scholarly journals Cystic Lesions of the Pancreas: Differential Diagnosis and Cytologic-Histologic Correlation

2019 ◽  
Vol 144 (1) ◽  
pp. 47-61 ◽  
Author(s):  
Amrou Abdelkader ◽  
Bryan Hunt ◽  
Christopher P. Hartley ◽  
Nicole C. Panarelli ◽  
Tamara Giorgadze
Keyword(s):  
Cyst Fluid ◽  
Integrative Approach ◽  
Cystic Degeneration ◽  
Pancreatic Cysts ◽  
Molecular Characteristics ◽  
Molecular Testing ◽  
Team Approach ◽  
Cystic Lesions ◽  
Cystic Neoplasms ◽  
Fluid Analysis

Context.— Pancreatic cystic lesions (PCLs) are very common, and their detection is increasing with the advances in imaging techniques. Because of the major implications for management, distinguishing between neoplastic and nonneoplastic PCLs is critical. Neoplastic cysts with potential to progress into cancer include mucinous PCLs (intraductal papillary mucinous neoplasms and mucinous cystic neoplasms) and nonmucinous cysts (solid pseudopapillary tumors, serous cystic neoplasms, and neuroendocrine tumors with cystic degeneration). Nonneoplastic cysts with no risk of malignant transformation include pseudocysts, retention cysts, lymphoepithelial cysts, cystic pancreatic lymphangioma, and duplication cyst/ciliated foregut cysts. The role of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology with cyst fluid analysis in the diagnosis of PCLs has evolved during the last decade; however, a definitive diagnosis on cytologic specimens is hampered by the sparse cellularity and can be challenging. EUS-FNA can play an important role to differentiate low-risk from high-risk pancreatic cysts and to distinguish between patients with cysts who need clinical follow-up versus those who require surgery. Objective.— To provide an integrative approach to diagnose pancreatic cystic lesions using EUS-FNA cytology and cyst fluid analysis, along with clinical, radiologic, histologic, genetic, and molecular characteristics. Data Sources.— The review and analysis of the latest literature describing pancreatic cystic lesions. Conclusions.— Accurate diagnosis of PCLs requires a multidisciplinary and multimodal team approach, including the integration of clinical findings, imaging, cytology, cyst fluid analysis, and molecular testing.

Utility of EUS-FNA and Cyst Fluid Analysis in the Diagnosis of Pancreatic Cysts: Correlation with Histopathology in 51 Patients

2006 ◽  
Vol 63 (5) ◽  
pp. AB278 ◽  
Author(s):  
Siriboon Attasaranya ◽  
Shireen A. Pais ◽  
Julia K. Leblanc ◽  
Stuart Sherman ◽  
Lee Mchenry ◽  
...  
Keyword(s):  
Cyst Fluid ◽  
Pancreatic Cysts ◽  
Fluid Analysis

The Differentiation between Pancreatic Neoplastic Cysts and Pancreatic Pseudocyst

2005 ◽  
Vol 94 (2) ◽  
pp. 161-164 ◽  
Author(s):  
J. Sand ◽  
I. Nordback
Keyword(s):  
Pancreatic Pseudocyst ◽  
Emission Tomography ◽  
Cystic Lesions ◽  
Imaging Studies ◽  
Cystic Neoplasms ◽  
Fluid Analysis ◽  
Positron Emission ◽  
Serous Cystadenomas ◽  
History Of ◽  
Quality Imaging

The number of small and often asymptomatic cystic lesions detected in pancreas has increased during the last decade. Historically the vast majority of the pancreatic cystic lesions were considered pseudocysts, but in recent series the incidence of various neoplastic cysts, such as intraductal papillary mucinous neoplasm, serous cystadenomas and cystic endocrine tumours, has increased. The possible malignant potential in these cystic neoplasms warrants careful diagnostic workup to choose the optimal treatment for each patient. Patient's age, symptoms and a possible history of acute or chronic pancreatitis with known aetiology together with high quality imaging studies are important in the differential diagnosis between pseudocysts and neoplastic cysts. Endoscopic ultrasound, cyst fluid analysis and positron emission tomography may be used in selected patients, but the accuracy of these methods needs further investigation.

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.

Cyst Fluid Analysis to Improve the Differential Diagnosis of Pancreatic Cysts

2016 ◽  
Vol 111 ◽  
pp. S31
Author(s):  
Enqiang Linghu ◽  
Wei Zhang ◽  
Zhiqiang Wang ◽  
Xiangdong Wang ◽  
Ping Tang ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cyst Fluid ◽  
Pancreatic Cysts ◽  
Fluid Analysis

scholarly journals The Role of Confocal Endomicroscopy in the Diagnosis and Management of Pancreatic Cysts

2021 ◽  
pp. 41-49
Author(s):  
Margaret G Keane ◽  
Stephen P Pereira
Keyword(s):  
Diagnostic Accuracy ◽  
Needle Aspiration ◽  
Diagnostic Techniques ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Pancreatic Cysts ◽  
Cystic Lesions ◽  
Cystic Neoplasms ◽  
Common Clinical Finding

Pancreatic cystic lesions are an increasingly common clinical finding. Current diagnostic techniques cannot reliably differentiate patients with high-risk lesions requiring surgical resection from those that can be safely surveyed or discharged. As a result, some patients may undergo unnecessary surgery with associated morbidity while others enter long-term surveillance with associated healthcare costs. Needle-based confocal laser endomicroscopy enables real time microscopic examination of the epithelial lining of a cyst wall at the time of a standard endoscopic ultrasound examination. The procedure is associated with low rates of adverse events, especially when the probe is loaded into the fine-needle aspiration needle before the procedure and examination times are limited. Needle-based confocal laser endomicroscopy has consistently been shown to have better diagnostic accuracy than cytology, which is often paucicellular and non-diagnostic in pancreatic cystic lesions. Studies have shown that diagnostic accuracy in needle-based confocal laser endomicroscopy is 84–95% in mucinous lesions and 39–99% in serous lesions. However, this technology is expensive and its place in diagnostic algorithms remains uncertain. Despite this, health economic analyses in certain health systems have been favourable, largely because of its potential to be able to discharge patients with benign lesions, such as serous cystic neoplasms, from long-term surveillance. Widespread adoption of this technology is unlikely but it has the potential to have an important role in indeterminate pancreatic cystic lesions.

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.

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