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Revista Medica de Chile Dec 2021Pancreatic cystic neoplasms (PCN) are frequently detected on abdominal images performed for non-pancreatic indications. Their prevalence in asymptomatic population...
Pancreatic cystic neoplasms (PCN) are frequently detected on abdominal images performed for non-pancreatic indications. Their prevalence in asymptomatic population ranges from 2.7 to 24.8%, and increases with age. There are several types of pancreatic cysts. Some may contain cancer or have malignant potential, such as mucinous cystic neoplasms, including mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasms (IPMN). In contrast, others are benign, such as serous cystadenoma (SCA). However, even those cysts with malignant potential rarely progress to cancer. Currently, the only treatment for pancreatic cysts is surgery, which is associated with high morbidity and occasional mortality. The Board of the Chilean Pancreas Club of the Chilean Gastroenterology Society developed the first Chilean multidisciplinary consensus for diagnosis, management, and surveillance of PCN. Thirty experts were invited and answered 21 statements with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree. A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. The consensus was approved by the Board of Directors of the Chilean Pancreas Club for publication.
Topics: Humans; Chile; Consensus; Pancreatic Cyst; Pancreatic Neoplasms
PubMed: 35735345
DOI: 10.4067/s0034-98872021001201773 -
Experimental and Therapeutic Medicine Jul 2022Epithelial tumors that originate from the kidney are uncommon. The majority of cases reported in the literature are malignant, with <1% of adenocarcinomas. Adenomas are...
Epithelial tumors that originate from the kidney are uncommon. The majority of cases reported in the literature are malignant, with <1% of adenocarcinomas. Adenomas are even rarer. A case of mucinous cystadenoma of the kidney was diagnosed and treated in Cangzhou Hospital of Integrated TCM-WM•HEBEI. The clinical feature of this disease was atypical. The principal symptom of mucinous cystadenoma of the kidney was a lump in the upper abdomen with intermittent pain in the abdomen. The tumor size ranged from 5-12 cm. The patient was clinically diagnosed with multiple renal cysts with thickened walls and hemorrhage. The patient was admitted to the hospital five days later, and a left nephrectomy was performed. The tumor capsule was integrated and did not adhere to the adjacent tissue. One or multiple smooth-walled dilated cystic areas were found on the cut section, some of which were filled with grey opaque gelatinous clots. Under light microscopy, the epithelial lining was characterized by a single layer of columnar with papillary proliferation and almost had no mitosis. Immunohistochemistry showed that the cyst was positive for carcinoembryonic antigen (CEA) and proliferating cell nuclear antigen (PCNA). Following nephrectomy, the patient was followed up for 8 years and no recurrence and metastasis were found. A total of five articles were retrieved, including six cases with mucinous cystadenoma of the kidney. The clinical feature of this disease was atypical, making clinical diagnosis difficult. Histopathological examination revealed that the cyst consisted of mucinous epithelium with supporting fibrous tissue and immunohistochemistry showed that the cyst was positive for CEA and PCNA. Patients with all resection of the affected kidney had an improved prognosis.
PubMed: 35720631
DOI: 10.3892/etm.2022.11378 -
Ultrasound (Leeds, England) May 2022Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is one of the most common benign salivary gland neoplasms. The current first-line treatment for...
INTRODUCTION
Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is one of the most common benign salivary gland neoplasms. The current first-line treatment for Warthin's tumor is parotidectomy. However, surgical resection has the risk of complications including facial nerve weakness and Frey's syndrome. Recently, ultrasound-guided ethanol sclerotherapy (UGES) has been found to be efficacious in the treatment of a variety of head and neck lesions.
CASE REPORT
We present a patient with multifocal Warthin's tumor who was managed with partial parotidectomy and two cycles of ultrasound-guided ethanol sclerotherapy.
DISCUSSION
Ethanol sclerotherapy has been used as a minimally invasive alternative to surgical excision or observation alone for a variety of head and neck masses. To our knowledge, this is the first case presented in the literature where sclerotherapy was used in conjunction with a partial parotidectomy. Minimizing the extent of surgical resection can reduce the risk of facial nerve weakness and Frey's syndrome and negate the need for fat grafting for defect reconstruction.
CONCLUSION
UGES may serve as a safe and reliable procedure that can be performed in conjunction with partial parotidectomy for patients who wish to achieve definitive diagnosis while also minimizing the risk of complications associated with extensive parotidectomy.
PubMed: 35509301
DOI: 10.1177/1742271X211030302 -
Histopathology Oct 2022The 5th edition of the World Health Organisation Blue Book was published recently and includes a comprehensive update on testicular tumours. This builds upon the work of... (Review)
Review
The 5th edition of the World Health Organisation Blue Book was published recently and includes a comprehensive update on testicular tumours. This builds upon the work of the 4th edition, retaining its structure and main nomenclature, including the use of the term 'germ cell neoplasia in situ' (GCNIS) for the pre-invasive lesion of most germ cell tumours and division from those not derived from GCNIS. While there have been important developments in understanding the molecular underpinnings of testicular cancer, this updated classification paradigm and approach remains rooted in morphology. Nomenclature changes include replacement of the term 'primitive neuroectodermal tumour' by 'embryonic neuroectodermal tumour' based on the non-specificity of the former term and to separate these tumours clearly from Ewing sarcoma. Seminoma is placed in a germinoma family of tumours emphasising relation to those tumours at other sites. Criteria for the diagnosis of 'teratoma with somatic transformation' have been modified to not include variable field size assessments. The word 'carcinoid' has been changed to 'neuroendocrine tumour', with most examples in the testis now classified as 'prepubertal type testicular neuroendocrine tumour'. For sex cord-stromal tumours, the use of mitotic counts per high-power field has been changed to per mm2 for malignancy assessments, and the new entities, 'signet ring stromal tumour' and 'myoid gonadal stromal tumour', are defined. Well-differentiated papillary mesothelial tumour has now been defined as tumour type with a favourable prognosis. Sertoliform cystadenoma has been removed as an entity from testicular adnexal tumours and placed with Sertoli cell tumours.
Topics: Carcinoid Tumor; Humans; Male; Neoplasms, Germ Cell and Embryonal; Seminoma; Sex Cord-Gonadal Stromal Tumors; Testicular Neoplasms; World Health Organization
PubMed: 35502823
DOI: 10.1111/his.14675 -
Autopsy & Case Reports 2022Papillary cystadenoma is a rare benign neoplasm of the epididymis. It may occur sporadically or in association with von Hippel-Lindau disease (VHLD). Papillary...
BACKGROUND
Papillary cystadenoma is a rare benign neoplasm of the epididymis. It may occur sporadically or in association with von Hippel-Lindau disease (VHLD). Papillary cystadenoma of the epididymis (PCE) is a benign mimic of metastatic clear cell renal cell carcinoma (CCRCC) given their histologic similarities.
CASE PRESENTATION
Herein, we present the case of a 40-year-old man with a four-year history of microhematuria and a recently detected right paratesticular mass. A testicular sonogram revealed a hypoechoic, hypervascular solid mass in the right epididymal head treated by surgical excision. Histopathological examination demonstrated a 1.1 cm papillary cystadenoma of the epididymis. Genetic testing performed later showed no signs of VHLD. However, heterozygous mutations in three genes - , , and - were found which have never been reported in PCE before.
CONCLUSIONS
Papillary cystadenoma of the epididymis should always be considered in the differential diagnosis of epididymal lesions, especially those that are cystic. The mainstay of treatment remains surgical excision, which provides an excellent prognosis.
PubMed: 35496736
DOI: 10.4322/acr.2021.374 -
Endoscopy Dec 2022BACKGROUND AND STUDY AIMS : Endoscopic ultrasound-guided through-the-needle biopsy (TTNB) of pancreatic cystic lesions (PCLs) is associated with a non-negligible risk...
BACKGROUND AND STUDY AIMS : Endoscopic ultrasound-guided through-the-needle biopsy (TTNB) of pancreatic cystic lesions (PCLs) is associated with a non-negligible risk for adverse events (AEs). We aimed to identify the hierarchic interaction among independent predictors for TTNB-related AEs and to generate a prognostic model using recursive partitioning analysis (RPA). PATIENTS AND METHODS : Multicenter retrospective analysis of 506 patients with PCLs who underwent TTNB. RPA of predictors for AEs was performed and the model was validated by means of bootstrap resampling. RESULTS : Mean cysts size was 36.7 mm. Most common diagnoses were intraductal papillary mucinous neoplasm (IPMN, 45 %), serous cystadenoma (18.8 %), and mucinous cystadenoma (12.8 %). Fifty-eight (11.5 %) AEs were observed. At multivariate analysis, age (odds ratio [OR] 1.32, 1.09-2.14; p = 0.05), number of TTNB passes (OR from 2.17, 1.32-4.34 to OR 3.16, 2.03-6.34 with the increase of the number of passes), complete aspiration of the cyst (OR 0.56, 0.31-0.95; p = 0.02), and diagnosis of IPMN (OR 4.16, 2.27-7.69; p < 0.001) were found to be independent predictors of AEs, as confirmed by logistic regression and random forest analyses. RPA identified three risk classes: high-risk (IPMN sampled with multiple microforceps passes, 28 % AEs rate), low-risk (1.4 % AE rate, including patients < 64 years with other-than-IPMN diagnosis sampled with ≤ 2 microforceps passes and with complete aspiration of the cyst) and middle-risk class (6.1 % AEs rate, including the remaining patients). CONCLUSION : TTNB should be selectively used in the evaluation of patients with IPMN. The present model could be applied during patient selection as to optimize the benefit/risk of TTNB.
Topics: Humans; Pancreatic Intraductal Neoplasms; Retrospective Studies; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Pancreatic Cyst; Endosonography; Pancreatic Neoplasms
PubMed: 35451041
DOI: 10.1055/a-1831-5385 -
Journal of Computer Assisted TomographyThe objective of this study is to determine the role of apparent diffusion coefficient (ADC) value at 3T magnetic resonance imaging (MRI) in the characterization of...
OBJECTIVE
The objective of this study is to determine the role of apparent diffusion coefficient (ADC) value at 3T magnetic resonance imaging (MRI) in the characterization of pancreatic cystic lesions.
METHODS
We retrospectively selected a total number of 223 patients with a conclusive diagnosis of pancreatic cystic lesion, previously undergoing MR examination on a 3 T system. The MRI protocol first included axial T1/T2-weighted sequences and magnetic resonance cholangiopancreatography. Diffusion-weighted MRI was performed using a spin-echo echo-planar sequence with multiple b values (0, 150, 500, 1000, and 1500 s/mm2) in all diffusion directions, obtaining an ADC map. Contrast-enhanced T1-weighted sequences were performed during the initial work-up of a pancreatic cystic lesion and when signs of malignancy were suspected during the MRI follow-up. The ADC value of each pancreatic lesion was measured using a monoexponential curve fitting with all the multiple b.
RESULTS
The final diagnosis of our study group included the following: serous cystadenomas (n = 42), mucinous cystadenomas (n = 14), intraductal papillary mucinous neoplasms (IPMNs) (n = 121), IPMNs with signs of malignancy at histopathologic examination (n = 24), pseudocysts (n = 9), other cystic lesions (n = 13). A statistically significant difference was observed between the ADC values of malignant IPMNs and those of each other group of pancreatic lesions (P < 0.001). The ADC value of benign IPMN was significantly higher than that of serous cystadenomas (P = 0.024). A statistically significant difference was observed between the ADCs of all mucinous cystic tumors (benign IPMNs together to mucinous cystadenomas) and the ADCs of serous cystadenomas (P = 0.014).
CONCLUSIONS
Fitted ADC value obtained at 3T MRI may be helpful in the characterization of pancreatic cystic lesions with particular regards of differential diagnosis between mucinous and serous cystic tumors and between malignant and benign IPMNs.
Topics: Cystadenoma, Mucinous; Cystadenoma, Serous; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Humans; Magnetic Resonance Imaging; Pancreas; Pancreatic Cyst; Pancreatic Neoplasms; Retrospective Studies
PubMed: 35405726
DOI: 10.1097/RCT.0000000000001302 -
Cureus Feb 2022Oral cancer is a common site of cancer worldwide with oral squamous cell carcinoma (OSCC) comprising the major segment. The risk factors include tobacco and alcohol...
Oral cancer is a common site of cancer worldwide with oral squamous cell carcinoma (OSCC) comprising the major segment. The risk factors include tobacco and alcohol abuse, betel quid, and areca nut consumption. Warthin tumour (WT), also known as papillary cystadenoma lymphomatosum is a benign tumour of the salivary gland. It is one of the most common benign parotid neoplasms with cigarette smoking and radiation exposure as possible cited etiologic factors. Rarely, two or more histologically distinct neoplasms may occur synchronously. The synchronous occurrence of OSCC and WT is infrequent. The aim of this case series is to report the incidence rate of synchronous OSCC and WT in our centre between 2010 and 2019 and their socio-demographic, clinical, histopathological features, management, and prognosis and discuss the relevant literature. Out of 143 OSCC cases reported in our centre from the year 2010 to 2019, two had synchronous OSCC and WT with an incidence rate of 1.4%. These two cases occurred in a 63-year-old female and a 68-year-old male both with smoking habits. One OSCC was present in the left buccal mucosa and the other in the right ventral surface of the tongue, whereas the WT in both cases occurred in the tail of the parotid. One patient had a recurrence and died while the other is under follow-up without any recurrence. These unusual findings of synchronous occurrence of WT at a distant site from the primary tumour may mimic a malignant disease, more likely a metastasis from the primary OSCC, which could further complicate the management of these patients. Therefore, radiologists, head and neck surgeons, and pathologists should be aware of the occurrence of these unusual presentations to avoid overtreatment in such cases.
PubMed: 35345750
DOI: 10.7759/cureus.22547 -
Human Pathology May 2022von Hippel-Lindau (VHL) disease occurs secondary to pathogenic alterations of the VHL tumor suppressor gene, manifesting with cysts and tumors in multiple organ systems....
von Hippel-Lindau (VHL) disease occurs secondary to pathogenic alterations of the VHL tumor suppressor gene, manifesting with cysts and tumors in multiple organ systems. VHL protein (pVHL) is a known downregulator of hypoxia inducible factor-1a (HIF1a). Loss of function of pVHL is associated with upregulation of the HIF1a pathway including carbonic anhydrase 9 (CA9) and glucose transporter 1 (GLUT1). Paired box 8 (PAX8) is an important transcription factor regulator of mesonephric development. We investigated the role of immunohistochemistry in the assessment of CA9, GLUT1, and PAX8 expression in VHL disease-related lesions. Clinicopathologic information and archived pathology material from 5 patients with VHL disease were reviewed and evaluated for expression of CA9, GLUT1, and PAX8. The spectrum of VHL disease-related lesions included hemangioblastoma, endolymphatic sac tumor, pulmonary microcysts, pheochromocytoma, pancreatic neuroendocrine tumor and serous cystadenoma, renal cysts, renal cell carcinoma, and epididymal papillary cystadenoma. CA9 was expressed in all lesions and exhibited diffuse positivity (15/15 lesions, 100%; 5/5 patients), while GLUT1 expression was focal/weak or absent in some instances (strong positive: 12/15 lesions, 80%; 5/5 patients). PAX8 was expressed only in renal and epididymal lesions. CA9 and GLUT1 are consistently overexpressed in VHL disease-related lesions, reflecting upregulation of the HIF1a pathway. PAX8 is only expressed in genitourinary lesions, mirroring organ-specific differentiation. A combination of CA9 and GLUT1 immunostains is useful in screening lesions of patients with VHL spectrum manifestations, which may be targeted by the recently Food and Drug Administration-approved HIF-2a inhibitors.
Topics: Carbonic Anhydrase IX; Carcinoma, Renal Cell; Female; Glucose Transporter Type 1; Humans; Kidney Neoplasms; Male; PAX8 Transcription Factor; United States; von Hippel-Lindau Disease
PubMed: 35196526
DOI: 10.1016/j.humpath.2022.02.009 -
Annals of Medicine and Surgery (2012) Feb 2022Intraductal papillary mucinous neoplasms (IPMNs) constitute a group of rare conditions with a potential for malignant degeneration. The appearance of symptoms should...
INTRODUCTION
Intraductal papillary mucinous neoplasms (IPMNs) constitute a group of rare conditions with a potential for malignant degeneration. The appearance of symptoms should suggest degeneration. This case demonstrates an unusual case of a patient presenting an intestinal type IPMN that was revealed by a large abdominal mass.
CASE REPORT
47-year-old woman with a history of hydatid cyst of the liver. The patient was admitted to our hospital for management of large abdominal mass measuring 185 × 128*190 mm. Intra-operative findings showed a voluminous tumor, of approximately 20 cm in all its dimensions, with double solido-cystic component at the expense of the neck and the body of the pancreas. The patient underwent splenopancreatectomy. The histopathological examination confirmed the presence of intestinal type of IPMN of pancreas.
DISCUSSION
Acute pancreatitis is revealed in the majority of cases of IPMNs, related to duct obstruction by secreting mucus plug. IPMNs are rarely the cause of a large abdominal mass. They are cystic lesions of slow evolution, macroscopically visible and rarely macrocystic, unlike serous cystadenoma. The tumor size is a powerful indicator of the malignancy of IPMNs. The current definitive and ideal treatment for main duct and mixed type IMPNs is a surgical resection.
CONCLUSION
IPMNs are a cystic lesion, rarely revealed by a large mass.
PubMed: 35145659
DOI: 10.1016/j.amsu.2022.103264