-
Pathobiology : Journal of... 2022Endoscopic ultrasound-guided ablation (EUS-A) therapy is a minimally invasive procedure for pancreatic-cystic tumors in patients with preoperative comorbidities or in...
BACKGROUND
Endoscopic ultrasound-guided ablation (EUS-A) therapy is a minimally invasive procedure for pancreatic-cystic tumors in patients with preoperative comorbidities or in patients who are not indicated for surgical resection. However, histopathologic characteristics of pancreatic cysts after ablation have not been well-elucidated.
METHODS
Here, we analyzed pathological findings of 12 surgically resected pancreatic cysts after EUS-A with ethanol and/or paclitaxel injection.
RESULTS
Mean patient age was 49.8 ± 13.6 years with a 0.3 male/female ratio. Clinical impression before EUS-A was predominantly mucinous cystic neoplasms. Mean cyst size before and after ablation therapy was similar (3.7 ± 1.0 cm vs. 3.4 ± 1.6 cm; p = 0.139). Median duration from EUS-A to surgical resection was 18 (range, 1-59) months. Mean percentage of the residual neoplastic lining epithelial cells were 23.1 ± 37.0%. Of the resected cysts, 8 cases (67%) showed no/minimal (<5%) residual lining epithelia, while the remaining 4 cases (33%) showed a wide range of residual mucinous epithelia (20-90%). Ovarian-type stroma was noted in 5 cases (42%). Other histologic features included histiocytic aggregation (67%), stromal hyalinization (67%), diffuse egg shell-like calcification along the cystic wall (58%), and fat necrosis (8%).
CONCLUSION
Above all, diffuse egg shell-like calcification along the pancreatic cystic walls with residual lining epithelia and/or ovarian-type stroma were characteristics of pancreatic cysts after EUS-A. Therefore, understanding these histologic features will be helpful for precise pathological diagnosis of pancreatic cystic tumor after EUS-A, even without knowing the patient's history of EUS-A.
Topics: Adult; Endosonography; Ethanol; Female; Humans; Male; Middle Aged; Paclitaxel; Pancreatic Cyst; Pancreatic Neoplasms; Pancreatic Pseudocyst
PubMed: 34515187
DOI: 10.1159/000518050 -
Ugeskrift For Laeger Nov 2014Incidental cystic lesions of the pancreas are often detected due to the increased use of cross-sectional imaging. Since mucinous cysts have a malignant potential,... (Review)
Review
Incidental cystic lesions of the pancreas are often detected due to the increased use of cross-sectional imaging. Since mucinous cysts have a malignant potential, whereas pseudocysts and serous cystadenomas are benign, the distinction is of key clinical importance. Current recommendations advocate the use of multiple imaging modalities (CT/MRI/endoscopic US/endoscopic US & fine-needle aspiration) during evaluation and follow-up. This review describes the most frequent cystic lesions of the pancreas and suggests a simple investigation and treatment algorithm.
Topics: Algorithms; Carcinoma, Pancreatic Ductal; Cystadenocarcinoma, Mucinous; Cystadenoma, Serous; Humans; Pancreatic Cyst; Pancreatic Pseudocyst
PubMed: 25394925
DOI: No ID Found -
Journal of the National Cancer Institute Nov 2014
Topics: Biomarkers, Tumor; Cyst Fluid; Female; Gene Expression Profiling; Humans; Male; Mucins; Pancreatic Cyst; Pancreatic Neoplasms; Precancerous Conditions
PubMed: 25359854
DOI: 10.1093/jnci/dju330 -
World Journal of Gastroenterology Jan 2016The approach to incidentally noted pancreatic cysts is constantly evolving. While surgical resection is indicated for malignant or higher risk cysts, correctly... (Review)
Review
The approach to incidentally noted pancreatic cysts is constantly evolving. While surgical resection is indicated for malignant or higher risk cysts, correctly identifying these highest risk pancreatic cystic lesions remains difficult. Using parameters including cyst size, presence of solid components, and pancreatic duct involvement, the 2012 International Association of Pancreatology (IAP) and the 2015 American Gastroenterological Association (AGA) guidelines have sought to identify the higher risk patients who would benefit from further evaluation using endoscopic ultrasound (EUS). Not only can EUS help further assess the presence of solid component and nodules, but also fine needle aspiration of cyst fluid aids in diagnosis by obtaining cellular, molecular, and genetic data. The impact of new endoscopic innovations with novel methods of direct visualization including confocal endomicroscopy require further validation. This review also highlights the differences between the 2012 IAP and 2015 AGA guidelines, which include the thresholds for sending patients for EUS and surgery and methods, interval, and duration of surveillance for unresected cysts.
Topics: Cholangiopancreatography, Magnetic Resonance; Diagnosis, Differential; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Incidental Findings; Microscopy, Confocal; Neoplasms, Cystic, Mucinous, and Serous; Pancreatectomy; Pancreatic Cyst; Pancreatic Neoplasms; Practice Guidelines as Topic; Predictive Value of Tests; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26811661
DOI: 10.3748/wjg.v22.i3.1236 -
PloS One 2023Although main pancreatic duct dilatation and pancreatic cysts are risk factors for developing pancreatic cancer, limited data exist regarding these findings in relatives...
Although main pancreatic duct dilatation and pancreatic cysts are risk factors for developing pancreatic cancer, limited data exist regarding these findings in relatives and spouses of pancreatic cancer patients. The frequency of these findings was examined using long-term follow-up data and transabdominal ultrasonography focusing on the pancreas. We prospectively enrolled 184 relatives and spouses of pancreatic cancer patients and performed special pancreatic ultrasonography to detect main pancreatic duct dilatation and pancreatic cysts. First-degree relatives (148 participants) of patients with pancreatic cancer were significantly younger than the spouses (36 participants; 41 vs. 65 years old). The frequency of ultrasonographic findings was significantly different between the relative (8.8%) and spouse (33.3%) groups. Main pancreatic duct dilatation and pancreatic cysts were observed in seven (4.7%) and seven (4.7%) participants in the relative group, and in nine (25.0%) and five (13.9%) participants in the spouse group, respectively. On multivariate analysis, age was an independent risk factor for the ultrasonographic findings. The frequency of ultrasonographic findings was significantly higher in spouses than in first-degree relatives of patients with pancreatic cancer and was strongly influenced by the age gap between the groups. Main pancreatic duct dilatation was frequently observed, especially in the spouse group.
Topics: Humans; Aged; Spouses; Dilatation; Pancreatic Ducts; Pancreatic Neoplasms; Pancreatic Cyst; Gastrointestinal Diseases; Dilatation, Pathologic
PubMed: 36630426
DOI: 10.1371/journal.pone.0280403 -
Archives of Pathology & Laboratory... Mar 2022The detection of pancreatic cystic neoplasms (PCNs) has increased owing to the advancement and widespread use of imaging modalities, resulting in differences between... (Review)
Review
CONTEXT.—
The detection of pancreatic cystic neoplasms (PCNs) has increased owing to the advancement and widespread use of imaging modalities, resulting in differences between past and current management methods for PCNs, including intraductal papillary mucinous neoplasms (IPMNs). Therefore, clinicians should accurately diagnose and determine appropriate treatment strategies. However, previously published treatment guidelines for IPMNs present different indications for treatment.
OBJECTIVE.—
To review the current status of PCNs, including epidemiologic change, malignancy risk, and factors for treatment, and to provide the optimal management algorithms for PCNs, including IPMNs, from the clinician's point of view.
DATA SOURCES.—
Literature review of published studies and the authors' own work.
CONCLUSIONS.—
The treatment of PCNs relies on the type of cyst that is present or suspected. Serous cystic neoplasms are usually benign, and observation is sufficient. However, surgical treatment is required for mucinous cystic neoplasms, and malignancy risk differs according to lesion size. Solid pseudopapillary neoplasms also require surgery. The detection of small IPMNs has been increasing, and most branch duct-type IPMNs are dormant. However, cysts 3 cm or larger or growing branch duct-type IPMNs must be carefully monitored because of the increasing risk of malignancy. Therefore, surveillance strategies should be different according to the size of the lesions. A tailored approach is needed for selecting surgery or surveillance, considering the malignancy potential of the lesion and patient-associated factors such as operative risks and life expectancy. Nomograms are valuable tools for selecting treatment methods as a customized approach for IPMNs.
Topics: Algorithms; Carcinoma, Pancreatic Ductal; Humans; Pancreatic Cyst; Pancreatic Neoplasms
PubMed: 33503225
DOI: 10.5858/arpa.2020-0395-RA -
Journal of General Internal Medicine Jan 2022
Topics: Humans; Pancreatic Cyst; von Hippel-Lindau Disease
PubMed: 34704208
DOI: 10.1007/s11606-021-07202-9 -
The Turkish Journal of Gastroenterology... Sep 2021There are studies reporting that the location of intraductal papillary mucinous neoplasia (IPMN) predicts malignancy. Therefore, we evaluated the cyst location's...
BACKGROUND
There are studies reporting that the location of intraductal papillary mucinous neoplasia (IPMN) predicts malignancy. Therefore, we evaluated the cyst location's relationship with malignancy, and the possibility of using cyst size and location to distinguish between non-main duct (non-MD)-IPMNs, mucinous cystic neoplasia (MCN), and cystic pancreatic ductal adenocarcinoma (PDAC).
METHODS
We performed a retrospective analysis of data from 122 patients with a definite cyto-histological diagnosis of non-MDIPMNs, LR-MCNs, and cystic PDACs via endoscopic ultrasound fine-needle aspiration between October 2011 and October 2020. We grouped the cyst locations as head, uncinate, neck (HUN), and corpus or tail (CT). On histology, low-grade dysplasia and intermediategrade dysplasia were considered low risk (LR), whereas high-grade dysplasia and invasive carcinoma were considered high risk (HR).
RESULTS
Of the 122 patients (61 (50%) women, median age 61.5 years (range 19-85), there were 34 (27.9%) LR-non-MD-IPMNs, 33 (27%) HR-non-MD-IPMNs, 19 (15.6%) LR-MCNs, and 36 (29.5%) cystic PDACs. We found no significant difference between LRand HR-non-MD-IPMN locations (P = .803). Low-risk non-MD-IPMNs were significantly smaller than HR-non-MD-IPMNs (P < .001), LR-MCNs (P = .002), and cystic PDACs (P < .001). The area under the receiver operating characteristic curve (AUROC) was 0.819 (95% CI: 0.716-0.902; P < .0001), and demonstrated a cyst size cut-off <2.2 cm to differentiate LR cysts, while cysts <1.6 cm had a negative predictive value (NPV) of 100% in non-MD-IPMNs.
CONCLUSION
Cyst location is not predictive of malignancy in non-MD-IPMNs. Low-risk non-MD-IPMNs were smaller than HR-non MDIPMNs, LR-MCNs, and cystic PDACs. The cyst size cut-off was 2.2 cm; however, <1.6 cm had a 100% NPV differentiating LR- from HR-non-MD-IPMNs.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Pancreatic Cyst; Pancreatic Intraductal Neoplasms; Retrospective Studies; Young Adult
PubMed: 34609302
DOI: 10.5152/tjg.2021.21318 -
Revista de Gastroenterologia de Mexico... 2022The differential diagnosis of pancreatic cystic lesions (PCLs) includes non-neoplastic lesions and neoplastic epithelial lesions. Given that management is determined by... (Review)
Review
The differential diagnosis of pancreatic cystic lesions (PCLs) includes non-neoplastic lesions and neoplastic epithelial lesions. Given that management is determined by the risk for malignant progression, associated symptoms, and other characteristics, an accurate diagnosis is imperative. The present review attempts to provide a critical path that facilitates the characterization and management of PCLs.
Topics: Diagnosis, Differential; Humans; Pancreatic Cyst; Pancreatic Neoplasms
PubMed: 35610168
DOI: 10.1016/j.rgmxen.2022.05.002 -
Pancreas 2019Pancreatic lesions in autosomal dominant polycystic kidney disease (ADPKD) are primarily cysts. They are increasingly recognized, with isolated reports of intraductal...
OBJECTIVES
Pancreatic lesions in autosomal dominant polycystic kidney disease (ADPKD) are primarily cysts. They are increasingly recognized, with isolated reports of intraductal papillary mucinous neoplasia (IPMN).
METHODS
Retrospective study to determine prevalence, number, size, and location of pancreatic abnormalities using abdominal magnetic resonance imaging (MRI) of genotyped ADPKD patients (seen February 1998 to October 2013) and compared with age- and sex-matched non-ADPKD controls. We evaluated presentation, investigation, and management of all IPMNs among individuals with ADPKD (January 1997 to December 2016).
RESULTS
Abdominal MRIs were examined for 271 genotyped ADPKD patients. A pancreatic cyst lesion (PCL) was detected in 52 patients (19%; 95% confidence interval, 15%-23%). Thirty-seven (71%) had a solitary PCL; 15 (28%) had multiple. Pancreatic cyst lesion prevalence did not differ by genotype. Intraductal papillary mucinous neoplasia was detected in 1% of ADPKD cases. Among 12 IPMN patients (7 branch duct; 5 main duct or mixed type) monitored for about 140 months, 2 with main duct IPMNs required Whipple resection, and 1 patient died of complications from small-bowel obstruction after declining surgical intervention.
CONCLUSIONS
With MRI, PCLs were detected in 19% and IPMNs in 1% of 271 ADPKD patients with proven mutations, without difference across genotypes. Pancreatic cyst lesions were asymptomatic and remained stable in size.
Topics: Adenocarcinoma, Mucinous; Adenocarcinoma, Papillary; Adult; Carcinoma, Pancreatic Ductal; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mutation; Outcome Assessment, Health Care; Pancreatic Cyst; Pancreatic Neoplasms; Polycystic Kidney, Autosomal Dominant; Retrospective Studies
PubMed: 31091218
DOI: 10.1097/MPA.0000000000001306