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Hirokawa T, Kobayashi M, Ueda G, Shamoto T, Mitsui A, Kuwabara Y, Ogawa R, Takahashi H, Matsuo Y, Takahashi S, Takiguchi S. Serous Cystic Neoplasm With Typical Clinical Findings and Perineural Invasion. Pancreas 2022; 51:e69-e71. [PMID: 35775643 DOI: 10.1097/mpa.0000000000002038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Tirkes T, Patel AA, Tahir B, Kim RC, Schmidt CM, Akisik FM. Pancreatic cystic neoplasms and post-inflammatory cysts: interobserver agreement and diagnostic performance of MRI with MRCP. Abdom Radiol (NY) 2021; 46:4245-4253. [PMID: 34014363 DOI: 10.1007/s00261-021-03116-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to answer several clinically relevant questions; (1) the interobserver agreement, (2) diagnostic performance of MRI with MRCP for (a) branch duct intraductal papillary mucinous neoplasms (BD-IPMN), mucinous cystic neoplasms (MCN) and serous cystic neoplasms (SCN), (b) distinguishing mucinous (BD-IPMN and MCN) from non-mucinous cysts, and (c) distinguishing three pancreatic cystic neoplasms (PCN) from post-inflammatory cysts (PIC). METHODS A retrospective analysis was performed at a tertiary referral center for pancreatic diseases on 71 patients including 44 PCNs and 27 PICs. All PCNs were confirmed by surgical pathology to be 17 BD-IPMNs, 13 MCNs, and 14 SCNs. Main duct and mixed type IPMNs were excluded. Two experienced abdominal radiologists blindly reviewed all the images. RESULTS Sensitivity of two radiologists for BD-IPMN, MCN and SCN was 88-94%, 62-69% and 57-64%, specificity of 67-78%, 67-78% and 67-78%, and accuracy of 77-82%, 65-75% and 63-73%, respectively. There was 80% sensitivity, 63-73% specificity, 70-76% accuracy for distinguishing mucinous from non-mucinous neoplasms, and 73-75% sensitivity, 67-78% specificity, 70-76% accuracy for distinguishing all PCNs from PICs. There was moderate-to-substantial interobserver agreement (Cohen's kappa: 0.65). CONCLUSION Two experienced abdominal radiologists had moderate-to-high sensitivity, specificity, and accuracy for BD-IPMN, MCN, and SCN. The interobserver agreement was moderate-to-substantial. MRI with MRCP can help workup of incidental pancreatic cysts by distinguishing PCNs from PICs, and premalignant mucinous neoplasms from cysts with no malignant potential.
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Affiliation(s)
- Temel Tirkes
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd UH 0663, Indianapolis, IN, 46202, USA.
| | - Aashish A Patel
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd UH 0663, Indianapolis, IN, 46202, USA
| | - Bilal Tahir
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd UH 0663, Indianapolis, IN, 46202, USA
| | - Rachel C Kim
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Fatih M Akisik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, 550 N. University Blvd UH 0663, Indianapolis, IN, 46202, USA
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Murtha TD, Cornman-Homonoff J, Ayyagari R, Zhang X, Salem RR. A Novel Treatment for Metastatic Serous Cystadenocarcinoma Using a Microwave Ablation: Case Report and Review of the Literature. Pancreas 2021; 50:434-440. [PMID: 33835976 DOI: 10.1097/mpa.0000000000001785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ABSTRACT The incidence of pancreatic cystic neoplasms has grown because of increased detection. Among these lesions, serous cystadenoma was traditionally thought to be universally benign and indolent. However, there is an exceedingly rare malignant variant of serous cystadenoma known as serous cystadenocarcinoma (SCAC) that can exhibit local invasion into adjacent structures, hepatic implants, and metastatic spread to the abdominal viscera. Diagnosis of SCAC can be challenging as it is histologically identical to serous cystadenoma. To better understand this entity, a review of all published accounts of SCAC was performed in which tumor and patient factors were characterized. In addition, we present the case of a 49-year-old woman who was found to have a solitary hepatic metastasis due to SCAC, 11 years after a distal pancreatectomy for serous cystadenoma. She was successfully treated with percutaneous microwave ablation and has no evidence of recurrence 3 years later. This report details the first published account of percutaneous ablation in such a setting. Compared with hepatectomy, hepatic ablation may offer a less invasive but equally effective treatment option in well-selected patients.
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Affiliation(s)
| | | | | | - Xuchen Zhang
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Ronald R Salem
- From the Division of Surgical Oncology, Department of Surgery
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Kawai M, Fukuda A, Yogo A, Kozu T, Taira K, Okuno T, Shirase T, Matsumoto A, Kawanami C, Seno H. A case of a malignant serous neoplasm of the pancreas with synchronous vascular invasion and metachronous metastases. Clin J Gastroenterol 2020; 13:1347-1354. [PMID: 32880811 DOI: 10.1007/s12328-020-01223-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
Serous neoplasms (SNs) of the pancreas are usually considered benign tumors. However, they rarely manifest malignant behaviors. Here we present a case of malignant SN and review the literature of malignant SN. A 71-year-old woman presented to our hospital with a palpable abdominal mass. Imaging studies revealed a 7 cm mass with a cluster of microcysts having a honeycomb appearance in the head of the pancreas, which invaded the superior mesenteric vein (SMV). After being clinically diagnosed with SN, pancreaticoduodenectomy was performed with resection of limited SMV. Microscopically, the tumor was diagnosed as an SN concomitant with the tumor thrombus in the SMV. Four years after the surgery, two liver tumors and two peritoneal nodules were detected and three of them were surgically resected. All of those lesions had a honeycomb appearance in their cut surfaces and they were microscopically indistinguishable from the originally resected SN. A review of the literature identified 22 cases of malignant metastatic SNs published to date. Even though extremely rare, metachronous metastasis could occur in SNs of the pancreas. Local invasion indicated an increased likelihood of future metastasis. Thus, periodic surveillance should be considered for SNs after resection, especially when they have a local invasion.
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Affiliation(s)
- Munenori Kawai
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Akihisa Fukuda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akitada Yogo
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takumi Kozu
- Department of Surgery, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-0046, Japan
| | - Kaoru Taira
- Taira Clinic of Gastroenterological Medicine, 3-33-1 Tsukinowa, Otsu, Shiga, 520-2152, Japan
| | - Tomoko Okuno
- Department of Pathology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-0046, Japan
| | - Tomoyuki Shirase
- Department of Pathology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-0046, Japan
| | - Atsushi Matsumoto
- Department of Gastroenterology, Tenri Yorozu Sodanjo Hospital, 200 Mishima-cho, Tenri, Nara, 632-0015, Japan
| | - Chiharu Kawanami
- Department of Gastroenterology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-0046, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Wu YHA, Samuels JM, Harnke B, Negrini D, Al-Musawi MH, Meguid C, Ahrendt S, Schulick RD, Del Chiaro M, Oba A. Multifocal/diffuse pancreatic serous cystic neoplasms: Systematic review with a new case. Pancreatology 2020; 20:902-909. [PMID: 32418758 DOI: 10.1016/j.pan.2020.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES Pancreatic cystic neoplasms (PCNs) are common, among which 13%-23% are serous cystic neoplasms (SCNs). However, diffuse and multifocal variants of SCNs are extremely rare. The differential diagnosis of SCNs from other PCNs is important as the former entities are benign and do not become invasive. OBJECTIVE This study analyzes the clinical characteristics of multifocal/diffuse SCN through a systematic review of the literature and a case report. METHODS A comprehensive literature search was executed in the Ovid MEDLINE, Embase, and Google Scholar databases. The search strategy was designed to capture the concept of multifocal/diffuse SCN cases with sufficient clinical information for detailed analysis. Using the final included articles, we analyzed tumor characteristics, diagnostic modalities used, initial management and indications, and patient outcomes. RESULTS A review of 262 articles yielded 19 publications with 22 cases that had detailed clinical information. We presented an additional case from our institution database. The systematic review of 23 cases revealed that the diffuse variant is more common than the multifocal variant (15 vs 8 cases, respectively). Patients were managed with surgical intervention, conservative treatment, or conservative treatment followed by surgical intervention. Indications for surgery following conservative management mainly included new onset or worsening of symptoms. Only one case reported significant tumor growth after attempting an observational approach. No articles reported recurrence of SCN after pancreatectomy, and no articles reported mortality related to multifocal/diffuse SCNs. CONCLUSION Despite their expansive-growing and space-occupying characteristics, multifocal/diffuse SCNs should be treated similarly to their more common unifocal counterpart.
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Affiliation(s)
- Y H Andrew Wu
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Jason M Samuels
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Ben Harnke
- Strauss Health Sciences Library, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel Negrini
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; Department of Anesthesiology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mohammed H Al-Musawi
- Clinical Trials Office, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Cheryl Meguid
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Ahrendt
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA
| | - Richard D Schulick
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA
| | - Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; University of Colorado Cancer Center, Aurora, CO, USA.
| | - Atsushi Oba
- Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Pointer L, Rothermel LD, Strosberg C, Anaya D, Hodul P. Giant symptomatic serous cystadenoma mimicking carcinoma: A case report and literature review. Int J Surg Case Rep 2019; 60:106-110. [PMID: 31212091 PMCID: PMC6581980 DOI: 10.1016/j.ijscr.2019.05.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/19/2019] [Accepted: 05/23/2019] [Indexed: 02/07/2023] Open
Abstract
The diagnosis of serous cystadenoma is challenging. Surgery may be indicated for select serous cystadenoma. Serous cystadenocarcinoma is a rare entity and histologically indistinguishable from its benign counterpart.
Introduction Advanced imaging has led to an increase in the incidental diagnosis of pancreatic cysts. Serous cystadenomas (SCAs) account for nearly 30% of cases. These are typically considered benign lesions but up to 16% of cases are resected for aggressive behavior and symptoms. Presentation of case A 64 year old female presented with a large incidental cyst in the pancreatic body. Pre-operative imaging conferred a diagnosis of SCA. After 2 years the cyst grew resulting in abdominal pain. Enlargement was associated with splenic vein occlusion and varices of the short gastric vessels. This change in behavior was concerning for malignant transformation. The cyst was resected by distal pancreatectomy and splenectomy. The patient recovered with minimal morbidity. Final pathology revealed a 15.5 × 10.3 × 8.5 cm SCA with negative margins. Discussion In this case a patient presents with aggressive radiographic features and new symptoms suggesting malignant transformation of a previously diagnosed SCA on imaging. Although malignant variants can be diagnosed by findings of metastatic deposits at the time of surgery or as recurrence years later, histologic findings cannot discriminate benign from malignant potential. Preoperative imaging is challenging with erroneous characterization in nearly 60% of cases. Conclusion Based on the low risk of malignancy, selective surgical resection for SCA appears warranted. Accepted indications for surgery include development of symptoms or concern for correct diagnosis in a medically fit individual. Routine resection for cysts >4 cm has been suggested however, prospective studies are needed to determine benefit over risk rationale.
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Affiliation(s)
- Lauren Pointer
- University of South Florida, Gastroenterology, 12901 Bruce B. Downs Blvd., MDC 82, Tampa, FL, 33612, United States.
| | - Luke D Rothermel
- Moffitt Cancer Center, Department of Gastrointestinal Oncology, 12902 Magnolia Drive, Tampa, FL, 33612, United States.
| | - Carolina Strosberg
- Moffitt Cancer Center, Department of Anatomic Pathology, 12902 Magnolia Drive, Tampa, FL, 33612, United States.
| | - Daniel Anaya
- Moffitt Cancer Center, Department of Gastrointestinal Oncology, 12902 Magnolia Drive, Tampa, FL, 33612, United States.
| | - Pamela Hodul
- Moffitt Cancer Center, Department of Gastrointestinal Oncology, 12902 Magnolia Drive, Tampa, FL, 33612, United States.
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Cystadenoma of Minor Salivary Gland With Cervical Metastasis: Benign or Malignant? J Oral Maxillofac Surg 2017; 76:670-675. [PMID: 28806540 DOI: 10.1016/j.joms.2017.07.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 11/24/2022]
Abstract
A cystadenoma originating in the salivary gland is a rare neoplasm that can originate from the major or minor salivary glands. Although this tumor has the potential to recur if it is incompletely excised, it has been regarded as a benign tumor because it has not been determined to be associated with local tissue destruction or metastasis. This report serves as an update to the current understanding of cystadenoma. The patient in this case study presented with a recurrent painless mass in her left retromolar and submandibular regions that had persisted for more than 2 years. Histologic analysis showed that this lesion was a recurrent cystadenoma of the minor salivary gland, with cervical lymph nodes testing positive for tumor cells. After more than 3 years of clinical follow-up, no signs of recurrence were observed. A case of cystadenoma with cervical metastasis is presented; further attention should be paid to patients with recurrent cystadenoma that also might contain lymph node metastasis.
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Sriussadaporn S, Sriussadaporn S, Pak-art R, Kritayakirana K, Prichayudh S, Samorn P. Surgical treatments of cystic neoplasms of the pancreas: an Asian university hospital experience. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0901.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Premalignant and malignant cystic neoplasms of the pancreas are relatively rare, but absolute indications for surgical resection. Modern imaging modalities have increased recognition of asymptomatic cysts resulting in therapeutic dilemmas of whether surgery or observation is appropriate.
Objectives
To examine our surgical experience with cystic neoplasms of the pancreas.
Methods
A retrospective study of patients who had cystic neoplasms of the pancreas and underwent surgical resections from June 2000 to April 2013. Presenting symptoms, surgical procedures, pathological diagnoses, and postoperative complications were analyzed.
Results
Data from 16 patients were examined. Two patients had asymptomatic cystic neoplasms. Fourteen had symptoms ranging from 2 days to 6 years before diagnosis and surgery. Six patients underwent pylorus preserving pancreaticoduodenectomy, 4 underwent distal pancreatectomy with splenectomy, 2 underwent splenic preserving distal pancreatectomy, and 1 each underwent a classical Whipple operation, total pancreatectomy, distal pancreatectomy with splenectomy with partial resection of the posterior gastric wall, and distal pancreatectomy with splenectomy with left colectomy. The operative time ranged from 150 to 450 minutes. Operative blood transfusion ranged from 0 to 5 units. Four patients had mucinous cystadenoma, 4 had intraductal papillary mucinous neoplasia with varying degree of dysplasia and carcinomatous changes, 6 had other malignancies, and 2 had other benign cysts. Postoperative complications occurred in 3 patients. There was no perioperative mortality.
Conclusion
Any suspicion of malignant changes in asymptomatic cysts should have them considered for surgical resection. Meticulous surgical techniques are important for pancreatic resection to minimize the occurrence of postoperative complications.
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Affiliation(s)
- Suvit Sriussadaporn
- Department of Surgery, Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Sukanya Sriussadaporn
- Department of Surgery, Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Rattaplee Pak-art
- Department of Surgery, Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Kritaya Kritayakirana
- Department of Surgery, Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Supparerk Prichayudh
- Department of Surgery, Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Pasurachate Samorn
- Department of Surgery, Faculty of Medicine , Chulalongkorn University , Bangkok 10330 , Thailand
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Huh J, Byun JH, Hong SM, Kim KW, Kim JH, Lee SS, Kim HJ, Lee MG. Malignant pancreatic serous cystic neoplasms: systematic review with a new case. BMC Gastroenterol 2016; 16:97. [PMID: 27549181 PMCID: PMC4994257 DOI: 10.1186/s12876-016-0518-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/11/2016] [Indexed: 02/08/2023] Open
Abstract
Background This study analyzes the clinicopathologic and radiologic characteristics of malignant serous cystic neoplasm (SCN) of the pancreas through systematic review and an institutional case report. Methods A comprehensive literature search was performed in the MEDLINE database to identify studies on malignant SCNs of the pancreas that had detailed clinicopathologic and radiologic information. A computerized systematic search of our institutional database was also performed to identify cases of malignant SCN for addition to the systematic review. Using the final included cases, we analyzed the clinicopathologic and radiologic features of malignant SCNs of the pancreas. Results A review of 136 candidate articles identified 26 studies with 26 cases that had detailed clinical information. Our institutional data search added one case. The systematic review of the 27 cases revealed that primary tumors (mean diameter 10.2 ± 4.0 cm) mainly involved the body and tail of the pancreas (n = 16) and frequently invaded adjacent organs (n = 19). Distant metastases occurred in 14 patients (synchronous, n = 5; metachronous, n = 8; both, n = 1), most commonly in the liver (n = 13). Imaging features of malignant SCNs of the pancreas were identical to the benign counterpart, except local invasion or distant metastases. The prognosis was excellent in that 17 were alive at the time of writing with a median follow-up period of 2 years. Conclusions The malignant potential of SCNs of the pancreas should be considered in the diagnosis and management of patients with pancreatic SCNs.
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Affiliation(s)
- Jimi Huh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.,Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan, 44033, Korea
| | - Jae Ho Byun
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea.
| | - Seung-Mo Hong
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Jin Hee Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Moon-Gyu Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Korea
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Gao Y, Zhang JP, Zhu P. Serous cystadenoma of the pancreas with atypical clinical manifestations: A case report. Mol Clin Oncol 2016; 4:584-586. [PMID: 27073668 DOI: 10.3892/mco.2016.771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/27/2016] [Indexed: 01/18/2023] Open
Abstract
The present study reported a 4.8 cm space-occupying cystic solid mass of the pancreas, which caused recurrent bilateral lower back discomfort in a 60-year-old female. Combined with the clinical data, an impression of a solid-pseudopapillary neoplasm was generated prior to surgery. Abdominal exploration revealed splenic vessel encasement by the mass similar to the invasion observed in a malignant tumor. Distal pancreatectomy with splenectomy was subsequently performed. Grossly, the tumor was solid and consisted of numerous small cysts. Histopathological examination of the cystic solid mass revealed classic microcystic serous cystadenoma of the pancreas. These findings suggested that microcystic serous cystadenoma can exhibit atypical clinical manifestations. Asymptomatic patients with a small lesion (<4 cm) require imaging surveillance every 2 years; however, tumors >4 cm with atypical presentations require surgical resection.
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Affiliation(s)
- Yuan Gao
- Department of General Surgery, The Second People's Hospital of Changzhou Affiliated to Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Jing Ping Zhang
- Department of General Surgery, The Second People's Hospital of Changzhou Affiliated to Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
| | - Ping Zhu
- Department of General Surgery, The Second People's Hospital of Changzhou Affiliated to Nanjing Medical University, Changzhou, Jiangsu 213000, P.R. China
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Machado MCC, Fonseca GM, de Meirelles LR, Siqueira LTDB, Katz B, Jukemura J. Synchronous resection of pancreatic serous cystadenocarcinoma and liver metastasis: First reported case and review of literature. Pancreatology 2015; 15:708-12. [PMID: 26463518 DOI: 10.1016/j.pan.2015.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/24/2015] [Accepted: 09/16/2015] [Indexed: 12/11/2022]
Abstract
Cystic neoplasms account for approximately 10-20% of all pancreatic cysts and 1% of pancreatic cancers. Serous cystadenomas are considered benign tumors with almost no malignant potential, and thus the management is typically only observation with serial imaging. According to the current World Health Organization classification, cases with distant metastases are defined as serous cystadenocarcinomas. To date, only 17 such cases with concomitant synchronous or metachronous liver metastasis have been described in the literature, and eight of these reports described treatment of secondary liver lesions. This report describes the first case of synchronous resection of pancreatic serous cystadenocarcinoma and liver metastasis in a 56-year-old female patient. The patient is currently well after 30 months of follow-up with no tumor recurrence or new metastatic liver nodules based on magnetic resonance imaging.
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Affiliation(s)
| | - Gilton Marques Fonseca
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-900, Brazil
| | | | | | - Betina Katz
- Department of Pathology, Hospital Sírio-Libanês, São Paulo 01308-050, Brazil
| | - José Jukemura
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo 05403-900, Brazil
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12
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Kadhirvel V, Ramu S, Mishra N, Adaikalam MLS, Venkatesan R. Serous Microcystic Adenocarcinoma of Pancreas Infiltrating Into Spleen: A Case Report. J Clin Diagn Res 2015; 9:ED01-2. [PMID: 26500911 DOI: 10.7860/jcdr/2015/12869.6439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 06/23/2015] [Indexed: 11/24/2022]
Abstract
Cystic tumours of pancreas account for 5-10% of all pancreatic neoplasms and serous tumours represent 1% among those tumours. Most of the serous tumours are benign and very rarely they infiltrate adjacent organs like liver and spleen. Herewith we present a rare case report of serous cystadenocarcinoma of pancreas in a 65-year-old woman. The tumour involved the body and tail of pancreas and contiguously invaded the spleen. The histopathology of tumour was similar to serous cystadenoma with mild nuclear hyperchromasia and atypia. The spleen showed tumour infiltration as microcysts diffusely infitrating the red pulp.
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Affiliation(s)
- Valarmathi Kadhirvel
- Professor, Department of Pathology, Medical College, Dr.M.G.R. Medical University Government Stanley , Chennai, Tamil Nadu, India
| | - Sathyalakshmi Ramu
- Assistant Professor, Department of Pathology, Medical College, Dr.M.G.R. Medical University Government Stanley , Chennai, Tamil Nadu, India
| | - Nidhi Mishra
- Post Graduate, Department of Pathology, Medical College, Dr.M.G.R. Medical University Government Stanley , Chennai, Tamil Nadu, India
| | - Mary Lilly Susai Adaikalam
- Professor, Department of Pathology, Medical College, Dr.M.G.R. Medical University Government Stanley , Chennai, Tamil Nadu, India
| | - Ramya Venkatesan
- Post Graduate, Department of Pathology, Medical College, Dr.M.G.R. Medical University Government Stanley , Chennai, Tamil Nadu, India
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13
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Cystic neoplasms of the pancreas; findings on magnetic resonance imaging with pathological, surgical, and clinical correlation. ACTA ACUST UNITED AC 2015; 39:1088-101. [PMID: 24718661 DOI: 10.1007/s00261-014-0138-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Pancreatic cysts are increasingly being identified by cross-sectional imaging studies. Pancreatic cystic lesions comprise a spectrum of underlying pathologies ranging from benign and pre-malignant lesions to frank malignancies. Magnetic resonance imaging with cholangiopancreatography is a non-invasive imaging modality used for the characterization of cystic pancreatic lesions. This article will review the most common pancreatic cystic neoplasms and the utility of MR imaging in the characterization of these cysts.
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14
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Nai Q, Regeti K, Arshed S, Hossain MA, Zhang P, Luo H, Singh S, Mathew T, Islam M, Sen S, Yousif AM, Duhl J. Elevated erythropoietin and multicystic neoplasm of the pancreas. Case Rep Oncol 2015; 8:148-52. [PMID: 25873882 PMCID: PMC4376927 DOI: 10.1159/000377670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Cystic lesions of the pancreas are more frequently recognized due to the widespread use of improved imaging techniques. There are a variety of pancreatic cystic lesions with different clinical presentations and malignant potentials, and their management depends on the type of the cysts. Although the early recognition of a cystic neoplasm with malignant potential provides an opportunity of early surgical treatment, the precise diagnosis of the cystic neoplasm can be a challenge, largely due to the lack of reliable biomarkers of malignant transformation. We report a case of a large, multicystic neoplasm within the body and tail of the pancreas complicated by elevated erythropoietin, which is likely related to the malignant transformation of the pancreatic neoplasm.
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Affiliation(s)
- Qiang Nai
- Internal Medicine Residency Program, Raritan Bay Medical Center, Perth Amboy, N.J., USA
| | - Kalyani Regeti
- Internal Medicine Residency Program, Raritan Bay Medical Center, Perth Amboy, N.J., USA
| | - Sabrina Arshed
- Internal Medicine Residency Program, Raritan Bay Medical Center, Perth Amboy, N.J., USA
| | | | - Ping Zhang
- Internal Medicine Residency Program, Raritan Bay Medical Center, Perth Amboy, N.J., USA
| | - Hongxiu Luo
- Internal Medicine Residency Program, Raritan Bay Medical Center, Perth Amboy, N.J., USA
| | - Shilpi Singh
- Internal Medicine Residency Program, Raritan Bay Medical Center, Perth Amboy, N.J., USA
| | - Teena Mathew
- Internal Medicine Residency Program, Raritan Bay Medical Center, Perth Amboy, N.J., USA
| | - Mohammed Islam
- Internal Medicine Residency Program, Raritan Bay Medical Center, Perth Amboy, N.J., USA
| | - Shuvendu Sen
- Internal Medicine Residency Program, Raritan Bay Medical Center, Perth Amboy, N.J., USA
| | - Abdalla M Yousif
- Internal Medicine Residency Program, Raritan Bay Medical Center, Perth Amboy, N.J., USA
| | - Jozsef Duhl
- Internal Medicine Residency Program, Raritan Bay Medical Center, Perth Amboy, N.J., USA
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Antonini F, Fuccio L, Fabbri C, Macarri G, Palazzo L. Management of serous cystic neoplasms of the pancreas. Expert Rev Gastroenterol Hepatol 2015; 9:115-25. [PMID: 24981593 DOI: 10.1586/17474124.2014.934675] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pancreatic serous cystadenomas are uncommon benign tumours that are often found incidentally on routine imaging examinations. Radiological imaging techniques alone have proven to be suboptimal to fully characterize cystic pancreatic lesions. Endoscopic ultrasound, with the addition of fine-needle aspiration in difficult cases, has showed greater diagnostic accuracy than conventional imaging techniques. The best management strategy of these neoplasms is still debated. Surgery should be limited only to symptomatic and highly selected cases and most of the patients should only be strictly monitored. In the current paper, we provide an updated overview on pancreatic serous cystadenomas, focusing our attention on epidemiology, clinical characteristics and diagnostic evaluation; finally, we also discuss different management strategies and areas for future research.
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Affiliation(s)
- Filippo Antonini
- Department of Gastroenterology, A.Murri Hospital, Polytechnic University of Marche, Fermo, Italy
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16
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Kawaguchi Y, Nakajima T, Kawashima Y, Maruno A, Ito H, Ogawa M, Mine T, Izumi H, Furukawa D, Yazawa N, Nakagohri T, Hirabayashi K. A case of a giant growing serous cystic neoplasm of the pancreas. Case Rep Oncol 2014; 7:47-51. [PMID: 24575016 PMCID: PMC3934618 DOI: 10.1159/000358048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Because of the widespread use of diagnostic imaging in recent years, serous cystic neoplasm (SCN) of the pancreas can often be detected even when small in diameter. SCNs are usually benign, but it is important to differentiate them from other types of cystic tumors. We report a case of a giant growing SCN that posed a challenge in differential diagnosis.
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Affiliation(s)
- Yoshiaki Kawaguchi
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
| | - Takayuki Nakajima
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
| | - Yohei Kawashima
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Atsuko Maruno
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Ito
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
| | - Masami Ogawa
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
| | - Tetsuya Mine
- Department of Gastroenterology, Tokai University School of Medicine, Isehara, Japan
| | - Hideki Izumi
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Daisuke Furukawa
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Naoki Yazawa
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Toshio Nakagohri
- Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Kenichi Hirabayashi
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
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Unique presentation of giant metastatic microcystic serous adenocarcinoma of the pancreas. Case Rep Gastrointest Med 2014; 2014:913745. [PMID: 24782930 PMCID: PMC3978389 DOI: 10.1155/2014/913745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 01/14/2014] [Indexed: 01/07/2023] Open
Abstract
Tumors of the pancreas that contain substantial cystic components include mainly mucinous cystic neoplasm, intraductal papillary mucinous neoplasm, solid pseudopapillary tumor, and cystadenomas (which encompass microcystic, macrocystic/oligocystic, and rare solid serous adenomas). Microcystic adenoma of the pancreas is a tumor that is benign in nature. Malignant transformation in the tumor with metastases is rare and only about 26 cases have been reported so far. Here we present a giant microcystic adenoma of the pancreas, possibly the largest ever malignant type in this group ever reported in the literature with extensive metastases to the liver and causing extensive compression and encasement on surrounding structures.
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Bai XL, Zhang Q, Masood N, Masood W, Zhang Y, Liang TB. Pancreatic cystic neoplasms: a review of preoperative diagnosis and management. J Zhejiang Univ Sci B 2013; 14:185-94. [PMID: 23463761 DOI: 10.1631/jzus.b1200283] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pancreatic cystic neoplasms (PCNs) are a diverse group of neoplasms in the pancreas, and are more increasingly encountered with widespread abdominal screening and improved imaging techniques. The most common types of PCNs are serous cystic neoplasms (SCNs), mucinous cystic neoplasms (MCNs), and intraductal papillary mucinous neoplasms (IPMNs). Clinicians frequently feel bewildered in the differential diagnosis and subsequent management among the various types of lesions in the pancreas, which may lead to overtreatment or delayed treatment. The current review provides recent developments in the understanding of the three most common types of PCNs, the latest modalities used in preoperative diagnosis and differential diagnosis, as well as the most up to date management. Suggestions for diagnosis and differential diagnosis of SCNs, MCNs, and IPMNs are also provided for young surgeons. Better understanding of these neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.
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Affiliation(s)
- Xue-li Bai
- Department of Hepatobiliary-Pancreatic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Salomao M, Remotti H, Allendorf JD, Poneros JM, Sethi A, Gonda TA, Saqi A. Fine-needle aspirations of pancreatic serous cystadenomas: improving diagnostic yield with cell blocks and α-inhibin immunohistochemistry. Cancer Cytopathol 2013; 122:33-9. [PMID: 23939868 DOI: 10.1002/cncy.21347] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 06/17/2013] [Accepted: 07/12/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND The diagnosis of serous cystadenoma (SCA), a rare benign pancreatic neoplasm, can alter the management of patients with pancreatic masses. Although characteristic imaging findings and fluid chemical analysis have been described, SCAs are not always recognized preoperatively. Furthermore, scant cellular yield on fine-needle aspiration (FNA) often leads to a nondiagnostic or nonspecific benign diagnosis. α-Inhibin (AI), a sensitive marker for SCA, is infrequently required for diagnosis in surgical specimens due to their characteristic histologic appearance. The objective of the current study was to determine whether AI staining can improve SCA diagnosis on FNA specimens. METHODS Fifteen confirmed cases of SCA with prior FNA specimens were selected for this study. FNAs were evaluated for cellularity, cellular arrangement, and cytomorphology. Resection specimens were reviewed. RESULTS Of the 15 FNA cases, approximately 75% demonstrated scant cellularity (11 of 15 cases). On smears, the cells were arranged as flat sheets, corresponding to strips of cells on cell block sections. The cells were small and round to cuboidal, with clear cytoplasm; occasional plasmacytoid cells and oncocytic cells were identified. Flattened cells, corresponding to attenuated epithelial cells lining macrocysts on the resections, were also noted. Stromal fragments were present in 5 FNAs and correlated with the hyalinized stroma in the resection specimens. AI immunostaining was positive in 88% of cases (7 of 8 of cases), thereby supporting the diagnosis of SCA. CONCLUSIONS The results of the current study indicate that low cellularity and bland cytology are inherent to SCAs. Performing cell blocks and AI staining on FNA specimens is useful for establishing the diagnosis of SCA. An immunohistochemical panel including AI, chromogranin, and synaptophysin may enhance the diagnostic accuracy of pancreatic FNA specimens.
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Affiliation(s)
- Marcela Salomao
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
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20
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Wasel BA, Keough V, Huang WY, Molinari M. Histological percutaneous diagnosis of stage IV microcystic serous cystadenocarcinoma of the pancreas. BMJ Case Rep 2013; 2013:bcr-2012-007924. [PMID: 23370947 DOI: 10.1136/bcr-2012-007924] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Malignant serous cystic neoplasms (SCN) of the pancreas are exceptionally rare, and only a few cases have been reported. As a result, SCN have been unanimously classified as benign tumours. Contrary to this conviction, in 1989, George et al published the very first case of a patient found to have a malignant pancreatic SCN. Up to the time of the submission of this paper, 27 cases of serous cystoadenocarcinomas have been published. In all the previously published cases of malignant SCN, the correct diagnosis was made postoperatively or at the time of autopsy. The authors present a case of a 68-year-old patient who was incidentally found to have a large liver mass on transthoracic echocardiogram ordered for suspected coronary artery insufficiency. Subsequent investigations revealed an additional large mass in the pancreas and percutaneous biopsies of both lesions revealed histological features consistent with malignant SCN metastasised to the left hepatic lobe.
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21
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Dikmen K, Bostanci H, Yildirim AC, Sakrak O, Kerem M. Giant serous microcystic pancreas adenoma. Rare Tumors 2012; 4:e56. [PMID: 23372920 PMCID: PMC3557570 DOI: 10.4081/rt.2012.e56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/14/2012] [Accepted: 08/20/2012] [Indexed: 01/07/2023] Open
Abstract
Serous cystadenomas are rare tumors comprising 1-2% of exocrine pancreas tumors. They are mostly known as benign conditions but malign transformation as serous cystadenocarcinoma is also reported. It is usually seen in females. Non-specific symptoms, such as abdominal pain or symptoms due to mass affect, are usually seen. A 64-year old female patient was investigated for abdominal pain. Physical and laboratory findings were normal. Abdomen ultrasonography confirmed an 11×9.5 cm solid cystic lesion and abdomen computed tomography scan confirmed a 12×11 cm lobulated cystic solid lesion which had central cystic necrotic areas extending from liver hilus inferiorly. Fine needle biopsy confirmed benign cytology and trucut biopsy of the pancreatic mass reported chronic inflamation. Nevertheless, this mass could have malignant contents and transformation potential. A laparatomy was decided due to patient's symptoms and mass effect. Due to vascular invasion of the tumor, Whipple procedure was performed. The pathology report confirmed serous microcystic adenoma. These rare tumors are usually benign but pre-operative malignity criterias are not identified. There are few differential diagnostic tools for excluding malignity. We suggest surgical resection as best treatment approach for selected cases.
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Affiliation(s)
- Kursat Dikmen
- Turkish Ministry of Health, Dr. Nafiz Korez Sincan State Hospital General Surgery Clinic, Ankara
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22
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Abstract
OBJECTIVES There have been only a few reports on follow-up results of serous cystic neoplasm (SCN) of the pancreas. The frequency of malignancy and surgical indication of SCN are not determined yet. METHODS In this multi-institutional study of the Japan Pancreas Society, a total of 172 patients with SCN were enrolled. The mean follow-up period was 4.5 years. Surgical resection was performed in 90 patients, whereas the remaining 82 were simply observed. RESULTS Of all patients, 20% were symptomatic. The tumor was located in the pancreatic head (39%), body (35%), and tail (22%). The mean diameter of the tumor was 4.1 cm. None of the patients showed distant or lymph node metastasis except for liver metastasis found in 2 patients (1.2%). No patient died during the follow-up. The preoperative diagnosis did not correctly identify SCN in 57 (63%) of 90 resected cases. A honeycomb appearance, which is one of the most characteristic findings of SCN, could be diagnosed better by endoscopic ultrasonography than by other imaging diagnostic modalities. CONCLUSIONS Surgical resection should be considered only when clear distinction from other surgical diseases is difficult, when symptoms or mass effects are present, and when the tumor size is large.
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Bramis K, Petrou A, Papalambros A, Manzelli A, Mantonakis E, Brennan N, Felekouras E. Serous cystadenocarcinoma of the pancreas: report of a case and management reflections. World J Surg Oncol 2012; 10:51. [PMID: 22400805 PMCID: PMC3317835 DOI: 10.1186/1477-7819-10-51] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 03/08/2012] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Serous adenomas represent 1-2% of pancreatic neoplasms and typically are asymptomatic not requiring any treatment and simple observation is the option of choice. Although, they carry a realistic risk of malignancy despite the general view that they never become malignant. We report a case, which, according to our best knowledge is the 27th case reported in the literature. METHODS We reviewed the literature by performing a search in Pub Med and Medline. RESULTS A 86-year old patient known to have a serous cystadenoma of the pancreas treated conservatively through a close clinical and radiological follow up which was unattended for 4 years ending up to our emergency department suffering an acute abdomen. Exploratory laparotomy revealed a perforated prepyloric ulcer which was treated accordingly. Patient died some weeks later due to severe medical co morbidities. CONCLUSION Serous cystic neoplasms of the pancreas carry a realistic risk of malignancy despite the general view that they never become malignant. In our opinion the treatment strategy of serous cystic neoplasms of the pancreas should be aggressive even in cases of remote metastases since prognosis of the disease is satisfactory.
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Affiliation(s)
- K Bramis
- LAIKON Hospital, First Department of Surgery, University of Athens Medical School, Greece
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Khashab MA, Shin EJ, Amateau S, Canto MI, Hruban RH, Fishman EK, Cameron JL, Edil BH, Wolfgang CL, Schulick RD, Giday S. Tumor size and location correlate with behavior of pancreatic serous cystic neoplasms. Am J Gastroenterol 2011; 106:1521-6. [PMID: 21468008 DOI: 10.1038/ajg.2011.117] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The majority of pancreatic serous cystic neoplasms (SCNs) are benign. However, these neoplasms can cause symptoms and rarely can be aggressive. Identification of factors associated with symptomatic or aggressive SCNs may aid management decisions. The aim of this study was to identify variables that predict aggressive SCNs. METHODS Prospective pathology database was queried for SCNs that were surgically resected at Johns Hopkins Hospital. Tumors were considered aggressive if they invaded surrounding structures and/or vessels or if they metastasized to lymph nodes or distant organs. The associations of gender, tumor size, and tumor location, with the presence or absence of symptoms and tumor behavior were examined using Fisher's exact test, logistic regression, and multivariate analyses. RESULTS A total of 257 patients with SCNs underwent surgical resection. Mean tumor diameter was 4.9 cm. Tumor location in the head of pancreas (HOP) was associated with symptoms (odds ratio (OR) 1.87, 95% confidence interval (CI) 1.1-3.3). Computed tomography (CT) predicted the diagnosis of SCN in approximately a quarter of patients. Thirteen tumors (mean 10.5 cm) were considered aggressive. Multivariate analysis showed that tumor diameter (OR 1.53, 95% CI 1.24-1.89) and location of tumor in pancreatic head (OR 10.44, 95% CI 1.73-63.04) were independently associated with aggressive behavior. CONCLUSIONS We describe the largest case series of patients with pathologically proven SCNs. CT performed poorly in preoperative diagnosis of SCNs. Large tumor size and head location predicted aggressive behavior. These factors should be considered in the management of patients with SCN.
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Affiliation(s)
- Mouen A Khashab
- Department of Medicine and Division of Gastroenterology and Hepatology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205, USA
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Fukasawa M, Maguchi H, Takahashi K, Katanuma A, Osanai M, Kurita A, Ichiya T, Tsuchiya T, Kin T. Clinical features and natural history of serous cystic neoplasm of the pancreas. Pancreatology 2011; 10:695-701. [PMID: 21242709 DOI: 10.1159/000320694] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 08/19/2010] [Indexed: 12/11/2022]
Abstract
AIMS To clarify the clinical features and the natural history of serous cystic neoplasm (SCN) of the pancreas. METHODS We retrospectively analyzed data from 30 patients affected by SCN. SCNs were classified as (1) microcystic type, (2) micro- and macrocystic type, and (3) macrocystic type according to the modified WHO classification. Eighteen patients who underwent serial radiographic imaging were identified, and tumor growth rate in these patients was evaluated. RESULTS The median age was 62 years, and the female:male ratio was 2:1. Twenty-five patients (83%) were asymptomatic and 5 (17%) were symptomatic. The median tumor size was 2.6 cm. Fifteen cases (50%) had the microcystic type, 7 (23%) the micro- and macrocystic type, and 8 (27%) the macrocystic type. Age, gender, symptoms, location or tumor size did not differ significantly among the three subtypes. Eighteen patients were followed up for a median of 58 months. Morphological changes were observed in 3 patients (17%) and enlargement of tumor size in 9 patients (50%) during the follow-up. The growth rate was 0.29 cm per year and doubling time was 3.5 years; these rates did not differ among morphological subtypes or size of tumors. CONCLUSIONS In asymptomatic patients with a clear imaging diagnosis of SCN, nonoperative management with a careful follow-up should be recommended. Surgery should be suggested in only symptomatic patients, those with giant tumors (>10 cm), rapid growing or when the presence of a potentially malignant tumor cannot be excluded. and IAP.
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Affiliation(s)
- Mitsuharu Fukasawa
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan. fukasawa3286 @ aol.com
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Sakorafas GH, Smyrniotis V, Reid-Lombardo KM, Sarr MG. Primary pancreatic cystic neoplasms revisited. Part I: serous cystic neoplasms. Surg Oncol 2011; 20:e84-92. [PMID: 21237638 DOI: 10.1016/j.suronc.2010.12.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 12/13/2010] [Accepted: 12/14/2010] [Indexed: 12/12/2022]
Abstract
Primary pancreatic cystic neoplasms have been recognized increasingly during the two recent decades and include mainly serous cystic neoplasms, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. Serous cystic neoplasms represent about 30% of all cystic neoplasms of the pancreas and are characterized by their microcystic appearance (on imaging, macroscopically, and microscopically) and their benign biologic behavior. Modern diagnostic methodology allows the preoperative diagnosis with an acceptable accuracy. Currently, indications for resection of serous cystic neoplasms of the pancreas include the presence of symptoms, size > 4 cm (because these 'large' neoplasms have a more rapid growth rate and probably will soon become symptomatic), and any uncertainty about the diagnosis of a serous versus a mucinous cystic neoplasm. Resection should also be considered for lesions in the body/tail of the pancreas. Conservative treatment is a reasonable option in selected patients (for example in the presence of small, asymptomatic lesions in the pancreatic head, especially in the frail or elderly patient).
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Affiliation(s)
- George H Sakorafas
- 4th Department of Surgery, Medical School, University of Athens, Attikon University Hospital, Arkadias 19-21, Athens 12462, Greece.
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Roggin KK, Chennat J, Oto A, Noffsinger A, Briggs A, Matthews JB. Pancreatic Cystic Neoplasm. Curr Probl Surg 2010; 47:459-510. [DOI: 10.1067/j.cpsurg.2010.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Menard A, Tomlinson G, Cleary S, Wei A, Gallinger S, Haider MA. Serous cystadenomas of the pancreas: long-term follow-up measurement of growth rate. Can Assoc Radiol J 2010; 62:190-6. [PMID: 20494547 DOI: 10.1016/j.carj.2010.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 04/06/2010] [Accepted: 04/09/2010] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To measure the growth rate of microcystic subtype serous adenomas of the pancreas diagnosed by imaging. METHODS For this retrospective study, 241 imaging studies were reviewed from 1998 to 2005. Thirty-one patients met our strict diagnostic imaging inclusion criteria and had at least 18 months of imaging follow-up. Patient demographics and lesion imaging characteristics were tested as predictors of growth. RESULTS Growth was measured over a mean period of 42 months. There was a significant (P = .0004) linear growth of tumour for the population. There was significant clustering (P = .001) of the population into 2 growth rates: 0.50 mm/y (n = 23) and 5.5 mm/y (n = 8). The diameter of the lesion at presentation was significantly correlated with growth (r = 0.45; P = .01). CONCLUSION The microcystic subtype of serous cystadenomas of the pancreas diagnosed with imaging criteria demonstrates 2 distinct and slow growth rates. The size of the lesion at presentation is correlated with growth rate.
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Affiliation(s)
- Alexandre Menard
- Department of Medical Imaging, St Michael's Hospital, Toronto Ontario, Canada
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Abstract
Cystic neoplasms of the pancreas are a heterogeneous group of pancreatic tumors that vary in pathophysiology, malignant potential, clinical course, and outcomes. Their management is heavily predicated on establishing an accurate diagnosis. This can be particularly challenging, but can often be achieved by a thorough history and physical examination combined with high-quality, thin-slice computed tomography, although additional diagnostic tools may be required. Once the diagnosis is established, treatment can range from simple observation to total pancreatectomy. This decision rests on a clear and complete understanding of each disease process in the context of the patient's age and comorbidities. This article reviews the most common cystic neoplasms of the pancreas, focusing on their diagnosis and management.
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Abstract
With more widespread use of imaging, cystic neoplasms of the pancreas are being diagnosed with increased frequency. Serous cystadenomas are the most common type of cystic neoplasm of the pancreas and have a natural history and malignant potential different than that of other cystic neoplasms. Although characteristic findings on imaging may be supportive, definitive diagnosis of these lesions often cannot be made by imaging alone. Endoscopic ultrasound with fine needle aspiration and cyst aspiration may facilitate the diagnosis, and after definitive diagnosis, patients with lesions that are small and asymptomatic may be followed with serial imaging. If definitive diagnosis cannot be made or if the patient is symptomatic, resection is warranted. In addition, large (> 4 cm) serous cystadenomas should be resected in appropriate surgical candidates given their propensity for growth and developing symptoms.
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Affiliation(s)
- Jennifer A Wargo
- Harvard Medical School, Massachusetts General Hospital, White 506, 55 Fruit St., Boston, MA 02114, USA.
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Pancreatic serous cystadenocarcinoma: a case report and review of the literature. J Gastrointest Surg 2009; 13:1864-8. [PMID: 19459016 PMCID: PMC2759006 DOI: 10.1007/s11605-009-0926-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 04/28/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Serous cystic neoplasms of the pancreas are benign lesions with little chance for malignant degeneration. We report a case of malignant serous cystadenocarcinoma of the pancreas and review the literature. METHODS Structured review of the literature was performed using PubMed and MEDLINE searches, and cases of serous cystadenocarcinoma of the pancreas were compiled. RESULTS A 70-year-old man diagnosed with a serous cystadenoma was managed expectantly until he became symptomatic, and studies revealed an increase in the size of the lesion as well as duodenal invasion. The patient underwent a pancreaticoduodenectomy, and histopathological examination revealed a locally invasive cystadenocarcinoma without metastatic disease. Seven years later, the patient remains disease-free. Review of the literature identified 25 cases of serous cystadenocarcinoma published to date. The mean age at diagnosis is 68 +/- 2 years (range, 52 to 81), and women are affected more commonly (2:1). CONCLUSIONS We conclude that there is a small but finite risk of malignancy for serous cystic neoplasms of the pancreas. The clinician should bear this in mind when faced with decisions regarding patient management. Prognosis is excellent with multiple reports of long-term survival even in the face of metastatic disease.
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Laparoscopic resection of a pancreatic serous cystadenoma preserving the integrity of main pancreatic duct: a case report. CASES JOURNAL 2009; 2:8318. [PMID: 19830064 PMCID: PMC2740060 DOI: 10.4076/1757-1626-2-8318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 07/05/2009] [Indexed: 11/08/2022]
Abstract
Pancreatic serous cystadenomas are rare benign cystic neoplasms. Extended operations are unnecessary for serous cystadenomas and minimally invasive surgery should be performed. Laparoscopic pancreatic procedures are under evaluation. We present a case of a 79-year-old Greek woman with symptomatic cholelithiasis and a serous pancreatic cystadenoma located at the neck of the pancreas. In the occasion of a standard laparoscopic cholecystectomy the pancreatic mass was resected with a novel minimally invasive laparoscopic method preserving the integrity of the main pancreatic duct and the whole pancreas. Laparoscopic resection is a feasible, safe and effective treatment of benign pancreatic tumors, in experienced hands under proper indications.
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Basturk O, Coban I, Adsay NV. Pancreatic cysts: pathologic classification, differential diagnosis, and clinical implications. Arch Pathol Lab Med 2009; 133:423-38. [PMID: 19260748 DOI: 10.5858/133.3.423] [Citation(s) in RCA: 198] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2008] [Indexed: 12/14/2022]
Abstract
CONTEXT Cystic lesions of the pancreas are being recognized with increasing frequency and have become a more common finding in clinical practice because of the widespread use of advanced imaging modalities and the sharp drop in the mortality rate of pancreatic surgery. Consequently, in the past 2 decades, the nature of many cystic tumors in this organ has been better characterized, and significant developments have taken place in the classification and in our understanding of pancreatic cystic lesions. OBJECTIVE To provide an overview of the current concepts in classification, differential diagnosis, and clinical/biologic behavior of pancreatic cystic tumors. DATA SOURCES The authors' personal experience, based on institutional and consultation materials, combined with an analysis of the literature. CONCLUSIONS In contrast to solid tumors, most of which are invasive ductal adenocarcinomas with dismal prognosis, cystic lesions of the pancreas are often either benign or low-grade indolent neoplasia. However, those that are mucinous, namely, intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, constitute an important category because they have well-established malignant potential, representing an adenoma-carcinoma sequence. Those that are nonmucinous such as serous tumors, congenital cysts, lymphoepithelial cysts, and squamoid cyst of pancreatic ducts have no malignant potential. Only rare nonmucinous cystic tumors that occur as a result of degenerative/necrotic changes in otherwise solid neoplasia, such as cystic ductal adenocarcinomas, cystic pancreatic endocrine neoplasia, and solid-pseudopapillary neoplasm, are also malignant and have variable degrees of aggressiveness.
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Affiliation(s)
- Olca Basturk
- Department of Pathology, New York University, New York, New York, USA
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Ng DZW, Goh BKP, Tham EHW, Young SM, Ooi LLPJ. Cystic Neoplasms of the Pancreas: Current Diagnostic Modalities and Management. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n3p251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cystic neoplasm of the pancreas is a relatively uncommon condition covering a wide spectrum of pathology. The increasing incidence as a result of routine imaging tests in asymptomatic patients presents a diagnostic and therapeutic problem to the clinician. This paper discusses the role of the various investigative modalities in the management of cystic neoplasia of the pancreas.
Key words: Frantz tumour, Intraductal papillary mucinous neoplasm, Mucinous cystadenoma, Mucinous cystadenocarcinoma, Mucinous neoplasm of the pancreas, Solid pseudopapillary neoplasm
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[Serous microcystic adenoma of the head of the pancreas causing an obstructive jaundice]. VOJNOSANIT PREGL 2008; 65:839-42. [PMID: 19069716 DOI: 10.2298/vsp0811839c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Serous microcystic adenoma is a rare benign tumor of the exocrine pancreas originating from the ductal system and composed of a large number of small cysts covered by cuboid cells, filled with clear serous fluid and separated with fibrocolagenous stroma. Most frequently it appears in women in 7th and 8th decades, in the distal pancreas. It shows a very low malignant potential. In 2/3 of patients symptoms are uncharacteristic and in 1/3 they are absent When localised within the head of the pancreas it rarely causes an obstructive jaundice. CASE REPORT We presented a 61-year-old female patient who for months had had mild and nonspecific abdominal symptoms developing to progressive obstructive jaundice. At surgery we revealed a rather large policystic mass of the head of the pancreas causing not only obstructive jaundice but also a venous stasis by compression and dislocation of the portomesenteric vein. The tumor was removed with pylorus preserving cephalic duodenopancreatectomy (Whipple's procedure modified by Longmire-Traverso). Histology confirmed serous microcystic adenoma of the pancreas. The postoperative recovery was uneventful and preoperative symptoms disappeared. CONCLUSION Although very rare, serous microcystic adenoma might appear within the head of the pancreas and has to be taken into consideration in differential diagnosis of cystic lesions of the head of the pancreas. Very rarely the tumour might cause obstructive jaundice. Surgical resection, which might be demanding, leads to complete recovery.
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Diagnosis and management of cystic neoplasms of the pancreas: an evidence-based approach. J Am Coll Surg 2008; 207:106-20. [PMID: 18589369 DOI: 10.1016/j.jamcollsurg.2007.12.048] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 11/30/2007] [Accepted: 12/19/2007] [Indexed: 02/06/2023]
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Abstract
Serous cystadenoma of the pancreas is a diagnosis being entertained with increasing frequency. The histopathologic findings, diagnostic strategy, differential diagnosis, and treatment strategy of these generally benign but sometimes symptomatic lesions are discussed. Based on the available case series, surgical resection should be considered in good-risk patients with symptomatic tumors, with tumors at least 4 cm in maximum diameter, or in whom a more worrisome diagnosis cannot be excluded.
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39
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Left-sided portal hypertension caused by serous cystadenoma of the pancreas: Report of a case. Surg Today 2008; 38:184-7. [DOI: 10.1007/s00595-007-3600-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2006] [Accepted: 03/15/2007] [Indexed: 01/07/2023]
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40
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Pancreatic cystic lesions: discrimination accuracy based on clinical data and high resolution CT features. J Comput Assist Tomogr 2008; 31:860-7. [PMID: 18043347 DOI: 10.1097/rct.0b013e318039b277] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the accuracy of high-resolution computed tomography in discriminating among pancreatic cystic lesions with and without clinical history. METHODS Multiphasic high-resolution computed tomographic scans of 100 proven cystic pancreatic lesions were retrospectively reviewed by 2 blinded imagers. Before and after a history of pancreatitis was revealed, readers classified lesions as either nontumor-related or tumor-related. Reviewers also classified lesions as benign or malignant and finally categorized each lesion as serous, mucinous, or other lesion. Diagnostic performance parameters for classification were calculated for each reader with and without history. RESULTS Sixty-two lesions were tumor-related and 38 were not. Accuracy for classifying tumor-related from unrelated cysts for both reviewers increased (83%-92%, 85%-91%) when unblinded to pancreatitis history. Specificity also significantly increased (66%-88% and 84%) for both reviewers. CONCLUSIONS Pancreatic-phase computed tomography enabled more than 80% accuracy in discriminating between tumor-related and unrelated lesions and increased with information of pancreatitis history.
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Abstract
The increasing use of radiological imaging has led to greater detection of small and asymptomatic cystic lesions of the pancreas. Most are resectable, but not all are neoplastic. This review provides an update on the histopathology, immunohistochemistry, molecular biology, pathogenesis and management of cystic neoplasms of the exocrine pancreas. These include the serous, the mucinous cystic, the intraductal papillary mucinous and the solid pseudopapillary neoplasms. Recently reported variants are described and very rare cystic variants of other pancreatic epithelial and mesenchymal neoplasms are briefly mentioned.
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MESH Headings
- Biomarkers, Tumor/analysis
- Carcinoma, Pancreatic Ductal/chemistry
- Carcinoma, Pancreatic Ductal/pathology
- Carcinoma, Pancreatic Ductal/therapy
- Cystadenocarcinoma/chemistry
- Cystadenocarcinoma/pathology
- Cystadenocarcinoma/therapy
- Cystadenocarcinoma, Mucinous/chemistry
- Cystadenocarcinoma, Mucinous/pathology
- Cystadenocarcinoma, Mucinous/therapy
- Cystadenocarcinoma, Papillary/chemistry
- Cystadenocarcinoma, Papillary/pathology
- Cystadenocarcinoma, Papillary/therapy
- Cystadenocarcinoma, Serous/chemistry
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/therapy
- Humans
- Immunohistochemistry
- Pancreas, Exocrine/chemistry
- Pancreas, Exocrine/pathology
- Pancreatic Ducts/chemistry
- Pancreatic Ducts/pathology
- Pancreatic Neoplasms/chemistry
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/therapy
- Precancerous Conditions/chemistry
- Precancerous Conditions/pathology
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Affiliation(s)
- F Campbell
- Department of Pathology, Royal Liverpool University Hospital, Liverpool, UK.
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Galanis C, Zamani A, Cameron JL, Campbell KA, Lillemoe KD, Caparrelli D, Chang D, Hruban RH, Yeo CJ. Resected serous cystic neoplasms of the pancreas: a review of 158 patients with recommendations for treatment. J Gastrointest Surg 2007; 11:820-6. [PMID: 17440789 DOI: 10.1007/s11605-007-0157-4] [Citation(s) in RCA: 160] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Serous cystic neoplasms of the pancreas are regarded as a benign entity with rare malignant potential. Surgical resection is generally considered curative. OBJECTIVE To perform the largest single institution review of patients who underwent surgical resection for serous cystic neoplasms of the pancreas in the hopes of guiding future management. METHODS Between June 1988 and January 2005, 158 patients with serous cystic neoplasms of the pancreas underwent surgical resection. A retrospective analysis was performed. Univariate and multivariate models were used to determine factors influencing perioperative morbidity and mortality. Major complications were defined as pancreatic fistula or anastomotic leak, postoperative bleed, retained operative material, or death. Minor complications were defined as wound infection, postoperative obstruction/ileus requiring total parenteral nutrition (TPN), delayed gastric emptying, arrhythmia, or other infection. RESULTS The mean age of the patients was 62.1 years, with 75% being female. The majority of patients were symptomatic at presentation (63%), with abdominal pain as the most common symptom. Of the 158 patients, 75 underwent distal pancreatectomy, 65 underwent pancreaticoduodenectomy, nine underwent central pancreatectomy, five underwent local resection or enucleation, and four underwent total pancreatectomy. Mean tumor diameter was 5.1 cm. Mean operative time was 277 min. Mean postoperative length of hospital stay was 11 days. One patient was diagnosed at presentation with serous cystadenocarcinoma. The remaining 157 patients were initially diagnosed with benign serous cystadenoma. One of three patients with locally aggressive benign disease later presented with metastatic disease. Resection margins for all 158 patients were negative for tumor, and only one (0.6%) showed lymph node involvement. There was one intraoperative death. The incidence of major perioperative complications was 18%, whereas the incidence of minor complications was 33%. Men were significantly more likely to experience minor perioperative complications (OR = 3.74, P = 0.008), whereas patients greater than 65 years showed a trend toward fewer major complications (OR = 0.36, P = 0.09). CONCLUSIONS Surgically resected serous cystic neoplasms of the pancreas are typically seen in asymptomatic women as 5 cm neoplasms and are predominantly benign. Most are resected via either a left- or right-sided pancreatectomy with low mortality risk, but with notable major or minor morbidity. Cystadenocarcinoma is a rare finding on initial resection of serous cystic neoplasms. However, initial pathology specimens exhibiting benign but locally aggressive neoplasia may indicate an increased likelihood of recurrence or metachronous metastasis, although this claim is limited by a small patient subpopulation in this study and warrants further review.
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Affiliation(s)
- Charles Galanis
- Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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43
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Stern JR, Frankel WL, Ellison EC, Bloomston M. Solid serous microcystic adenoma of the pancreas. World J Surg Oncol 2007; 5:26. [PMID: 17338818 PMCID: PMC1821026 DOI: 10.1186/1477-7819-5-26] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 03/05/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cystic neoplasms of the pancreas are less common than solid tumors, and portend a better prognosis. They can be divided into serous and mucinous subtypes, with the former behaving less aggressively and generally considered benign. Of the serous neoplasms, serous microcystic adenoma is the most common. An extremely rare solid variant of serous microcystic adenoma lacking secretory capability has been described. Herein, we present the fourth described case of this solid variant and review the literature. CASE PRESENTATION We present a case of a 62 year-old man with a history of abdominal pain, who on CT scan was found to have a solid mass at the junction of the head and body of the pancreas. The patient was offered resection for diagnosis and treatment, and subsequently underwent distal pancreatectomy and splenectomy. Based on gross pathology, histology and immunohistochemistry, the mass was determined to be a solid serous microcystic adenoma. CONCLUSION Solid serous microcystic adenoma shows similar histologic and immunohistologic features to its classic cystic counterpart, but lacks any secretory functionality. It appears to behave in a benign manner, and as such, surgical resection is curative for patients with this tumor. Furthermore, until more cases of solid SMA are identified to further elucidate its natural history and improve the reliability of preoperative diagnosis, surgical resection of this solid pancreatic tumor should be considered standard therapy in order to exclude malignancy.
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Affiliation(s)
- Jordan R Stern
- Department of Surgery, The Ohio State University, 410 W 10th Ave, N924 Doan, Columbus OH 43210, USA
| | - Wendy L Frankel
- Department of Pathology, The Ohio State University, Columbus OH 43210, USA
| | - E Christopher Ellison
- Department of Surgery, The Ohio State University, 410 W 10th Ave, N924 Doan, Columbus OH 43210, USA
| | - Mark Bloomston
- Department of Surgery, The Ohio State University, 410 W 10th Ave, N924 Doan, Columbus OH 43210, USA
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44
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Abstract
Although cystic tumors of the pancreas are relatively rare, they constitute an increasingly important category. Advances in imaging and interventional techniques and the sharp drop in the mortality rate of pancreatic surgery have rendered pancreatic biopsies and resections commonplace specimens. Consequently, in the past two decades, the nature of many cystic tumors in this organ has been better characterized. The names of some existing entities were revised; for example, what was known as papillary-cystic tumor is now regarded as solid-pseudopapillary tumor. New entities, in particular, intraductal papillary mucinous neoplasm and its variants, such as oncocytic and intestinal subtypes were recognized. The importance of clinical and pathologic correlation in the evaluation of these lesions was appreciated, in particular, with regards to the multifocality of these lesions, their association with invasive carcinomas, and thus their 'preinvasive' nature. Consensus criteria for the distinction of these from the ordinary precursors of adenocarcinoma, the pancreatic intraepithelial neoplasia, were established. The definition of mucinous cystic neoplasms was refined; ovarian-like stroma has now become almost a requirement for the diagnosis of mucinous cystic neoplasia, and defined as such, the propensity of these tumors to occur in perimenopausal women became even more striking. The validity and clinical value of classifying the pancreatic cysts of mucinous type as adenoma, borderline, CIS and invasive have been established. Related to this, the importance of thorough sampling in accurate classification of these mucinous lesions was recognized. Greater accessibility of the pancreas afforded by improved invasive as well as noninvasive modalities has also increased the detection of otherwise clinically silent cystic tumors, which has led to the recognition of more innocuous entities such as acinar cell cystadenoma and squamoid cyst of pancreatic ducts. As the significance of the cystic lesions emerged, cystic forms of otherwise typically solid tumors were also better characterized. Thus, significant developments have taken place in the classification and our understanding of pancreatic cystic tumors in the past few years, and experience with these lesions is likely to grow exponentially in the coming years.
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Affiliation(s)
- N Volkan Adsay
- Department of Pathology, Harper Hospital and Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA.
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45
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Schulz HU, Kellner U, Kahl S, Effenberger O, Asperger W, Lippert H, Röcken C. A giant pancreatic serous microcystic adenoma with 20 years follow-up. Langenbecks Arch Surg 2007; 392:209-13. [PMID: 17235583 DOI: 10.1007/s00423-006-0146-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2006] [Accepted: 12/21/2006] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS There is only little information about the spontaneous course of large pancreatic serous tumours. We followed up a white woman with a giant serous microcystic adenoma over more than 20 years. CASE REPORT At first clinical presentation, in 1986, the tumour measured 4.5 cm in diameter. Two years later, it measured 6 cm and was considered as non-resectable at laparotomy. A biopsy was obtained, and the tumour was diagnosed as lymphangioma, based on hematoxylin and eosin-staining. During the follow-up, the tumour progressively increased in size, measuring 12 cm in diameter in 1993 and 17 cm in 2000. Thus, an average growth rate of 0.83 cm per year was calculated. Unspecific abdominal discomfort and pain were the leading clinical symptoms. A colonic resection was necessary because of compression by the tumour in 1993. Portal hypertension was detected at laparotomy. Finally, the initial biopsy specimen was re-evaluated, using immunohistochemistry, and the final diagnosis of a serous microcystic adenoma was made. CONCLUSION This unique case demonstrates that the spontaneous course of serous microcystic adenoma of the pancreas may be favourable even with huge tumour size and that immunohistochemistry may prove a valuable tool for differential diagnosis of cystic pancreatic lesions. Due to their size and progressive, space-occupying growth, these biologically benign tumours may cause injury to adjacent organs and thus clinical symptoms. For this reason, curative surgical resection is the treatment of choice for this tumour entity except for small, asymptomatic lesions, which do not require intervention. When radical resection is impossible, palliative surgery may improve the quality of life for several years. The risk of malignant transformation seems to be low even in the long-term course.
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Affiliation(s)
- Hans-Ulrich Schulz
- Chirurgie/Department of Surgery, University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
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46
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Abstract
Endoscopic ultrasound (EUS) has emerged as a valuable tool in the evaluation of benign and malignant pancreatic diseases. The ability to obtain high quality images and perform fine-needle aspiration (FNA) has led EUS to become the diagnostic test of choice when evaluating the pancreas. This article will review the role of EUS in benign pancreatic diseases.
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47
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Pautrat K, Chevalier Y, Barbey C, De Calan L. [A case of compressing serous cystadenoma with renal carcinoma]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2006; 30:1090-2. [PMID: 17075457 DOI: 10.1016/s0399-8320(06)73482-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Pancreas cystadenoma tumors represent 10 to 15% of all cystic lesions of the pancreas. These tumors are asymptomatic in around 30% of patients, serous adenoma being the most common. Malignancy should be suspected when cystadenoma is compressive. We report the case of a 72-year-old man with a compressive serous cystadenoma associated to renal carcinoma.
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Affiliation(s)
- Karine Pautrat
- Service de Chirurgie Digestive et Endocrinienne, CHU Trousseau, 37044 Tours Cedex 1.
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48
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Tampi C, Mullerpatan P, Shah R, Jagannath P, Zimmermann A. Microcystic serous cystadenoma of the pancreas: a report of two cases with one of diffuse presentation. Pancreatology 2006; 6:248-53. [PMID: 16543776 DOI: 10.1159/000092028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Microcystic adenoma or serous cystadenoma is an uncommon tumor and accounts for 1-2% of the exocrine neoplasms of the pancreas. Usually unifocal, they present as single, large, well-demarcated multiloculated cystic tumors, ranging in size from 1 to 25 cm. Multifocal variants or diffuse serous cystadenomas are extremely rare. We present 2 cases of which 1 is a diffuse variant affecting the body, tail and part of the neck of the pancreas. In both the patients the tumors were detected incidentally. We highlight on the diffuse variant in view of its rarity and present a review of literature. In this case the entire body and tail of the pancreas was spongy replaced by multicystic lobules and hyalinized fibrocollagenous stroma. The cysts were lined by low cuboidal glycogen containing bland cells. Such a unique presentation wherein the entire body and tail of the pancreas is replaced with multiple cysts is a diffuse presentation of microcystic adenoma and a search through literature revealed only 7 such cases among the 15 cases with multifocal presentation reported.
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Affiliation(s)
- Chandralekha Tampi
- Department of Pathology, Lilavati Hospital and Research Centre, Mumbai, India
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49
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Imaoka H, Yamao K, Salem AAS, Sawaki A, Takahashi K, Mizuno N, Kawai H, Tajika M, Isaka T, Okamoto Y, Shimizu Y, Yanagisawa A. Pancreatic endocrine neoplasm can mimic serous cystadenoma. ACTA ACUST UNITED AC 2005; 35:217-20. [PMID: 16110124 DOI: 10.1385/ijgc:35:3:217] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 57-yr-old female patient was referred to our hospital with a cystic lesion of the head of the pancreas that had been noted on abdominal computed tomography (CT). Endoscopic ultrasonography (EUS) showed a 3.0 cm rounded mass in the head of the pancreas. EUS images showed that the tumor had a solid component consisting of multiple microcysts separated by septae and a cystic component consisting of a macrocystic lesion. Thus, the tumor was suspected of being a serous cystadenoma (SCA). However, the histopathological diagnosis based on endoscopic ultrasound- guided fine-needle-aspiration biopsy (EUS-FNAB) was that of a pancreatic endocrine neoplasm (PEN). Surgical resection was performed. Despite having very similar macroscopic findings to SCA, microscopic examination revealed that the patient's tumor was definitely a PEN. This case suggests that it is very difficult to distinguish PENs from SCAs based solely on imaging methods. EUS-FNAB is essential for determining the appropriate therapeutic strategy, as it provides the histopathological diagnosis.
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Affiliation(s)
- Hiroshi Imaoka
- Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden Chikusa-ku, Nagoya, Japan.
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50
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Tseng JF, Warshaw AL, Sahani DV, Lauwers GY, Rattner DW, Fernandez-del Castillo C. Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment. Ann Surg 2005; 242:413-9; discussion 419-21. [PMID: 16135927 PMCID: PMC1357749 DOI: 10.1097/01.sla.0000179651.21193.2c] [Citation(s) in RCA: 305] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To define the natural history and optimal management of serous cystadenoma of the pancreas. SUMMARY BACKGROUND DATA Serous cystadenoma of the pancreas is the most common benign pancreatic neoplasm. Diagnostic criteria, potential for growth or malignancy, and outcomes are not well defined. As a result, management for patients with serous cystadenomas varies widely in current practice. METHODS A total of 106 patients presenting with serous cystadenoma of the pancreas from 1976-2004 were identified. Hospital records were evaluated for patient and tumor characteristics, diagnostic workup, treatment, and outcome. Twenty-four patients with serial radiographic imaging were identified, and tumor growth curves calculated. RESULTS Mean age at presentation was 61.5 years and 75% of patients were female. The most common symptoms were abdominal pain (25%), fullness/mass (10%), and jaundice (7%); 47% were asymptomatic. Mean tumor diameter was 4.9 +/- 3.1 cm, which did not vary by location. Tumors <4 cm were less likely to be symptomatic than were tumors > or =4 cm (22% vs. 72%, P < 0.001). The median growth rate in the patients who had serial radiography was 0.60 cm/y. For tumors <4 cm at presentation (n = 15), the rate was 0.12 cm/y, whereas for tumors > or =4 cm (n = 9), the rate was 1.98 cm/y (P = 0.0002). Overall, 86 patients underwent surgery, with one perioperative death. CONCLUSIONS Large (>4 cm) serous cystadenomas are more likely to be symptomatic. Although the median growth rate for this neoplasm is only 0.6 cm/y, it is significantly greater in large tumors. Whereas expectant management is reasonable in small asymptomatic tumors, we recommend resection for large serous cystadenomas regardless of the presence or absence of symptoms.
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Affiliation(s)
- Jennifer F Tseng
- Departments of Surgery, Massachusetts General Hospital, Boston, MA 02114, USA
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