scholarly journals Fifteen-Year Follow-Up of a Patient with Acinar Cystic Transformation of the Pancreas and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Xiaoyun Wen ◽  
Jela Bandovic
Keyword(s):  
Abdominal Pain ◽  
Cystic Lesion ◽  
Pancreatic Head ◽  
Single Layer ◽  
Exploratory Laparotomy ◽  
Final Diagnosis ◽  
Cystic Neoplasm ◽  
Histologic Diagnosis ◽  
Ultrasound Surveillance

Acinar cystic transformation (ACT), also known as “acinar cell cystadenoma,” is a rare and newly recognized benign pancreatic cystic neoplasm. However, its true malignant potential remains unknown. Here, we report a case of ACT with 15-year follow-up. A 10-year-old female initially presented with abdominal pain and was found to have a cystic lesion in the region of pancreatic head on computed tomography scan. She underwent an exploratory laparotomy, and the intraoperative biopsy of the cyst wall showed a true pancreatic cyst without malignancy. Her symptoms subsequently resolved, and she was placed under close ultrasound surveillance. For the next fifteen years, the patient was asymptomatic without any complications and had a successful pregnancy. Surveillance showed the tumor grew in size from 4.2 cm to 6.2 cm in diameter. In the latest five months, she noted occasional abdominal pain. A pylorus-preserving pancreaticoduodenectomy was performed. The resected cystic lesion was multilocular and lined by a single layer of bland epithelium ranging from nondescript flat/cuboidal epithelium to apparent acinar cells which were strongly positive for trypsin, so the final diagnosis was confirmed to be ACT. The prior biopsy was retrospectively reviewed to reveal similar epithelial lining. To the best of our knowledge, this is the longest period of follow-up for ACT to date. Our findings suggest that ACT is a slow-growing neoplasm without malignant transformation after fifteen years. Therefore, we recommend biopsy for histologic diagnosis followed by close ultrasound surveillance without surgical intervention in asymptomatic or young ACT patients.

scholarly journals Jejuno-jejunal intussusception secondary to diffuse intestinal lipomatosis

2019 ◽  
Vol 2019 (11) ◽  
Author(s):  
Renee Angela Tabone ◽  
Tom DeGreve ◽  
Peita Webb ◽  
Peter Yuide
Keyword(s):  
Abdominal Pain ◽  
Gastrointestinal Endoscopy ◽  
Primary Anastomosis ◽  
Exploratory Laparotomy ◽  
Uneventful Recovery ◽  
Adult Intussusception ◽  
Structural Abnormality ◽  
Successful Approach ◽  
Rare Diagnosis

Abstract A 25-year-old man presented to the emergency department with severe abdominal pain and vomiting. He had previously presented 10 days prior with similar symptoms. Computed tomography imaging showed a large jejuno-jejunal intussusception. Multiple intestinal masses were identified intraoperatively with the rare diagnosis of intestinal lipomatosis later confirmed via histopathology. Diagnosis and management of rare surgical pathologies is always challenging. Intussusception should always be considered as a differential diagnosis for abdominal pain in adults, as adult intussusception is typically due to a structural abnormality with majority of cases requiring surgical intervention. Exploratory laparotomy with segmental resection and primary anastomosis proved to be a successful approach in our case, with the patient having an uneventful recovery. Follow-up has consisted of gastrointestinal endoscopy and colonoscopy, which have not demonstrated any further lipomas.

scholarly journals Antenatal Ovarian Torsion Presenting With Features of Intestinal Obstruction in a Neonate

2020 ◽  
Vol 40 (3) ◽  
pp. 265-269
Author(s):  
Jayateertha Joshi ◽  
Nutan Kamath ◽  
Jyoti Ramnath Kini ◽  
Jayashree K ◽  
Suchetha Rao ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Ovarian Cyst ◽  
Cystic Lesion ◽  
Exploratory Laparotomy ◽  
Ovarian Torsion ◽  
Cystic Lesions ◽  
Antenatal Ultrasonography ◽  
Histopathology Examination

With the advent of antenatal ultrasonography (USG), detection of neonatal intra-abdominal cystic lesions is on the rise. We present a neonate who was detected antenatally to have a cystic lesion per abdomen and presented with features of intestinal obstruction on first postnatal day. Emergency exploratory laparotomy revealed a left torsed ovarian cyst compressing the ileoceacal junction. Left oophorectomy was done and ovarian torsion was confirmed by histopathology examination. The USG abdomen at six months follow up showed a well visualised right ovary.

scholarly journals Cystic Lesions in Autoimmune Pancreatitis

2015 ◽  
Vol 9 (3) ◽  
pp. 366-374 ◽  
Author(s):  
Macarena Gompertz ◽  
Claudia Morales ◽  
Hernán Aldana ◽  
Jaime Castillo ◽  
Zoltán Berger
Keyword(s):  
Autoimmune Pancreatitis ◽  
Cystic Lesion ◽  
Pancreatic Head ◽  
Pancreatic Tissue ◽  
Steroid Treatment ◽  
Cystic Neoplasm ◽  
Blood Levels ◽  
Cystic Lesions ◽  
Lymphoplasmacytic Infiltration ◽  
One Year

Autoimmune pancreatitis (AIP) can be chronic or recurrent, but frequently completely reversible after steroid treatment. A cystic lesion in AIP is a rare finding, and it can mimic a pancreatic cystic neoplasm. Difficulties in an exact diagnosis interfere with treatment, and surgery cannot be avoided in some cases. We report the history of a 63-year-old male presenting with jaundice and pruritus. AIP was confirmed by imaging and elevated IgG4 blood levels, and the patient completely recovered after corticosteroid therapy. One year later, he presented with a recurrent episode of AIP with elevated IgG4 levels, accompanied by the appearance of multiple intrapancreatic cystic lesions. All but 1 of these cysts disappeared after steroid treatment, but the remaining cyst in the pancreatic head was even somewhat larger 1 year later. Pancreatoduodenectomy was finally performed. Histology showed the wall of the cystic lesion to be fibrotic; the surrounding pancreatic tissue presented fibrosis, atrophy and lymphoplasmacytic infiltration by IgG4-positive cells, without malignant elements. Our case illustrates the rare possibility that cystic lesions can be part of AIP. These pseudocysts appear in the pancreatic segments involved in the autoimmune disease and can be a consequence of the local inflammation or related to ductal strictures. Steroid treatment should be initiated, after which these cysts can completely disappear with recovery from AIP. Surgical intervention may be necessary in some exceptional cases.

scholarly journals Type 1 Autoimmune Pancreatitis with Imaging Appearance Similar to That of Malignant Cystic Tumor

2019 ◽  
Vol 13 (2) ◽  
pp. 265-270
Author(s):  
Takeshi Ezaki ◽  
Atsuhiro Masuda ◽  
Hideyuki Shiomi ◽  
Takashi Nakagawa ◽  
Keitaro Sofue ◽  
...  
Keyword(s):  
Plasma Cell ◽  
Autoimmune Pancreatitis ◽  
Cystic Lesion ◽  
Pancreatic Head ◽  
Mural Nodule ◽  
Cell Infiltration ◽  
Cystic Neoplasm ◽  
Plasma Cell Infiltration ◽  
Type 1 Autoimmune Pancreatitis

A 79-year-old man was admitted with asymptomatic elevation of liver enzymes and tumor markers. Abdominal contrast-enhanced computed tomography demonstrated swelling of the pancreatic head, and additional blood test showed raised IgG4 levels. Histological examination by endoscopic ultrasonography (EUS)-guided fine needle aspiration for pancreatic head mass revealed storiform fibrosis and IgG4-positive plasma cell infiltration. We diagnosed this case as type 1 autoimmune pancreatitis (AIP). In addition, there was a cystic lesion in the pancreatic body apart from the pancreatic head mass. A mural nodule in the multilocular cyst was detected by EUS, and there was positive uptake of fluorodeoxyglucose in positron emission tomography/magnetic resonance imaging. The preoperative diagnosis of this cystic lesion was intraductal papillary mucinous carcinoma, and distal pancreatomy was performed. Histopathological findings showed various sizes of retention cysts caused by IgG4-positive plasma cell infiltration around the pancreatic branch ducts. The mural nodule was a fibrotic mass with diffuse infiltration of IgG4-positive cells. This cystic lesion mimicking malignant cystic neoplasm occurred in relation to AIP. This case provided important information helping to understand the mechanism of formation of mural nodules in multilocular cysts in patients with type 1 AIP.

The Pylorus Preserving Whipple Procedure for the Treatment of Chronic Pancreatitis

Swiss Surgery ◽  
2000 ◽  
Vol 6 (5) ◽  
pp. 259-263 ◽  
Author(s):  
Traverso
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pancreatic Head ◽  
Symptomatic Patient ◽  
Whipple Procedure ◽  
Long Term Outcomes ◽  
Long Term Follow Up ◽  
New Procedures

A schema is developed that outlines criteria to consider more than medical therapy for patients with severe pancreatitis that develop disabling abdominal pain. If the symptomatic patient has severe chronic pancreatitis that reaches the Cambridge Class V "marked" stage of image severity then endotherapy is indicated. If endotherapy fails then surgery is indicated. Usually these patients will have pathological changes centered in the pancreatic head and PPW is performed. After an average follow-up of > 4 years PPW was observed to provide either good to excellent relief of disabling abdominal pain. These patients were highly selected by the guidance of the anatomic profile of the composite pancreas. Long-term follow-up has never been available with cancer patients after the Whipple procedure. These chronic pancreatitis patients after PPW showed few GI side effects. In addition we did not observe a predisposition for diabetes other than that from the continued parenchymal destruction from smoldering chronic pancreatitis in the pancreatic remnant. Surgeons should avoid total pancreatectomy in patients, even if the patient is already diabetic. Marginal ulceration is highly associated with the total resection. From this personal experience using anatomic criteria and close follow-up, it is hoped that the long term outcomes of pain relief in virtually all patients after PPW will represent a benchmark for results after procedures which employ less resection. Therapy should be based on reliable imaging criteria to select patients. Then the outcomes of new and promising procedures such as lithotripsy or limited head resections can be compared to the benchmarks derived after PPW. None of the new procedures, however address the main problem after PPW of remnant pancreatitis in the pancreatic body/tail. Even though this discomfort is no longer disabling after head resection remnant pancreatitis does occur in approximately one out of four patients.

scholarly journals Primary mesenchymal chondrosarcoma of the pancreas

2010 ◽  
Vol 92 (3) ◽  
pp. e10-e12 ◽  
Author(s):  
Xianmin Bu ◽  
Xianwei Dai
Keyword(s):  
Abdominal Pain ◽  
Exploratory Laparotomy ◽  
Mesenchymal Chondrosarcoma ◽  
Histopathological Diagnosis ◽  
Hepatoduodenal Ligament ◽  
Hepatic Vessels ◽  
History Of ◽  
Radiological Studies

Extraskeletal chondrosarcomas are rare and there is only one reported case of primary pancreatic chondrosarcoma. We report the case of a 34-year-old woman with a 6-month history of abdominal pain and distention. Radiological studies indicated a mass in the pancreas, and exploratory laparotomy revealed a tumour of the pancreas extending to the hepatic vessels and hepatoduodenal ligament. The mass was completely excised, and the histopathological diagnosis was primary mesenchymal pancreatic chondrosarcoma. Tumour recurred at follow-up 52 months postoperatively.

Puestow Procedure for the Management of Pediatric Chronic Pancreatitis

2017 ◽  
Vol 29 (02) ◽  
pp. 153-158 ◽  
Author(s):  
Erica Hodgman ◽  
Steve Megison ◽  
Joseph Murphy
Keyword(s):  
Abdominal Pain ◽  
Chronic Pancreatitis ◽  
Pancreatic Head ◽  
Childhood Development ◽  
Drug Induced ◽  
Lateral Pancreaticojejunostomy ◽  
Pancreatic Duct Stenting ◽  
Puestow Procedure ◽  
Pain Symptoms

Objective Recurrent pancreatitis significantly impacts childhood development and quality of life. Our goal was to evaluate the efficacy of the Puestow procedure. Materials and Methods After obtaining the Institutional Review Board approval, we reviewed the charts of all patients who underwent lateral pancreaticojejunostomy from January 1999 to January 2014. Statistical analysis was performed using paired Student's t-test and Fisher's exact test as appropriate. Results During the 15-year study period, 13 patients underwent a lateral pancreaticojejunostomy for chronic pancreatitis. The most common causes of pancreatitis were hereditary (n = 5) or obstructive (n = 5); pancreas divisum (n = 2), one iatrogenic stricture, one idiopathic stricture, and one unresectable pancreatic head mass); two patients had idiopathic disease, and one case was drug-induced. Six patients had failed management with endoscopic retrograde cholangiopancreatography and pancreatic duct stenting. Preoperatively, the median body mass index (BMI) percentile-for-age was 61.0% (range 11.0–99.0%). Median age at operation was 12.8 years (range 7.7–16.7). There were no deaths, four patients developed postoperative ileus, and one patient developed an intra-abdominal abscess, which resolved with antibiotics. Median postoperative length of stay was 7 days (range 5–15).Two patients were lost to follow-up; median follow-up for the remaining 12 patients was 35.5 months (range 4.9–131.2). Four patients were readmitted within 90 days: three due to abdominal pain which were not recurrences of pancreatitis, and one due to complications of chemotherapy. Postoperatively, there was no change in the average BMI percentile-for-age (p = 0.64). Seven patients reported resolution or significant improvement in their abdominal pain symptoms at the time of last follow-up. Patients with obstructive causes of pancreatitis were not more likely to experience relief than those with nonobstructive causes (42.9 vs. 80.0%, p = 0.29). Conclusion In our experience, lateral pancreaticojejunostomy results in durable improvement or resolution of abdominal pain symptoms in nearly 60% of patients with chronic pancreatitis regardless of etiology.

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 Massive Relief: Papillary Adenoma of the Lung in Asymptomatic Former Smoker Patient

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 906
Author(s):  
Jelena Stojšić ◽  
Marko Popović ◽  
Federica Pezzuto ◽  
Jelena Marković
Keyword(s):  
Wide Spectrum ◽  
Single Layer ◽  
Final Diagnosis ◽  
Malignant Potential ◽  
Diagnostic Process ◽  
Capsular Invasion ◽  
Diagnostic Challenge ◽  
Immunohistochemical Markers ◽  
Long Time

Benign epithelial tumors of the lung are uncommon and can represent a diagnostic challenge. Herein, we describe one such emblematic case. A 59-year-old former smoker male was admitted to the hospital complaining of cough for a long time. A radiological examination showed a centrally excavated mass strictly connected to the visceral pleura. The patient underwent tumorectomy. At gross examination, the tumor was composed of solid and cystic areas containing clear liquid. Histological examination highlighted a sub-pleural encapsulated tumor, with foci of capsular invasion, characterized by a single layer of columnar and cuboidal epithelial cells lining moderately cellular fibro-vascular cores. A wide spectrum of immunohistochemical markers was performed. The final diagnosis was suggestive of a peripheral pulmonary papillary tumor of undetermined malignant potential. At the last follow-up, six years after surgery, no recurrence or metastases were described. Reporting this case, we would like to point out the existence of these rare entities that should be taken into account in the diagnostic process, thus avoiding potential misdiagnosis. Moreover, the presence of capsular invasion should be better investigated in order to reconsider the exact terminology of the tumor and the classification of its malignant potential.

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