scholarly journals Mucinous Cystic Lesions of the Pancreas an EUS-FNA-based Study with ClinicoPathological Follow Up

2021 ◽  
Vol 6 (3) ◽  
Keyword(s):  
Malignant Potential ◽  
Cyst Fluid ◽  
Institutional Review Board ◽  
Cystic Lesions ◽  
Radiological Findings ◽  
Cystic Neoplasms ◽  
Ras Mutation ◽  
Mucinous Cystic Neoplasms ◽  
Institutional Review

Background: Mucinous cystic lesions of pancreas harbor a pre-malignant potential thus necessitating their distinction from the non-mucinous ones. To make this distinction, EUS-FNA cytology along with cyst fluid CEA and amylase levels are utilized in addition to endoscopic and radiological findings. Evaluation of K-ras mutations has emerged as a useful adjunct for the evaluation of mucinous cystic neoplasms of the pancreas. Aim: We aimed to study mucinous cystic lesions of the pancreas diagnosed on EUS-FNA cytology, in conjunction with cyst fluid CEA and amylase levels and the frequency of K-ras mutation in a cohort of patients seen at the largest cancer hospital in our country. Materials and Methods: After approval from the institutional review board, all the cases of mucinous cystic lesions of pancreas evaluated between July 2005 and August 2019 were reviewed. Patient data, including age, gender, endoscopic and radiological findings, cytological and/or histological diagnosis, cyst fluid CEA, and amylase levels were collected. Results: Twenty-three patients enrolled in the study demonstrated an equal gender distribution with a mean age of 67.4 years. The sensitivity of EUS-FNA for mucinous cystic lesions of the pancreas was 84.6%. Cyst fluid CEA levels were elevated in some MCNs but not IPMNs resulting in a sensitivity of 37.5%. The specificity of cyst fluid amylase was 90%. K-ras mutation was found to have a sensitivity and specificity of 50% and 100% respectively, for mucinous lesions of the pancreas. Conclusion: EUS-FNA is a useful technique for evaluation of pancreatic cystic lesions, especially since cytological diagnosis can be augmented by cyst fluid CEA and amylase levels. K-ras analysis can add further to the diagnostic utility of EUS-FNA

scholarly journals Redo hypospadias repair: experience at a tertiary care children’s hospital

2012 ◽  
Vol 1 (1) ◽  
Author(s):  
Ahmed Al-Sayyad ◽  
John G. Pike ◽  
Michael P. Leonard
Keyword(s):  
Tertiary Care ◽  
Institutional Review Board ◽  
Hypospadias Repair ◽  
Urethral Plate ◽  
Institutional Review ◽  
Tubularized Incised Plate ◽  
Distal Shaft ◽  
The Status ◽  
Initial Severity

Objective: Treatment of patients with failed hypospadias repairs can be challenging.Our study aimed to determine the best type of redo repair dependingon the location and size of the urethral meatus, the status of the urethralplate and genital skin, the severity of residual chordee and the amount ofscar tissue.Methods: The Institutional Review Board approved our retrospective chart reviewof patients who had a redo hypospadias repair at our institution over the past6 years. We recorded the type and number of previous repair(s), the type andnumber of redo procedure(s),as well as the complications and functional outcomes.Results: There were 28 patients, aged 1–12 (mean 3.8) years, with failed hypospadiasrepairs. The initial severity of the hypospadias were as follows: perineal(1), penoscrotal (9), proximal shaft (1), mid-shaft (9), distal shaft (4), coronal(3) and mega-meatus (1). Of all the patients, 24 had 1 repair, 3 had 2 repairsand 1 had 3 repairs. The initial repairs comprised 11 tubularized island flaps(TIFs), 8 Snodgrass tubularized incised plate (TIP) techniques, 5 Mathieu repairs,1 Meatal Advancement and GlanuloPlasty Incorporated (MAGPI) technique,1 Pyramid, 1 Arap technique and 1 Thiersch-Duplay repair. Twenty-one of 28 patients had 1 redo operation, 5 had 2 redo operations, 1 had 3 redo operationsand 1 had 4 redo operations, for a total of 38 redo operations. Of these,26 were TIP techniques (68.4%), 3 were Mathieu (7.9%), 3 were TIF repairs(7.9%), 2 were onlay island flaps (5.3%) and 4 were buccal mucosal grafts(10.5%). Follow-up was 1–5 years (mean 3.5 yr). The final locations of urethralmeatus included glans (18), corona (6), mid-shaft (3) and penoscrotal (1).Complications after redo surgery comprised 4 urethrocutaneous fistulae, 2 meatalstenoses, 1 urethral stricture and 3 dehiscences. Sixteen patients were followedwith yearly uroflow with a Q-mean (mean uroflow) range of 3–14 mL/s (mean8.1 mL/s).Conclusion: The majority of hypospadias failures can be salvaged with one operation.The TIP repair is our procedure of choice in most cases. In the settingof a poor urethral plate, TIF or buccal mucosa may be necessary. Complicationsare not infrequent in redo procedures.

Outcomes of PD Patients at 6 Months

2017 ◽  
Vol 37 (1) ◽  
pp. 116-118 ◽  
Author(s):  
William Hoffman ◽  
Heena Sheth ◽  
Filitsa Bender ◽  
Beth Piraino
Keyword(s):  
Quality Care ◽  
Institutional Review Board ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
The Past ◽  
Institutional Review ◽  
Strong Focus ◽  
Comorbidity Index

The peritoneal dialysis (PD) patient population has grown rapidly in the past few years with concern over poor early outcomes. We report 6-month outcomes of incident PD patients in an experienced program with a strong focus on quality care. We analyzed data from an Institutional Review Board (IRB)- approved registry of all incident PD patients from January 1, 1991, to December 31, 2013, with follow-up to June 30, 2014. Time at risk began on the first day of training. Age, gender, race, diabetes mellitus (DM), Charlson comorbidity index (CCI), and albumin were collected at PD start. Exit-site infection (ESI), peritonitis, hospitalizations, and reasons for stopping PD were recorded. Multivariate analysis was done to examine outcomes.

scholarly journals Duodenal Leiomyosarcoma Mimicking a Pancreatic Pseudocyst

HPB Surgery ◽  
1994 ◽  
Vol 8 (1) ◽  
pp. 49-52 ◽  
Author(s):  
C. Sperti ◽  
C. Pasquali ◽  
F. Di Prima ◽  
R. Baffa ◽  
S. Pedrazzoli
Keyword(s):  
Smooth Muscle ◽  
Pancreatic Pseudocyst ◽  
Frozen Section ◽  
Exploratory Laparotomy ◽  
Cystic Mass ◽  
Tumour Markers ◽  
Cyst Fluid ◽  
Radiological Findings ◽  
Smooth Muscle Tumour

A case of duodenal leiomyosarcoma presenting as a cystic mass is reported. Amylase, tumour markers levels in the cyst fluid and radiological findings suggested an inflammatory pancreatic pseudocyst. Exploratory laparotomy and frozen section examination showed a smooth muscle tumour of the duodenum. Pancreatoduodenectomy with pylorus-preser vation was performed and the patient remained symptom-free at 8 months follow-up.

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 A277 DISCREPANCIES IN EUS-FNA CYTOPATHOLOGY AND SURGICAL SPECIMEN PATHOLOGY FOR HIGH RISK PANCREATIC MUCINOUS CYSTIC LESIONS: A CASE SERIES

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 155-156
Author(s):  
S Li ◽  
M Monachese ◽  
P James
Keyword(s):  
High Risk ◽  
Surgical Resection ◽  
Case Series ◽  
Surgical Pathology ◽  
Low Grade ◽  
Cystic Lesions ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Surgical Specimen

Abstract Background Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is the primary method of sampling pancreatic cystic lesions with reported specificity near 100% for diagnosing malignancy. Discrepant positive malignant cytopathology with final surgical pathology of pancreatic cystic lesions has not previously been described. Aims To present a case series and review the literature regarding the implications of positive malignant cytology with discrepant surgical pathology for high risk pancreatic mucinous cystic lesions. Methods Patient demographics, clinical history, procedure details, pathology evaluations and follow-up were collected. A thorough literature review was performed. Results Three patients with high-risk pancreatic cystic lesions on cross-sectional imaging underwent EUS-FNA evaluation. None of these patients had a history of pancreatitis. Cytology was reported as positive for adenocarcinoma in all patients by separate gastrointestinal cytopathologists. All patients underwent surgical resection. The pathology for all resected specimens were reported as intraductal papillary mucinous neoplasm. The resected cysts for two patients demonstrated foci of high-grade dysplasia and the third noted low grade dysplasia. All surgical pathology underwent consensus review by three separate gastrointestinal pathologists. None of the patients were treated with adjuvant chemotherapy. All patients have been followed post-operatively with surveillance magnetic resonance imaging with no evidence of recurrence to date (median follow-up time 239 days, range 133 – 447 days). Conclusions This phenomenon sheds light on the potential for variable interpretations of EUS-FNA cytopathology and surgical resection pathology for high risk pancreatic cystic neoplasms. EUS-FNA may identify foci of adenocarcinoma that is not seen on surgical pathology specimens. Further research is required to examine the long-term outcomes of these patients. Funding Agencies None

scholarly journals Highly Accurate Identification of Cystic Precursor Lesions of Pancreatic Cancer Through Targeted Mass Spectrometry: A Phase IIc Diagnostic Study

2018 ◽  
Vol 36 (4) ◽  
pp. 367-375 ◽  
Author(s):  
Karolina S. Jabbar ◽  
Liisa Arike ◽  
Caroline S. Verbeke ◽  
Riadh Sadik ◽  
Gunnar C. Hansson
Keyword(s):  
Mass Spectrometry ◽  
Pancreatic Cancer ◽  
Carcinoembryonic Antigen ◽  
Validation Cohort ◽  
Malignant Potential ◽  
Cyst Fluid ◽  
High Grade Dysplasia ◽  
High Grade ◽  
Cystic Lesions ◽  
Accurate Identification

Purpose Pancreatic cystic lesions are common incidental findings on imaging, but up to half may be forerunners of pancreatic cancer. Therefore, accurate differential diagnosis is crucial for correct patient management. Unfortunately, currently available diagnostic methods cannot robustly identify premalignant and malignant pancreatic cystic lesions. Methods Cyst fluid samples obtained by routine endoscopic ultrasound-guided aspiration were used for the analyses. In a cohort of 24 patients, eight biomarker candidates for malignant potential and high-grade dysplasia/cancer were identified by an explorative proteomic approach. Subsequently, a quantitative analysis, using 30 heavy-labeled peptides from the biomarkers and parallel reaction monitoring mass spectrometry, was devised, tested in a training cohort of 80, and prospectively evaluated in a validation cohort of 68 patients. End points were surgical pathology diagnosis/clinical follow-up. Diagnostic assessments were blinded to mass spectrometry results. Results The optimal set of markers for detecting malignant potential was a panel of peptides from mucin-5AC and mucin-2, which could discriminate premalignant/malignant lesions from benign with an accuracy of 97% (95% CI, 89% to 99%) in the validation cohort. This result compared favorably with the accuracy of standard analyses: cyst fluid carcinoembryonic antigen (61%; 95% CI, 46% to 74%; P < .001) and cytology (84%; 95% CI, 71% to 92%; P = .02). A combination of proteins mucin-5AC and prostate stem-cell antigen could identify high-grade dysplasia/cancer with an accuracy of 96% (95% CI, 90% to 99%), and detected 95% of malignant/severely dysplastic lesions, compared with 35% and 50% for carcinoembryonic antigen and cytology ( P < .001 and P = .003, respectively). Conclusion Targeted mass spectrometry analysis of just three cyst fluid biomarkers provides highly accurate identification and assessment of cystic precursors to pancreatic adenocarcinoma. Additional studies should determine whether the method can facilitate timely cancer diagnosis, successful intervention, and prevention.

scholarly journals Differentiation and management of hepatobiliary mucinous cystic neoplasms: a single centre experience for 8 years

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiaqi Gao ◽  
Junhao Zheng ◽  
Jingwei Cai ◽  
Mubarak Ali Kirih ◽  
Junjie Xu ◽  
...  
Keyword(s):  
Characteristic Curve ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Radical Resection ◽  
Left Lobe ◽  
Biliary Duct ◽  
Cystic Lesions ◽  
Simple Cyst ◽  
Cystic Neoplasms ◽  
Mucinous Cystic Neoplasms

Abstract Background Hepatobiliary mucinous cystic neoplasms (H-MCNs) are relatively rare cystic neoplasms in the liver. The differential diagnosis of H-MCNs remains big challenging, and the management and prognosis between the hepatic simple cyst (HSC) and H-MCNs are quite different. This study aimed to present our experience in the management of H-MCNs and provide a preoperative H-MCNs risk prediction nomogram to differentiating H-MCNs from liver cystic lesions. Methods 29 patients diagnosed with H-MCNs and 75 patients diagnosed with HSC between June 2011 and June 2019 at Zhejiang University School of medicine, Sir Run-Run Shaw Hospital were reviewed in this study. We analyzed the demographic and clinicopathological variables. Results US, CT, and MRI could accurately diagnose only 3.4%, 46.1%, and 57.1% of H-MCNs, respectively. After univariate analysis and multivariate logistic regression analysis, the variables significantly associated with H-MCNs were enhancement after contrast (p = 0.009), tumour located in the left lobe (p = 0.02) and biliary ductal dilation (p = 0.027). An H-MCNs risk predictive nomogram was constructed, which showed excellent discrimination (areas under the receiver operating characteristic curve were 0.940) and consistent calibration between the predicted probability and actual probability. Conclusion Among patients with H-MCNs, the location of the tumour, enhancement in CT scan, and biliary duct dilation are significantly independent risk factors. The appropriate treatment of H-MCNs is radical resection. Using our Nomogram could facilitate screening and identification of patients with liver cystic lesions.

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