scholarly journals Epidemiology, Diagnosis, and Management of Cystic Lesions of the Pancreas

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Koen de Jong ◽  
Marco J. Bruno ◽  
Paul Fockens
Keyword(s):  
Imaging Techniques ◽  
Diagnostic Algorithm ◽  
Diagnostic Methods ◽  
Pancreatic Cysts ◽  
Cystic Lesions ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Cross Sectional ◽  
Serous Cystadenomas ◽  
Mucinous Neoplasms ◽  
Radiologic Imaging

Although little is known on the true prevalence of pancreatic cysts, physicians are currently more frequently confronted with pancreatic cysts because of the increasing use of sophisticated cross-sectional abdominal imaging. Cystic lesions of the pancreas comprise of a heterogeneous group of diagnostic entities, some of which are benign such as inflammatory pseudocysts or serous cystadenomas and do not require resection when asymptomatic. Others like mucinous cysts or intraductal papillary mucinous neoplasms (IPMN) have a malignant potential and in these cases surgical resection is often indicated. For this reason an adequate distinction between the various cysts is crucial to optimize management strategy. Different diagnostic methods that could be of value in the differentiation include radiologic imaging techniques such as CT, MR, and endosonography. In addition, fluid aspiration for cytopathology, tumormarkers or molecular analysis is widely used. Different guidelines are available but so far no optimal diagnostic algorithm exists. We summarize the epidemiology, classification, clinical presentation, diagnostics, management, and future perspectives.

scholarly journals Management Guidelines for Pancreatic Cystic Lesions: Should we Adopt or Adapt the Current Roadmaps?

2019 ◽  
Vol 28 (4) ◽  
pp. 495-501 ◽  
Author(s):  
Filipe Vilas-Boas ◽  
Guilherme Macedo
Keyword(s):  
Needle Aspiration ◽  
Pancreatic Cysts ◽  
Cystic Lesions ◽  
International Consensus ◽  
Cross Sectional ◽  
Fluid Analysis ◽  
Mucinous Neoplasms ◽  
Cross Sectional Imaging ◽  
History Of ◽  
International Consensus Guidelines

Pancreatic cystic lesions are very prevalent, especially in elderly patients and are increasingly being diagnosed because of the massive use of cross sectional imaging. Our knowledge about the natural history of these lesions is limited, especially in the case of intraductal papillary mucinous neoplasms. This fact explains why scientific societies guidelines statements are based on evidence graded as very low quality and helps the understanding of some of the different guidelines recommendations. Several guidelines have been recently revised to incorporate the new evidence published in the literature with the aim to help clinicians make the best decisions. American Gastroenterological Association guidelines, a revision of the International Consensus Guidelines, the American College of Gastroenterology and the European Study Group guidelines are the most recent. Herein we review the current guidelines on pancreatic cysts and focus our discussion on controversies and updates about the best imaging modalities, the indications for endoscopic ultrasound guided fine needle aspiration, cyst fluid analysis, indications for resection and surveillance strategies.

scholarly journals Establishing a Living Biobank of Patient-Derived Organoids of Intraductal Papillary Mucinous Neoplasms of the Pancreas

2020 ◽  
Author(s):  
Francisca Beato ◽  
Dayana Reverón ◽  
Kaleena B. Dezsi ◽  
Antonio Ortiz ◽  
Joseph O. Johnson ◽  
...  
Keyword(s):  
Early Detection ◽  
Unmet Need ◽  
The United States ◽  
Cancer Center ◽  
Pancreatic Cysts ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Cross Sectional ◽  
Clinical Model ◽  
Mucinous Neoplasms

AbstractPancreatic cancer (PaCa) is the third leading cause of cancer-related deaths in the United States. There is an unmet need to develop strategies to detect PaCa at an early, operable stage and prevent its progression. Intraductal papillary mucinous neoplasms (IPMNs) are cystic PaCa precursors that comprise nearly 50% of pancreatic cysts detected incidentally via cross-sectional imaging. Since IPMNs can progress from low- and moderate-grade dysplasia to high-grade dysplasia and invasion, the study of these lesions offers a prime opportunity to develop early detection and prevention strategies. Organoids are an ideal preclinical platform to study IPMNs, and the objective of the current investigation was to establish a living biobank of patient-derived organoids (PDO) from IPMNs. IPMN tumors and adjacent normal pancreatic tissues were successfully harvested from 15 patients with IPMNs undergoing pancreatic surgical resection at Moffitt Cancer Center & Research Institute (Tampa, FL) between May of 2017 and March of 2019. Organoid cultures were also generated from cryopreserved tissues. Organoid count and size were determined over time by both Image-Pro Premier 3D Version 9.1 digital platform and Matlab application of a Circular Hough Transform algorithm, and histologic and genomic characterization of a subset of the organoids was performed using immunohistochemistry and targeted sequencing, respectively. The success rates for organoid generation from IPMN tumor and adjacent normal pancreatic tissues were 81% and 87%, respectively. IPMN organoids derived from different epithelial subtypes showed different morphologies in vitro, and organoids recapitulated histologic and genomic characteristics of the parental IPMN tumor. In summary, this pre-clinical model has the potential to provide new opportunities to unveil mechanisms of IPMN progression to invasion and to shed insight into novel biomarkers for early detection and targets for chemoprevention.

scholarly journals A novel approach for selecting combination clinical markers of pathology applied to a large retrospective cohort of surgically resected pancreatic cysts

2016 ◽  
Vol 24 (1) ◽  
pp. 145-152 ◽  
Author(s):  
David L Masica ◽  
Marco Dal Molin ◽  
Christopher L Wolfgang ◽  
Tyler Tomita ◽  
Mohammad R Ostovaneh ◽  
...  
Keyword(s):  
Pancreatic Cyst ◽  
Pancreatic Cysts ◽  
Clinical Markers ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Cystic Neoplasms ◽  
Mucinous Cystic Neoplasms ◽  
Serous Cystadenomas ◽  
Mucinous Neoplasms ◽  
Independent Cohort ◽  
Solid Pseudopapillary Neoplasms

Objective: Our objective was to develop an approach for selecting combinatorial markers of pathology from diverse clinical data types. We demonstrate this approach on the problem of pancreatic cyst classification. Materials and Methods: We analyzed 1026 patients with surgically resected pancreatic cysts, comprising 584 intraductal papillary mucinous neoplasms, 332 serous cystadenomas, 78 mucinous cystic neoplasms, and 42 solid-pseudopapillary neoplasms. To derive optimal markers for cyst classification from the preoperative clinical and radiological data, we developed a statistical approach for combining any number of categorical, dichotomous, or continuous-valued clinical parameters into individual predictors of pathology. The approach is unbiased and statistically rigorous. Millions of feature combinations were tested using 10-fold cross-validation, and the most informative features were validated in an independent cohort of 130 patients with surgically resected pancreatic cysts. Results: We identified combinatorial clinical markers that classified serous cystadenomas with 95% sensitivity and 83% specificity; solid-pseudopapillary neoplasms with 89% sensitivity and 86% specificity; mucinous cystic neoplasms with 91% sensitivity and 83% specificity; and intraductal papillary mucinous neoplasms with 94% sensitivity and 90% specificity. No individual features were as accurate as the combination markers. We further validated these combinatorial markers on an independent cohort of 130 pancreatic cysts, and achieved high and well-balanced accuracies. Overall sensitivity and specificity for identifying patients requiring surgical resection was 84% and 81%, respectively. Conclusions: Our approach identified combinatorial markers for pancreatic cyst classification that had improved performance relative to the individual features they comprise. In principle, this approach can be applied to any clinical dataset comprising dichotomous, categorical, and continuous-valued parameters.

scholarly journals Pancreaticogastric fistula secondary to intraductal papillary mucinous neoplasia: a case report and review of the literature

2011 ◽  
Vol 93 (5) ◽  
pp. e32-e34 ◽  
Author(s):  
TC Hall ◽  
G Garcea ◽  
A Rajesh ◽  
AR Dennison
Keyword(s):  
Case Report ◽  
Complete Resolution ◽  
Fistula Formation ◽  
Cystic Lesions ◽  
Main Duct ◽  
Review Of The Literature ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Mucinous Neoplasms

Intraductal papillary mucinous neoplasms (IPMNs) are benign cystic lesions of the pancreas with recognised premalignant potential. An occasional feature of IPMNs is fistula formation to surrounding organs. This report describes a case of a pancreaticogastric fistula from a main duct IPMN that produced the complete resolution of the patient’s symptoms.

scholarly journals Non-Tumor Cystic Lesions of the Adrenal Gland

PRILOZI ◽  
2015 ◽  
Vol 36 (3) ◽  
pp. 51-59 ◽  
Author(s):  
Vesna Janevska ◽  
Vlado Janevski ◽  
Oliver Stankov ◽  
Liljana Spasevska ◽  
Slavica Kostadinova-Kunovska ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Cystic Lesions ◽  
Pathological Features ◽  
Radiological Findings ◽  
Tissue Sections ◽  
Male Ratio ◽  
Radiologic Imaging ◽  
Vascular Origin ◽  
The Mean ◽  
Material Standard

Abstract Adrenal cystic lesions are uncommon but due to the improved radiologic imaging techniques their appearance seems to increase. Material and Methods: We analyzed the clinical and radiological findings of 10 patients with adrenal cysts and the pathological features of the operative material. Standard dissection procedure and paraffin embedded tissue sections were made, stained by HE and immunohistochemically with CD34, CD 31, Factor 8, Podoplanin, CKWS and AE1/AE3 Results: The mean age of the patients was 40.6 years; female to male ratio was 2.3:1. All the cysts were diagnosed as cystic lesions radiologically except one. The most present clinical symptom was abdominal pain. The diameter of the cysts measured from 2 to 7 cm. Four of the cysts were diagnosed as pseudocysts and six as endothelial. Six cysts were lined by CD34+ and CD31+ cells, four were lined by Factor 8+ and podoplanin+ cells and four had no lining. Conclusion: Endothelial cysts were more common cysts in our study and the immunohistochemical results suggested common vascular origin to all endothelial cysts and supported additional separation of angiomatous and lymphangiomathous adrenal vascular cysts.

scholarly journals A mixed-type intraductal papillary mucinous neoplasm of the pancreas with a histologic combination of gastric and pancreatobiliary subtypes in a 70-year-old woman: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Sawsan Ismail ◽  
Rama Darwisho ◽  
Mohammed Ali ◽  
Maen Haidar ◽  
Mohammad Adib Houreih ◽  
...  
Keyword(s):  
Histological Examination ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
Mixed Type ◽  
Epigastric Pain ◽  
The Body ◽  
Diagnostic Methods ◽  
Pancreatic Ducts ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Mucinous Neoplasm ◽  
Mucinous Neoplasms

Abstract Background Intraductal papillary mucinous neoplasms are rare papillary pancreatic neoplasms arising from major pancreatic ducts, characterized by duct dilation and mucin secretion. They comprise approximately 1% of all exocrine neoplasms and are classified according to their anatomical sites into main duct-type, branch duct-type, and mixed-type intraductal papillary mucinous neoplasms. Histological examination plays a crucial role in distinguishing and classifying intraductal papillary mucinous neoplasms into gastric, intestinal, pancreatobiliary, and oncocytic subtypes. Case presentation We present the case of a 70-year-old Syrian woman who was admitted to our hospital due to an intermittent epigastric pain accompanied by diarrhea and weight loss with a recent diagnosis of diabetes mellitus. Following clinical, laboratory, and radiological examination, distal pancreatectomy involving the body and the tail of the pancreas was performed. Interestingly, histological examination of the resected specimens revealed the diagnosis of a mixed-type intraductal papillary mucinous neoplasm with a unique combination of gastric and pancreatobiliary subtypes. Conclusion To the best of our knowledge, the combination of multiple histological subtypes of intraductal papillary mucinous neoplasms has been recorded in a few studies with reference to the challenging histological detection. Herein, we report a rare case with a significant histological combination, highlighting the difficulties in differential diagnosis due to the absence of ancillary techniques, with a brief review on diagnostic methods, histological characteristics and surgical recommendations.

scholarly journals The Utilization of Imaging Features in the Management of Intraductal Papillary Mucinous Neoplasms

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Stefano Palmucci ◽  
Claudia Trombatore ◽  
Pietro Valerio Foti ◽  
Letizia Antonella Mauro ◽  
Pietro Milone ◽  
...  
Keyword(s):  
Pancreatic Cysts ◽  
Low Grade ◽  
Imaging Features ◽  
Main Duct ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Radiological Features ◽  
Increased Risk ◽  
Mucinous Neoplasms

Intraductal papillary mucinous neoplasms (IPMNs) represent a group of cystic pancreatic neoplasms with large range of clinical behaviours, ranging from low-grade dysplasia or borderline lesions to invasive carcinomas. They can be grouped into lesions originating from the main pancreatic duct, main duct IPMNs (MD-IPMNs), and lesions which arise from secondary branches of parenchyma, denominated branch-duct IPMNs (BD-IPMNs). Management of these cystic lesions is essentially based on clinical and radiological features. The latter have been very well described in the last fifteen years, with many studies published in literature showing the main radiological features of IPMNs. Currently, the goal of imaging modalities is to identify “high-risk stigmata” or “worrisome feature” in the evaluation of pancreatic cysts. Marked dilatation of the main duct (>1 cm), large size (3–5 cm), and intramural nodules have been associated with increased risk of degeneration. BD-IPMNs could be observed as microcystic or macrocystic in appearance, with or without communication with main duct. Their imaging features are frequently overlapped with cystic neoplasms. The risk of progression for secondary IPMNs is lower, and subsequently an imaging based follow-up is very often proposed for these lesions.

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