) and AUC 0.64 for the diagnosis of mucinous cysts, and pooled sensitivity was 0.38 (95 % CI 0.23-0.55), specificity 0.99 (95 % CI 0.90-0.99) and AUC 0.84 for the diagnosis of a high-risk cyst. For a specific diagnosis, pooled sensitivity was 0.29 (95 % CI 0.21-0.39), specificity 0.45 (95 % CI 0.25-0.66) and AUC 0.30. Furthermore, immunohistochemical stains can be useful to establish the specific cyst subtype.
CONCLUSIONS
TTNBs have a higher sensitivity and specificity than cytology for the diagnosis of mucinous cyst and high- risk cysts of the pancreas.
Topics: Aged; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Humans; Male; Middle Aged; Neoplasms, Cystic, Mucinous, and Serous; Pancreatic Cyst; Pancreatic Neoplasms; Pancreatic Pseudocyst; Predictive Value of Tests; Reproducibility of Results
PubMed: 33652239
DOI: 10.1016/j.prp.2021.153368 -
BMC Gastroenterology Feb 2021Disconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Disconnected pancreatic duct syndrome (DPDS) is a complication of acute necrotizing pancreatitis in the neck and body of the pancreas often manifesting as persistent pancreatic fluid collection (PFC) or external pancreatic fistula (EPF). This systematic review and pairwise meta-analysis aimed to review the definitions, clinical presentation, intervention, and outcomes for DPDS.
METHODS
The PubMed, EMBASE, MEDLINE, and SCOPUS databases were systematically searched until February 2020 using the PRISMA framework. A meta-analysis was performed to assess the success rates of endoscopic and surgical interventions for the treatment of DPDS. Success of DPDS treatment was defined as long-term resolution of symptoms without recurrence of PFC, EPF, or pancreatic ascites.
RESULTS
Thirty studies were included in the quantitative analysis comprising 1355 patients. Acute pancreatitis was the most common etiology (95.3%, 936/982), followed by chronic pancreatitis (3.1%, 30/982). DPDS commonly presented with PFC (83.2%, 948/1140) and EPF (13.4%, 153/1140). There was significant heterogeneity in the definition of DPDS in the literature. Weighted success rate of endoscopic transmural drainage (90.6%, 95%-CI 81.0-95.6%) was significantly higher than transpapillary drainage (58.5%, 95%-CI 36.7-77.4). Pairwise meta-analysis showed comparable success rates between endoscopic and surgical intervention, which were 82% (weighted 95%-CI 68.6-90.5) and 87.4% (95%-CI 81.2-91.8), respectively (P = 0.389).
CONCLUSIONS
Endoscopic transmural drainage was superior to transpapillary drainage for the management of DPDS. Endoscopic and surgical interventions had comparable success rates. The significant variability in the definitions and treatment strategies for DPDS warrant standardisation for further research.
Topics: Acute Disease; Cholangiopancreatography, Endoscopic Retrograde; Drainage; Humans; Pancreatic Ducts; Pancreatic Pseudocyst; Pancreatitis; Retrospective Studies; Treatment Outcome
PubMed: 33632128
DOI: 10.1186/s12876-021-01663-2 -
The Journal of Oral Implantology Apr 2022A Schneiderian membrane (SM) thickness of >2 mm is regarded as a pathological mucosal change. The current study aimed to determine whether sinus floor elevation (SFE) in...
A Schneiderian membrane (SM) thickness of >2 mm is regarded as a pathological mucosal change. The current study aimed to determine whether sinus floor elevation (SFE) in the presence of SM pathology increases the risk of membrane perforation and implant failure rate. MEDLINE, Embase, Cochrane Library, and CNKI, Wanfang, and VIP databases were systemically searched for studies published until February 2020. Randomized and nonrandomized studies reporting the incidence of SM perforation in patients with SM pathology (antral pseudocyst or mucosal thickening) during SFE were included. The outcome measures were the incidence of SM perforation and implant survival rate. The pooled odds ratio (OR) and 95% confidence intervals (CIs) were calculated using fixed-effects model. A P value ≤.05 was considered to be statistically significant. Eighteen studies with a total of 1542 patients and 1797 SFE were included. A nonsignificant difference in the incidence of SM perforation was observed between the normal-appearing sinus and thickened sinus mucosa (fixed effects; OR, 0.896; 95% CI, 0.504-1.59; P = .707, I2 = 32%). The rates of SM perforation in the normal sinus, mucosal thickening, and antral pseudocysts were 14%, 6%, and 6% respectively. The implant survival rate was 98% in the normal sinus and 100% in antral pseudocyst and mucosal thickening. SM thickening or antral pseudocysts did not increase the risk of membrane perforation or rate of implant failure. Additional randomized controlled trials are needed to evaluate the effect of pathological changes in the SM on the failure of bone augmentation and dental implants.
Topics: Dental Implants; Humans; Incidence; Maxillary Sinus; Nasal Mucosa; Sinus Floor Augmentation
PubMed: 33270880
DOI: 10.1563/aaid-joi-D-20-00145