scholarly journals Cystic lesions of pancreas: challenges in diagnosis and management

2016 ◽  
Vol 18 (3) ◽  
pp. 53
Author(s):  
S Bohara ◽  
TY Tamang ◽  
DK Maharjan ◽  
SK Shrestha ◽  
PB Thapa
Keyword(s):  
Cystic Lesion ◽  
Mucinous Cystadenoma ◽  
Pancreatic Head ◽  
College Teaching ◽  
Serous Cystadenoma ◽  
Pancreatic Tumors ◽  
Pancreatic Cysts ◽  
Cystic Lesions ◽  
Pancreatic Cystic Lesion ◽  
First Case

Introduction: Pancreatic cysts are common (2.5%). Cystic neoplasms represent 10% of cystic lesions and 1% of pancreatic tumors. However, it is difficult to differentiate benign cyst from malignant cystic lesions preoperatively.Objective: To study the cases of pancreatic cystic lesion who underwent various forms of pancreatic resection.Materials and Methods: Nine cases of pancreatic cystic lesion who presented to Kathmandu Medical College Teaching Hospital, Surgical Unit 3 within December 2014- November 2015 were evaluated. Four pancreatic cysts who underwent resection are discussed whereas not managed with resection are excluded.Results: There were 4 cases of pancreatic cyst who underwent pancreatic resection. First case underwent pancreaticoduodenectomy for pancreatic mucinous cystadenoma. However histopathological examination revealed a serous cystadenoma. In second case, pancreatic neck lesion suspected to be mucinous cystadenoma or pseudocyst in MRCP, with negative malignant cells in EUS guided FNAC underwent Central pancreatectomy and was found to be serous cystadenoma. The third case with suspected pseudocyst underwent Pancreaticoduodenectomy after a 3X2 cm2 cystic mass was felt at the posteroinferior side of pancreatic head and malignancy was suspected intraoperatively . HPE report was mucinous cystadenoma. The fourth case with pancreatic pseudocyst at tail with duct calculi and chronic pancreatitis underwent distal pancreatectomy with splenectomy with Frey’s procedure.Conclusion: Management of pancreatic cystic lesion is challenging. Though radiological imaging has limited role in accurate diagnosis, endoscopic ultrasound may be of some benefit.

Benign and Premalignant Lesions of the Pancreas

2016 ◽  
Author(s):  
Abdurrahman Kadayifci ◽  
William R. Brugge
Keyword(s):  
Malignant Tumors ◽  
Balloon Dilation ◽  
Pancreatic Head ◽  
Premalignant Lesions ◽  
World Health ◽  
Pancreatic Tumors ◽  
Thick Wall ◽  
Cystic Lesions ◽  
Cystic Neoplasms

Pancreatic cancer is among the most aggressive human cancers, with few symptoms and clinical findings until it is detected in an advanced stage. Today, the only favorable treatment is surgical resection before progression to an invasive stage. There are a variety of benign and premalignant conditions of the pancreas that may appear similar to malignant tumors; early detection and management of those premalignant pancreatic lesions may provide a significant improvement in patient outcome. This review covers cystic neoplasms of the pancreas, premalignant solid lesions of the pancreas, and inflammatory lesions of the pancreas. Figures show a 30 mm diameter hypoechoic lesion without septae in the pancreatic head, an oval 20 mm diameter pancreatic mass with mixed solid and cystic components, a 24 mm diameter hypoechoic mass with well-defined borders in the tail of the pancreas, a 22 × 18 mm cystic lesion with a thick wall and internal debris in the head of the pancreas, and an endoscopic cyst gastrostomy after balloon dilation. Tables list World Health Organization (WHO) 2010 classification of pancreatic tumors, classification of pancreatic cystic lesions, main characteristics of common pancreatic cystic lesions, high-risk stigmata and worrisome features of intraductal papillary mucinous neoplasm on cross-sectional imaging, and WHO classification of pancreatic neuroendocrine tumors.   This review contains 5 highly rendered figures, 5 tables and 55 references

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.

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.

scholarly journals A Surgically Resected Pancreatic Schwannoma with Obstructive Jaundice with Special Reference to Differential Diagnosis from Other Cystic Lesions in the Pancreas

2018 ◽  
Vol 12 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Takayoshi Watanabe ◽  
Kenichiro Araki ◽  
Norihiro Ishii ◽  
Takamichi Igarashi ◽  
Akira Watanabe ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Obstructive Jaundice ◽  
Protein Expression ◽  
Histopathological Examination ◽  
S100 Protein ◽  
Pancreatic Head ◽  
Pancreatic Tumors ◽  
Cystic Lesions ◽  
Cystic Tumors ◽  
Pancreatic Schwannoma

Pancreatic schwannomas are uncommon. About 60% of pancreatic schwannomas develop cystic lesions, and the differential diagnosis from other cystic pancreatic tumors is difficult. A 43-year-old man presented for evaluation of liver dysfunction detected during a medical checkup. Blood testing detected obstructive jaundice. A computed tomography scan revealed a well-defined polycystic tumor of about 5 cm at the pancreatic head. We performed surgical resection to treat the patient’s symptoms and facilitate long-term management. Histopathological examination revealed spindle-shaped cells. Immunohistochemical studies showed S100 protein expression and the absence of CD34 and c-kit protein expression. Finally, we diagnosed a schwannoma. Pancreatic schwannoma is usually asymptomatic. The present case presented with obstructive jaundice, which is reportedly a rare symptom. Pancreatic schwannomas should be considered as a differential diagnosis of pancreatic cystic tumors. Dilatation of the pancreatic duct and the 18-fluorodeoxyglucose positron emission tomography findings are important for the differential diagnosis.

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.

The Coexistence Of Two Different Epithelial Ovarian Tumors: A Rare Case

2021 ◽  
Vol 17 ◽  
Author(s):  
Ömer Faruk Topaloğlu ◽  
Emine Uysal ◽  
Zeliha Esin Çelik ◽  
Çetin Çelik
Keyword(s):  
Ovarian Tumor ◽  
Cystic Lesion ◽  
Mucinous Cystadenoma ◽  
Serous Cystadenoma ◽  
Ovarian Tumors ◽  
Lumbar Region ◽  
Fluid Content ◽  
Tumor Subtypes ◽  
Epithelial Tumors ◽  
The Right

Background: Epithelial tumors are the most common subgroup and are seen in 60-70% of all ovarian tumors. Serous cystadenoma and mucinous cystadenoma are the most common benign epithelial tumors. Serous cystadenomas are ovarian tumors with the highest bilateral incidence. The coexistence of tumors with different histopathology in the ovaries is extremely rare and has only been reported in a few cases in the literature. We present a case of bilateral ovarian tumor that was diagnosed as serous and mucinous cystadenoma after laparoscopic surgery. Case report: A 45-year-old female patient was admitted to our center with swelling in the pelvic region and pain in the left lumbar region. US imaging showed a cystic lesion in the right adnexal area, 4x2cm in size, well-circumscribed, containing a few thin septa, and a low echo fluid content. A cystic lesion with 6x4cm sized multilocular, well-circumscribed, slightly high echo fluid content was observed in the left adnexal area. On CT, a complex cystic lesion measuring 6x4cm was observed in the left adnexal area, pushing the left ureter laterally and causing the hydroureter. In addition, a 4x2cm cystic lesion was observed in the right adnexal area and hydroureter was observed on the right side proximal to this lesion. Both lesions were removed by surgery. On histopathologic examination, the left-sided cystic lesion was diagnosed as mucinous cystadenoma, and the right-sided cystic lesion was diagnosed as serous cystadenoma. Conclusion: The coexistence of different ovarian tumor subtypes is rare. In this article, we presented a case in which serous and mucinous cystadenoma lesions were seen together for the fourth time in the literature, according to our knowledge.

scholarly journals Histopathologic spectrum of cystic ovarian masses

2017 ◽  
Vol 6 (1) ◽  
pp. 16-20
Author(s):  
S Ranabhat ◽  
M Tiwari ◽  
S Maharjan ◽  
A Bhandari ◽  
M Subedi ◽  
...  
Keyword(s):  
Cystic Lesion ◽  
Cystic Teratoma ◽  
College Teaching ◽  
Serous Cystadenoma ◽  
Mature Cystic Teratoma ◽  
Ovarian Cysts ◽  
Histopathological Study ◽  
Cross Sectional ◽  
Follicular Cyst ◽  
Ovarian Masses

This research was a cross sectional analytic observational histopathological study of cystic ovarian lesions carried out over three years from March, 2012 to February, 2015 at Chitwan Medical College Teaching Hospital in Nepal. The objective of this study was to study cystic ovarian masses histopathologically. A total of one hundred and fourteen patients with cystic ovarian masses were included into the study. 46.5% lesions were non-neoplastic (83% physiologic and 17% pathologic) and 53.5% lesions were neoplastic (91.8% benign and 8.2% malignant). Follicular cyst was the most common ovarian cystic lesion overall, followed by mature cystic teratoma and serous cystadenoma. 14.9% of all the ovarian cysts had undergone torsion; among them mature cystic teratoma was the most common lesion to have undergone the complication. Neoplastic ovarian cysts were more common than non-neoplastic. Follicular cyst was the most common ovarian cyst overall. Mature cystic teratoma was the ovarian cystic lesion to be affected by torsion most commonly.

scholarly journals Histopathologic spectrum of cystic ovarian masses

2017 ◽  
Vol 6 (1) ◽  
pp. 16
Author(s):  
S Ranabhat ◽  
M Tiwari ◽  
S Maharjan ◽  
A Bhandari ◽  
M Subedi ◽  
...  
Keyword(s):  
Cystic Lesion ◽  
Cystic Teratoma ◽  
College Teaching ◽  
Serous Cystadenoma ◽  
Mature Cystic Teratoma ◽  
Ovarian Cysts ◽  
Histopathological Study ◽  
Cross Sectional ◽  
Follicular Cyst ◽  
Ovarian Masses

<p><span>This research was a cross sectional analytic observational histopathological study of cystic ovarian lesions carried out over three years from March, 2012 to February, 2015 at Chitwan Medical College Teaching Hospital in Nepal. The objective of this study was to study cystic ovarian masses histopathologically. A total of one hundred and fourteen patients with cystic ovarian masses were included into the study. 46.5% lesions were non-neoplastic (83% physiologic and 17% pathologic) and 53.5% lesions were neoplastic (91.8% benign and 8.2% malignant). Follicular cyst was the most common ovarian cystic lesion overall, followed by mature cystic teratoma and serous cystadenoma. 14.9% of all the ovarian cysts had undergone torsion; among them mature cystic teratoma was the most common lesion to have undergone the complication. Neoplastic ovarian cysts were more common than non-neoplastic. Follicular cyst was the most common ovarian cyst overall. Mature cystic teratoma was the ovarian cystic lesion to be affected by torsion most commonly.</span></p>

scholarly journals Use of ultrasonic elastography in the differential diagnosis of pancreatic cystic lesions

2018 ◽  
Vol 17 (3) ◽  
pp. 45-52
Author(s):  
T. V. Dibina ◽  
E. S. Drozdov ◽  
A. P. Koshel ◽  
V. R. Latypov
Keyword(s):  
Differential Diagnosis ◽  
Predictive Value ◽  
Ultrasound Examination ◽  
Mucinous Cystadenoma ◽  
Serous Cystadenoma ◽  
Cystic Lesions ◽  
Transabdominal Ultrasound ◽  
Non Invasive ◽  
Invasive Method ◽  
Sensitivity Specificity

Aim. Evaluate the effectiveness of ultrasonic elastography in the differential diagnosis of pancreatic cystic lesions.Materials and methods. Seventy patients with pancreatic cystic lesions were examined. Structure of clinical forms is the following: cystadenoma – 30 (serous cystadenoma – 23, mucinous cystadenoma – 2, mucinous cystadenocarcinoma – 5), pseudocysts – 40. Diagnosis of pancreatic cystic lesions was conducted with the help of transabdominal ultrasound examination (with 3D-reconstruction) and ultrasonic elastography.Results. The parameters of ultrasonic elastography for various types of pancreatic cystic lesions were determined. Sensitivity, specificity, positive predictive value, negative predictive value, the overall accuracy of the technique accounted for 97, 75, 74, 97 and 84% respectively. The superiority of the elastography technique over the standard transabdominal ultrasound in differential diagnosis of cystic pancreatic formations was illustrated.Conclusions. Ultrasonic elastography is an effective, non-invasive method of differential diagnosis of pancreatic cystic lesions and can be widely used in clinical practice.

scholarly journals Diagnostic and treatment tactics in patients with pancreatic cystic lesion in the outcome of chronic pancreatitis

2017 ◽  
Vol 37 (3) ◽  
pp. 50-56
Author(s):  
A. P. Koshel ◽  
Y. S. Drozdov ◽  
T. V. Dibina
Keyword(s):  
Chronic Pancreatitis ◽  
Conservative Treatment ◽  
Treatment Strategy ◽  
Cystic Lesion ◽  
Optimal Treatment ◽  
Pancreatic Cysts ◽  
Prospective Analysis ◽  
Pancreatic Cystic Lesion ◽  
Optimal Treatment Strategy

Aim: To substantiate the choice of the optimal treatment strategy for patients with pancreatic cysts on the background of chronic pancreatitis. Materials and methods: A retrospective-prospective analysis of the treatment of 58 patients (31 (53.4%) men and 27 (46.6%) women, aged from 26 to 73) with chronic pancreatitis complicated by the formation of cystic lesion was done. Results: Conservative treatment was applied in 8 (13.8%) cases, the puncturing technique was used in 19 (32,8%) cases, various surgeries performed in 31 (53.4%) patients. Conservative treatment was effective in 3 (37.5%) cases, puncture treatment – in 7 (36.8%), surgical – in 28 (90.3%) patients. Conclusion: Based on the findings, an algorithm of choosing the tactics of treatment of patients with pancreatic cysts in the outcome of chronic pancreatitis was developed in the clinic.  

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