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Jain V, Jearth V, Gupta P, Sekar A, Kurdia KC. Serous cystic neoplasm of pancreas with surgical obstructive jaundice and double duct sign: Cystadenoma or cystadenocarcinoma? Indian J Gastroenterol 2024:10.1007/s12664-024-01584-4. [PMID: 38635009 DOI: 10.1007/s12664-024-01584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Vibhu Jain
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Vaneet Jearth
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Pankaj Gupta
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Aravind Sekar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Kailash Chand Kurdia
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
- Department of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
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Chhoda A, Schmidt J, Farrell JJ. Surveillance of Pancreatic Cystic Neoplasms. Gastrointest Endosc Clin N Am 2023; 33:613-640. [PMID: 37245939 DOI: 10.1016/j.giec.2023.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Pancreatic cystic neoplasms (PCNs) are increasingly detected because of the widespread use of cross-sectional imaging and overall aging population. While the majority of these cysts are benign, some can progress to advanced neoplasia (defined as high-grade dysplasia and invasive cancer). As the only widely accepted treatment for PCNs with advanced neoplasia is surgical resection, accurate preoperative diagnosis, and stratification of malignant potential for deciding about surgery, surveillance or doing nothing remains a clinical challenge. Surveillance strategies for pancreatic cysts (PCNs) combine clinical evaluation and imaging to assess changes in cyst morphology and symptoms that may indicate advanced neoplasia. PCN surveillance heavily relies on various consensus clinical guidelines that focus on high-risk morphology, surgical indications, and surveillance intervals and modalities. This review will focus on current concepts in the surveillance of newly diagnosed PCNs, especially on low-risk presumed intraductal papillary mucinous neoplasms (those without worrisome features and high-risk stigmata), and appraise current clinical surveillance guidelines.
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Affiliation(s)
- Ankit Chhoda
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Julie Schmidt
- Yale Multidisciplinary Pancreatic Cyst Clinic (Yale MPaCC), Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University School of Medicine, New Haven, CT, USA
| | - James J Farrell
- Yale Multidisciplinary Pancreatic Cyst Clinic (Yale MPaCC), Yale Center for Pancreatic Disease, Section of Digestive Disease, Yale University School of Medicine, New Haven, CT, USA.
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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
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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Yagi F, Akita H, Ueno A, Takano K, Masugi Y, Sakamoto M, Kitago M, Shinoda M, Kitagawa Y, Toyama K, Matsusaka Y, Yashiro H, Okuda S, Jinzaki M. Incidentally detected microcystic serous cystadenoma of the pancreas with splenic invasion: a case report and literature review. BJR Case Rep 2020; 6:20190109. [PMID: 33029373 PMCID: PMC7527013 DOI: 10.1259/bjrcr.20190109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/11/2019] [Accepted: 11/24/2019] [Indexed: 11/05/2022] Open
Abstract
Serous cystic neoplasms are relatively uncommon and rarely possess malignant potential. We report a rare case of pancreatic serous cystadenoma with splenic invasion in a female in her 60s. Dynamic contrast-enhanced CT revealed a 3 cm mass in the tail of the pancreas. The lesion showed marked enhancement in the arterial phase on dynamic CT, which extended into the spleen. No cystic components were detected in the pancreatic mass on either magnetic resonance cholangiopancreatography or T2 weighted imaging. No metastasis or lymph node swelling was detected. Based on the hypervascularity of the tumour, the pre-operative diagnosis was pancreatic neuroendocrine tumour with splenic invasion. The patient underwent laparoscopic distal pancreatectomy with splenectomy. The pathological diagnosis was microcystic serous cystadenoma with locally aggressive features (infiltration into spleen, lymph nodes, and splenic vein). A few cases of pancreatic serous cystadenomas with splenic invasion have been reported; all were symptomatic, with diameters greater than approximately 9 cm. This is the first known case of incidentally detected serous cystadenoma with splenic invasion, reported with detailed imaging findings of dynamic CT and MRI.
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Affiliation(s)
- Fumiko Yagi
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hirotaka Akita
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Akihisa Ueno
- Department of Pathology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | | | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kenji Toyama
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yohji Matsusaka
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | | | - Shigeo Okuda
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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5
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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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Park JH, Kang KA, Chang KS, Kwon HJ, Kim MS. [Malignant Pancreatic Serous Cystic Neoplasm: A Case of Local Recurrence and Liver Metastasis that Occurred During Follow-Up]. TAEHAN YONGSANG UIHAKHOE CHI 2020; 81:418-422. [PMID: 36237375 PMCID: PMC9431823 DOI: 10.3348/jksr.2020.81.2.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/30/2019] [Accepted: 07/01/2019] [Indexed: 06/16/2023]
Abstract
Serous cystic neoplasms of the pancreas are usually benign, with a low malignant potential. Herein, we report a case of malignant serous cystic neoplasm of the pancreas treated with subtotal pancreatectomy, which progressed to local recurrence and metachronous hepatic metastasis during the regular follow-up period.
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Kawanishi A, Hirabayashi K, Kono H, Takanashi Y, Hadano A, Kawashima Y, Ogawa M, Kawaguchi Y, Yamada M, Nakagohri T, Nakamura N, Mine T. A Serous Cystic Neoplasm of the Pancreas Coexisting with High-Grade Pancreatic Intraepithelial Neoplasia Mimicking an Intraepithelial Papillary Mucinous Neoplasm: A Case Report. Case Rep Oncol 2017; 10:143-150. [PMID: 28413390 PMCID: PMC5346927 DOI: 10.1159/000456611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/17/2017] [Indexed: 01/29/2023] Open
Abstract
Serous cystic neoplasms of the pancreas are rare exocrine pancreatic neoplasms, most of which are benign and do not communicate with the pancreatic duct. Pancreatic intraepithelial neoplasm (PanIN) is considered a precursor of ductal adenocarcinoma that is microscopically recognized in pancreatic ducts. A 67-year-old Japanese woman presented with a 10-mm multilocular cystic lesion at the pancreatic body. Magnetic resonance pancreatography showed stenosis of the main pancreatic duct at the pancreatic body and dilatation of the distal side of the main pancreatic duct. Furthermore, communication between the cystic lesion and the main pancreatic duct was suspected based on magnetic resonance pancreatography findings. Distal pancreatectomy was performed under the preoperative diagnosis of intraductal papillary mucinous neoplasm. Histologically, the cystic lesion was lined with a non-atypical cuboidal or flat epithelium with clear cytoplasm and was thus diagnosed as a serous cystic neoplasm. High-grade PanIN lesions with stromal fibrosis were observed at the main and branch pancreatic ducts. Histological examination revealed no communication between the serous cystic neoplasm and the pancreatic ducts. Immunohistochemically, the epithelium of the serous cystic neoplasm showed positive anti-von Hippel-Lindau antibody staining, whereas the epithelium of the PanIN showed negative staining. A serous cystic neoplasm coexisting with another pancreatic neoplasm is rare. When dilatation of the main or branch pancreatic ducts coexists with a serous cystic neoplasm, as in this case, the lesion clinically mimics an intraductal papillary mucinous neoplasm.
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Affiliation(s)
- Aya Kawanishi
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Japan
| | - Kenichi Hirabayashi
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Hirotaka Kono
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Yumi Takanashi
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Atsuko Hadano
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Japan
| | - Yohei Kawashima
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Japan
| | - Masami Ogawa
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Japan
| | - Yoshiaki Kawaguchi
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Japan
| | - Misuzu Yamada
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Toshio Nakagohri
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Naoya Nakamura
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsuya Mine
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, Isehara, Japan
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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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Honselmann KC, Krauss T, Geserick S, Wellner UF, Wittel U, Hopt UT, Keck T, Bausch D. Cystic lesions of the pancreas—is radical surgery really warranted? Langenbecks Arch Surg 2016; 401:449-56. [DOI: 10.1007/s00423-016-1416-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 03/30/2016] [Indexed: 01/24/2023]
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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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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; 15:708-12. [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] [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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12
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Shetty D, Bhatnagar G, Sidhu HS, Fox BM, Dodds NI. The increasing role of endoscopic ultrasound (EUS) in the management of pancreatic and biliary disease. Clin Radiol 2013; 68:323-35. [PMID: 23391284 DOI: 10.1016/j.crad.2012.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/14/2012] [Accepted: 09/27/2012] [Indexed: 12/28/2022]
Abstract
Pancreatic and biliary disease continues to have a significant impact on the workload of the National Health Service (NHS), for which there exists a multimodality approach to investigation and diagnosis. Endoscopic ultrasound (EUS) is fast becoming a fundamental tool in this cohort of patients, not only because of its ability to provide superior visualization of a difficult anatomical region, but also because of its valuable role as a problem-solving tool and ever-improving ability in an interventional capacity. We provide a comprehensive review of the benefits of EUS in everyday clinical practice.
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Affiliation(s)
- D Shetty
- Department of Clinical Radiology, Royal Cornwall Hospital, Truro, Cornwall, UK
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13
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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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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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Fukasawa M, Maguchi H, Takahashi K, Katanuma A, Osanai M, Kurita A, Ichiya T, Tsuchiya T, Kin T. Clinical features and natural history of serous cystic neoplasm of the pancreas. Pancreatology 2011; 10:695-701. [PMID: 21242709 DOI: 10.1159/000320694] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 08/19/2010] [Indexed: 12/11/2022]
Abstract
AIMS To clarify the clinical features and the natural history of serous cystic neoplasm (SCN) of the pancreas. METHODS We retrospectively analyzed data from 30 patients affected by SCN. SCNs were classified as (1) microcystic type, (2) micro- and macrocystic type, and (3) macrocystic type according to the modified WHO classification. Eighteen patients who underwent serial radiographic imaging were identified, and tumor growth rate in these patients was evaluated. RESULTS The median age was 62 years, and the female:male ratio was 2:1. Twenty-five patients (83%) were asymptomatic and 5 (17%) were symptomatic. The median tumor size was 2.6 cm. Fifteen cases (50%) had the microcystic type, 7 (23%) the micro- and macrocystic type, and 8 (27%) the macrocystic type. Age, gender, symptoms, location or tumor size did not differ significantly among the three subtypes. Eighteen patients were followed up for a median of 58 months. Morphological changes were observed in 3 patients (17%) and enlargement of tumor size in 9 patients (50%) during the follow-up. The growth rate was 0.29 cm per year and doubling time was 3.5 years; these rates did not differ among morphological subtypes or size of tumors. CONCLUSIONS In asymptomatic patients with a clear imaging diagnosis of SCN, nonoperative management with a careful follow-up should be recommended. Surgery should be suggested in only symptomatic patients, those with giant tumors (>10 cm), rapid growing or when the presence of a potentially malignant tumor cannot be excluded. and IAP.
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Affiliation(s)
- Mitsuharu Fukasawa
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan. fukasawa3286 @ aol.com
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17
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Association of epidermal growth factor receptor and mitogen-activated protein kinase with cystic neoplasms of the pancreas. Mod Pathol 2010; 23:1127-35. [PMID: 20495538 DOI: 10.1038/modpathol.2010.97] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The molecular pathobiology of pancreatic cystic neoplasms is poorly understood. The aim of this study was to know the involvement of epidermal growth factor receptor (EGFR) and its downstream targets in the serous cystic neoplasms and the mucinous cystic neoplasms of the pancreas. In a total of 72 pancreatic cystic neoplasms, including 39 serous cystic neoplasms and 33 mucinous cystic neoplasms, we examined the expression of native and phosphorylated EGFR, mitogen-activated protein kinase (MAPK), and AKT by immunohistochemistry and somatic mutations in EGFR, KRAS, BRAF, and PIK3CA, by direct sequencing. We also assessed the copy numbers of EGFR transcripts and the amplification of the EGFR gene in some of the samples. We found that EGFR, phosphorylated EGFR, MAPK, and phosphorylated MAPK were evidently expressed in 100, 54, 100, and 69% of the serous cystic neoplasms, and in 12%, none, 33, and 27% of the mucinous cystic neoplasms, respectively; the expression was significantly higher and more prevalent in the serous cystic neoplasms than in the mucinous cystic neoplasms. The expression of AKT and phosphorylated AKT was low in both the types of neoplasms. On average, EGFR transcripts in the serous cystic neoplasms and the mucinous cystic neoplasms increased 53.5- and 2.5-fold, respectively, as compared with that in normal tissues, with the increase in the former being significantly greater than that in the latter. Amplification of the EGFR gene was not detected in any of the examined serous cystic neoplasms. None of the tumors had mutations in any of the examined portions of the genes, except two mucinous cystic neoplasms with mutations in codon-12 of KRAS. These results indicate that EGFR and MAPK are actively involved in the pathobiology of serous cystic neoplasms and may therefore be potential diagnostic markers and therapeutic targets in patients with the above mentioned types of neoplasms.
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Coelho JCU, Valle CL, Ribas BM, Andriguetto LD, Claus CMP. Surgical treatment of cystic neoplasms of the pancreas. ARQUIVOS DE GASTROENTEROLOGIA 2010; 47:135-40. [DOI: 10.1590/s0004-28032010000200004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 08/20/2009] [Indexed: 11/22/2022]
Abstract
CONTEXT: Diagnosis and treatment of cystic neoplasms of the pancreas increased significantly in the last decades. There are only a few Brazilian publications on these tumors. The majority of them are limited to reports of one or few cases. OBJECTIVE: To present our experience with 27 patients with cystic neoplasms of the pancreas. METHODS: Demographic data, clinical manifestations, diagnostic exams, surgical procedures, postoperative complications, and follow-up data of 27 patients with cystic neoplasms of the pancreas were analyzed, according to the histological type of the tumor. RESULTS: There were 10 (37%) serous cystic tumors, 10 (37%) mucinous cystic tumors, 4 (15%) intraductal papillary mucinous tumors, and 3 (11%) solid pseudopapillary tumors or Frantz tumor. All serous cystic tumors, 6 (60%) mucinous tumors, 2 (50%) intraductal papillary mucinous tumors, and 2 (67%) solid pseudopapillary tumors were benign. The age of the patients varied from 31 to 82 years and all tumors were more common in female. Two patients had been treated previously as a pseudocyst. Surgical procedures depended on the location and extension of the tumor. Two patients underwent only laparotomy with tumor biopsy, one cholecystectomy with Roux-en-Y hepaticojejunostomy for jaundice treatment, 6 pancreatoduodenectomy, and 18 partial pancreatectomy. The most common postoperative complication was pancreatic fistula (n = 5; 19%). One patient died of necrotic pancreatitis. Of the 10 patients with serous cystic tumor, only 1 had tumor recurrence at the section border. The three patients with mucinous cystoadenocarcinoma in which was not possible to resect the tumor, died 6 to 24 months after laparotomy. The six patients with benign mucinous tumors did not have tumor recurrence. CONCLUSIONS: The most common cystic neoplasms of the pancreas are serous and mucinous cysts. These tumors are more frequent in female. Although almost all serous cysts are benign, 40% of mucinous cysts are malign. Misdiagnosis may delay appropriate treatment and increase mortality.
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Pancreatic serous cystadenocarcinoma: a case report and review of the literature. J Gastrointest Surg 2009; 13:1864-8. [PMID: 19459016 PMCID: PMC2759006 DOI: 10.1007/s11605-009-0926-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 04/28/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Serous cystic neoplasms of the pancreas are benign lesions with little chance for malignant degeneration. We report a case of malignant serous cystadenocarcinoma of the pancreas and review the literature. METHODS Structured review of the literature was performed using PubMed and MEDLINE searches, and cases of serous cystadenocarcinoma of the pancreas were compiled. RESULTS A 70-year-old man diagnosed with a serous cystadenoma was managed expectantly until he became symptomatic, and studies revealed an increase in the size of the lesion as well as duodenal invasion. The patient underwent a pancreaticoduodenectomy, and histopathological examination revealed a locally invasive cystadenocarcinoma without metastatic disease. Seven years later, the patient remains disease-free. Review of the literature identified 25 cases of serous cystadenocarcinoma published to date. The mean age at diagnosis is 68 +/- 2 years (range, 52 to 81), and women are affected more commonly (2:1). CONCLUSIONS We conclude that there is a small but finite risk of malignancy for serous cystic neoplasms of the pancreas. The clinician should bear this in mind when faced with decisions regarding patient management. Prognosis is excellent with multiple reports of long-term survival even in the face of metastatic disease.
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20
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21
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Typical and atypical manifestations of serous cystadenoma of the pancreas: imaging findings with pathologic correlation. AJR Am J Roentgenol 2009; 193:136-42. [PMID: 19542405 DOI: 10.2214/ajr.08.1309] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of this article is to present the typical and atypical manifestations of serous cystadenoma, which can be visualized with cross-sectional imaging. CONCLUSION Serous cystadenomas of the pancreas have various distinguishing imaging features. Typically, a serous cystadenoma is morphologically classified as having either a polycystic, honeycomb, or oligocystic pattern. Atypical manifestations of serous cystadenoma can include giant tumors with ductal dilatation, intratumoral hemorrhages, solid variants, unilocular cystic tumors, interval growth, and a disseminated form.
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22
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Basturk O, Coban I, Adsay NV. Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications. Arch Pathol Lab Med 2009; 133:423-38. [PMID: 19260748 DOI: 10.5858/133.3.423] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2008] [Indexed: 12/14/2022]
Abstract
CONTEXT Cystic lesions of the pancreas are being recognized with increasing frequency and have become a more common finding in clinical practice because of the widespread use of advanced imaging modalities and the sharp drop in the mortality rate of pancreatic surgery. Consequently, in the past 2 decades, the nature of many cystic tumors in this organ has been better characterized, and significant developments have taken place in the classification and in our understanding of pancreatic cystic lesions. OBJECTIVE To provide an overview of the current concepts in classification, differential diagnosis, and clinical/biologic behavior of pancreatic cystic tumors. DATA SOURCES The authors' personal experience, based on institutional and consultation materials, combined with an analysis of the literature. CONCLUSIONS In contrast to solid tumors, most of which are invasive ductal adenocarcinomas with dismal prognosis, cystic lesions of the pancreas are often either benign or low-grade indolent neoplasia. However, those that are mucinous, namely, intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, constitute an important category because they have well-established malignant potential, representing an adenoma-carcinoma sequence. Those that are nonmucinous such as serous tumors, congenital cysts, lymphoepithelial cysts, and squamoid cyst of pancreatic ducts have no malignant potential. Only rare nonmucinous cystic tumors that occur as a result of degenerative/necrotic changes in otherwise solid neoplasia, such as cystic ductal adenocarcinomas, cystic pancreatic endocrine neoplasia, and solid-pseudopapillary neoplasm, are also malignant and have variable degrees of aggressiveness.
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Affiliation(s)
- Olca Basturk
- Department of Pathology, New York University, New York, New York, USA
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23
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Yamaguchi H, Ishigami K, Inoue T, Eguchi T, Nagata S, Kuroda Y, Nishihara Y, Yamaguchi K, Tanaka M, Tsuneyoshi M. Three cases of serous oligocystic adenomas of the pancreas; evaluation of cyst wall thickness for preoperative differentiation from mucinous cystic neoplasms. J Gastrointest Cancer 2009; 38:52-8. [PMID: 19065725 DOI: 10.1007/s12029-008-9017-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Serous oligocystic adenoma (SOA), a rare pancreatic neoplasm, is generally a benign lesion without the necessity of surgery. Preoperatively, it is difficult to discriminate SOA from mucinous cystic neoplasm (MCN), which essentially needs surgical treatment. The purpose of this study was to evaluate the cyst wall thickness of SOAs and MCNs for preoperative differential diagnosis. METHODS We experienced three cases of SOAs with typical histopathological features. The cyst wall thickness of the SOAs was evaluated in the area protruding out of the pancreas and was compared with that of 13 MCNs histopathologically. The same evaluation and comparison were conducted on preoperative computed tomography (CT) images retrospectively. RESULTS The SOAs had a uniformly thin cyst wall measuring less than 1 mm. In contrast, the largest area of a cyst wall in MCNs ranged from 2.5 to 10.0 mm. On CT images, all but one of the MCNs showed a detectable cyst wall, while the cyst walls were hardly recognizable in two of the three SOAs. CONCLUSIONS For preoperative differentiation between SOAs and MCNs, the evaluation of cyst wall thickness may be an important tool and may contribute to the decision of treatment strategy.
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Affiliation(s)
- Hiroshi Yamaguchi
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Diagnosis and management of cystic neoplasms of the pancreas: an evidence-based approach. J Am Coll Surg 2008; 207:106-20. [PMID: 18589369 DOI: 10.1016/j.jamcollsurg.2007.12.048] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 11/30/2007] [Accepted: 12/19/2007] [Indexed: 02/06/2023]
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25
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26
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A clinical algorithm for the assessment of pancreatic lesions: utilization of 16- and 64-section multidetector CT and endoscopic ultrasound. Clin Radiol 2007; 62:1142-53. [DOI: 10.1016/j.crad.2007.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 05/01/2007] [Accepted: 05/22/2007] [Indexed: 02/06/2023]
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Abstract
OBJECTIVE Serous cystadenomas of the pancreas are being increasingly identified as the advancement of the diagnostic abdominal imaging. However, the optimal timing of surgical intervention for this disease remains controversial. METHODS A total of 44 patients presenting with serous cystadenoma of the pancreas from 1981 to 2006 were identified. The patients were divided into 3 groups, nonoperated, operated without correct preoperative diagnosis, and operated with correct preoperative diagnosis. The tumor characteristics, preoperative symptoms, operative procedures, morbidity, mortality, tumor recurrences, and postoperative life quality are compared. RESULTS Nine patients did not receive operation because of high surgical risks or no presenting symptoms. Fourteen patients received operation under correct preoperative diagnosis, and 21 patients received operation under incorrect preoperative diagnosis. In the group with correct preoperative diagnosis, the average tumor size was 5.4 cm, 5 patients had preoperative symptoms, and 4 patients received limited resection. In the group without correct preoperative diagnosis, the average tumor size was 4 cm, 11 patients had preoperative symptoms, and 3 patients underwent limited resection. All patients are satisfied with the quality of life postoperatively. No patients have tumor recurrences during follow-ups. CONCLUSIONS Unless the diagnosis of serous cystadenoma is certain, all cystic tumors should be resected if operative risks are acceptable. The procedures should be as limited as possible if no evidence of malignancy is noted preoperatively.
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28
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Abstract
The increasing use of radiological imaging has led to greater detection of small and asymptomatic cystic lesions of the pancreas. Most are resectable, but not all are neoplastic. This review provides an update on the histopathology, immunohistochemistry, molecular biology, pathogenesis and management of cystic neoplasms of the exocrine pancreas. These include the serous, the mucinous cystic, the intraductal papillary mucinous and the solid pseudopapillary neoplasms. Recently reported variants are described and very rare cystic variants of other pancreatic epithelial and mesenchymal neoplasms are briefly mentioned.
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MESH Headings
- Biomarkers, Tumor/analysis
- Carcinoma, Pancreatic Ductal/chemistry
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/therapy
- Cystadenocarcinoma/chemistry
- Cystadenocarcinoma/pathology
- Cystadenocarcinoma/therapy
- Cystadenocarcinoma, Mucinous/chemistry
- Cystadenocarcinoma, Mucinous/pathology
- Cystadenocarcinoma, Mucinous/therapy
- Cystadenocarcinoma, Papillary/chemistry
- Cystadenocarcinoma, Papillary/pathology
- Cystadenocarcinoma, Papillary/therapy
- Cystadenocarcinoma, Serous/chemistry
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/therapy
- Humans
- Immunohistochemistry
- Pancreas, Exocrine/chemistry
- Pancreas, Exocrine/pathology
- Pancreatic Ducts/chemistry
- Pancreatic Ducts/pathology
- Pancreatic Neoplasms/chemistry
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/therapy
- Precancerous Conditions/chemistry
- Precancerous Conditions/pathology
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Affiliation(s)
- F Campbell
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, UK.
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29
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Alzaraa A, Udom V, Mousa H, Alzein A, Benhamida A, Dalal N. Combined endocrine and exocrine tumours of the pancreas. World J Surg Oncol 2007; 5:103. [PMID: 17868437 PMCID: PMC2034388 DOI: 10.1186/1477-7819-5-103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 09/14/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cystic neoplasms of the pancreas comprise 10%-15% of pancreatic cystic lesions, with the serous cystadenoms being the commonest. The association of exocrine and endocrine tumours of the pancreas unrelated to Von Hipple Lindau disease is very rare. Very few cases have been reported in the literature. We present another case of both these tumours in one patient. CASE PRESENTATION A female patient was seen in the surgical clinic for a pain in the right groin. Clinical examination and investigations confirmed a diagnosis of combined endocrine and exocrine tumours of the pancreas. She underwent surgery and is under regular follow-up in the surgical clinic. CONCLUSION Biphasic differentiation of pancreatic stem cell during embryological development could happen and may result in combined endocrine and exocrine tumours of the pancreas. Imaging studies are excellent in diagnosing theses lesions. Surgery has a central role and could be curative.
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Affiliation(s)
- Ahmed Alzaraa
- Department of General Surgery, Tameside General Hospital, Manchester, UK
| | - Valeri Udom
- Department of Radiology, Tameside General Hospital, Manchester, UK
| | - Husam Mousa
- Department of General Surgery, Tameside General Hospital, Manchester, UK
| | - Abdulhalem Alzein
- Department of General Surgery, Tameside General Hospital, Manchester, UK
| | | | - Neha Dalal
- Department of Histopathology, Tameside General Hospital, Manchester, UK
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30
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Abstract
Pancreatic cystic lesions are detected more frequently as a result of increasing use of high-resolution cross-sectional imaging. The ability of imaging and cyst fluid analysis to predict the biologic behavior of the lesions has aroused much interest recently. A precise diagnosis is critical to help guide further management. The diagnostic criteria and the management principles have evolved dramatically over the past 10 years with the advent of endoscopic ultrasound and fine-needle aspiration. In this review, we summarize the recent publications that have examined the key issues in the diagnosis and management of cystic lesions of the pancreas.
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Affiliation(s)
- Bhavani Moparty
- Massachusetts General Hospital, Blake 452 C, 55 Fruit Street, Boston, MA 02144, USA
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31
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Abstract
Although cystic tumors of the pancreas are relatively rare, they constitute an increasingly important category. Advances in imaging and interventional techniques and the sharp drop in the mortality rate of pancreatic surgery have rendered pancreatic biopsies and resections commonplace specimens. Consequently, in the past two decades, the nature of many cystic tumors in this organ has been better characterized. The names of some existing entities were revised; for example, what was known as papillary-cystic tumor is now regarded as solid-pseudopapillary tumor. New entities, in particular, intraductal papillary mucinous neoplasm and its variants, such as oncocytic and intestinal subtypes were recognized. The importance of clinical and pathologic correlation in the evaluation of these lesions was appreciated, in particular, with regards to the multifocality of these lesions, their association with invasive carcinomas, and thus their 'preinvasive' nature. Consensus criteria for the distinction of these from the ordinary precursors of adenocarcinoma, the pancreatic intraepithelial neoplasia, were established. The definition of mucinous cystic neoplasms was refined; ovarian-like stroma has now become almost a requirement for the diagnosis of mucinous cystic neoplasia, and defined as such, the propensity of these tumors to occur in perimenopausal women became even more striking. The validity and clinical value of classifying the pancreatic cysts of mucinous type as adenoma, borderline, CIS and invasive have been established. Related to this, the importance of thorough sampling in accurate classification of these mucinous lesions was recognized. Greater accessibility of the pancreas afforded by improved invasive as well as noninvasive modalities has also increased the detection of otherwise clinically silent cystic tumors, which has led to the recognition of more innocuous entities such as acinar cell cystadenoma and squamoid cyst of pancreatic ducts. As the significance of the cystic lesions emerged, cystic forms of otherwise typically solid tumors were also better characterized. Thus, significant developments have taken place in the classification and our understanding of pancreatic cystic tumors in the past few years, and experience with these lesions is likely to grow exponentially in the coming years.
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Affiliation(s)
- N Volkan Adsay
- Department of Pathology, Harper Hospital and Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
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32
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Abstract
Recently, there has been an increased recognition of neoplasms of the pancreas other than ductal adenocarcinoma. Although not as well studied or characterized as pancreatic adenocarcinoma there are many distinct lesions which exhibit diverse biological behaviors and varying degrees of malignancy. These lesions include: endocrine neoplasms, cystic tumors, solid pseudopapillary tumors, acinar cell carcinoma, squamous cell carcinoma, primary lymphoma of the pancreas, and metastatic lesions to the pancreas. These less common neoplasms are being diagnosed more frequently as the number and sensitivity of diagnostic imaging studies increase. This review article discusses the clinical course, diagnosis, and treatment of these less common, but quite relevant, neoplasms of the pancreas.
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MESH Headings
- Adenocarcinoma, Mucinous/diagnosis
- Adenocarcinoma, Mucinous/therapy
- Carcinoma, Acinar Cell/diagnosis
- Carcinoma, Acinar Cell/therapy
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/therapy
- Carcinoma, Squamous Cell/diagnosis
- Carcinoma, Squamous Cell/therapy
- Cystadenoma, Mucinous/diagnosis
- Cystadenoma, Mucinous/therapy
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/therapy
- Endocrine Gland Neoplasms/diagnosis
- Endocrine Gland Neoplasms/therapy
- Humans
- Lymphoma/diagnosis
- Lymphoma/therapy
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/therapy
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Affiliation(s)
- Abby-L Mulkeen
- Department of Surgery, Yale University School of Medicine, 330 Cedar Street, LH 118, PO Box 208062, New Haven, CT 06520-8062, USA
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