scholarly journals Follow-up of patients with pseudotumoral chronic pancreatitis: outcome and surveillance

2018 ◽  
Vol 40 (2) ◽  
pp. 29-35
Author(s):  
F. I. Téllez-Âvila ◽  
Â. Villalobos-Garita ◽  
M. Giovannini ◽  
C. Chan ◽  
J. Hernandez-Calleros ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Pancreatic Adenocarcinoma ◽  
Endoscopic Ultrasound ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Surveillance Interval ◽  
Mass Lesions ◽  
Space Occupying Lesion

Aim: to follow up patients with pseudotumoral chronic pancreatitis (PCP) to assess their outcome and identify an optimal surveillance interval. Methods: data obtained prospectively were analyzed in a retrospective manner. Patients with clinical evidence of chronic pancreatitis (abdominal pain in the epigastrium, steatorrhea, and diabetes mellitus), endoscopic ultrasound (EUS) criteria > 4, and EUS-fine needle aspiration (FNA) were included. A pseudotumor was defined as a non-neoplastic space-occupying lesion, a cause of chronic pancreatitis that may mimic changes typical of pancreatic cancer on CT or endoscopic ultrasound but without histological evidence. A real tumor was defined as a neoplastic space-occupying lesion because of pancreatic cancer confirmed by histology. Results: thirty-five patients with chronic pancreatitis were included, 26 (74.2%) of whom were men. Nine (25.7%) patients were diagnosed with PCP and two (2/35; 5.7%) patients with PCP were diagnosed with pancreatic cancer on follow-up. The time between the diagnosis of PCP and pancreatic adenocarcinoma was 35 and 30 days in the two patients. Definitive diagnosis of pancreatic adenocarcinoma was made by surgery. In the remaining six patients with PCP, the median of follow-up was 11 months (range 1–22 months) and they showed no evidence of malignancy on surveillance. In the follow-up of patients without PCP but with chronic pancreatitis, none were diagnosed with pancreatic cancer. According to our data, older patients with chronic pancreatitis are at risk of PCP. Conclusion: according to characteristics of patient, detection of PCP should lead a surveillance program for pancreatic cancer with EUS-FNA in < 1 month or directly to surgical resection. Core tip: actually, there are no clear recommendations for follow-up of patients with chronic pancreatitis and solid pancreatic mass lesions. We followed-up patients with chronic pancreatitis and solid pancreatic mass lesions and we assessed the final outcome and identified an optimal surveillance interval. We found that almost one-third of patients with chronic pancreatitis had PCP, and 22.2% had unresectable pancreatic adenocarcinoma less than 2 mo after the initial diagnosis. Endoscopic ultrasound fine needle aspiration can miss malignancy in nearly 25% of patients with PCP.

scholarly journals Immunocytochemistry for MUC4 and MUC16 Is a Useful Adjunct in the Diagnosis of Pancreatic Adenocarcinoma on Fine-Needle Aspiration Cytology

2013 ◽  
Vol 137 (4) ◽  
pp. 546-551 ◽  
Author(s):  
Adam Horn ◽  
Subhankar Chakraborty ◽  
Parama Dey ◽  
Dhanya Haridas ◽  
Joshua Souchek ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Sensitivity And Specificity ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Needle Aspiration Cytology ◽  
Mass Lesions ◽  
Score Range

Context.—Diagnoses rendered as atypical/suspicious for malignancy on fine-needle aspiration (FNA) of pancreatic mass lesions range from 2% to 29% in various studies. We have identified the expression of 3 genes, MUC4, MUC16, and NGAL that are highly upregulated in pancreatic adenocarcinoma. In this study, we analyzed the expression of these markers in FNA samples to determine whether they could improve sensitivity and specificity. Objective.—To evaluate the utility of MUC4, MUC16, and NGAL in the evaluation of pancreatic FNA specimens. Design.—Records of pancreatic FNAs performed during 10 consecutive years were reviewed. Unstained sections from corresponding cell blocks were immunostained for MUC4, MUC16, and NGAL (polyclonal). Immunostaining was assessed using the H-score (range, 0–3). Any case with an H-score of &gt;0.5 was considered positive. Results.—Cases were classified using cytomorphologic criteria as adenocarcinoma (31 of 64; 48.4%), benign (17 of 64; 26.6%), and atypical/suspicious (16 of 64; 25%). On follow-up, all cases (100%; 31 of 31) diagnosed as carcinoma on cytology were confirmed on biopsy/resection samples or by clinical follow-up (such as unresectable disease). Of the cases diagnosed as atypical/suspicious, 69% (11 of 16) were found to be positive for adenocarcinoma and 31% (5 of 16) were benign on subsequent follow-up. Overall sensitivity and specificity, respectively, for the various markers for the detection of pancreatic adenocarcinoma were as follows: MUC4 (74% and 100%), MUC16 (62.9% and 100%), and NGAL (61.3% and 58.8%). In cases that were atypical/suspicious on cytology, expression of MUC4 and MUC16 was 100% specific for carcinoma with sensitivities of 63.6% and 66.7%, respectively. Conclusion.—Immunocytochemistry for MUC4 and MUC16 appears to be a useful adjunct in the classification of pancreatic FNA samples, especially in cases that are equivocal (atypical/suspicious) for adenocarcinoma on cytomorphologic assessment.

scholarly journals Pancreatic Tuberculosis or Autoimmune Pancreatitis

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Ayesha Salahuddin ◽  
Muhammad Wasif Saif
Keyword(s):  
Chronic Pancreatitis ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Autoimmune Pancreatitis ◽  
Needle Aspiration ◽  
Ultrasound Guided ◽  
Immunoglobulin G4 ◽  
Fine Needle ◽  
Pancreatic Tuberculosis

Introduction. Isolated pancreatic and peripancreatic tuberculosis is a challenging diagnosis due to its rarity and variable presentation. Pancreatic tuberculosis can mimic pancreatic carcinoma. Similarly, autoimmune pancreatitis can appear as a focal lesion resembling pancreatic malignancy. Endoscopic ultrasound-guided fine needle aspiration provides an effective tool for differentiating between benign and malignant pancreatic lesions. The immune processes involved in immunoglobulin G4 related systemic diseases and tuberculosis appear to have some similarities.Case Report. We report a case of a 59-year-old Southeast Asian male who presented with fever, weight loss, and obstructive jaundice. CT scan revealed pancreatic mass and enlarged peripancreatic lymph nodes. Endoscopic ultrasound-guided fine needle aspiration confirmed the presence ofmycobacterium tuberculosis. Patient also had high immunoglobulin G4 levels suggestive of autoimmune pancreatitis. He was started on antituberculosis medications and steroids. Clinically, he responded to treatment. Follow-up imaging showed findings suggestive of chronic pancreatitis.Discussion. Pancreatic tuberculosis and autoimmune pancreatitis can mimic pancreatic malignancy. Accurate diagnosis is imperative as unnecessary surgical intervention can be avoided. Endoscopic ultrasound-guided fine needle aspiration seems to be the diagnostic test of choice for pancreatic masses. Long-term follow-up is warranted in cases of chronic pancreatitis.

scholarly journals A rare non-oncological pancreatic mass: eosinophilic pancreatitis diagnosis through EUS-FNA

2019 ◽  
Vol 07 (02) ◽  
pp. E151-E154 ◽  
Author(s):  
Diogo De Moura ◽  
Rodrigo Rocha ◽  
José Jukemura ◽  
Vitor Brunaldi ◽  
Hugo Guedes ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Clinical Symptoms ◽  
Needle Aspiration ◽  
Pancreatic Mass ◽  
Eosinophilic Infiltration ◽  
Ultrasound Guided ◽  
Fine Needle

Abstract Background and study aims Eosinophilic pancreatitis (EP) is a rare etiology of chronic pancreatitis, and few cases have been reported. It is characterized by eosinophilic infiltration of the pancreas and elevated IgE levels. EP is difficult to distinguish from pancreatic cancer based on clinical symptoms and auxiliary exams. We present a case of EP and debate the routine performance of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for resectable pancreatic mass.

Surgical Diagnoses of Pancreatic Adenocarcinoma Not Found on Previous Endoscopic Ultrasound: A Case Series and Review of the Literature

2021 ◽  
pp. 000313482110545
Author(s):  
Vladimir Davidyuk ◽  
Neal Bhutiani ◽  
Maks K. Gold ◽  
Garrett F. Mortensen ◽  
Timothy Trestrail ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Adenocarcinoma ◽  
Endoscopic Ultrasound ◽  
Western Europe ◽  
Case Series ◽  
High Sensitivity ◽  
Fine Needle Biopsy ◽  
Needle Aspiration ◽  
Fine Needle ◽  
Final Pathology

Introduction Pancreatic cancer is a leading cause of death in North America and Western Europe with rising rates in the developing world. Endoscopic ultrasound (EUS) with FNA (fine needle aspiration) is a critical component in the evaluation and diagnosis of pancreatic lesions with a high sensitivity and specificity. In this paper, we report patients at our center who eventually developed pancreatic cancer despite an early negative EUS, and identifying factors that may result in a missed diagnosis. Methods The University of Louisville database was queried for patients who had a Whipple procedure for presumed benign disease and had a pre-operative EUS between 2008 and 2018. Patients who had pancreatic adenocarcinoma on final pathology were identified. Demographic, clinical, EUS, operative, and pathologic details were reviewed for each case in efforts to identify factors associated with failure to diagnose a pancreatic malignancy on EUS. Results Five patients who had pancreatic adenocarcinoma on final pathology were reviewed in detail and their cases are presented in the paper. Four of the patients had dilation of the common bile duct, three had chronic pancreatitis. Two of them had previous surgery on the pancreas or bile ducts. Conclusions All of the patients presented in the paper had variables that made their EUS evaluation challenging. A high index of suspicion must be maintained in patients that do not improve after appropriate treatment of their strictures or pancreatic lesions. In the future, new techniques, such as fine needle biopsy and biomarker assays, may improve diagnosis accuracy.

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