scholarly journals EUS Morphology Is Reliable in Selecting Patients with Mucinous Pancreatic Cyst(s) Most Likely to Benefit from Surgical Resection

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Siddharth Javia ◽  
Satish Munigala ◽  
Sushovan Guha ◽  
Banke Agarwal
Keyword(s):  
Surgical Resection ◽  
Pancreatic Cyst ◽  
Mucinous Cystic Neoplasm ◽  
Needle Aspiration ◽  
Surgical Pathology ◽  
Mesenteric Cyst ◽  
Cystic Neoplasm ◽  
Pancreatic Cysts ◽  
Wall Thickening ◽  
Cyst Size

Background and Study Aims. Endoscopic ultrasound (EUS) surveillance of patients with mucinous pancreatic cysts relies on the assessment of morphologic features suggestive of malignant transformation. These criteria were derived from the evaluation of surgical pathology in patients with pancreatic cysts who underwent surgery. Reliability of these criteria when evaluated by EUS in identifying lesions which require surgery has still not been established. Patients and Methods. This retrospective cohort study included seventy-eight patients who underwent surgical resection of pancreatic cysts based on EUS-FNA (fine-needle aspiration) findings suggestive of mucinous pancreatic cysts with concern for malignancy. Results. Final surgical pathology diagnoses of patients were the following: adenocarcinoma (19), intraductal papillary mucinous neoplasm (IPMN) (39), mucinous cystic neoplasm (MCN) (13), serous cystadenoma (2), pseudocyst (3), mucinous solid-cystic lesion of indeterminate type (1), and mesenteric cyst (1). Cysts with focal wall thickening ≥ 3 mm (p=0.0008), dilation of pancreatic duct (PD) (p=0.0067), and cyst size ≥ 3 cm (p=0.016) had significantly higher risk of adenocarcinoma. None of the patients without any of these morphologic features had cancer. Conclusions. In patients with mucinous pancreatic cyst(s), focal wall thickening, cyst size ≥ 3 cm, and PD dilation as assessed by EUS can help identify advanced mucinous cysts which require surgery and should routinely be evaluated during EUS surveillance.

scholarly journals Cytologic Assessment of Cystic/Intraductal Lesions of the Pancreatobiliary Tract

2021 ◽  
Author(s):  
Michelle D. Reid
Keyword(s):  
Fine Needle Aspiration ◽  
Intraductal Papillary Mucinous Neoplasm ◽  
Imaging Techniques ◽  
Mucinous Cystic Neoplasm ◽  
Needle Aspiration ◽  
Cyst Fluid ◽  
Cystic Neoplasm ◽  
Pancreatic Cysts ◽  
Fine Needle ◽  
Mucinous Neoplasm

Context.— Because of new and improved imaging techniques, cystic/intraductal pancreatobiliary tract lesions are increasingly being discovered, and brushings or endoscopic ultrasound/computed tomography/magnetic resonance imaging–guided fine-needle aspiration biopsies from these lesions have become an integral part of pathologists' daily practice. Because patient management has become increasingly conservative, accurate preoperative diagnosis is critical. Cytologic distinction of low-risk (pseudocysts, serous cystadenoma, lymphoepithelial cysts, and squamoid cysts of the pancreatic duct) from high-risk pancreatic cysts (intraductal papillary mucinous neoplasm and mucinous cystic neoplasm) requires incorporation of clinical, radiologic, and cytologic findings, in conjunction with chemical and molecular analysis of cyst fluid. Cytopathologists must ensure appropriate specimen triage, along with cytologic interpretation, cyst classification, and even grading of some (mucinous) cysts. Epithelial atypia in mucinous cysts (intraductal papillary mucinous neoplasm and mucinous cystic neoplasm) has transitioned from a 3-tiered to a 2-tiered classification system, and intraductal oncocytic papillary neoplasms and intraductal tubulopapillary neoplasms have been separately reclassified because of their distinctive clinicopathologic characteristics. Because these lesions may be sampled on brushing or fine-needle aspiration biopsy, knowledge of their cytomorphology is critical. Objective.— To use an integrated, multidisciplinary approach for the evaluation of cystic/intraductal pancreatobiliary tract lesions (incorporating clinical, radiologic, and cytologic findings with [chemical/molecular] cyst fluid analysis and ancillary stains) for definitive diagnosis and classification. Data Sources.— Review of current literature on the cytopathology of cystic/intraductal pancreatobiliary tract lesions. Conclusions.— Our knowledge/understanding of recent updates in cystic/intraductal pancreatobiliary lesions can ensure that cytopathologists appropriately triage specimens, judiciously use and interpret ancillary studies, and incorporate the studies into reporting.

Mucinous cystic neoplasm of the pancreas: Is surgical resection recommended for all surgically fit patients?

Pancreatology ◽  
2014 ◽  
Vol 14 (2) ◽  
pp. 131-136 ◽  
Author(s):  
Jae Woo Park ◽  
Jin-Young Jang ◽  
Mee Joo Kang ◽  
Wooil Kwon ◽  
Ye Rim Chang ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Mucinous Cystic Neoplasm ◽  
Cystic Neoplasm

Management of Cystic Neoplasms of the Pancreas

2018 ◽  
Author(s):  
Victoria R Rendell ◽  
Walker A Julliard ◽  
Adam M Awe ◽  
Daniel E Abbott ◽  
Emily R Winslow ◽  
...  
Keyword(s):  
Pancreatic Cyst ◽  
Cystic Neoplasm ◽  
Pancreatic Cysts ◽  
Multidisciplinary Teams ◽  
Pancreatic Cystic Neoplasm ◽  
Cross Sectional ◽  
Management Guidelines ◽  
Imaging Characteristics ◽  
Cross Sectional Imaging ◽  
Sectional Imaging

The diagnosis of pancreatic cystic lesions is increasingly common. The majority of pancreatic cysts are now diagnosed incidentally on cross-sectional imaging. Lack of clear evidence-based guidelines and overall poor understanding of the natural history of pancreatic cysts contribute to complexity of managing patients with pancreatic cysts. Pancreatic cystic neoplasm types differ in their presentation, histologic features, imaging characteristics, and predisposition to develop invasive malignancy. The diagnostic strategies to determine cyst type and presence of malignancy—cross-sectional imaging, endoscopic ultrasonography, and analyses of pancreatic cyst fluid aspirates—have improved over time. However, accurate characterization of cysts remains challenging. Several large groups, including the American College of Radiology, the American Gastroenterological Association, the European Study Group on Cystic Tumours of the Pancreas, and the International Association of Pancreatology, have released cyst management guidelines or recommendations that have important differences. In this review, we provide an overview of the most common pancreatic cystic neoplasm, evaluate recent advancements in diagnostic techniques, and compare current management guidelines. This review contains 7 figures, 5 tables, and 77 references. Key Words: intraductal papillary mucinous neoplasm, management guidelines, multidisciplinary teams, mucinous cystic neoplasm, pancreatic cyst, pancreatic cystic neoplasm, serous cystadenoma, solid pseudopapillary neoplasm, surgical oncology 

scholarly journals Diagnosis and Management of Cystic Lesions of the Pancreas

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Niraj Jani ◽  
Murad Bani Hani ◽  
Richard D. Schulick ◽  
Ralph H. Hruban ◽  
Steven C. Cunningham
Keyword(s):  
Pancreatic Pseudocyst ◽  
Mucinous Cystic Neoplasm ◽  
Cystic Neoplasm ◽  
Pancreatic Cysts ◽  
Ethanol Ablation ◽  
Fluid Analysis ◽  
Serous Cystic Neoplasm ◽  
Papillary Neoplasm ◽  
Associated Mass

Pancreatic cysts are challenging lesions to diagnose and to treat. Determining which of the five most common diagnoses—pancreatic pseudocyst, serous cystic neoplasm (SCN), solid pseudopapillary neoplasm (SPN), mucinous cystic neoplasm (MCN), and intraductal mucinous papillary neoplasm (IPMN)—is likely the correct one requires the careful integration of many historical, radiographic, laboratory, and other factors, and management is markedly different depending on the type of cystic lesion of the pancreas. Pseudocysts are generally distinguishable based on historical, clinical and radiographic characteristics, and among the others, the most important differentiation is between the mucin-producing MCN and IPMN (high risk for cancer) versus the serous SCN and SPN (low risk for cancer). EUS with FNA and cyst-fluid analysis will continue to play an important role in diagnosis. Among mucinous lesions, those that require treatment (resection currently) are any MCN, any MD IPMN, and BD IPMN larger than 3 cm, symptomatic, or with an associated mass, with the understanding that SCN or pseudocysts may be removed inadvertently due to diagnostic inaccuracy, and that a certain proportion of SPN will indeed be malignant at the time of removal. The role of ethanol ablation is under investigation as an alternative to resection in selected patients.

scholarly journals Ciliated Foregut Cyst of the Pancreas Presenting as a Mucinous Cystic Neoplasm

2018 ◽  
Vol 09 (03) ◽  
pp. 125-127
Author(s):  
Nadia Huq ◽  
Wesley Papenfuss ◽  
Nalini M. Guda
Keyword(s):  
Mucinous Cystic Neoplasm ◽  
Needle Aspiration ◽  
Cystic Neoplasm ◽  
Limited Data ◽  
Diagnostic Dilemma ◽  
Posterior Aspect ◽  
Laparoscopic Excision ◽  
Elevated Tumor Marker ◽  
Foregut Cyst ◽  
Current Report

A 53‑year‑old underwent an abdominal computed tomography for hematuria that incidentally discovered a cystic lesion of the pancreas. Endoscopic ultrasound revealed a structure with debris and septations; fine‑needle aspiration with negative cytology but elevated tumor marker suggested a mucinous cystic neoplasm or an intraductal papillary mucinous neoplasm. Laparoscopic excision confirmed a walled‑off cyst detachable from the posterior aspect of the pancreas consistent with a ciliated foregut cyst. There are limited data on ciliated foregut cysts of the pancreas, and the current report highlights the diagnostic dilemma and a review of the current literature.

scholarly journals Evaluation of the 2015 AGA guidelines on pancreatic cystic neoplasms in a large surgically confirmed multicenter cohort

2017 ◽  
Vol 05 (03) ◽  
pp. E201-E208 ◽  
Author(s):  
Phillip Ge ◽  
V. Muthusamy ◽  
Srinivas Gaddam ◽  
Diana-Marie Jaiyeola ◽  
Stephen Kim ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Predictive Value ◽  
Needle Aspiration ◽  
Surgical Pathology ◽  
Cystic Neoplasms ◽  
Digestive Diseases ◽  
Diagnostic Characteristics ◽  
Diagnosis Of Cancer ◽  
Pancreatic Cystic Neoplasms ◽  
Retrospective Multicenter Study

Absract Background and study aims The American Gastroenterological Association (AGA) recently published guidelines for the management of asymptomatic pancreatic cystic neoplasms (PCNs). We aimed to evaluate the diagnostic characteristics of the AGA guidelines in appropriately recommending surgery for malignant PCNs. Patients and methods A retrospective multicenter study was performed of patients who underwent endoscopic ultrasound (EUS) for evaluation of PCNs who ultimately underwent surgical resection from 2004 – 2014. Demographics, EUS characteristics, fine-needle aspiration (FNA) results, type of resection, and final pathologic diagnosis were recorded. Patients were categorized into 2 groups (surgery or surveillance) based on what the AGA guidelines would have recommended. Performance characteristics for the diagnosis of cancer or high-grade dysplasia (HGD) on surgical pathology were calculated. Results Three hundred patients underwent surgical resection for PCNs, of whom the AGA guidelines would have recommended surgery in 121 (40.3 %) and surveillance in 179 (59.7 %) patients. Among patients recommended for surgery, 45 (37.2 %) had cancer, whereas 76 (62.8 %) had no cancer/HGD. Among patients recommended for surveillance, 170 (95.0 %) had no cancer/HGD; however, 9 (5.0 %) patients had cancer that would have been missed. For the finding of cancer/HGD on surgical pathology, the AGA guidelines had 83.3 % sensitivity (95 % CI 70.7 – 92.1), 69.1 % specificity (95 % CI 62.9 – 74.8), 37.2 % positive predictive value (95 % CI 28.6 – 46.4), 95.0 % negative predictive value (95 % CI 90.7 – 97.7), and 71.7 % accuracy (95 % CI 67.4 – 74.6). Conclusions The 2015 AGA guidelines would have resulted in 60 % fewer patients being referred for surgical resection, and accurately recommended surveillance in 95 % of patients with asymptomatic PCNs. Future prospective studies are required to validate these guidelines.Meeting presentations: Presented in part at Digestive Diseases Week 2016

scholarly journals Surgical resection of mucinous cystic neoplasm which showed increase and decrease in size over 30-months follow-up: A case report

Suizo ◽  
2019 ◽  
Vol 34 (5) ◽  
pp. 262-269
Author(s):  
Makoto TAKAHASHI ◽  
Takashi HATORI ◽  
Tomohisa KADOMURA ◽  
Atsushi KATO ◽  
Yoshifumi IKEDA ◽  
...  
Keyword(s):  
Case Report ◽  
Surgical Resection ◽  
Mucinous Cystic Neoplasm ◽  
Cystic Neoplasm

scholarly journals Endoscopic ultrasound for differential diagnosis of malignant pancreatic cystic lesions: case report and review of literature

Oncoreview ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 103-107
Author(s):  
Jacek Janiszewski ◽  
Joanna Woźniak ◽  
Iwona Kot-Gromuł ◽  
Maciej Michalak ◽  
Zygmunt Kozielec ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Cystic Lesion ◽  
Histopathological Examination ◽  
Final Diagnosis ◽  
Mucinous Cystic Neoplasm ◽  
Needle Aspiration ◽  
Cystic Neoplasm ◽  
Review Of Literature ◽  
Potentially Malignant ◽  
Tomography Scan

A 63-year-old female patient was admitted to the hospital for an in-depth diagnosis of accidentally found pancreatic cystic lesion. The lesion was detected by computed tomography scan and magnetic resonance imaging of the abdomen and identified as potentially malignant mucinous cystic neoplasm (MCN). Endoscopic ultrasound-guided fine-needle aspiration biopsy with the analysis of the fluid from the cyst was performed as well and it confirmed the malignancy of the cystic lesion. The patient was qualified for surgery and the final diagnosis based on histopathological examination of the surgical material confirmed MCN with the accompanying invasive pancreatic adenocarcinoma.

scholarly journals The Pathological Features and Prognoses of Intraductal Papillary Mucinous Neoplasm and Mucinous Cystic Neoplasm After Surgical Resection: A Single Institution Series

2020 ◽  
Author(s):  
Yuqiong Li ◽  
Zhongfei Zhu ◽  
Lisi Peng ◽  
Zhendong Jin ◽  
Liqi Sun ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Mucinous Cystic Neoplasm ◽  
Cystic Neoplasm ◽  
Study Cohort ◽  
Single Institution ◽  
Cystic Neoplasms ◽  
Mucinous Neoplasms ◽  
Transformation Potential ◽  
Independent Risk Factors

Abstract Background: Intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) represent the tumors with malignant transformation potential. The objective of the study was to verify their pathological characteristics, prognoses, and recurrence factors. Methods: 218 IPMNs and 27 MCNs resected at a single institution were included. The demographic, preoperative, histopathological and follow-up data of the patients were recorded and analyzed. Results: Of the 218 IPMN and 27 MCN patients, 93 (42.7%) and 8 (29.6 %) cases were malignant, respectively. IPMNs occurred in older patients compared with MCN patients (median 63 years vs 54 years, P<0.0001) and MCNs occurred exclusively in females (100%). Of the overall study cohort, the pathological specimens presented peripheral invasion in 37 (15.1%) patients and incisal margin invasion was observed in 46 (18.8%) patients. After a median follow-up of 34 months, 37(14.9%) patients relapsed. The 1, 3, 5 -year overall survival rate (OS) and diseases-free survival (DFS) rate for IPMNs were 98.75%, 98.75%, 97.5%, and 85.7%, 81.1%, 80.6%; and for MCNs the rates were 95.7%, 95.7%, 95.7%, and 91.3%%, 87.0%, 87.0%, respectively. There were four independent risk factors associated with recurrence: pathological diagnoses with malignancy (Odds rate, OR=3.65), presence of oncocytic type for IPMN (OR=1.69), peripheral invasion (OR=12.87) and incisal margin invasion (OR=1.99). Conclusions: IPMNs and MCNs are indolent tumors with favorable prognoses after surgical resection in terms of their relatively high OS and DFS rate. Patients with malignant pathological-related diagnoses should accept strict tumor surveillance in view of their higher risk of recurrence.

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