Lymphoepithelial Cyst of the Pancreas: Can Common Imaging Features Help to Avoid Resesction?

2021 ◽  
Author(s):  
Ekaterina Khristenko ◽  
Elena Esteban Garcia ◽  
Matthias M. Gaida ◽  
Thilo Hackert ◽  
Philipp Mayer ◽  
...  
Keyword(s):  
Clinical Data ◽  
Imaging Features ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Male Predominance ◽  
Unenhanced Ct ◽  
Aged Woman ◽  
Lymphoepithelial Cysts ◽  
Solid Lesions ◽  
Cystic Pancreatic Lesions

Abstract Background: Differentiation of cystic pancreatic neoplasms remains a challenging task for radiologists with main aim of characterizing malignant and premalignant conditions. Purpose: The study aimed to compare radiological features of lymphoepithelial cysts (LEC) with other cystic pancreatic lesions, which could help to differentiate them in order to avoid unnecessary resection and optimize surveillance.Material and Methods: We retrospectively reviewed 12 cases of resected and histopathological confirmed LECs in last 12 years, for 10 patients imaging studies were available. 20 patients with mucinous cystic neoplasms (MCN) and 20 patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) were selected consecutively to serve as control groups. Imaging findings as well as clinical data were analyzed. Results: Three imaging subtypes of LEC were identified: simple cystic morphology (20%) and mixed cystic-solid lesions (80%) with either diffuse subsolid component (30%) or mural nodule (50%). All lesions revealed exophytic location with strong male predominance (9:1). MCNs were presented exclusively in middle-aged woman and IPMN in both sexes showing slight male predominance (13:7). Mean patient age in IPMN (70.5+7.7 years) was significantly higher compared to other groups (p<0.001 for LEC, p=0.005 for MCN). Unenhanced CT-attenuation of LEC was higher than MCNs (p=0.025) and IPMNs (p=0.021). Conclusion: The present study provides three imaging subtypes of LEC with key features for the differentiation from other cystic pancreatic lesions such as increased native attenuation, absence of connection to main pancreatic duct (MPD) and exophytic location. Clinical data, such as male predominance in LEC, is crucial in differentiating cystic pancreatic lesions.

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 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.

Magnetic Resonance Imaging of Uncommon Hepatic Mesenchymal Tumours: Haemangioendothelioma and Angiosarcoma

2019 ◽  
Vol 15 (4) ◽  
pp. 362-368
Author(s):  
Andrzej Cieszanowski ◽  
Agnieszka Anysz-Grodzicka ◽  
Joanna Podgorska ◽  
Beata Jagielska ◽  
Jakub Pałucki
Keyword(s):  
Contrast Enhancement ◽  
Correct Diagnosis ◽  
Malignant Potential ◽  
Hepatobiliary Phase ◽  
Imaging Features ◽  
Liver Tumours ◽  
Aged Woman ◽  
High Apparent Diffusion Coefficient ◽  
Adc Values ◽  
Mesenchymal Tumours

<P>Background: Primary Hepatic Epithelioid Haemangioendothelioma (HEHE) and Primary Hepatic Angiosarcoma (PHA) are rare mesenchymal tumours with different malignant potential. Whereas HEHE demonstrates low to intermediate malignant potential, PHA is an aggressive malignancy with poor prognosis. The knowledge of typical imaging features of these lesions may facilitate correct diagnosis; however, the ultimate diagnosis of HEHE and PHA is based on histopathologic examination. </P><P> Discussion: The most typical findings helpful in diagnosing HEHE are: Presence of multiple, confluent nodules located at the liver periphery (in young to middle-aged woman), retraction of the liver capsule, marked hyperintensity on T2-weighted images, “target-sign” appearance, progressive centripetal contrast enhancement, and relatively high Apparent Diffusion Coefficient (ADC) values. More than &#8805;50% of nodules are hyper- or isointense on Hepatobiliary Phase (HBP) images. Conclusion: The imaging features suggestive of PHA are: Occurrence of metastases (lungs, spleen) at the time of diagnosis, presence of a large dominant mass with smaller satellites, heterogeneity and areas of haemorrhage in a dominant mass, progressive contrast enhancement, slightly elevated ADC values as compared to other malignant liver tumours.</P>

Mucinous Cystic Neoplasms of the Pancreas: Imaging Features and Diagnostic Difficulties

2000 ◽  
Vol 55 (3) ◽  
pp. 187-192 ◽  
Author(s):  
J. SCOTT ◽  
I. MARTIN ◽  
D. REDHEAD ◽  
P. HAMMOND ◽  
O.J. GARDEN
Keyword(s):  
Imaging Features ◽  
Cystic Neoplasms ◽  
Mucinous Cystic Neoplasms ◽  
Diagnostic Difficulties

scholarly journals Renal cancer at unenhanced CT: imaging features, detection rates, and outcomes

2017 ◽  
Vol 43 (7) ◽  
pp. 1756-1763 ◽  
Author(s):  
Stacy D. O’Connor ◽  
Stuart G. Silverman ◽  
Laila R. Cochon ◽  
Ramin K. Khorasani
Keyword(s):  
Renal Cancer ◽  
Ct Imaging ◽  
Imaging Features ◽  
Detection Rates ◽  
Unenhanced Ct

scholarly journals Multi-Phase CT-Based Radiomics Nomogram for Discrimination Between Pancreatic Serous Cystic Neoplasm From Mucinous Cystic Neoplasm

2021 ◽  
Vol 11 ◽  
Author(s):  
Jiahao Gao ◽  
Fang Han ◽  
Xiaoshuang Wang ◽  
Shaofeng Duan ◽  
Jiawen Zhang
Keyword(s):  
Single Phase ◽  
Validation Cohort ◽  
Curve Analysis ◽  
Ct Scans ◽  
Cystic Neoplasm ◽  
Arterial Phase ◽  
Imaging Features ◽  
Cystic Neoplasms ◽  
Training Cohort ◽  
Multi Phase

PurposeThis study aimed to develop and verify a multi-phase (MP) computed tomography (CT)-based radiomics nomogram to differentiate pancreatic serous cystic neoplasms (SCNs) from mucinous cystic neoplasms (MCNs), and to compare the diagnostic efficacy of radiomics models for different phases of CT scans.Materials and MethodsA total of 170 patients who underwent surgical resection between January 2011 and December 2018, with pathologically confirmed pancreatic cystic neoplasms (SCN=115, MCN=55) were included in this single-center retrospective study. Radiomics features were extracted from plain scan (PS), arterial phase (AP), and venous phase (VP) CT scans. Algorithms were performed to identify the optimal features to build a radiomics signature (Radscore) for each phase. All features from these three phases were analyzed to develop the MP-Radscore. A combined model comprised the MP-Radscore and imaging features from which a nomogram was developed. The accuracy of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration tests, and decision curve analysis.ResultsFor each scan phase, 1218 features were extracted, and the optimal ones were selected to construct the PS-Radscore (11 features), AP-Radscore (11 features), and VP-Radscore (12 features). The MP-Radscore (14 features) achieved better performance based on ROC curve analysis than any single phase did [area under the curve (AUC), training cohort: MP-Radscore 0.89, PS-Radscore 0.78, AP-Radscore 0.83, VP-Radscore 0.85; validation cohort: MP-Radscore 0.88, PS-Radscore 0.77, AP-Radscore 0.83, VP-Radscore 0.84]. The combination nomogram performance was excellent, surpassing those of all other nomograms in both the training cohort (AUC, 0.91) and validation cohort (AUC, 0.90). The nomogram also performed well in the calibration and decision curve analyses.ConclusionsRadiomics for arterial and venous single-phase models outperformed the plain scan model. The combination nomogram that incorporated the MP-Radscore, tumor location, and cystic number had the best discriminatory performance and showed excellent accuracy for differentiating SCN from MCN.

Gastric Duplication Cysts Expressing Carcinoembryonic Antigen Mimicking Cystic Pancreatic Neoplasms in Two Adults

2008 ◽  
Vol 74 (1) ◽  
pp. 91-94 ◽  
Author(s):  
Jeffrey Johnston ◽  
Grayson H. Wheatley ◽  
Hosam F. El Sayed ◽  
William B. Marsh ◽  
E. Christopher Ellison ◽  
...  
Keyword(s):  
Pancreatic Neoplasms ◽  
Malignant Potential ◽  
Cystic Lesions ◽  
Cystic Neoplasms ◽  
Gastric Duplication ◽  
Fluid Analysis ◽  
Close Proximity ◽  
Cystic Pancreatic Lesions ◽  
Bryonic Antigen ◽  
Cystic Pancreatic Neoplasms

Gastric duplication cysts in adults are very rare and usually found incidentally during evaluation for an unrelated ailment. When they are found in close proximity to the pancreas, they can be confused with cystic neoplasms of the pancreas, which are typically also asymptomatic yet more common. As part of the evaluation of cystic pancreatic lesions, cyst fluid analysis for carcinoem-bryonic antigen (CEA) is undertaken to determine malignant potential. Herein we present two cases of cystic lesions thought to arise from the pancreas found to have elevated preoperative cystic CEA levels. At operation, they were found to be gastric duplication cysts and were resected. We report the histologic findings and review of the current literature.

scholarly journals Lymphoepithelial Cysts of the Pancreas: The Use of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Diagnosis

2010 ◽  
Vol 24 (6) ◽  
pp. 348-350 ◽  
Author(s):  
Zamil Karim ◽  
Blair Walker ◽  
Eric C Lam
Keyword(s):  
Surgical Resection ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Lower Abdominal Pain ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Cystic Neoplasms ◽  
Fine Needle ◽  
Lymphoepithelial Cysts

Lymphoepithelial cysts (LECs) are rare non-neoplastic lesions that can appear as a complex cyst or a mass in the pancreas. Cytology from endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) can be helpful in making a diagnosis with the aim of avoiding unnecessary surgical resection. A case involving a 51-year-old woman with lower abdominal pain who was found to have a multiloculated cystic lesion at the junction of the pancreatic body and tail is described. Cytology from EUS-FNA was consistent with a pancreatic LEC. The lesion was managed conservatively and follow-up imaging of the cyst over the following two years was unchanged. The patient remains clinically well. Cytology from EUS-FNA can help distinguish LECs from cystic neoplasms, thus preventing radical surgical resection of this benign pancreatic cyst.

A Pictorial Review of Intracranial Haemorrhage Revisited

2019 ◽  
Vol 15 (9) ◽  
pp. 853-865
Author(s):  
Andrew Martin ◽  
George Tse ◽  
Daniel James Anthony Connolly ◽  
Ruth Batty
Keyword(s):  
Intracerebral Haemorrhage ◽  
Sinus Thrombosis ◽  
Vascular Malformations ◽  
Amyloid Angiopathy ◽  
Phase Imaging ◽  
Imaging Features ◽  
Diagnostic Features ◽  
Unenhanced Ct ◽  
Ct Angiogram ◽  
Pictorial Review

Background: The many causes of Intracerebral Haemorrhage (IH) can be difficult to differentiate. However, there are imaging features that can provide useful clues. This paper aims to provide a pictorial review of the common causes of IH, to identify some distinguishing diagnostic features and to provide guidance on subsequent imaging and follow up. It is hoped that this review would benefit radiology and non-radiology consultants, multi-professional workers and trainees who are commonly exposed to unenhanced CT head studies but are not neuroradiology specialists. Discussion: In the absence of trauma, Spontaneous Intracerebral Haemorrhage (SIH) can be classified as idiopathic or secondary. Secondary causes of IH include hypertension and amyloid angiopathy (75-80%) and less common pathologies such as vascular malformations (arteriovenous malformations, aneurysms and cavernomas), malignancy , venous sinus thrombosis and infection. SIH causes between 10 to 15% of all strokes and has a higher mortality than ischaemic stroke. Trauma is another cause of IH with significant mortality and some of the radiological features will be reviewed. Conclusion: Unenhanced CT is a mainstay of acute phase imaging due to its availability and, sensitivity and specificity for detecting acute haemorrhage. Several imaging features can be identified on CT and, along with clinical information, can provide some certainty in diagnosis. For those suitable and where diagnostic uncertainty remains CT angiogram, time-resolved CT angiography and catheter angiography can help identify underlying AVMs, aneurysms, cavernomas and vasculitides. MRI is more sensitive for the detection of subacute and chronic haemorrhage and identification of underlying mass lesions.

Sign in / Sign up

Export Citation Format

Share Document