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1
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Hickman K, Sadler T, Zhang T, Boninsegna E, Majcher V, Godfrey E. Pancreatic cystic lesions and the role of contrast enhanced endoscopic ultrasound. Clin Radiol 2022; 77:418-427. [PMID: 35387743 DOI: 10.1016/j.crad.2022.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/22/2022] [Indexed: 11/16/2022]
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2
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Murtha TD, Cornman-Homonoff J, Ayyagari R, Zhang X, Salem RR. A Novel Treatment for Metastatic Serous Cystadenocarcinoma Using a Microwave Ablation: Case Report and Review of the Literature. Pancreas 2021; 50:434-440. [PMID: 33835976 DOI: 10.1097/mpa.0000000000001785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The incidence of pancreatic cystic neoplasms has grown because of increased detection. Among these lesions, serous cystadenoma was traditionally thought to be universally benign and indolent. However, there is an exceedingly rare malignant variant of serous cystadenoma known as serous cystadenocarcinoma (SCAC) that can exhibit local invasion into adjacent structures, hepatic implants, and metastatic spread to the abdominal viscera. Diagnosis of SCAC can be challenging as it is histologically identical to serous cystadenoma. To better understand this entity, a review of all published accounts of SCAC was performed in which tumor and patient factors were characterized. In addition, we present the case of a 49-year-old woman who was found to have a solitary hepatic metastasis due to SCAC, 11 years after a distal pancreatectomy for serous cystadenoma. She was successfully treated with percutaneous microwave ablation and has no evidence of recurrence 3 years later. This report details the first published account of percutaneous ablation in such a setting. Compared with hepatectomy, hepatic ablation may offer a less invasive but equally effective treatment option in well-selected patients.
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Affiliation(s)
| | | | | | - Xuchen Zhang
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Ronald R Salem
- From the Division of Surgical Oncology, Department of Surgery
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3
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Sekiguchi N, Nakashima S, Koh M, Ueda M, Tsuda Y, Tanida T, Matsuyama J, Ikenaga M, Yamada T. A case of multiple serous cystadenoma of pancreas. Ann Med Surg (Lond) 2020; 60:566-570. [PMID: 33299562 PMCID: PMC7704365 DOI: 10.1016/j.amsu.2020.11.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Typically, SCN is single and doesn't invade around tissue. In our case, tumors were multiple and had gradually grown and caused vein stenosis. This is extremely rare and unique resected multiple SCN case. In addition, I report that it was thought to be educational that even benign tumors could cause such changes. Presentation of case A 60-year-old female was diagnosed with 3 multilocular cystic tumors in distal pancreas by contrast enhanced computed tomography (CT) at the preoperative staging for rectal neoplasm. The diameters of cystic tumors were 22/23/29 mm. The CT showed that the tumors had multiple internal septa enhanced in the arterial phase and the second tumor contained internal calcifications located centrally. The main pancreatic duct was not dilated. Although SCN often occurred single and multiple SCN was very rare, we diagnosed that the tumors were suspected microcystic type SCN because they had typical image findings. So, we planned to follow up every six months after resection for rectal neoplasm. 2 years and half later, they had gradually grown, and splenic vein stenosis appeared. The pancreatic parenchyma atrophy and dilatation of the main pancreatic duct had been gradually progressing. We performed distal pancreatectomy because of possibility of malignancy. The histopathological findings showed that 2 cystic tumors the side of pancreatic head had a connection and had typical findings of SCA of pancreas. The other tumor was independent from two tumors. They had no malignant findings. Discussion At first, we expected tumor invasion had caused the changes. But tumors had no malignant findings, so we considered that compression from the tumor had caused stenosis, and obstructive pancreatitis had induced the pancreatic parenchyma atrophy. Conclusion We learned from this case that not only invasion but also compression caused vein stenosis and pancreatic duct dilation.
Multiple serous cystic neoplasms are rare tumors. The tumors had gradually grown and main pancreatic duct dilatation had appeared. We performed laparotomy because we couldn't deny local infiltration. The main pancreatic duct dilatation had been caused by the compression. This is unique that even benign tumors could cause pancreatic duct dilatation.
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Affiliation(s)
- Naoko Sekiguchi
- Department of Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Shinsuke Nakashima
- Department of Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Masahiro Koh
- Department of Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Masami Ueda
- Department of Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Yujiro Tsuda
- Department of Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Tsukasa Tanida
- Department of Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Jin Matsuyama
- Department of Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Masakazu Ikenaga
- Department of Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
| | - Terumasa Yamada
- Department of Surgery, Higashiosaka City Medical Center, Nishiiwata 3-4-5, Higashiosaka, Osaka, 567-8588, Japan
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Zhou XH, Ma JK, Valluru B, Sharma K, Liu L, Hu JB. Diagnosis and differentiation of mature cystic teratoma of pancreas from its mimics: A case report. Medicine (Baltimore) 2020; 99:e23267. [PMID: 33217853 PMCID: PMC7676578 DOI: 10.1097/md.0000000000023267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Mature cystic teratoma originating in the pancreas is very unusual, often observed as an incidental finding during routine examinations or recognized perioperatively as the patients present with very unspecific clinical symptoms. The confirmatory diagnosis of a pancreatic cystic teratoma is generally made by histopathology after surgical excision. So, the preoperative diagnosis is very challenging, especially differentiation from the other pancreatic pathologies. PATIENT CONCERNS A 23-year-old woman was admitted to our hospital with a complaint of mild grade periumbilical abdominal pain. A pancreatic mass was revealed on a preliminary abdominal ultrasound examination. Her medical history was unremarkable with no long-standing illness or malignancy. DIAGNOSIS Mature cystic teratoma in the head of the pancreas. INTERVENTIONS Roux-enY choledochojejunostomy with gastrojejunostomy was performed, excising the tumor from the pancreatic head. OUTCOMES The postoperative course was uneventful; the patient was asymptomatic and has no evidence of recurrence on a 2-year follow up. CONCLUSIONS Pancreatic cystic teratoma is a benign, well-differentiated, and extremely rare congenital tumor. MRI is the choice of imaging modality and phase-GRE or fat suppression is the best technique for pre-operative diagnosis.
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Affiliation(s)
- Xin he Zhou
- Department of Radiology, the First Affiliated Hospital of Dali University
| | - Ji Kong Ma
- Department of Nephrology, Dali Bai Autonomous Prefecture People's Hospital Dali 671000, China
| | - Bimbadhar Valluru
- Department of Radiology, the First Affiliated Hospital of Dali University
| | - Kalyan Sharma
- Department of Radiology, the First Affiliated Hospital of Dali University
| | - Ling Liu
- Department of Radiology, the First Affiliated Hospital of Dali University
| | - Jin Bo Hu
- Department of Radiology, the First Affiliated Hospital of Dali University
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Kawai M, Fukuda A, Yogo A, Kozu T, Taira K, Okuno T, Shirase T, Matsumoto A, Kawanami C, Seno H. A case of a malignant serous neoplasm of the pancreas with synchronous vascular invasion and metachronous metastases. Clin J Gastroenterol 2020; 13:1347-1354. [PMID: 32880811 DOI: 10.1007/s12328-020-01223-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
Serous neoplasms (SNs) of the pancreas are usually considered benign tumors. However, they rarely manifest malignant behaviors. Here we present a case of malignant SN and review the literature of malignant SN. A 71-year-old woman presented to our hospital with a palpable abdominal mass. Imaging studies revealed a 7 cm mass with a cluster of microcysts having a honeycomb appearance in the head of the pancreas, which invaded the superior mesenteric vein (SMV). After being clinically diagnosed with SN, pancreaticoduodenectomy was performed with resection of limited SMV. Microscopically, the tumor was diagnosed as an SN concomitant with the tumor thrombus in the SMV. Four years after the surgery, two liver tumors and two peritoneal nodules were detected and three of them were surgically resected. All of those lesions had a honeycomb appearance in their cut surfaces and they were microscopically indistinguishable from the originally resected SN. A review of the literature identified 22 cases of malignant metastatic SNs published to date. Even though extremely rare, metachronous metastasis could occur in SNs of the pancreas. Local invasion indicated an increased likelihood of future metastasis. Thus, periodic surveillance should be considered for SNs after resection, especially when they have a local invasion.
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Affiliation(s)
- Munenori Kawai
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Akihisa Fukuda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akitada Yogo
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takumi Kozu
- Department of Surgery, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-0046, Japan
| | - Kaoru Taira
- Taira Clinic of Gastroenterological Medicine, 3-33-1 Tsukinowa, Otsu, Shiga, 520-2152, Japan
| | - Tomoko Okuno
- Department of Pathology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-0046, Japan
| | - Tomoyuki Shirase
- Department of Pathology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-0046, Japan
| | - Atsushi Matsumoto
- Department of Gastroenterology, Tenri Yorozu Sodanjo Hospital, 200 Mishima-cho, Tenri, Nara, 632-0015, Japan
| | - Chiharu Kawanami
- Department of Gastroenterology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-0046, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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6
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[Quality of indications in cystic lesions of the pancreas]. Chirurg 2020; 91:736-742. [PMID: 32642818 DOI: 10.1007/s00104-020-01217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cystic tumors of the pancreas (PCN) have increasingly gained importance in the clinical routine as they are frequently diagnosed as an incidental finding due to the continuous improvement in cross-sectional imaging. A differentiation is made between non-neoplastic and neoplastic cysts, whereby the latter has a tendency to malignant transformation to a varying extent. Therefore, they can be considered as precursor lesions of pancreatic cancer (PDAC). In addition to a detailed patient history and examination, imaging modalities, such as computed tomography (CT), magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS) with fine needle aspiration (FNA) are used for the differential diagnosis. The indications for surgical resection of these lesions are based on the current European guidelines from 2018; however, the content is not evidence-based but relies on knowledge and recommendations from experts. According to these consensus recommendations asymptomatic serous cystic neoplasms (SCN) are serous lesions with a low tendency for malignant transformation and can be monitored. In contrast resection is warranted for all mucinous cystic neoplasms (MCN) >4 cm and all solid pseudopapillary neoplasms (SPN). Intraductal papillary mucinous neoplasms (IPMN), which are differentiated into main duct (MD-IPMN) and branch duct type (BD-IPMN) IPMN based on the position in the pancreatic duct system, should be resected as MD-IPMN and mixed type (MT)-IPMN. The risk of malignant transformation in BD-IPMN is variable and depends on risk factors, which are defined clinically and by imaging morphology. The treatment management is therefore carried out on an individual basis following risk estimation. In order to quantify the quality of indications in PCN and thereby also contributing to optimized medical care, prospective long-term studies are urgently needed.
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Mamone G, Barresi L, Tropea A, Di Piazza A, Miraglia R. MRI of mucinous pancreatic cystic lesions: a new updated morphological approach for the differential diagnosis. Updates Surg 2020; 72:617-637. [PMID: 32462610 DOI: 10.1007/s13304-020-00800-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022]
Abstract
Pancreatic cystic lesions (PCLs) have been increasingly identified over the past 2 decades due to the widespread use of high-resolution non-invasive abdominal imaging. They cover a vast spectrum, from benign to malignant and invasive lesions, thus they constitute a significant clinical entity. Among PCLs, mucin-producing lesions are those at risk of progression to malignancy. They include mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN). The diagnosis and management of these cystic lesions are a dilemma since there is a significant overlap in the morphology of benign and premalignant lesions. At the moment, there is no single test that will allow a correct diagnosis in all cases. Magnetic resonance (MR) and endoscopic ultrasound (EUS) morphology, with cyst fluid analysis and cytohistology done with EUS-guided procedure are the best techniques that can narrow the differential diagnosis and identify potentially malignant lesions requiring resection from those requiring follow-up only. The purpose of this paper is to present an updated review of MR imaging findings of mucinous PCLs and to provide a new morphological approach that can serve as a practical guide for the diagnosis of these lesions, allowing a more confident characterization and avoiding relevant misdiagnosis. Furthermore, we provide some information about EUS and cystic fluid analysis and cytohistology, since they are diagnostic modalities that radiologists and surgeons should be familiar with.
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Affiliation(s)
- Giuseppe Mamone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy.
| | - Luca Barresi
- Endoscopic Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Alessandro Tropea
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Ambra Di Piazza
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Roberto Miraglia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
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8
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Kang JS, Kim HJ, Choi YJ, Byun Y, Lee JM, Han Y, Kim H, Kwon W, Jang JY. Clinicoradiological features of resected serous cystic neoplasms according to morphological subtype and preoperative tentative diagnosis: can radiological characteristics distinguish serous cystic neoplasms from other lesions? Ann Surg Treat Res 2020; 98:247-253. [PMID: 32411629 PMCID: PMC7200608 DOI: 10.4174/astr.2020.98.5.247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/12/2020] [Accepted: 03/06/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose Serous cystic neoplasm (SCN) of the pancreas is considered benign in most cases. However, some SCN patients undergo surgical resection because lesions could not be differentiated preoperatively. This study evaluated causes of resection for SCN, investigated clinical and radiological features of surgically resected SCNs, and compared characteristics of SCNs diagnosed accurately and those misdiagnosed. Methods One hundred patients, who underwent surgery for pancreatic cystic tumors with pathological confirmation of SCN between 2000 and 2014 were retrospectively analyzed. Results The mean patient age was 52.9 years, 67 (67%) were female, and most lesions (72%) were located in the pancreatic body or tail. Fifty-one (51%) pathologically confirmed SCNs were preoperatively diagnosed as non-SCNs. Patients underwent surgery due to uncertain diagnosis (58%) or symptomatology (18%). According to radiological examination, most lesions were macrocystic (85%), exhibited septation (58%), or were enhancing lesions (48%). Compared with preoperatively diagnosed non-SCNs, accurately diagnosed SCNs exhibited septation (75.5% vs. 41.2%, P = 0.001) and central scar (36.7% vs. 11.8%, P = 0.003) more frequently in radiological examinations. In terms of macrocystic tumors (n = 85), most parameters did not differentiate preoperative diagnoses, although lesions accurately diagnosed as SCN exhibited septation more frequently than those preoperatively misdiagnosed as mucinous cystic neoplasm or intraductal papillary mucinous neoplasm (70.7% vs. 38.9% vs. 33.3%, respectively, P = 0.009). Conclusion It is difficult to accurately distinguish macrocystic SCNs from other cystic tumors using conventional radiological methods. For more accurate diagnosis, new biomarkers and/or other diagnostic modalities are needed and warrant further investigation.
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Affiliation(s)
- Jae Seung Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jun Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo Jin Choi
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonhyeong Byun
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hongbeom Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Massaras D, Pantiora EV, Koutalas J, Primetis EC, Fragulidis GP. Serous Microcystic Cystadenocarcinoma of the Pancreas with Synchronous Liver Metastases: Clinical Characteristics and Management. Cureus 2020; 12:e7707. [PMID: 32431986 PMCID: PMC7233488 DOI: 10.7759/cureus.7707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Serous cystadenocarcinoma of the pancreas is a rare but well-established entity. The origin and evolution of this disorder remain unclear, but even metastatic cases have an excellent prognosis. These tumors are very similar to benign serous cystic neoplasms (SCNs) of the pancreas, except that they tend to be larger, are locally invasive, and present distant metastasis. The most frequent local invasion is adjacent vessels, spleen, stomach, and duodenum. The most common site of distant metastasis is the liver. Diagnosis via imaging as well as pathology examination may be misguided due to atypical characteristics of the tumor. In fact, in some, the diagnosis of malignancy was established only after metastases were detected. We present a 60-year-old female patient with malignant serous microcystic cystadenocarcinoma of the pancreas and liver metastasis that was initially misdiagnosed as a metastatic renal cell carcinoma. The patient underwent tumor resection and liver metastasectomy and she is currently doing well after three years of follow-up, with no tumor recurrence or new metastatic liver nodules based on imaging findings.
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Affiliation(s)
- Dimitrios Massaras
- Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Eirini V Pantiora
- Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - John Koutalas
- Anesthesiology, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | - Georgios P Fragulidis
- 2nd Department of Surgery, "Aretaeio" Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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10
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Taggart MW, Foo WC, Lee SM. Tumors of the Gastrointestinal System Including the Pancreas. ONCOLOGICAL SURGICAL PATHOLOGY 2020:691-870. [DOI: 10.1007/978-3-319-96681-6_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Abstract
The diagnostic approach to pancreaticobiliary disease requires a multidisciplinary team in which the cytopathologist plays a crucial role. Fine-needle aspiration, obtained by endoscopic ultrasound, is the diagnostic test of choice for pancreatic lesions. Preoperative clinical management depends on many factors, many of which rely on accurate cytologic assessment. Pancreaticobiliary cytology is wrought with diagnostic pitfalls. Clinical history, imaging studies, cytology samples, and ancillary tests, including immunohistochemistry, biochemical analysis, and genetic sequencing, are integral to forming a complete diagnosis and guiding optimal patient management. This article reviews clinical aspects and the diagnostic work-up of commonly encountered diagnostic entities within the field of pancreatic cytology.
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Affiliation(s)
- Raza S Hoda
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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12
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Abstract
As modern abdominal imaging equipment advances, pancreatic lesion detection improves. Most of these lesions are incidental, and present a conundrum to the clinician and create great anxiety to the patient until a final diagnosis is made. For the practicing physician, the plethora of diagnostic options is overwhelming. The relevant question is, what is the most efficient algorithm to follow and to arrive at a timely and accurate diagnosis. This article presents a logical approach to the initial evaluation of a pancreatic lesion to get the most information possible with the least amount of testing, and to avoid duplicative measures.
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Affiliation(s)
- Seth Cohen
- Division of Digestive Diseases, Mount Sinai Beth Israel, 305 2nd Avenue, #3, New York, NY 10003, USA
| | - Alexander C Kagen
- Department of Radiology, Mount Sinai West and Mount Sinai St. Luke's, Icahn School of Medicine at Mount Sinai, 1000 Tenth Avenue, 4B-25, New York, NY 10019, USA.
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13
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Saldaña DV, Mateo de Acosta Andino DA, Gurria JP. Serous Microcystic Adenoma of the Pancreas. Gastroenterol Hepatol (N Y) 2017; 13:440-442. [PMID: 28867975 PMCID: PMC5572977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Diego Vázquez Saldaña
- Division of Colorectal Surgery, Hospital General de México, Secretaría de Salud Federal, Mexico City, Mexico
| | | | - Juan Pablo Gurria
- Department of Surgery, University of Illinois College of Medicine at Peoria, Peoria, Illinois
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14
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Abstract
Pancreatic cysts, especially incidental asymptomatic ones seen on noninvasive imaging such as CT or MR imaging, remain a clinical challenge. The etiology of such cysts may range from benign cysts without any malignant potential such as pancreatic pseudocysts and serous cystadenomas to premalignant or frankly malignant cysts such as mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, cystic degeneration associated with solid tumors such as pancreatic ductal adenocarcinoma or pancreatic endocrine neoplasms, and solid pseudopapillary neoplasms. The clinical challenge in 2017 is to accurately preoperatively diagnose them and their malignant potential before deciding about surgery, surveillance or doing nothing. This review will focus on the currently available clinical guidelines for doing so.
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Affiliation(s)
- James J Farrell
- Yale Center for Pancreatic Diseases, Interventional Endoscopy, Yale School of Medicine, New Haven, CT, USA. .,Section of Digestive Diseases, Yale University School of Medicine, LMP 1080, 15 York Street, New Haven, CT, 06510-3221, USA.
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15
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Serous Cystadenocarcinoma Arising in Presumed Vitelline Duct Remnant: A Case Report and Implications in the Management of Cancer of Unknown Primary. Case Rep Pathol 2016; 2016:4365217. [PMID: 27999702 PMCID: PMC5143717 DOI: 10.1155/2016/4365217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/09/2016] [Indexed: 01/09/2023] Open
Abstract
Background. Malignant neoplasms arising in Meckel's diverticulum, a vitelline duct remnant, are rare yet well-documented. Case Presentation. A 53-year-old previously healthy female presented with an enlarging midline abdominal wall mass. A computed tomography scan revealed a mass involving the linea alba, bilateral rectus abdominis, and subcutaneous fat. Extensive clinical workup failed to demonstrate other lesions, except local and paratracheal/hilar lymphadenopathy. Histopathologic examination of the resected tumor demonstrated a spectrum of serous neoplasia including serous cystadenoma, papillary serous carcinoma with numerous Psammoma bodies, and a poorly differentiated component. Immunophenotypically, the tumor cells were strongly positive for CK7, CK19, CA19.9, and MUC1 but negative for other lineage markers, findings suggestive of pancreatobiliary type differentiation. The patient died of the disease one year after the initial presentation despite chemotherapy, radiation, and surgery. Conclusion. We present a case of adenocarcinoma arising from the anterior midline abdominal wall, from presumed vitelline duct remnant, with histologic and immunophenotypic features of serous cystadenocarcinoma of pancreatobiliary origin. Though the origin from vitelline duct remnant is difficult to prove in this single case, understanding tumorigenesis of embryonic remnant origin is potentially important to improve the management of cancer of unknown primary.
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16
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Huh J, Byun JH, Hong SM, Kim KW, Kim JH, Lee SS, Kim HJ, Lee MG. Malignant pancreatic serous cystic neoplasms: systematic review with a new case. BMC Gastroenterol 2016; 16:97. [PMID: 27549181 PMCID: PMC4994257 DOI: 10.1186/s12876-016-0518-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/11/2016] [Indexed: 02/08/2023] Open
Abstract
Background This study analyzes the clinicopathologic and radiologic characteristics of malignant serous cystic neoplasm (SCN) of the pancreas through systematic review and an institutional case report. Methods A comprehensive literature search was performed in the MEDLINE database to identify studies on malignant SCNs of the pancreas that had detailed clinicopathologic and radiologic information. A computerized systematic search of our institutional database was also performed to identify cases of malignant SCN for addition to the systematic review. Using the final included cases, we analyzed the clinicopathologic and radiologic features of malignant SCNs of the pancreas. Results A review of 136 candidate articles identified 26 studies with 26 cases that had detailed clinical information. Our institutional data search added one case. The systematic review of the 27 cases revealed that primary tumors (mean diameter 10.2 ± 4.0 cm) mainly involved the body and tail of the pancreas (n = 16) and frequently invaded adjacent organs (n = 19). Distant metastases occurred in 14 patients (synchronous, n = 5; metachronous, n = 8; both, n = 1), most commonly in the liver (n = 13). Imaging features of malignant SCNs of the pancreas were identical to the benign counterpart, except local invasion or distant metastases. The prognosis was excellent in that 17 were alive at the time of writing with a median follow-up period of 2 years. Conclusions The malignant potential of SCNs of the pancreas should be considered in the diagnosis and management of patients with pancreatic SCNs.
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Affiliation(s)
- Jimi Huh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.,Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
| | - Seung-Mo Hong
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Jin Hee Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
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17
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Giant Serous Cystadenoma of the Pancreas (⩾10 cm): The Clinical Features and CT Findings. Gastroenterol Res Pract 2016; 2016:8454823. [PMID: 27610132 PMCID: PMC5004016 DOI: 10.1155/2016/8454823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 07/20/2016] [Indexed: 12/28/2022] Open
Abstract
Purpose. To report the clinical features and CT manifestations of giant pancreatic serous cystadenoma (≥10 cm). Methods. We retrospectively reviewed the clinical features and CT findings of 6 cases of this entity. Results. All 6 patients were symptomatic. The tumors were 10.2 cm–16.5 cm (median value, 13.0 cm). CT imaging revealed that all 6 cases showed microcystic appearances (n = 5) or mixed microcystic and macrocystic appearances (n = 1). Five patients with tumors at the distal end of the pancreas received distal pancreatectomy. Among these 5 patients, 2 patients underwent partial transverse colon resection or omentum resection due to close adhesion. One patient whose tumor was located in the pancreatic head underwent pancreaticoduodenectomy; however, due to encasement of the portal and superior mesenteric veins, the tumor was incompletely resected. One patient had abundant draining veins on the tumor surface and suffered large blood loss (700 mL). After 6–49 months of follow-up the 6 patients showed no tumor recurrence or signs of malignant transformation. Conclusions. Giant pancreatic serous cystadenoma necessitates surgical resection due to large size, symptoms, uncertain diagnosis, and adjacent organ compression. The relationship between the tumors and the neighboring organs needs to be carefully assessed before operation on CT image.
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18
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Farrell JJ. Prevalence, Diagnosis and Management of Pancreatic Cystic Neoplasms: Current Status and Future Directions. Gut Liver 2016; 9:571-89. [PMID: 26343068 PMCID: PMC4562774 DOI: 10.5009/gnl15063] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cystic neoplasms of the pancreas are found with increasing prevalence, especially in elderly asymptomatic individuals. Although the overall risk of malignancy is very low, the presence of these pancreatic cysts is associated with a large degree of anxiety and further medical investigation due to concerns about malignancy. This review discusses the different cystic neoplasms of the pancreas and reports diagnostic strategies based on clinical features and imaging data. Surgical and nonsurgical management of the most common cystic neoplasms, based on the recently revised Sendai guidelines, is also discussed, with special reference to intraductal papillary mucinous neoplasm (IPMN; particularly the branch duct variant), which is the lesion most frequently identified incidentally. IPMN pathology, its risk for development into pancreatic ductal adenocarcinoma, the pros and cons of current guidelines for management, and the potential role of endoscopic ultrasound in determining cancer risk are discussed. Finally, surgical treatment, strategies for surveillance of pancreatic cysts, and possible future directions are discussed.
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Affiliation(s)
- James J Farrell
- Yale Center for Pancreatic Diseases, Interventional Endoscopy, Yale School of Medicine, New Haven, CT, USA
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19
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Brandone N, Poizat F, Thomassin-Piana J, Turrini O, Popovici C, Terris B. Un cystadénocarcinome séreux du pancréas dans une variante solide. Ann Pathol 2016; 36:125-9. [DOI: 10.1016/j.annpat.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 11/13/2015] [Accepted: 12/12/2015] [Indexed: 01/08/2023]
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20
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Serous Neoplasms of the Pancreas: A Clinicopathologic Analysis of 193 Cases and Literature Review With New Insights on Macrocystic and Solid Variants and Critical Reappraisal of So-called "Serous Cystadenocarcinoma". Am J Surg Pathol 2016; 39:1597-610. [PMID: 26559376 DOI: 10.1097/pas.0000000000000559] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The literature on "variants" and "malignant" counterparts of pancreatic serous cystic neoplasms (SCNs) is highly conflicted. Clinicopathologic characteristics of 193 SCNs were investigated, along with a critical literature review. For the macrocystic (oligocystic) variant, in this largest series, a demographic profile in contrast to current literature was elucidated, with 21% frequency, predominance in female individuals (4:1), body/tail location (1.7×), younger age of patients (mean age, 50 y), and frequent radiologic misdiagnosis as other megacystic neoplasms. Solid SCNs were rare (n=4, 2%) and often misinterpreted radiologically as neuroendocrine tumors. Available fine-needle aspiration in 11 cases was diagnostic in only 1. Radiologic impression was "malignancy" in 5%. Associated secondary tumors were detected in 13% of resections, mostly neuroendocrine. Secondary "infiltration" (direct adhesion/penetration) of spleen, stomach, colon, and/or adjacent nodes was seen in 6 (3%) fairly large SCNs (mean, 11 cm) with no distant metastasis. Three SCNs recurred locally, but completeness of original resection could not be verified. Our only hepatic SCN lacked a concurrent pancreatic tumor. Literature appraisal revealed that there are virtually no deaths that are directly attributable to dissemination/malignant behavior of SCNs, and most cases reported as "malignant" in fact would no longer fulfill the more recent World Health Organization criteria but instead would represent either (1) local adhesion/persistence of tumor, (2) cases with no histologic verification of malignancy, or (3) liver SCNs with benevolent behavior (likely representing multifocality, rather than true metastasis, especially considering there was no fatality related to this and no reported metastases to other remote sites). In conclusion, in contrast to the literature, the clinicopathologic characteristics of solid and macrocystic SCN variants are similar to their microcystic counterpart, although their radiologic diagnosis is challenging. Recurrence/secondary invasion of neighboring organs occurs rarely in larger SCNs but seems innocuous. An SCN should not be classified as "malignant" unless there is clear-cut evidence of histologic malignancy or documented distant metastasis.
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21
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Abstract
Cystic neoplasms of the pancreas are being identified at an increasing frequency largely due to the increased use of abdominal cross-sectional imaging. These neoplasms represent a heterogeneous group of tumors with various genetic alterations, molecular features, and risks of malignancy. Despite the use of high-resolution radiographic studies, endoscopic evaluation, cyst fluid analysis, and novel molecular diagnostics, many of these lesions remain difficult to classify without operative resection. These diagnostic challenges are coupled with an improving but limited understanding of the natural history of these neoplasms. Treatment of pancreatic cystic neoplasms therefore remains controversial but consists largely of a selective tumor-specific approach to surgical resection. Future research remains necessary to better discriminate the biological behavior of these tumors in order to more appropriately select patients for operative intervention.
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Affiliation(s)
- Rohit Chandwani
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065; ,
| | - Peter J Allen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065; ,
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22
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Machado MCC, Fonseca GM, de Meirelles LR, Siqueira LTDB, Katz B, Jukemura J. Synchronous resection of pancreatic serous cystadenocarcinoma and liver metastasis: First reported case and review of literature. Pancreatology 2015; 15:708-712. [PMID: 26463518 DOI: 10.1016/j.pan.2015.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/24/2015] [Accepted: 09/16/2015] [Indexed: 12/11/2022]
Abstract
Cystic neoplasms account for approximately 10-20% of all pancreatic cysts and 1% of pancreatic cancers. Serous cystadenomas are considered benign tumors with almost no malignant potential, and thus the management is typically only observation with serial imaging. According to the current World Health Organization classification, cases with distant metastases are defined as serous cystadenocarcinomas. To date, only 17 such cases with concomitant synchronous or metachronous liver metastasis have been described in the literature, and eight of these reports described treatment of secondary liver lesions. This report describes the first case of synchronous resection of pancreatic serous cystadenocarcinoma and liver metastasis in a 56-year-old female patient. The patient is currently well after 30 months of follow-up with no tumor recurrence or new metastatic liver nodules based on magnetic resonance imaging.
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Affiliation(s)
| | - Gilton Marques Fonseca
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-900, Brazil
| | | | | | - Betina Katz
- Department of Pathology, Hospital Sírio-Libanês, São Paulo 01308-050, Brazil
| | - José Jukemura
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-900, Brazil
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23
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Kadhirvel V, Ramu S, Mishra N, Adaikalam MLS, Venkatesan R. Serous Microcystic Adenocarcinoma of Pancreas Infiltrating Into Spleen: A Case Report. J Clin Diagn Res 2015; 9:ED01-2. [PMID: 26500911 DOI: 10.7860/jcdr/2015/12869.6439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/23/2015] [Indexed: 11/24/2022]
Abstract
Cystic tumours of pancreas account for 5-10% of all pancreatic neoplasms and serous tumours represent 1% among those tumours. Most of the serous tumours are benign and very rarely they infiltrate adjacent organs like liver and spleen. Herewith we present a rare case report of serous cystadenocarcinoma of pancreas in a 65-year-old woman. The tumour involved the body and tail of pancreas and contiguously invaded the spleen. The histopathology of tumour was similar to serous cystadenoma with mild nuclear hyperchromasia and atypia. The spleen showed tumour infiltration as microcysts diffusely infitrating the red pulp.
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Affiliation(s)
- Valarmathi Kadhirvel
- Professor, Department of Pathology, Medical College, Dr.M.G.R. Medical University Government Stanley , Chennai, Tamil Nadu, India
| | - Sathyalakshmi Ramu
- Assistant Professor, Department of Pathology, Medical College, Dr.M.G.R. Medical University Government Stanley , Chennai, Tamil Nadu, India
| | - Nidhi Mishra
- Post Graduate, Department of Pathology, Medical College, Dr.M.G.R. Medical University Government Stanley , Chennai, Tamil Nadu, India
| | - Mary Lilly Susai Adaikalam
- Professor, Department of Pathology, Medical College, Dr.M.G.R. Medical University Government Stanley , Chennai, Tamil Nadu, India
| | - Ramya Venkatesan
- Post Graduate, Department of Pathology, Medical College, Dr.M.G.R. Medical University Government Stanley , Chennai, Tamil Nadu, India
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24
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Dokmak S, Aussilhou B, Rasoaherinomenjanahary F, Sauvanet A, Vullierme MP, Rebours V, Lévy P. Laparoscopic fenestration of pancreatic serous cystadenoma: Minimally invasive approach for symptomatic benign disease. World J Gastroenterol 2015; 21:7047-7051. [PMID: 26078583 PMCID: PMC4462747 DOI: 10.3748/wjg.v21.i22.7047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/23/2014] [Accepted: 02/05/2015] [Indexed: 02/06/2023] Open
Abstract
Serous cystadenoma (SC) is a benign pancreatic cystic tumor. Surgical resection is recommended for symptomatic forms, but laparoscopic fenestration of large symptomatic macrocystic SC was not yet described in the literature. In this study, 3 female patients underwent laparoscopic fenestration for macrocystic SC (12-14 cm). Diagnosis was established via magnetic resonance imaging and endoscopic ultrasound, with intra-cystic dosage of tumors markers (ACE and CA19-9) in 2 patients. All patients were symptomatic and operated on 15-60 mo after diagnosis. Radiological evaluation showed constant cyst growth. Patients were informed about this new surgical modality that can avoid pancreatic resection. The mean operative time was 103 min (70-150 min) with one conversion. The post-operative course was marked by a grade A pancreatic fistula in one patient and was uneventful in the other two. The hospital stay was 3, 10, and 18 d, respectively. The diagnosis of macrocystic SC was histologically-confirmed in all cases. At the last follow-up (13-26 mo), all patients were symptom-free, and radiological evaluation showed complete disappearance of the cyst. Laparoscopic fenestration, as opposed to resection, should be considered for large symptomatic macrocystic SC, thereby avoiding pancreatic resection morbidity and mortality.
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25
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Cyst Fluid Glucose is Rapidly Feasible and Accurate in Diagnosing Mucinous Pancreatic Cysts. Am J Gastroenterol 2015; 110:909-14. [PMID: 25986360 DOI: 10.1038/ajg.2015.148] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 04/06/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Better diagnostic tools are needed to differentiate pancreatic cyst subtypes. A previous metabolomic study showed cyst fluid glucose as a potential marker to differentiate mucinous from non-mucinous pancreatic cysts. This study seeks to validate these earlier findings using a standard laboratory glucose assay, a glucometer, and a glucose reagent strip. METHODS Using an IRB-approved prospectively collected bio-repository, 65 pancreatic cyst fluid samples (42 mucinous and 23 non-mucinous) with histological correlation were analyzed. RESULTS Median laboratory glucose, glucometer glucose, and percent reagent strip positive were lower in mucinous vs. non-mucinous cysts (P<0.0001 for all comparisons). Laboratory glucose<50 mg/dl had a sensitivity of 95% and a specificity of 57% (LR+ 2.19, LR- 0.08). Glucometer glucose<50 mg/dl had a sensitivity of 88% and a specificity of 78% (LR+ 4.05, LR- 0.15). Reagent strip glucose had a sensitivity of 81% and a specificity of 74% (LR+ 3.10, LR- 0.26). CEA had a sensitivity of 77% and a specificity of 83% (LR+ 4.67, LR- 0.27). The combination of having either a glucometer glucose<50 mg/dl or a CEA level>192 had a sensitivity of 100% but a low specificity of 33% (LR+ 1.50, LR- 0.00). CONCLUSIONS Glucose, whether measured by a laboratory assay, a glucometer, or a reagent strip, is significantly lower in mucinous cysts compared with non-mucinous pancreatic cysts.
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26
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Serous microcystic adenoma to adenocarcinoma of pancreas-a case report. Indian J Surg Oncol 2015; 6:82-5. [PMID: 25937769 DOI: 10.1007/s13193-013-0217-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022] Open
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27
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The changing spectrum of surgically treated cystic neoplasms of the pancreas. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2015; 2015:791704. [PMID: 25918455 PMCID: PMC4396146 DOI: 10.1155/2015/791704] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 02/15/2015] [Accepted: 03/19/2015] [Indexed: 12/14/2022]
Abstract
Introduction. While the incidence of pancreatic cystic lesions has steadily increased, we sought to evaluate the changes in their surgical management. Methods. Patients with pancreatic cystic lesions who underwent surgical resection from 2003 to 2013 were identified. Clinicopathologic factors were analyzed and compared to a similar cohort from 1992 to 2002. Results. There were 134 patients with pancreatic cystic lesions who underwent surgical resection from 2003 to 2013, compared to 73 from 1992 to 2002. The most common preoperative imaging was a CT scan, although 66% underwent EUS and 63% underwent biopsy. Pathology included 18 serous, 47 mucinous, 11 pseudopapillary, and 58 intraductal papillary mucinous neoplasms (IPMN). In comparing cohorts, there were significantly fewer serous lesions and more IPMN. Postoperative complication rates were similar, and perioperative mortality rates were comparable. Conclusion. There has been a dramatic change in surgically treated pancreatic cystic tumors over the past two decades. Our data suggests that the incorporation of new imaging and diagnostic tests has led to greater detection of cystic tumors and a decreased rate of potentially unnecessary resections. Therefore, all patients with cystic pancreatic lesions should undergo a focused CT-pancreas, and an EUS biopsy should be considered, in order to best select those that would benefit from surgical resection.
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28
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D'Haese JG, Hartwig W, Angele M, Werner J. [Cystic tumors of the pancreas: diagnosis and therapy]. MMW Fortschr Med 2015; 157:60-64. [PMID: 26015016 DOI: 10.1007/s15006-015-2827-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Jan G D'Haese
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie am Klinikum, Universität München, Standort Großhadern Marchioninistr. 15, D-81377, München, Deutschland,
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29
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Antonini F, Fuccio L, Fabbri C, Macarri G, Palazzo L. Management of serous cystic neoplasms of the pancreas. Expert Rev Gastroenterol Hepatol 2015; 9:115-125. [PMID: 24981593 DOI: 10.1586/17474124.2014.934675] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pancreatic serous cystadenomas are uncommon benign tumours that are often found incidentally on routine imaging examinations. Radiological imaging techniques alone have proven to be suboptimal to fully characterize cystic pancreatic lesions. Endoscopic ultrasound, with the addition of fine-needle aspiration in difficult cases, has showed greater diagnostic accuracy than conventional imaging techniques. The best management strategy of these neoplasms is still debated. Surgery should be limited only to symptomatic and highly selected cases and most of the patients should only be strictly monitored. In the current paper, we provide an updated overview on pancreatic serous cystadenomas, focusing our attention on epidemiology, clinical characteristics and diagnostic evaluation; finally, we also discuss different management strategies and areas for future research.
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Affiliation(s)
- Filippo Antonini
- Department of Gastroenterology, A.Murri Hospital, Polytechnic University of Marche, Fermo, Italy
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30
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Klassifikation und malignes Potenzial der zystischen Pankreastumoren. DER PATHOLOGE 2014; 36:99-112; quiz 113-4. [DOI: 10.1007/s00292-014-1971-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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31
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Magnetic resonance imaging of less common pancreatic malignancies and pancreatic tumors with malignant potential. Eur J Radiol Open 2014; 1:49-59. [PMID: 26937427 PMCID: PMC4750607 DOI: 10.1016/j.ejro.2014.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 02/07/2023] Open
Abstract
Pancreatic tumors are an increasingly common finding in abdominal imaging. Various kinds of pathologies of the pancreas are well known, but it often remains difficult to classify the lesions radiologically in respect of type and grade of malignancy. Magnetic resonance imaging (MRI) is the method of choice for the evaluation of pancreatic pathologies due to its superior soft tissue contrast. In this article we present a selection of less common malignant and potentially malignant pancreatic neoplasms with their characteristic appearance on established MRI sequences with and without contrast enhancement.
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32
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Buscarini E, Pezzilli R, Cannizzaro R, De Angelis C, Gion M, Morana G, Zamboni G, Arcidiacono P, Balzano G, Barresi L, Basso D, Bocus P, Calculli L, Capurso G, Canzonieri V, Casadei R, Crippa S, D'Onofrio M, Frulloni L, Fusaroli P, Manfredi G, Pacchioni D, Pasquali C, Rocca R, Ventrucci M, Venturini S, Villanacci V, Zerbi A, Falconi M. Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 2014; 46:479-493. [PMID: 24809235 DOI: 10.1016/j.dld.2013.12.019] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/07/2013] [Accepted: 12/30/2013] [Indexed: 12/11/2022]
Abstract
This report contains clinically oriented guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms in patients fit for treatment. The statements were elaborated by working groups of experts by searching and analysing the literature, and then underwent a consensus process using a modified Delphi procedure. The statements report recommendations regarding the most appropriate use and timing of various imaging techniques and of endoscopic ultrasound, the role of circulating and intracystic markers and the pathologic evaluation for the diagnosis and follow-up of cystic pancreatic neoplasms.
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Affiliation(s)
| | - Raffaele Pezzilli
- Pancreas Unit, Department of Digestive Diseases and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Claudio De Angelis
- Gastroenterology and Hepatology Department, A.O. San Giovanni Battista/Molinette, University of Turin, Turin, Italy
| | - Massimo Gion
- Department of Clinical Pathology, AULSS 12, Venice, Italy
| | - Giovanni Morana
- Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy
| | | | - Paolo Arcidiacono
- Division of Gastroenterology and Gastrointestinal Endoscopy, Vita-Salute, Italy
| | - Gianpaolo Balzano
- Department of Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Barresi
- Gastroenterology and Endoscopy Unit, ISMETT, Palermo, Italy
| | - Daniela Basso
- Department of Laboratory Medicine, University Hospital, Padua, Italy
| | - Paolo Bocus
- Gastroenterology Unit, Ospedale Sacro Cuore-Don Calabria, Negrar, Verona, Italy
| | - Lucia Calculli
- Department of Radiology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gabriele Capurso
- Digestive and Liver Disease Unit, Faculty of Medicine and Psychology, Sapienza University of Rome at S. Andrea Hospital, Rome, Italy
| | | | - Riccardo Casadei
- Department of Surgery, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Stefano Crippa
- Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, University Hospital G.B. Rossi, University of Verona, Verona, Italy
| | - Luca Frulloni
- Department of Surgical and Gastroenterological Sciences, University of Verona, Verona, Italy
| | - Pietro Fusaroli
- Department of Clinical Medicine, University of Bologna, Bologna, Italy
| | | | | | - Claudio Pasquali
- Surgery Unit IV, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
| | - Rodolfo Rocca
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Maurizio Ventrucci
- Department of Internal Medicine and Gastroenterology, Bentivoglio Hospital, Bologna, Italy
| | - Silvia Venturini
- Department of Diagnostic Radiology, Ospedale Cà Foncello, Treviso, Italy
| | | | - Alessandro Zerbi
- Pancreatic Surgery, Department of Surgery, Humanitas Clinical and Research Center, Milan, Italy
| | - Massimo Falconi
- Department of Surgery, Pancreas Unit, Università Politecnica delle Marche, Ancona, Italy
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Unique presentation of giant metastatic microcystic serous adenocarcinoma of the pancreas. Case Rep Gastrointest Med 2014; 2014:913745. [PMID: 24782930 PMCID: PMC3978389 DOI: 10.1155/2014/913745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 01/14/2014] [Indexed: 01/07/2023] Open
Abstract
Tumors of the pancreas that contain substantial cystic components include mainly mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, solid pseudopapillary tumor, and cystadenomas (which encompass microcystic, macrocystic/oligocystic, and rare solid serous adenomas). Microcystic adenoma of the pancreas is a tumor that is benign in nature. Malignant transformation in the tumor with metastases is rare and only about 26 cases have been reported so far. Here we present a giant microcystic adenoma of the pancreas, possibly the largest ever malignant type in this group ever reported in the literature with extensive metastases to the liver and causing extensive compression and encasement on surrounding structures.
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Clores MJ, Thosani A, Buscaglia JM. Multidisciplinary diagnostic and therapeutic approaches to pancreatic cystic lesions. J Multidiscip Healthc 2014; 7:81-91. [PMID: 24520195 PMCID: PMC3917951 DOI: 10.2147/jmdh.s43098] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Pancreatic cystic lesions are commonly encountered today with the routine use of cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). The majority of patients discovered to have a pancreatic cyst are completely asymptomatic; yet the presence of such a finding instills fear in the minds of both patient and physician, as the concern for malignant transformation to pancreatic cancer is great despite the relatively low overall likelihood of cyst progression. Not all cysts in the pancreas represent pancreatic cystic neoplasms (PCNs), and not all PCNs have significant malignant potential. Mucinous PCNs are the most concerning, as these lesions have the greatest potential for cancerous transformation to adenocarcinoma. Within the group of mucinous PCNs, intraductal papillary mucinous neoplasms (IPMNs) involving the main pancreatic duct are the most worrisome, and surgical resection should be pursued if the patient has appropriate operative risks. IPMN lesions involving the branch ducts, and mucinous cystadenomas, have a lower likelihood for malignancy, and they may be closely followed for the development of any worrisome or high-risk features. Surveillance of known PCNs is performed with a combination of CT, MRI and endoscopic ultrasound (EUS). EUS-guided fine-needle aspiration (EUS-FNA) may be used to assess cyst fluid cytology, and also to detect cyst fluid amylase level, carcinoembryonic antigen level, and DNA molecular analysis in certain cases. The presence or absence of specific cyst morphological features, as well as the cyst fluid analysis, is what enables the physician to guide the patient towards continued surveillance, versus the pursuit of surgical resection.
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Affiliation(s)
- Michael J Clores
- Division of Gastroenterology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Amar Thosani
- Division of Gastroenterology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jonathan M Buscaglia
- Division of Gastroenterology, Department of Medicine, Stony Brook University School of Medicine, Stony Brook, NY, USA
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Ćwik G, Krupski W, Zakościelny A, Wallner G. Diagnosis and treatment of pancreatic pseudocysts and cystic tumors based on own material and quoted literature. J Ultrason 2013; 13:263-81. [PMID: 26673675 PMCID: PMC4603218 DOI: 10.15557/jou.2013.0028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 12/18/2012] [Accepted: 12/23/2012] [Indexed: 01/03/2023] Open
Abstract
Pseudocysts constitute the most basic cystic lesions of the pancreas. Symptomatic cysts may be treated by means of both minimally invasive methods and surgery. Currently, it is believed that approximately 5% of cystic lesions in the pancreas may in fact, be neoplastic cystic tumors. Their presence is manifested by generally irregular multilocular structures, solid nodules inside the cyst or in the pancreatic duct, frequently vascularized, as well as fragmentary thickening of the cystic wall or septation.
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Affiliation(s)
- Grzegorz Ćwik
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie, Lublin, Polska
| | - Witold Krupski
- II Zakład Radiologii Lekarskiej, Uniwersytet Medyczny w Lublinie, Lublin, Polska
| | - Artur Zakościelny
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie, Lublin, Polska
| | - Grzegorz Wallner
- II Katedra i Klinika Chirurgii Ogólnej, Gastroenterologicznej i Nowotworów Układu Pokarmowego, Uniwersytet Medyczny w Lublinie, Lublin, Polska
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Räty S, Sand J, Laukkarinen J, Vasama K, Bassi C, Salvia R, Nordback I. Cyst fluid SPINK1 may help to differentiate benign and potentially malignant cystic pancreatic lesions. Pancreatology 2013; 13:530-3. [PMID: 24075519 DOI: 10.1016/j.pan.2013.06.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 06/04/2013] [Accepted: 06/20/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Differential diagnosis between benign and potentially malignant cystic pancreatic lesions may be difficult. Previously we have compared cyst fluid serine protease inhibitor Kazal type I (SPINK1) with some traditionally used tumour markers (amylase, CEA, Ca19-9) and found that it may be a new promising maker in the differential diagnosis of cystic pancreatic lesions. In the present study, we focused on cyst fluid SPINK1 levels in benign and potentially malignant cystic pancreatic lesions. DESIGN Sixty-one patients operated on for cystic pancreatic lesion in Tampere University Hospital, Finland and in Verona University Hospital, Italy, were included. Cyst fluid was aspirated during surgery, stored at -70 °C, and analysed with immunofluorometric assay for SPINK1. The final diagnosis was acute pancreatitis with fluid collection (Acute FC) in 4 patients, chronic pseudocyst (PS) in 17 patients, serous cystadenoma (SCA) in 7 patients, mucinous cystadenoma (MCA) in 21 patients and intraductal papillary-mucinous neoplasm (IPMN) in 12 patients (9 main/mixed duct type and 3 branch duct type). RESULTS The acute FC patients had high SPINK1 levels. Among chronic cysts, SPINK1 levels were significantly higher in patients with potentially malignant cysts (main/mixed duct IPMN and MCA) than with benign cysts (side branch IPMN and SCA), (median and range, [480 (13-3602) vs. 18 (0.1-278) μg/L]; p < 0.0001). In the subcohort of 24 patients with <3 cm chronic cyst, cyst fluid SPINK 1 levels were significantly lower in SCA or side branch IPMN (3 [2-116] μg/L) than in main duct IPMN or MCA (638 [66-3602] μg/L; p = 0.018). The best sensitivity and specificity to differentiate any size MCA or main/mixed type IPMN from SCA or side branch IPMN were 85% and 84% (AUC 0.94; cut-off value 118 μg/L). The best sensitivity and specificity to differentiate <3 cm MCA or main duct IPMN from SCA or side branch IPMN were 93% and 89% (AUC 0.98; cut-off value 146 μg/L). CONCLUSIONS Cyst fluid SPINK1 may be a possible marker in the differential diagnosis of benign and potentially malignant cystic pancreatic lesions.
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Affiliation(s)
- Sari Räty
- Department of Gastroenterology and Alimentary Tract Surgery, Finland; ARC-NET Research Center, University and Hospital Trust of Verona, Italy.
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Wasel BA, Keough V, Huang WY, Molinari M. Histological percutaneous diagnosis of stage IV microcystic serous cystadenocarcinoma of the pancreas. BMJ Case Rep 2013; 2013:bcr-2012-007924. [PMID: 23370947 DOI: 10.1136/bcr-2012-007924] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Malignant serous cystic neoplasms (SCN) of the pancreas are exceptionally rare, and only a few cases have been reported. As a result, SCN have been unanimously classified as benign tumours. Contrary to this conviction, in 1989, George et al published the very first case of a patient found to have a malignant pancreatic SCN. Up to the time of the submission of this paper, 27 cases of serous cystoadenocarcinomas have been published. In all the previously published cases of malignant SCN, the correct diagnosis was made postoperatively or at the time of autopsy. The authors present a case of a 68-year-old patient who was incidentally found to have a large liver mass on transthoracic echocardiogram ordered for suspected coronary artery insufficiency. Subsequent investigations revealed an additional large mass in the pancreas and percutaneous biopsies of both lesions revealed histological features consistent with malignant SCN metastasised to the left hepatic lobe.
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Turcotte S, Turkbey B, Barak S, Libutti SK, Alexander HR, Linehan WM, Hughes MS, Nilubol N, Gesuwan K, Millo C, Quezado M, Choyke PL, Kebebew E, Phan GQ. von Hippel-Lindau disease-associated solid microcystic serous adenomas masquerading as pancreatic neuroendocrine neoplasms. Surgery 2012; 152:1106-17. [PMID: 23107912 PMCID: PMC3501588 DOI: 10.1016/j.surg.2012.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 08/10/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with von Hippel-Lindau disease (VHL) commonly develop pancreatic cysts and neuroendocrine neoplasms (PNENs or PNETs). Solid microcystic serous adenoma (SMSA), a rare neoplasm described in VHL patients, can be mistaken for PNEN on imaging. METHODS Clinical, pathologic, and radiologic data were reviewed on VHL patients who underwent surgery for a preoperative diagnosis of PNEN since 1994 at 1 institution. Blinded to the pathologic diagnoses, radiologists reassessed available imaging. RESULTS For 55 patients, 79 pancreatectomies were performed for presumed PNENs. Ten (18%) patients underwent 12 (15%) resections for neoplasms diagnosed as SMSA on final pathology. The average size of a SMSA leading to operation was 3.6 ± 0.4 cm. Four out of 11 SMSAs were still mistaken for PNENs when imaging was reassessed. The mean FDG-positron emission tomography (PET) standardized uptake value was greater for 17 PNENs (12.1 ± 1.2) compared with 6 SMSAs (4.2 ± 0.5; P = .002). The mean doubling time of SMSAs and PNENs was similar. Seven (15%) patients with pathologically proven PNENs had malignant disease. CONCLUSION SMSAs can mimic PNENs on nonfunctional imaging; FDG-PET may help to differentiate them. A high index of suspicion is needed to minimize operations performed for SMSA and to counsel VHL patients of their risks of undergoing operation for a lesion with no known malignant potential.
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Affiliation(s)
- Simon Turcotte
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Baris Turkbey
- Molecular Imaging Program, Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Stephanie Barak
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Steven K. Libutti
- Department of Surgery, Albert Einstein College of Medicine, Bronx, NY
| | - H. Richard Alexander
- Division of Surgical Oncology, Department of Surgery, and the Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, MD
| | - W. Marston Linehan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Marybeth S. Hughes
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Naris Nilubol
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Krisana Gesuwan
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Corina Millo
- Positron Emission Tomography Department, National Institutes of Health Clinical Center, Bethesda, MD
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Peter L. Choyke
- Molecular Imaging Program, Center for Interventional Oncology, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Electron Kebebew
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Giao Q. Phan
- Endocrine Oncology Section, Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Reid MD, Bagci P, Adsay NV. Histopathologic assessment of pancreatic cancer: Does one size fit all? J Surg Oncol 2012; 107:67-77. [DOI: 10.1002/jso.23194] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 05/21/2012] [Indexed: 01/04/2023]
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Barresi L, Tarantino I, Granata A, Curcio G, Traina M. Pancreatic cystic lesions: How endoscopic ultrasound morphology and endoscopic ultrasound fine needle aspiration help unlock the diagnostic puzzle. World J Gastrointest Endosc 2012; 4:247-59. [PMID: 22720127 PMCID: PMC3377868 DOI: 10.4253/wjge.v4.i6.247] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 05/08/2012] [Accepted: 05/27/2012] [Indexed: 02/06/2023] Open
Abstract
Cystic lesions of the pancreas are being diagnosed with increasing frequency, covering a vast spectrum from benign to malignant and invasive lesions. Numerous investigations can be done to discriminate between benign and non-evolutive lesions from those that require surgery. At the moment, there is no single test that will allow a correct diagnosis in all cases. Endoscopic ultrasound (EUS) morphology, cyst fluid analysis and cytohistology with EUS-guided fine needle aspiration can aid in this difficult diagnosis.
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Affiliation(s)
- Luca Barresi
- Luca Barresi, Ilaria Tarantino, Antonino Granata, Gabriele Curcio, Mario Traina, Unit of Gastroenterology and Digestive Endoscopy, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, 90146 Palermo, Italy
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Hwang HK, Kim H, Kang CM, Lee WJ. Serous cyst adenoma of the pancreas: appraisal of active surgical strategy before it causes problems. Surg Endosc 2012; 26:1560-1565. [PMID: 22179458 PMCID: PMC3351602 DOI: 10.1007/s00464-011-2070-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 11/09/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND Patients who are diagnosed with symptomatic or ambiguous serous cyst adenoma (SCA) need surgery. The purpose of this study is to suggest a potential management plan based on analysis of surgically treated SCAs. METHODS Between August 1995 and December 2010, 38 patients with SCA were surgically treated. Data were analyzed retrospectively. RESULTS Among 38 patients, 28 were female and ten were male. Mean age was 49.6 ± 14.1 years, and five patients (13.2%) were older than 65 years. Among the five patients, two were more than 70 years old. Seventeen patients (44.7%) were symptomatic, and the rest (21, 55.3%) were incidentally found to have SCA. Twenty-seven patients underwent open pancreatectomy, and 11 patients received laparoscopic distal pancreatectomy. Mean tumor size was 4.4 ± 2.8 cm. Most asymptomatic patients of SCA had a left-sided pancreatic tumor and distal pancreatectomy with or without splenectomy were frequently performed with short operative time and less blood transfusion (P < 0.05). Minimally invasive surgery was mostly applied to left-sided tumors less than 5 cm in size (11/19 vs. 0/6, P = 0.029). Combined resection of the right colon was performed in two patients (5.3%) due to severe adhesion associated with large tumors. Significant association was noted between age and tumor size in asymptomatic patients (correlation coefficient = 0.541, R (2) = 0.293, P = 0.014). Postoperative pancreatic fistula was observed in five patients (13.2%, grade B) but could be managed conservatively. No mortality was found. CONCLUSION Before SCA causes symptoms or grows larger than 5 cm, an active surgical approach, such as minimally invasive surgery, needs to be considered.
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Affiliation(s)
- Ho Kyoung Hwang
- Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Korea
- Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
- Young Yonsei Pancreatic Tumor Study Group, Seoul, Korea
| | - Hyunki Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
- Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
- Young Yonsei Pancreatic Tumor Study Group, Seoul, Korea
| | - Chang Moo Kang
- Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Korea
- Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
- Young Yonsei Pancreatic Tumor Study Group, Seoul, Korea
| | - Woo Jung Lee
- Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Korea
- Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System, Seoul, Korea
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Bramis K, Petrou A, Papalambros A, Manzelli A, Mantonakis E, Brennan N, Felekouras E. Serous cystadenocarcinoma of the pancreas: report of a case and management reflections. World J Surg Oncol 2012; 10:51. [PMID: 22400805 PMCID: PMC3317835 DOI: 10.1186/1477-7819-10-51] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 03/08/2012] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Serous adenomas represent 1-2% of pancreatic neoplasms and typically are asymptomatic not requiring any treatment and simple observation is the option of choice. Although, they carry a realistic risk of malignancy despite the general view that they never become malignant. We report a case, which, according to our best knowledge is the 27th case reported in the literature. METHODS We reviewed the literature by performing a search in Pub Med and Medline. RESULTS A 86-year old patient known to have a serous cystadenoma of the pancreas treated conservatively through a close clinical and radiological follow up which was unattended for 4 years ending up to our emergency department suffering an acute abdomen. Exploratory laparotomy revealed a perforated prepyloric ulcer which was treated accordingly. Patient died some weeks later due to severe medical co morbidities. CONCLUSION Serous cystic neoplasms of the pancreas carry a realistic risk of malignancy despite the general view that they never become malignant. In our opinion the treatment strategy of serous cystic neoplasms of the pancreas should be aggressive even in cases of remote metastases since prognosis of the disease is satisfactory.
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Affiliation(s)
- K Bramis
- LAIKON Hospital, First Department of Surgery, University of Athens Medical School, Greece
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Yoon WJ, Brugge WR. Pancreatic cystic neoplasms: diagnosis and management. Gastroenterol Clin North Am 2012; 41:103-18. [PMID: 22341252 DOI: 10.1016/j.gtc.2011.12.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PCNs are composed of a wide range of lesions from benign cysts to malignancies . Although a cross-sectional imaging provides a sensitive screening test, EUS with FNA and cyst fluid analysis greatly increase the diagnostic certainty. Cyst fluid CEA offers the greatest accuracy in the differentiation between mucinous and nonmucinous PCNs. In the future, endoscopic ablation therapy might offer an alternative to the traditional surgical approach.
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Affiliation(s)
- Won Jae Yoon
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA 02114, USA
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Rossidis G, Arroyo MR, Abbitt PL, Grobmyer SR, Hochwald SN. Malignant Transformation of a Pancreatic Serous Cystadenoma. Am Surg 2012. [DOI: 10.1177/000313481207800249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- George Rossidis
- Department of Surgery University of Florida College of Medicine Gainesville, Florida
| | - May R. Arroyo
- Department of Pathology University of Florida College of Medicine Gainesville, Florida
| | - Patricia L. Abbitt
- Department of Radiology University of Florida College of Medicine Gainesville, Florida
| | - Stephen R. Grobmyer
- Department of Surgery University of Florida College of Medicine Gainesville, Florida
| | - Steven N. Hochwald
- Department of Surgery University of Florida College of Medicine Gainesville, Florida
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Imaging of pancreatic serous cystadenocarcinoma. Jpn J Radiol 2011; 29:730-4. [DOI: 10.1007/s11604-011-0617-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 05/31/2011] [Indexed: 12/22/2022]
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Pancreatic Cystic Lesions of Nonmucinous Type. Surg Pathol Clin 2011; 4:553-77. [PMID: 26837488 DOI: 10.1016/j.path.2011.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cystic lesions of nonmucinous type can arise within the pancreas or can develop from adjacent structures and appear to involve the pancreas. In addition, some typically solid masses can become cystic or can present as cystic lesions. Nonmucinous cysts can be neoplastic, inflammatory, reactive, or congenital. The vast majority of neoplastic nonmucinous cysts are benign. Because of the difficulty in determining the neoplastic potential of a pancreatic cyst preoperatively, many non-neoplastic cysts are resected. This article reviews the surgical pathology of nonmucinous cysts.
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Hwang HK, Chung YE, Kim HK, Park JY, Choi HJ, Kang CM, Lee WJ. Serous Cystic Neoplasm: Do We Have to Wait Till It Causes Trouble? KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2011; 15:134-8. [PMID: 26421029 PMCID: PMC4582553 DOI: 10.14701/kjhbps.2011.15.2.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 04/02/2011] [Indexed: 01/17/2023]
Abstract
Serous cystic neoplasm (SCN) of the pancreas is considered a benign tumor with almost no malignant potential. Most surgeons agree that asymptomatic SCN requires only regular observation. However, several complexities and interference with organ preservation during the operation, may develop when a huge symptomatic tumor is treated with surgery. So, the purpose of this study is to develop a potential management plan based on a literature review and by describing three recent cases of SCN of the pancreas. We suggest that SCNs be responded to with a timely and appropriate surgical intervention - before they require clinical attention.
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Affiliation(s)
- Ho Kyoung Hwang
- Department of Surgery, Yonsei University College of Medicine, Korea. ; Pancreaticobiliary Cancer Clinic, Yonsei University Health System, Korea. ; Young Yonsei Pancreatic Tumor Study Group, Korea
| | - Young Eun Chung
- Department of Radiology, Yonsei University College of Medicine, Korea. ; Pancreaticobiliary Cancer Clinic, Yonsei University Health System, Korea. ; Young Yonsei Pancreatic Tumor Study Group, Korea
| | - Hyun Ki Kim
- Department of Pathology, Yonsei University College of Medicine, Korea. ; Pancreaticobiliary Cancer Clinic, Yonsei University Health System, Korea. ; Young Yonsei Pancreatic Tumor Study Group, Korea
| | - Jung Yub Park
- Department of Internal Medicine, Yonsei University College of Medicine, Korea. ; Pancreaticobiliary Cancer Clinic, Yonsei University Health System, Korea. ; Young Yonsei Pancreatic Tumor Study Group, Korea
| | - Hye Jin Choi
- Department of Medical Oncology, Yonsei University College of Medicine, Korea. ; Pancreaticobiliary Cancer Clinic, Yonsei University Health System, Korea. ; Young Yonsei Pancreatic Tumor Study Group, Korea
| | - Chang Moo Kang
- Department of Surgery, Yonsei University College of Medicine, Korea. ; Pancreaticobiliary Cancer Clinic, Yonsei University Health System, Korea. ; Young Yonsei Pancreatic Tumor Study Group, Korea
| | - Woo Jung Lee
- Department of Surgery, Yonsei University College of Medicine, Korea. ; Pancreaticobiliary Cancer Clinic, Yonsei University Health System, Korea
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Sharma C, Eltawil KM, Renfrew PD, Walsh MJ, Molinari M. Advances in diagnosis, treatment and palliation of pancreatic carcinoma: 1990-2010. World J Gastroenterol 2011; 17:867-97. [PMID: 21412497 PMCID: PMC3051138 DOI: 10.3748/wjg.v17.i7.867] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 12/08/2010] [Accepted: 12/15/2010] [Indexed: 02/06/2023] Open
Abstract
Several advances in genetics, diagnosis and palliation of pancreatic cancer (PC) have occurred in the last decades. A multidisciplinary approach to this disease is therefore recommended. PC is relatively common as it is the fourth leading cause of cancer related mortality. Most patients present with obstructive jaundice, epigastric or back pain, weight loss and anorexia. Despite improvements in diagnostic modalities, the majority of cases are still detected in advanced stages. The only curative treatment for PC remains surgical resection. No more than 20% of patients are candidates for surgery at the time of diagnosis and survival remains quite poor as adjuvant therapies are not very effective. A small percentage of patients with borderline non-resectable PC might benefit from neo-adjuvant chemoradiation therapy enabling them to undergo resection; however, randomized controlled studies are needed to prove the benefits of this strategy. Patients with unresectable PC benefit from palliative interventions such as biliary decompression and celiac plexus block. Further clinical trials to evaluate new chemo and radiation protocols as well as identification of genetic markers for PC are needed to improve the overall survival of patients affected by PC, as the current overall 5-year survival rate of patients affected by PC is still less than 5%. The aim of this article is to review the most recent high quality literature on this topic.
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50
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Schlitter AM, Esposito I, Klöppel G. Klassifikation und Diagnose zystischer Pankreastumoren. VISZERALMEDIZIN 2011. [DOI: 10.1159/000329194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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