scholarly journals Surgical treatment of cystic neoplasms of the pancreas

2010 ◽  
Vol 47 (2) ◽  
pp. 135-140 ◽  
Author(s):  
Júlio Cezar Uili Coelho ◽  
Christian Lopez Valle ◽  
Bruno Moraes Ribas ◽  
Leonardo Dudeque Andriguetto ◽  
Christiano Marlo Paggi Claus
Keyword(s):  
Surgical Procedures ◽  
Tumor Recurrence ◽  
Demographic Data ◽  
Clinical Manifestations ◽  
Cystic Tumor ◽  
Cystic Neoplasms ◽  
Partial Pancreatectomy ◽  
Cystic Tumors ◽  
Intraductal Papillary Mucinous Tumors ◽  
Solid Pseudopapillary Tumors

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.

Pancreatic cysts or pancreatic cystic neoplasms? An analysis of 145 cases.

2018 ◽  
Vol 90 (4) ◽  
pp. 1-4
Author(s):  
Aleksandra Oleśna ◽  
Michał Wlaźlak ◽  
Janusz Strzelczyk ◽  
Marian Danilewicz
Keyword(s):  
Cystic Lesion ◽  
Demographic Data ◽  
Pancreatic Cysts ◽  
Histopathological Diagnosis ◽  
Cystic Neoplasms ◽  
Pancreatic Cystic Lesion ◽  
Cystic Tumors ◽  
Mucinous Neoplasms ◽  
Risk Of Malignancy ◽  
History Of

Introduction Frequency of detection of pancreatic cystic lesions increased recent years. The majorities are pseudocysts, the remaining cysts are mainly neoplasms. Proven risk of malignancy affects intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). Material and methods 145 patients operated on at the Department of General and Transplant Surgery in Barlicki Hospital in Lodz, Poland, in 2007-2016 due to pancreatic cystic lesion. The type of surgery, histopathological diagnosis and basic demographic data were analyzed. Results Nonneoplastic cyst (mainly pseudocysts) was found in 66.9% of patients, neoplasms were detected in 33.1%. The mean age was significantly higher in patients with neoplasms than without neoplasm (57.06 years vs. 50.88 years, p = 0.009). Neoplastic cyst occurred more frequently in women (68.75% of women, 31.25% of men, p = 0.001), Nonneoplastic cyst was found significantly more often in men (64.95% of men, 35.05% of women, p = 0.001). Malignant tumor was found in 14.58% of neoplasms cases. Pancreatic resections in neoplastic cysts were performed in 77,08%. In patients with nonneoplastic cysts drainage operations were performed most frequently (80.41%). Conclusions Neoplastic cysts are more common in women. The average age in the group of patients with neoplasms is higher than in the group with nonneoplastic cysts. In women with pancreatic cystic lesion without history for pancreatitis, the probability of neoplasms diagnosis is high. Discussion Pancreatic cystic tumors are treated radically due to the lack of sufficiently sensitive and specific pre-operative examinations. The natural history of mucinous neoplasms (IPMN and MCN) ranges from dysplasia to cancer. There are no guidelines that could be in satisfactory way used in follow up patients with pancreatic cysts.

Comparison of computerized tomographic and radionuclide methods in determining intracranial cystic tumor volumes

1985 ◽  
Vol 63 (5) ◽  
pp. 740-744 ◽  
Author(s):  
L. Dade Lunsford ◽  
Geoffrey Levine ◽  
Lewis W. Gumerman
Keyword(s):  
Isotope Dilution ◽  
Accurate Determination ◽  
Measurement Techniques ◽  
Cystic Tumor ◽  
Cystic Neoplasms ◽  
Radioactive Phosphorus ◽  
Content Type ◽  
Ct Technique ◽  
Cyst Volume ◽  
Cystic Tumors

✓ The dosimetry of radioactive phosphorus (32P) for intracavitary treatment of cystic brain tumors is dependent upon accurate determination of the cyst volume. The authors have used both high-resolution computerized tomography (CT) scanning and an isotope dilution technique with technetium-99m (99mTc) sulfur colloid to determine cyst volumes in an experimental model and in six patients with intracerebral cystic tumors. In six separate comparisons using an experimental phantom “cyst,” no significant differences between CT and 99mTc values were detected. In six patients with cystic neoplasms varying from 3 to 6.7 ml in volume, the percent differences between values obtained by CT and isotope dilution ranged from −17.26% to +13.13%. In individual patients, these differences proved to be of little significance for planning dosimetry. In both experimental and clinical trials comparing isotope dilution and CT measurement techniques, the CT technique using the standard software of the scanner and 5-mm thick slices proved to be a highly accurate method of determining cyst volume. The authors now base dosimetric calculations for intracavitary radiation with 32P on CT technique alone.

scholarly journals Surgery for Cystic Pancreatic Lesions in the Post-Sendai Era: A Single Institution Experience

HPB Surgery ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Jörg Kleeff ◽  
Christoph Michalski ◽  
Bo Kong ◽  
Mert Erkan ◽  
Susanne Roth ◽  
...  
Keyword(s):  
Preoperative Diagnosis ◽  
Postoperative Morbidity ◽  
Intraepithelial Neoplasia ◽  
Cystic Tumor ◽  
Diagnostic Challenge ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Biological Behaviour ◽  
Risk Of Malignancy ◽  
Cystic Pancreatic Lesions

Introduction. The management of cystic pancreatic lesions has changed in recent years as a result of increasing knowledge of their biological behaviour, better diagnostic options, and international guidelines. Methods. Retrospective analysis of a cohort of 86 patients operated for cystic pancreatic lesions during a seven-year period (2007–2014). Results. Final histopathology revealed 53 intraductal papillary mucinous neoplasms (19 branch duct IPMNs, 15 mixed type IPMNs, and 19 main duct IPMNs), 14 serous and 13 mucinous cystic neoplasms, 3 solid pseudopapillary neoplasms, and 3 other lesions. 4 cases displayed high grade intraepithelial neoplasia and 2 cases displayed invasive cancer. A pylorus-preserving partial duodenopancreatectomy was carried out in 27 patients, a total pancreatectomy was carried out in 9 patients, a left resection was carried out in 42 patients, and segmental resections and enucleations were carried out in 4 patients each. Overall postoperative morbidity and mortality were 40% and 2.3%, respectively. The preoperative diagnosis of a specific cystic tumor was accurate in 79% of patients and 9 patients (10%) could have avoided surgery with the correct preoperative diagnosis. Conclusion. Cystic pancreatic lesions are still a diagnostic challenge, requiring a dedicated multidisciplinary approach. The rate of malignancy is relatively small, whereas postoperative morbidity is substantial, underscoring the importance of adequate patient selection considering both the risk of surgery and the long term risk of malignancy.

scholarly journals Pancreatic Cysts after Endoscopic Ultrasonography-Guided Ethanol and/or Paclitaxel Ablation Therapy: Another Mimic of Pancreatic Pseudocysts

Pathobiology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Soyeon An ◽  
You-Na Sung ◽  
Sung Joo Kim ◽  
Dong-Wan Seo ◽  
Sun-Young Jun ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Cystic Tumor ◽  
Pancreatic Pseudocysts ◽  
Pancreatic Cysts ◽  
Clinical Impression ◽  
Female Ratio ◽  
Ablation Therapy ◽  
Cystic Tumors ◽  
Wide Range ◽  
Egg Shell

<b><i>Background:</i></b> Endoscopic ultrasound-guided ablation (EUS-A) therapy is a minimally invasive procedure for pancreatic-cystic tumors in patients with preoperative comorbidities or in patients who are not indicated for surgical resection. However, histopathologic characteristics of pancreatic cysts after ablation have not been well-elucidated. <b><i>Methods:</i></b> Here, we analyzed pathological findings of 12 surgically resected pancreatic cysts after EUS-A with ethanol and/or paclitaxel injection. <b><i>Results:</i></b> Mean patient age was 49.8 ± 13.6 years with a 0.3 male/female ratio. Clinical impression before EUS-A was predominantly mucinous cystic neoplasms. Mean cyst size before and after ablation therapy was similar (3.7 ± 1.0 cm vs. 3.4 ± 1.6 cm; <i>p</i> = 0.139). Median duration from EUS-A to surgical resection was 18 (range, 1–59) months. Mean percentage of the residual neoplastic lining epithelial cells were 23.1 ± 37.0%. Of the resected cysts, 8 cases (67%) showed no/minimal (&#x3c;5%) residual lining epithelia, while the remaining 4 cases (33%) showed a wide range of residual mucinous epithelia (20–90%). Ovarian-type stroma was noted in 5 cases (42%). Other histologic features included histiocytic aggregation (67%), stromal hyalinization (67%), diffuse egg shell-like calcification along the cystic wall (58%), and fat necrosis (8%). <b><i>Conclusion:</i></b> Above all, diffuse egg shell-like calcification along the pancreatic cystic walls with residual lining epithelia and/or ovarian-type stroma were characteristics of pancreatic cysts after EUS-A. Therefore, understanding these histologic features will be helpful for precise pathological diagnosis of pancreatic cystic tumor after EUS-A, even without knowing the patient’s history of EUS-A.

scholarly journals The clinical features of COVID-19 patients with positive viral RNA stool test results and possibility of fecal-oral transmission : A Systematic Review

2021 ◽  
Vol 22 (1) ◽  
pp. 42-51
Author(s):  
Selina Natalia ◽  
Felicia Imanuella Thorion ◽  
Luky Adlino ◽  
Clifford Eltin John ◽  
Andree Kurniawan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Gastrointestinal Tract ◽  
Demographic Data ◽  
Clinical Manifestations ◽  
Viral Rna ◽  
World Health ◽  
Test Results ◽  
Oral Transmission ◽  
Positive Stool ◽  
Health Organization

Objective : Coronavirus disease 2019 (COVID-19) has been declared as an international public health emergency by the World Health Organization (WHO), with outbreaks in over 200 countries and causing over 390,000 deaths globally. ACE-2 receptors are highly expressed in the upper and lower gastrointestinal system, providing a prerequisite for SARS-CoV-2 infection in the gastrointestinal tract. In addition, over half of the COVID-19 patients have viral nucleic acid detected in their feces and almost one-quarter of the cases, the stool samples test positive even when respiratory samples are negative. The aim of this systematic review is to summarize literature and to evaluate the clinical characteristics of patients with positive viral RNA stool test for COVID-19 and if there is a possibility of fecal-oral transmission of SARS-CoV-2 virus.Method : This systematic review has been registered in PROSPERO (CRD42020183049). A systematic search of the literature for observational study and randomized control trial was conducted in PubMed central and Google Scholar through May 5th, 2020. Three reviewers independently searched and selected. The risk of bias was evaluated using Newcastle-Ottawa Quality assessment tool.Results : 340 articles were screened, then from which eight articles were selected. Of eight articles that were included in this study, we sought for three main categories of the clinical manifestation; gastrointestinal, respiratory, and others. Each study was reviewed systematically to gain demographic data and evidence regarding the possibility of fecal oral transmission in SARS-CoV-2. Two studies reported prolongation of positive stool test results after the respiratory specimen conversion to negative which support the theory of fecal oral transmission.Conclusion : In conclusion, diarrhea, cough, and fever are the most common clinical manifestations in COVID-19 patients with positive RNA stool test results. Fecal oral transmission may be possible due to the ACE-2 receptors in the lining of the gastrointestinal tract. RNA stool test should be used as addition in discharging COVID-19 patients.

scholarly journals Comparison of Quantiferon-TB Gold and TST tests in the diagnosis of latent tuberculosis infection among HIV infected patients in Hamadan, west of Iran

2020 ◽  
Vol 14 (04) ◽  
pp. 360-365
Author(s):  
Fariba Keramat ◽  
Benyamin Bagheri Delavar ◽  
Alireza Zamani ◽  
Jalal Poorolajal ◽  
Elham Lajevardi ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Latent Tuberculosis Infection ◽  
Demographic Data ◽  
Clinical Manifestations ◽  
Latent Tuberculosis ◽  
Cd4 Count ◽  
Tuberculosis Infection ◽  
Percent Agreement ◽  
Immunodeficiency Virus ◽  
The Mean

Introduction: Human immunodeficiency virus (HIV) infection increases the susceptibility of patients for latent tuberculosis infection (LTBI) and reactivtion tuberculosis. This study aimed to compare the Quantiferon-TB gold-in tube test (QFT) with tuberculin skin test (TST) in the diagnosis of LTBI in HIV infected patients. Methodology: This comparative study of 89 patients with HIV in the Behavioral Diseases Counseling Center in Hamadan was carried out from July 2015 to November 2016. After obtaining consent from the patients, all demographic data, clinical manifestations, and laboratory results (CD4 count, TST and QFT) were entered into the questionnaires. The CD4 count is usually routinely performed using flow cytometry at the Behavioral Counselling Center. Quantiferon-TB test was done by using Qiagen – Quantiferon-2 plate kit ELISA. Results: Totally, 89 HIV infected patients with the mean age of 39.55 ± 10.31 years old were enrolled in the study. Sixty patients (67.42%) were male. The mean duration of HIV infection was 4.44 ± 3.88 years and the mean of CD4 count was 388.65 ± 260.66 cells/µL . Twenty patients had LTBI based on TST. Considering the QFT intermediate results as a positive test, the percent agreement of QFT and TST was 59.55%, which was not statistically significant (P = 0.2387). Conclusions: According to the results, there was no significant percent agreement between QFT and TST for detecting LTBI in HIV infected patients. However, by decreasing CD4 counts, there was a significant relation between TST positive and LTBI in HIV patients.

scholarly journals Solid-Pseudopapillary Tumor of the Pancreas: A Single Center Experience

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Valentina Beltrame ◽  
Gioia Pozza ◽  
Enrico Dalla Bona ◽  
Alberto Fantin ◽  
Michele Valmasoni ◽  
...  
Keyword(s):  
Preoperative Diagnosis ◽  
Abdominal Ultrasound ◽  
Diagnostic Tools ◽  
Solid Pseudopapillary Tumor ◽  
Sufficient Information ◽  
Cystic Neoplasms ◽  
Single Center Experience ◽  
Positron Emission ◽  
Institutional Experience ◽  
Solid Pseudopapillary Tumors

Aim of this study was to review the institutional experience of solid-pseudopapillary tumors of the pancreas with particular attention to the problems of preoperative diagnosis and treatment. From 1997 to 2013, SPT was diagnosed in 18 patients among 451 pancreatic cystic neoplasms (3.7%). All patients underwent preoperative abdominal ultrasound, computed assisted tomography, and tumor markers (CEA and CA 19-9) determinations. In some instances, magnetic resonance, positron emission tomography, and endoscopic ultrasound with aspiration cytology were performed. There were two males and 16 females. Serum CA 19-9 was slightly elevated in one case. Preoperative diagnosis was neuroendocrine tumor (n=2), mucinous tumor (n=2), and SPT (n=14). Two patients underwent previous operation before referral to our department: one explorative laparotomy and one enucleation of SPT resulting in surgical margins involvement. All patients underwent pancreatic resection associated with portal vein resection (n=1) or liver metastases (n=1). One patient died of metastatic disease, 77 months after operation, and 17 are alive and free with a median survival time of 81.5 months (range 36–228 months). Most of SPT can be diagnosed by CT or MRI, and the role of other diagnostic tools is very limited. We lack sufficient information regarding clinicopathologic features predicting prognosis. Caution is needed when performing limited resection, and long and careful follow-up is required for all patients after surgery.

Progression of carotid near-occlusion to complete occlusion: related factors and clinical implications

2020 ◽  
pp. neurintsurg-2019-015638
Author(s):  
Andrés García-Pastor ◽  
Antonio Gil-Núñez ◽  
José María Ramírez-Moreno ◽  
Noelia González-Nafría ◽  
Javier Tejada ◽  
...  
Keyword(s):  
Collateral Circulation ◽  
Demographic Data ◽  
Clinical Manifestations ◽  
Treatment Modalities ◽  
Clinical Implications ◽  
Related Factors ◽  
Complete Occlusion ◽  
Clinical Consequences ◽  
Near Occlusion

BackgroundThe clinical consequences and factors related to the progression from a carotid near-occlusion (CNO) to a complete occlusion are not well established. Our aim is to describe the rate, predictive factors and clinical implications of the progression to complete carotid occlusion (PCCO) in a population of patients with symptomatic CNO.MethodsWe conducted a multicenter, nationwide, prospective study from January 2010 to May 2016. Patients with angiography-confirmed CNO were included. We collected information on demographic data, clinical manifestations, radiological and hemodynamic findings, and treatment modalities. A 24 month carotid-imaging follow-up of the CNO was performed.Results141 patients were included in the study, and carotid-imaging follow-up was performed in 122 patients. PCCO occurred in 40 patients (32.8%), and was more frequent in medically-treated patients (34 out of 61; 55.7%) compared with patients treated with revascularization (6 out of 61; 9.8%) (p<0.001). 7 of the 40 patients with PCCO (17.5%) suffered ipsilateral symptoms. Factors independently related with PCCO in the multivariate analysis were: age ≥75 years (OR 2.93, 95% CI 1.05 to 8.13), revascularization (OR 0.07, 95% CI 0.02 to 0.20), and collateral circulation through the ipsilateral ophthalmic artery (OR 3.25, 95% CI 1.01 to 10.48).ConclusionsPCCO occurred within 24 months in more than half of the patients under medical treatment. Most episodes of PCCO were not associated with ipsilateral symptoms. Revascularization reduces the risk of PCCO.

Surgical treatment of pancreatic cystic tumors

2017 ◽  
Vol 89 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Beata Jabłońska ◽  
Łukasz Braszczok ◽  
Weronika Szczęsny-Karczewska ◽  
Beata Dubiel-Braszczok ◽  
Paweł Lampe
Keyword(s):  
Surgical Treatment ◽  
Distal Pancreatectomy ◽  
Pancreatic Resection ◽  
Tumor Resection ◽  
Mucinous Cystadenoma ◽  
Pancreatic Head ◽  
Serous Cystadenoma ◽  
Cystic Tumor ◽  
Cystic Tumors ◽  
Pancreatic Cystic Tumors

The aim of this study was to assess short-term outcomes of surgical treatment of pancreatic cystic tumors (PCTs). Material and methods: We retrospectively reviewed medical records of 46 patients (31 women and 15 men) who had undergone surgery for pancreatic cystic tumors in our department. Results: Pancreatic cystic tumors were located within the pancreatic head (21), body (11), tail (13), and whole pancreas (1). The following surgical procedures were performed: pancreatoduodenectomy (20), central pancreatectomy (9), distal pancreatectomy (3), distal pancreatectomy with splenectomy (3), distal extended pancreatectomy with splenectomy (2), total pancreatectomy (1), duodenum preserving pancreatic head resection (1), local tumor resection (4), and other procedures (2). Histopathological tumor types were as follows: serous cystadenoma (14), intraductal papillary mucinous adenoma (5), intraductal papillary mucinous carcinoma (5), solid pseudopapillary tumor (5), mucinous cystadenoma (5), mucinous cystadenoma with border malignancy (1), mucinous cystadenocarcinoma (2), adenocarcinoma (4), and other tumors (5). Early postoperative complications were observed in 14 (30.43%) patients. Reoperations were performed in 9 (19.56%) patients. The perioperative mortality rate was 6.52%. Conclusions: Serous cystadenoma was the most common pancreatic cystic tumor in the analyzed group. PCTs were most frequently located within the pancreatic head. Pancreatic resection was possible in most patients, and pancreatoduodenectomy was the most common pancreatic resection type.

Factors affecting the hematological and nonhematological toxicities in B-cell lymphoma patients during treatment

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e18004-e18004
Author(s):  
P. Karimi ◽  
A. Shokri ◽  
L. Etemadi ◽  
N. Negar Rezania
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Demographic Data ◽  
Bone Marrow Involvement ◽  
Clinical Manifestations ◽  
B Cell Lymphoma ◽  
Hematological Toxicity ◽  
Cross Sectional ◽  
Factors Affecting ◽  
Grade 3

e18004 Background: Despite recent improvements, toxicities in B-cell lymphoma patients during treatment remains a major challenge for leukemia community. The aim of this study was to determine factors affecting the hematological and non-hematological toxicities in B-cell lymphoma patients during treatment. Methods: This multicentral cross-sectional study was performed on 68 diagnosed B-cell lymphoma patients (17–72 y/o, mean age 53y/o) admitted in three cancer centers for treatment during 2003–2008. Patients with other malignancies, serious illness or infection were not included. Demographic data, clinical and para clinical manifestations were recorded during treatment. Results: 31 (45%) patients developed grade 2 or greater non-hematological toxicities: 11:fever, 8:chills, 6:vomiting, 4:rash, and 3:pruritus. Moreover, 7 patients developed grade 3 non-hematological toxicities. 42 (62%) patients developed grade 2 or greater hematological toxicities. Non-hematological toxicities were more frequent in patients with BM (Bone Marrow) involvement [15/32 (47%) versus 21/60 (35%), p = 0.01] and with extranodal disease [23/48 (48%) versus 11/42 (26%), p = 0.008]. The incidence of grade 3 or 4 hematological toxicity was higher in females than males [17/43 (40%) versus 13/50 (26%), p = 0.001]. Furthermore, being female was significantly associated with the development of grade 3 or 4 neutropenia [17/49 (35%) versus 8/53 (15%), p = 0.003]. In addition, high LDH was also associated with grade 3 or 4 leukopenia [7/27 (26%) versus 9/58 (16%), p = 0.01], but not with neutropenia. Conclusions: Multivariate analysis demonstrate that some factors like female gender, BM involvement, and serum LDH level could be useful for predicting the hematological and nonhematological toxicities in B-cell lymphoma patients during treatment. No significant financial relationships to disclose.

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