• Humans
• Cost-Benefit Analysis
• Pancreatic Neoplasms/surgery
• Pancreatic Neoplasms/economics
• Pancreatectomy/economics
• Pancreatectomy/methods
• Diabetes Mellitus/economics
• Quality-Adjusted Life Years
• Markov Chains
• Female
• Male
• Middle Aged
• Postoperative Complications/economics
• Postoperative Complications/etiology
• Laparoscopy/economics
• Laparoscopy/methods
• Aged

• IPMN
• LAPC
• MCN
• NGS
• PDAC
• pancreatic disease
• pancreatitis

• IPMN
• MCN
• acinar
• adenosquamous
• hepatoid
• medullary
• pseudopapillary
• signet ring
• undifferentiated

• advantages
• artificial intelligence
• disadvantages
• endoscopic interventions
• endoscopic ultrasound
• pancreatic cystic lesions

• mucinous nonneoplastic cyst (MNNC)
• ovarian-like stroma
• pancreatic cyst

• DP
• MCN
• minimally invasive surgery

• Humans
• Pancreatic Intraductal Neoplasms
• Pancreatic Neoplasms
• Carcinoma, Pancreatic Ductal
• Adenocarcinoma, Papillary

Pancreatic mucinous cystic neoplasms (MCNs) represent one of the precursor lesions of pancreatic ductal adenocarcinoma, and their detection has been facilitated by advances in preoperative imaging. Due primarily to the rarity of MCNs, however, there is limited knowledge regarding the prognostic variables and high-risk factors for malignant transformation. A more comprehensive and nuanced approach is necessary to fill this gap and provide a basis for improved treatment decisions and patient outcomes.

To investigate the high-risk factors associated with malignant MCNs and to explore the prognostic factors of MCN with associated invasive carcinoma (MCN-AIC).

All cases of resected MCNs from a single high-volume institution between January 2012 and January 2022 were retrospectively reviewed. Only cases with ovarian-type stroma verified by progesterone receptor staining were included. Preoperative features, histological findings and postoperative course were documented. Multivariate logistic regression was employed to investigate variables related to malignancy. Survival analysis was performed using the Kaplan-Meier curve, and the prognostic factors were assessed to evaluate the postoperative course of patients with MCN-AIC.

Among the 48 patients, 36 had benign MCNs, and 12 had malignant MCNs (1 high-grade atypical hyperplasia and 11 MCN-AIC). Age, tumour size, presence of solid components or mural nodules and pancreatic duct dilatation were identified as independent risk factors associated with malignancy. The follow-up period ranged from 12 mo to 120 mo, with a median overall survival of 58.2 mo. Only three patients with MCN-AIC died, and the 5-year survival rate was 70.1%. All 11 cases of MCN-AIC were stage I, and extracapsular invasion was identified as a prognostic factor for poorer outcomes.

The risk factors independently associated with malignant transformation of MCNs included age, tumour size, presence of solid components or mural nodules, and pancreatic duct dilatation. Our study also revealed that encapsulated invasion was a favourable prognostic factor in MCN-AIC patients.

• Mucinous cystic neoplasms
• Pancreatic adenocarcinoma
• Invasive carcinoma
• Risk of malignancy
• Prognostic factor
• Retrospective study

• Humans
• Carcinoma, Pancreatic Ductal/epidemiology
• Carcinoma, Pancreatic Ductal/pathology
• Carcinoma, Pancreatic Ductal/surgery
• East Asian People
• Neoplasms, Cystic, Mucinous, and Serous/epidemiology
• Neoplasms, Cystic, Mucinous, and Serous/pathology
• Neoplasms, Cystic, Mucinous, and Serous/surgery
• Pancreatic Neoplasms/epidemiology
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/surgery
• Prognosis
• Receptors, Progesterone
• Retrospective Studies

• NGS
• advanced diagnostics
• endomicroscopy
• histology
• molecular
• morphology
• nCLE
• pancreatic cystic lesions

• NA Mauna Kea Technologies (France)

This study aimed to investigate the prognostic value of clinical features for cancer-specific survival (CSS) and metastasis in patients with pancreatic mucinous cystadenocarcinoma (MCAC). We further constructed and validated an effective nomogram to predict CSS.

We screened patients diagnosed with pancreatic MCAC from Surveillance Epidemiology and End Results (SEER) database. Kaplan-Meier curves were used to determine the CSS time. Univariate and multivariate Cox and logistic regression analyses were conducted to identify the prognostic factors for CSS and metastasis. The nomogram was constructed to predict the prognosis of pancreatic MCAC based on the results from the multivariate analysis. We used the concordance index (C-index), the area under the curve (AUC), and the calibration plots to determine the predictive accuracy and discriminability of the nomogram.

Multivariate Cox analysis revealed that age, primary site, grade, and radiotherapy were independent prognostic factors associated with CSS. Multivariate logistic regression analysis revealed that surgery and grade were independent risk factors associated with metastasis. The independent risk factors were included to construct a prognosis prediction model for predicting CSS in patients with pancreatic MCAC. The concordance index (C-index), receiver operating characteristic (ROC) curves, and calibration plots of the training cohort and the validation cohort showed that the nomogram had an acceptable predictive performance.

We established a nomogram that could determine the 3- and 5-year CSS, which could evaluate individual clinical outcomes and provide individualized clinical decisions.

• National Natural Science Foundation of China
• China Postdoctoral Science Foundation

• Intraductal papillary mucinous neoplasm
• Mucinous cystic neoplasm
• Pancreatic cystic lesion
• Serous cystadenoma

• Cystic neoplasm of pancreas
• Distal pancreatectomy
• Mucinous cystadenocarcinoma
• Mucinous cystic neoplasm

• Adult
• Ascites/etiology
• Cystadenocarcinoma, Mucinous/complications
• Cystadenocarcinoma, Mucinous/diagnosis
• Cystadenocarcinoma, Mucinous/surgery
• Female
• Humans
• Pancreatectomy
• Pancreatic Neoplasms/complications
• Pancreatic Neoplasms/diagnostic imaging
• Pancreatic Neoplasms/surgery
• Peritoneal Neoplasms/complications
• Peritoneal Neoplasms/diagnostic imaging
• Peritoneal Neoplasms/surgery
• Pancreatic Neoplasms

Pancreatic cystic lesions (PCLs) are common in clinical practice. The accurate classification and diagnosis of these lesions are crucial to avoid unnecessary treatment of benign lesions and missed opportunities for early treatment of potentially malignant lesions.

To evaluate the role of cyst fluid analysis of different tumor markers such as cancer antigens [e.g., cancer antigen (CA)19-9, CA72-4], carcinoembryonic antigen (CEA), serine protease inhibitor Kazal-type 1 (SPINK1), interleukin 1 beta (IL1-β), vascular endothelial growth factor A (VEGF-A), and prostaglandin E2 (PGE2)], amylase, and mucin stain in diagnosing pancreatic cysts and differentiating malignant from benign lesions.

This study included 76 patients diagnosed with PCLs using different imaging modalities. All patients underwent endoscopic ultrasound (EUS) and EUS-fine needle aspiration (EUS-FNA) for characterization and sampling of different PCLs.

The mean age of studied patients was 47.4 ± 11.4 years, with a slight female predominance (59.2%). Mucin stain showed high statistical significance in predicting malignancy with a sensitivity of 87.1% and specificity of 95.56%. It also showed a positive predictive value and negative predictive value of 93.1% and 91.49%, respectively (P < 0.001). We found that positive mucin stain, cyst fluid glucose, SPINK1, amylase, and CEA levels had high statistical significance (P < 0.0001). In contrast, IL-1β, CA 72-4, VEGF-A, VEGFR2, and PGE2 did not show any statistical significance. Univariate regression analysis for prediction of malignancy in PCLs showed a statistically significant positive correlation with mural nodules, lymph nodes, cyst diameter, mucin stain, and cyst fluid CEA. Meanwhile, logistic multivariable regression analysis proved that mural nodules, mucin stain, and SPINK1 were independent predictors of malignancy in cystic pancreatic lesions.

EUS examination of cyst morphology with cytopathological analysis and cyst fluid analysis could improve the differentiation between malignant and benign pancreatic cysts. Also, CEA, glucose, and SPINK1 could be used as promising markers to predict malignant pancreatic cysts.

• Pancreatic cystic neoplasm
• Mucinous cystic neoplasm
• Intraductal papillary mucinous neoplasm
• Mucin stain
• Amylase

• Biomarker
• Pancreatic cancer
• Prediction model
• Screening
• Trend

• Bile duct
• Cholangiocarcinoma
• IPMN
• IPNB
• MCN
• Pancreas

• Mucinous cystic neoplasm (MCN)
• retrospective study
• risk of malignancy

•

CT can distinguish between benign and premalignant or malignant pancreatic cysts.

It is important to identify features on computed tomography (CT) that can distinguish between benign and premalignant or malignant pancreatic cysts to avoid unnecessary surgeries. This study investigated the preoperative diagnostic evaluation of cystic pancreatic lesions to determine how advanced imaging and clinical factors should guide management.

In total, 53 patients with 27 benign and 26 premalignant or malignant cysts were enrolled. CT features of the cysts were compared using univariate and multivariate analyses.

On univariate analysis, a solid component (p < 0.01), septation (p < 0.01), location (p < 0.01), border (p < 0.01), wall enhancement (p = 0.01), lesion margins (p < 0.01), pancreatic atrophy (p = 0.04), and a cystic wall (p < 0.01) were all significantly different between benign and premalignant or malignant cysts. On multivariate analysis, only a solid component (p < 0.01) and septation (p < 0.01) were significant.

A thin cystic wall, uniform homogeneity, a clear border, the presence of septation, pancreatic atrophy, and the absence of both wall enhancements and solid components were more frequently seen in benign cysts. A thick wall, lack of homogeneity, the presence of wall enhancements and solid components, absence of septation, only a small degree of pancreatic atrophy, and unclear borders were more frequent among premalignant or malignant cysts. The only CT features to differentiate benign from premalignant or malignant cysts were a solid component and septation.

• CEA, Carcinoembryonic antigen
• CPR, Curved planar reformation
• CTA, CT angiography
• DWI, Diffusion-weighted imaging
• ERCP, Endoscopic retrograde cholangiopancreatography
• FDG PET, Fluorodeoxyglucose PET
• FNA, Fine-needle aspiration
• HASTE, Half-Fourier acquisition single-shot turbo spin-echo
• IPMN, Intraductal papillary mucinous neoplasia
• MCA, Mucinous cystadenoma
• MCB, Mucinous cystic borderline tumor
• MCC, Mucinous cystadenocarcinoma
• MCN, Mucinous cystic neoplasm
• MPD, Main pancreatic duct
• MPR, Multi-planar reformation
• MRA, MR angiography
• MRCP, MR cholangiopancreatography
• MRI, Magnetic resonance imaging
• MSCT, Multi-slice helical computed tomography
• PACS, Picture archiving and communicating system
• PCN, Cystic neoplasms of the pancreas
• PDAC, Pancreatic ductal adenocarcinoma
• PET, Positron emission computed tomography
• Pancreatic cystic lesions
• Pancreatic ductal adenocarcinoma
• Pancreatic neoplasm
• ROI, Region of interest
• SCA, Serous cystadenoma
• SMA, Serous microcystic adenoma
• US, Ultrasonography

The prognosis of invasive pancreatic mucinous cystadenocarcinoma (MCC) is poor, and the molecular mechanism underlying its development remains unclear. The present study aimed to explore the potential role of autophagy in pancreatic MCC. The results demonstrated an increase in autophagy signaling in pancreatic MCC tissues and the MCC1 cell line compared with adjacent tissues and normal human pancreatic ductal epithelium (HPDE) cells. In addition, abnormal autophagy activation facilitated the migration and invasion of MCC1 cells. MicroRNA (miR)-224-5p expression levels were significantly higher in MCC1 cells compared with those in HPDE cells. Treatment with rapamycin further demonstrated that high levels of autophagy elevated miR-224-5p expression in MCC1 cells in a time-dependent manner. BCL2 was identified as a downstream target gene of miR-224-5p, which binds to the 3′-untranslated region of BCL2. In addition, the results of the present study demonstrated that BCL2 knockdown reversed the inhibition of autophagy mediated by the miR-224-5p inhibitor. To the best of our knowledge, this is the first study to evaluate the role of autophagy in pancreatic MCC. Thus, these results suggested that autophagy may be hyperactivated in pancreatic MCC. In addition, the present study identified a positive feedback loop between autophagy signaling and miR-224-5p, which may promote the aggressive migration and invasion of MCC1. These results may provide a new insight into the relationship between autophagy and tumor metastasis in pancreatic MCC.

• Bcl2
• MCC1
• autophagy
• metastasis
• microRNA-224-5p
• mucinous cystadenocarcinoma

Accurate diagnosis of Pancreatic cysts (PC) is key in the management. The knowledge of indications for surgery, the role of endoscopic ultrasound-guided fine needle aspiration, cyst fluid analysis, imaging, and surveillance of PC are all important in the diagnosis and management of PC. Currently, there are many guidelines for the management of PC. The optimal use of these guidelines with a patient-centered approach helps diagnose early cancer and prevent the spread of cancer.

• Pancreatic cysts
• Serous cystadenoma
• Main pancreatic duct
• Intraductal papillary mucinous neoplasm
• Endoscopic ultrasound-guided fine needle aspiration
• Carcinoembryonic antigen

• Cyst Fluid/chemistry
• Endoscopic Ultrasound-Guided Fine Needle Aspiration/standards
• Gastroenterology/methods
• Gastroenterology/standards
• Humans
• Magnetic Resonance Imaging/standards
• Pancreas/diagnostic imaging
• Pancreas/pathology
• Pancreas/surgery
• Pancreatic Cyst/diagnosis
• Pancreatic Cyst/epidemiology
• Pancreatic Cyst/pathology
• Pancreatic Cyst/surgery
• Patient-Centered Care/methods
• Patient-Centered Care/standards
• Practice Guidelines as Topic
• Prevalence
• Tomography, X-Ray Computed/standards
• Watchful Waiting/methods
• Watchful Waiting/standards

• Biomarker
• Early detection
• IPMN
• Pancreatic cancer
• Pancreatic cystic lesions
• Pancreatic ductal adenocarcinoma
• Radiomics

• Machine learning
• Pancreatic cancer
• Pancreatic cystic lesions
• Radiomics
• Radiomics in pancreatic cancer

• Breast Neoplasms/diagnosis
• Breast Neoplasms/prevention & control
• Female
• Humans
• Incidence
• Male
• Mass Screening
• Medical Overuse
• Neoplasms/diagnosis
• Neoplasms/epidemiology
• Neoplasms/pathology
• Neoplasms/prevention & control
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/epidemiology
• Pancreatic Neoplasms/prevention & control
• Prostatic Neoplasms/diagnosis
• Prostatic Neoplasms/prevention & control
• Tumor Microenvironment

• U01 CA196403 NCI NIH HHS

Pancreatic duct disruption is a challenging condition leading to pancreatic juice leakage and consequently to pancreatic fluid collections. The manifestations of pancreatic main duct leak include pseudocysts, walled-off necrosis, pancreatic fistulas, ascites, pleural and pericardial effusions. Pseudocyst formation is the most frequent outcome of a pancreatic duct leak.

We describe a case of a 64-year old man with large multiple pancreatic cysts discovered for progressive jaundice and significant weight loss in the absence of a previous episode of acute pancreatitis. Computed tomography scan showed lesion with thick enhancing walls. The main cyst dislocated the stomach and the duodenum inducing intra and extrahepatic bile ducts enlargement. Magnetic resonance cholangiopancreatography revealed a communication between the main pancreatic duct and the cystic lesions due to Wirsung duct rupture. Endoscopic ultrasound guided fine needle aspiration cytology did not show neoplastic cells and cyst fluid analysis revealed high amylase concentration. Preoperative exams were suggestive but not conclusive for a benign lesion. Laparotomy was necessary to confirm the presence of large communicating pseudocysts whose drainage was performed by cystogastrostomy. Histology confirmed the inflammatory nature of the cyst wall. Subsequently, the patient had progressive jaundice resolution.

Pancreatic cystic masses include several pathological entities, ranging from benign to malignant lesions. Rarely pseudocysts present as complex cystic pancreatic lesions with biliary compression in absence of history of acute pancreatitis. We describe the rare case of multiple pancreatic pseudocysts due to Wirsung duct rupture in absence of previous trauma or acute pancreatitis. Magnetic resonance showed the presence of communication with the main pancreatic duct and endoscopic ultrasound fine needle aspiration suggested the benign nature of the lesion.

• Acute pancreatitis
• Jaundice
• Pancreatic cystic mass
• Pancreatic duct rupture
• Pseudocyst

Cystic lesions of the pancreas have been increasingly recognized. Some lesions exhibit benign behavior, while others have unequivocal malignant potential. Thus, accurate identification of malignancy in patients diagnosed with pancreatic cystic neoplasms (PCNs) remains a major challenge. The aim of this study was to define a combined criterion to better predict malignant lesions in patients with PCNs.

We retrospectively analyzed 165 patients who underwent resection of PCNs from October 2011 to May 2017. The relationship among malignancy and serum carbohydrate antigen 19-9 (CA19-9), preoperative neutrophil-to-lymphocyte ratio (NLR), and the presence of enhanced solid component on imaging was analyzed.

NLR before surgery in patients with malignant PCNs (2.81±2.14) was significantly higher than that in patients diagnosed with pancreatic neuroendocrine tumor (1.90±0.69, P=0.013) or healthy volunteers (1.40±0.48; P<0.001). Serum CA19-9 ≥39 U/mL, NLR >1.976 and presence of enhanced solid component were independent predictors of PCN malignancy. A combined criterion meeting any two or more of the three elements including CA19-9 ≥39 U/mL, NLR >1.976, and presence of enhanced solid component on computed tomography imaging is an indicator with a high positive predictive value of 80.5% and a high negative predictive value of 87.9%, and thus, represents a highly accurate test (86.1%).

The new combined criterion is an effective predictor of tumor malignancy in patients with PCNs.

• Malignant pancreatic cystic neoplasm
• combined criterion
• diagnosis
• enhanced solid component
• neutrophil-lymphocyte ratio

• biomarkers
• early diagnosis
• exosomes
• liquid biopsy
• pancreatic cancer

• laparoscopic
• mucinous cystic neoplasm
• pancreatectomy
• robotic

• Carcinoma in Situ/classification
• Carcinoma in Situ/etiology
• Carcinoma in Situ/pathology
• Carcinoma, Pancreatic Ductal/classification
• Carcinoma, Pancreatic Ductal/etiology
• Carcinoma, Pancreatic Ductal/pathology
• Humans
• Mutation
• Neoplasm Invasiveness/pathology
• Pancreatic Neoplasms/classification
• Pancreatic Neoplasms/etiology
• Pancreatic Neoplasms/pathology
• Precancerous Conditions/classification
• Precancerous Conditions/etiology
• Precancerous Conditions/pathology
• Prognosis

Mucinous cystic neoplasms (MCNs) of the pancreas in male patients are very rare. Though few cases of MCNs in male patients have been reported, it is difficult to reveal them preoperatively. The first patient was a 50-year-old man and was incidentally found to have a cystic mass of 51 mm in the tail of the pancreas. We performed a distal pancreatectomy. The second patient was a 73-year-old man, incidentally found to have a cystic mass of 25 mm in diameter in the tail of the pancreas and a carcinoma of the bile duct. We performed a subtotal stomachpreserving pancreaticoduodenectomy and distal pancreatectomy. In both cases, the cystic lesion was diagnosed pathologically as MCNs. Since MCNs have the risk of malignancy, a resection is recommended. Cases of MCNs in male patients exhibit features that are similar to MCNs in women. We should recognize that MCNs of the pancreas in male patients exists.

• male
• mucinous cystic neoplasm
• ovarian type stroma
• pancreas

• Endosonographic characteristics of pancreatic cysts
• Endosonographic-guided pancreas cyst ablation
• Fine needle aspiration
• Intraductal papillary mucinous neoplasm
• Mucinous cystic neoplasm
• Pancreatic cysts
• Serous cystic neoplasm

• Endoscopic ultrasound
• Intraductal papillary mucinous neoplasm
• Mucinous cystic neoplasm
• Pancreatic cancer
• Pancreatic intraepithelial neoplasia

• APC
• MCN
• anaplastic pancreatic carcinoma
• osteoclast-like giant cell
• pancreatic cystic lesion
• spindle cell

• Intraductal papillary mucinous neoplasm (IPMN)
• Mucinous cystic neoplasm
• Natural history
• Pancreatic cystic neoplasms
• Serous cystadenoma

• Cystic neoplasms of the pancreas
• Cystic pancreatic endocrine neoplasm
• Intraductal papillary mucinous neoplasm
• Mucinous cystic neoplasm
• Serous cystic neoplasm
• Solid pseudopapillary neoplasm

Using serum carbohydrate antigen 19–9 (CA 19–9) in discriminating between benign and malignant pancreatic disease remains controversial. We aim to evaluate the diagnostic value of serum CA 19–9 in predicting malignant pancreatic cystic lesions.

Eligible studies were identified through searching MEDLINE and EMBASE prior to March 2016. Studies were assessed for quality using the Quality Assessment for Studies of Diagnostic Accuracy, 2nd version (QUADAS-2). Pooled sensitivity and specificity with 95% confidence interval (CI) were calculated using random-effects models. Summary receiver operator characteristic (SROC) curves and the area under curve (AUC) were performed.

A total of thirteen studies including 1437 patients were enrolled in this meta-analysis. The pooled sensitivity and specificity were 0.47(95% CI: 0.35–0.59), and 0.88(95% CI: 0.86–0.91), respectively, and the AUC was 0.87(95% CI, 0.84–0.90). Meta-regression analysis showed that sample size, region and reference standards were not the main sources of heterogeneity.

Serum CA 19–9 has satisfying pooled specificity while poor pooled sensitivity for discriminating benign from malignant PCNs. It deserves to be widely used as complementary to other clinical diagnostic methods.

• Adult
• Aged
• Area Under Curve
• Biomarkers, Tumor/blood
• CA-19-9 Antigen/blood
• Diagnosis, Differential
• Female
• Humans
• Male
• Middle Aged
• Neoplasms/blood
• Neoplasms/diagnosis
• Neoplasms/pathology
• Pancreas/metabolism
• Pancreas/pathology
• Pancreatic Cyst/blood
• Pancreatic Cyst/diagnosis
• Pancreatic Cyst/pathology
• Pancreatic Neoplasms/blood
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/pathology
• Prospective Studies
• ROC Curve
• Retrospective Studies

• MCN
• Mucinous cystic neoplasm
• Pancreatic cystic neoplasm
• Pancreatic cystic tumor

• Mucinous cystadenocarcinoma
• Neoplasms
• Pancreas