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 Branch Duct Intraductal Papillary Mucinous Neoplasms: Recommendations for Follow-Up and Surgery

2020 ◽  
Vol 109 (1) ◽  
pp. 34-41
Author(s):  
A. Caravati ◽  
S. Andrianello ◽  
T. Pollini ◽  
M. Biancotto ◽  
A. Balduzzi ◽  
...  
Keyword(s):  
High Volume ◽  
Cystic Neoplasm ◽  
Pancreatic Cysts ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Increased Risk ◽  
Mucinous Neoplasms ◽  
Risk Of Malignancy

Background and Aims: Pancreatic cysts are increasingly diagnosed, mainly during abdominal imaging performed for other reasons. Between pancreatic cystic neoplasm, intraductal papillary mucinous neoplasms are the most common pre-malignant entities. Intraductal papillary mucinous neoplasms involving side branches overall harbor a low risk of malignancy, and in the recent past, a progressively more conservative approach has been consolidated. Purpose of this report is to summarize the evidence supporting the current practice for the management of branch duct intraductal papillary mucinous neoplasm and to offer a useful practical guide from first observation to post-operative follow-up. Materials and Methods: Review of the most important scientific literature on intraductal papillary mucinous neoplasms was made. In this review article, we also report the experience of a high volume center in managing Pancreatic cystic neoplasms. Results: The correct management during surveillance still is a matter of debate, since many guidelines have been published suggesting different clinical approaches. Recently, follow-up discontinuation has also been proposed in selected cases. Conclusion: Despite significant improvements made by the increase of evidence, selecting surgical candidates because of an increased risk of malignant progression remains an unsolved issue and a hot topic for pancreatologists.

scholarly journals Management Guidelines for Pancreatic Cystic Lesions: Should we Adopt or Adapt the Current Roadmaps?

2019 ◽  
Vol 28 (4) ◽  
pp. 495-501 ◽  
Author(s):  
Filipe Vilas-Boas ◽  
Guilherme Macedo
Keyword(s):  
Needle Aspiration ◽  
Pancreatic Cysts ◽  
Cystic Lesions ◽  
International Consensus ◽  
Cross Sectional ◽  
Fluid Analysis ◽  
Mucinous Neoplasms ◽  
Cross Sectional Imaging ◽  
History Of ◽  
International Consensus Guidelines

Pancreatic cystic lesions are very prevalent, especially in elderly patients and are increasingly being diagnosed because of the massive use of cross sectional imaging. Our knowledge about the natural history of these lesions is limited, especially in the case of intraductal papillary mucinous neoplasms. This fact explains why scientific societies guidelines statements are based on evidence graded as very low quality and helps the understanding of some of the different guidelines recommendations. Several guidelines have been recently revised to incorporate the new evidence published in the literature with the aim to help clinicians make the best decisions. American Gastroenterological Association guidelines, a revision of the International Consensus Guidelines, the American College of Gastroenterology and the European Study Group guidelines are the most recent. Herein we review the current guidelines on pancreatic cysts and focus our discussion on controversies and updates about the best imaging modalities, the indications for endoscopic ultrasound guided fine needle aspiration, cyst fluid analysis, indications for resection and surveillance strategies.

The role of molecular biology in the diff erential diagnosis of pancreatic cystic neoplasias

2021 ◽  
Vol 75 (5) ◽  
pp. 417-423
Author(s):  
Ivo Horný ◽  
Tomáš Hucl
Keyword(s):  
Precancerous Lesions ◽  
Clinical Status ◽  
Pancreatic Disease ◽  
Pancreatic Cysts ◽  
Cytological Examination ◽  
Asymptomatic Patients ◽  
Wide Range ◽  
Risk Of Malignancy ◽  
History Of

Summary: Pancreatic cysts have been detected ever more frequently in recent years due to the advanced and wider use of imaging methods. We find them on CT or MR also in asymptomatic patients who do not have a history of any pancreatic disease. Pancreatic cystic lesions represent a wide range of pathological changes from simple cysts through precancerous lesions to malignant cysts. Accurate dia­gnosis remains difficult despite the combination of clinical status evaluation, imaging findings, and bio­chemical and cytological examination. Molecular bio­logical examination of cyst aspirate obtained by endosonographic examination increases the detection rate of mucinous cysts (KRAS/GNAS/VHL) and cysts with a high risk of malignancy (KRAS/GNAS/p53/PIK3CA/PTEN/CDKN2A/SMAD4) and optimizes therapeutic approach. Larger prospective validation studies are necessary to make this costly and limited method a routine part of clinical practice. Key words: molecular bio­logy – neoplasia – pancreatic cysts

scholarly journals Survival in Cystic Neoplasms of the Pancreas

2009 ◽  
Vol 23 (8) ◽  
pp. 537-542 ◽  
Author(s):  
Ali Cadili ◽  
Amy Bazzerelli ◽  
Sipi Garg ◽  
Robert Bailey
Keyword(s):  
Overall Survival ◽  
Pancreatic Cyst ◽  
Patient Survival ◽  
Survival Rates ◽  
Pancreatic Cysts ◽  
Cystic Neoplasms ◽  
Patient Age ◽  
Patient Âgé ◽  
History Of ◽  
Pancreatic Cystic Neoplasms

BACKGROUND: The natural history of pancreatic cystic neoplasms remains poorly understood despite growing evidence on the subject. Pancreatic cysts display a wide spectrum of pathological phenotypes, each associated with a different prognostic implication. Many pancreatic cysts are of undetermined malignant potential at presentation and remain so until surgically resected. While the survival rates of patients with malignant cysts are known to be poor, survival rates in patients with undetermined pancreatic cysts are unknown.OBJECTIVE: To identify the factors associated with survival in a group of patients diagnosed with a pancreatic cyst(s).METHODS: The present study was a retrospective multicentre review of pancreatic cystic neoplasms. All patients with a diagnosis of a neoplastic pancreatic cyst from 1994 to 2003 were identified at five different institutions in Edmonton, Alberta. The data collected included patient age, sex, imaging modality, cyst location, cyst size, number of cysts, comorbid illnesses, history of upper abdominal surgery, previous cancer, previous or concurrent metastases, symptoms (pain, upper gastrointestinal bleeding, signs of biliary obstruction, nausea/vomiting), remarkable radiological features, elevated amylase or lipase, type of pancreatic surgery, final pathology (benign or malignant) and overall survival. Survival models were used to assess whether any covariates were predictors of the survival time. Patient data were plotted using the Kaplan-Meier method. The resulting plot was used to calculate survival in the cohort.RESULTS: In total, 64 patients were identified as having neoplastic pancreatic cysts from 1994 to 2003 at the five institutions. The median overall patient survival time was 86 months. The median age at diagnosis for the patient population was 73 years, with 40 patients being women. Univariate analysis revealed that the risk of death was associated with patient age, sex and history of major comorbid illness. Multivariate models identified increased patient age and male sex as the factors that correlated most strongly with decreased overall survival.CONCLUSION: Overall survival in patients with neoplastic pancreatic cysts is determined by patient factors (ie, age and sex) rather than factors descriptive of the cyst such as size and morphology. No conclusions could be made regarding the relationship between cyst pathology and patient survival.

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.

scholarly journals A novel approach for selecting combination clinical markers of pathology applied to a large retrospective cohort of surgically resected pancreatic cysts

2016 ◽  
Vol 24 (1) ◽  
pp. 145-152 ◽  
Author(s):  
David L Masica ◽  
Marco Dal Molin ◽  
Christopher L Wolfgang ◽  
Tyler Tomita ◽  
Mohammad R Ostovaneh ◽  
...  
Keyword(s):  
Pancreatic Cyst ◽  
Pancreatic Cysts ◽  
Clinical Markers ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Cystic Neoplasms ◽  
Mucinous Cystic Neoplasms ◽  
Serous Cystadenomas ◽  
Mucinous Neoplasms ◽  
Independent Cohort ◽  
Solid Pseudopapillary Neoplasms

Objective: Our objective was to develop an approach for selecting combinatorial markers of pathology from diverse clinical data types. We demonstrate this approach on the problem of pancreatic cyst classification. Materials and Methods: We analyzed 1026 patients with surgically resected pancreatic cysts, comprising 584 intraductal papillary mucinous neoplasms, 332 serous cystadenomas, 78 mucinous cystic neoplasms, and 42 solid-pseudopapillary neoplasms. To derive optimal markers for cyst classification from the preoperative clinical and radiological data, we developed a statistical approach for combining any number of categorical, dichotomous, or continuous-valued clinical parameters into individual predictors of pathology. The approach is unbiased and statistically rigorous. Millions of feature combinations were tested using 10-fold cross-validation, and the most informative features were validated in an independent cohort of 130 patients with surgically resected pancreatic cysts. Results: We identified combinatorial clinical markers that classified serous cystadenomas with 95% sensitivity and 83% specificity; solid-pseudopapillary neoplasms with 89% sensitivity and 86% specificity; mucinous cystic neoplasms with 91% sensitivity and 83% specificity; and intraductal papillary mucinous neoplasms with 94% sensitivity and 90% specificity. No individual features were as accurate as the combination markers. We further validated these combinatorial markers on an independent cohort of 130 pancreatic cysts, and achieved high and well-balanced accuracies. Overall sensitivity and specificity for identifying patients requiring surgical resection was 84% and 81%, respectively. Conclusions: Our approach identified combinatorial markers for pancreatic cyst classification that had improved performance relative to the individual features they comprise. In principle, this approach can be applied to any clinical dataset comprising dichotomous, categorical, and continuous-valued parameters.

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.

scholarly journals Prevalence of pancreatic cystic neoplasms on imaging exams: association with signs of malignancy risk

2018 ◽  
Vol 51 (4) ◽  
pp. 218-224 ◽  
Author(s):  
Aline Falqueto ◽  
Gustavo Lemos Pelandré ◽  
Mariânges Zadrozny Gouvêa da Costa ◽  
Marcelo Souto Nacif ◽  
Edson Marchiori
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Pancreatic Cysts ◽  
Resonance Imaging ◽  
Cystic Neoplasms ◽  
Cross Sectional ◽  
Malignancy Risk ◽  
Pancreatic Cystic Neoplasms

Abstract Objective: To analyze the prevalence of cystic lesions of the pancreas on imaging exams and their association with signs of malignancy risk. Materials and methods: This was an observational cross-sectional study, in which we evaluated 924 sequential computed tomography and magnetic resonance imaging scans of the abdomen. For all of the patients included in the study, we reviewed the demographic data available in the medical records and evaluated the images. Results: Cysts were observed in 4.5% of patients, the prevalence of cysts being highest (7.6%) in patients over 60 years of age. Lesions were detected at higher rates on magnetic resonance imaging and in patients with pancreatic symptoms (6.1% and 42.9%, respectively). Signs of malignancy risk were observed in 26.3% of the patients, more frequently in those who were male and over 60 years of age. Conclusion: The prevalence of pancreatic cysts was 4.5%. Signs of malignancy risk were observed in 26.3% of the cystic neoplasms identified.

scholarly journals The Evolving Role of Pathology in New Developments, Classification, Terminology, and Diagnosis of Pancreatobiliary Neoplasms

2017 ◽  
Vol 141 (3) ◽  
pp. 366-380 ◽  
Author(s):  
Michelle D. Reid ◽  
Melinda M. Lewis ◽  
Field F. Willingham ◽  
N. Volkan Adsay
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pancreatic Cysts ◽  
Routine Practice ◽  
Resonance Imaging ◽  
Cystic Neoplasms ◽  
Ki 67 ◽  
Mucinous Neoplasms ◽  
Serous Cystic Neoplasms ◽  
Intraepithelial Neoplasms

Pancreatobiliary tract lesions are increasingly being discovered because of more sensitive imaging modalities. Magnetic resonance imaging has identified incidental pancreatic cysts in 13.5% of patients of progressively increasing age. Pancreatobiliary tissue is more accessible through endoscopic ultrasound and magnetic resonance imaging–guided biopsy procedures, and is now an integral part of pathologists' routine practice. Accordingly, several new tumor categories have been recently recognized, including intraductal tubulopapillary neoplasm, a new addition to tumoral intraepithelial neoplasms. Other entities have been reclassified, including the recent transition to 2-tiered grading of preinvasive neoplasms, as well as new perspectives on the distinctive biologic behavior of oncocytic intraductal papillary mucinous neoplasms (IPMNs) compared with other IPMN subtypes. This has led to proposals for revised staging of virtually every segment of the pancreatobiliary tree, with theranostic markers becoming an integral part of workup. Ki-67 is now an integral part of the classification of neuroendocrine tumors, with new definitions of “high-grade neuroendocrine carcinoma.” Although bile duct brushings have opened new avenues for diagnosis, their sensitivity remains low and often requires concomitant fluorescent in situ hybridization to better define ambiguous cases. Various molecular pathways have been elucidated for pancreatic cysts, including KRAS for ductal neoplasia, GNAS for intestinal IPMNs, RNF3 for mucinous cysts, and VHL for serous cystic neoplasms, all key players in diagnostic workup. Integration of these updates into our understanding of pancreatobiliary disease requires active engagement of pathologists for appropriate specimen triage, judicious interpretation of results, and incorporation into reporting and staging. They also provide exciting opportunities for targeted therapy.

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.

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