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Talbot CT, Cheung R, Holmes EJ, Cook SD. Medical and surgical management of pancreatic fluid accumulations in dogs: A retrospective study of 15 cases. J Vet Intern Med 2022; 36:919-926. [PMID: 35319111 PMCID: PMC9151450 DOI: 10.1111/jvim.16411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 03/04/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Limited data exist on the diagnosis and successful medical management of suspected pancreatic abscessation, and the appropriate terminology of this condition. HYPOTHESIS/OBJECTIVES To describe the diagnosis and management of pancreatic fluid accumulations in dogs where pancreatic fluid cytology results were available, to describe those medically and surgically managed at the same institution, and reconsider the terminology describing acute pancreatitis with pancreatic fluid accumulation. ANIMALS Fifteen dogs treated for suspected pancreatic abscessation at a university teaching hospital between January 2010 and March 2020. METHODS Retrospective descriptive study. RESULTS Ultrasonographic findings described pancreatic fluid accumulations as hypoechoic in 10/15 and anechoic in 2/15 cases, ranging between 1.6 and 7 cm in diameter (median, 3.5 cm). No complications were documented after ultrasound guided fine-needle aspiration. Cytologically, all samples revealed a predominantly neutrophilic inflammation. 11/15 samples yielded a negative culture (9/11 received antimicrobials before sampling) and in 4 cases culture was positive. 7/15 were initially managed surgically including all 4 infected cases. 4/7 surgically managed cases were discharged, including 2 infected cases. The remaining 3/7 surgically managed cases were euthanized due poor quality of life. 8/15 cases were managed medically; 7/8 were discharged, 1 died. 3/7 then represented, and underwent successful surgical intervention after recrudescence of clinical signs, and all were discharged. The remaining 4 medically managed cases did not require further therapeutic intervention, with no clinical deterioration on reassessment. CONCLUSIONS AND CLINICAL IMPORTANCE Medical management is a viable treatment option for some dogs with pancreatic fluid accumulation, or as a prequel to surgical management. Subclassifications of pancreatic fluid accumulations using diagnostic findings could enable more tailored management approaches and accurate prognostication.
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Affiliation(s)
- Charles T Talbot
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hertfordshire, United Kingdom
| | - Ring Cheung
- Royal Veterinary College, University of London, London, United Kingdom
| | - Emma J Holmes
- Department of Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hertfordshire, United Kingdom
| | - Simon D Cook
- Department of Veterinary Clinical Science and Services, Royal Veterinary College, University of London, Hertfordshire, United Kingdom
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Bicci E, Cozzi D, Ferrari R, Grazzini G, Pradella S, Miele V. Pancreatic neuroendocrine tumours: spectrum of imaging findings. Gland Surg 2020; 9:2215-2224. [PMID: 33447574 DOI: 10.21037/gs-20-537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Pancreatic neuroendocrine tumours (pNETs) are rare and heterogeneous group of neoplasms presenting with a wide variety of symptoms and biological behaviour, from indolent to aggressive ones. pNETs are stratified into functional or non-functional, because of their ability to produce metabolically active hormones. pNETs can be an isolate phenomenon or a part of a hereditary syndrome like von Hippel-Lindau syndrome or neurofibromatosis-1. The incidence has increased in the last years, also because of the improvement of cross-sectional imaging. Computed tomography (CT), magnetic resonance imaging (MRI) and functional imaging are the mainstay imaging modalities used for tumour detection and disease extension assessment, due to easy availability and better contrast/spatial resolution. Radiological imaging plays a fundamental role in detection, characterization and surveillance of pNETs and is involved in almost every stage of patients' management. Moreover, with specific indications and techniques, interventional radiology can also play a role in therapeutic management. Surgery is the treatment of choice, consisting of either partial pancreatectomy or enucleation of the primary tumour. This article reviews the radiologic features of different pNETs as well as imaging mimics, in order to help radiologists to avoid potential pitfalls, to reach the correct diagnosis and to support the multidisciplinary team in establishing the right treatment.
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Affiliation(s)
- Eleonora Bicci
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Riccardo Ferrari
- Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Giulia Grazzini
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Silvia Pradella
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
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Yadav RK, Jiang X, Chen J. Differentiating benign from malignant pancreatic cysts on computed tomography. Eur J Radiol Open 2020; 7:100278. [PMID: 33163586 PMCID: PMC7607418 DOI: 10.1016/j.ejro.2020.100278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022] Open
Abstract
CT can distinguish between benign and premalignant or malignant pancreatic cysts. Solid component and septation were the only CT features that could differentiate benign from malignant cysts. Cyst wall enhancements on CT were more commonly observed in premalignant or malignant cysts than in benign cysts. CT is a necessary diagnostic modality to preoperatively detect and characterize pancreatic lesions.
Purpose It is important to identify features on computed tomography (CT) that can distinguish between benign and premalignant or malignant pancreatic cysts to avoid unnecessary surgeries. This study investigated the preoperative diagnostic evaluation of cystic pancreatic lesions to determine how advanced imaging and clinical factors should guide management. Methods In total, 53 patients with 27 benign and 26 premalignant or malignant cysts were enrolled. CT features of the cysts were compared using univariate and multivariate analyses. Results On univariate analysis, a solid component (p < 0.01), septation (p < 0.01), location (p < 0.01), border (p < 0.01), wall enhancement (p = 0.01), lesion margins (p < 0.01), pancreatic atrophy (p = 0.04), and a cystic wall (p < 0.01) were all significantly different between benign and premalignant or malignant cysts. On multivariate analysis, only a solid component (p < 0.01) and septation (p < 0.01) were significant. Conclusion A thin cystic wall, uniform homogeneity, a clear border, the presence of septation, pancreatic atrophy, and the absence of both wall enhancements and solid components were more frequently seen in benign cysts. A thick wall, lack of homogeneity, the presence of wall enhancements and solid components, absence of septation, only a small degree of pancreatic atrophy, and unclear borders were more frequent among premalignant or malignant cysts. The only CT features to differentiate benign from premalignant or malignant cysts were a solid component and septation.
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Key Words
- CEA, Carcinoembryonic antigen
- CPR, Curved planar reformation
- CTA, CT angiography
- DWI, Diffusion-weighted imaging
- ERCP, Endoscopic retrograde cholangiopancreatography
- FDG PET, Fluorodeoxyglucose PET
- FNA, Fine-needle aspiration
- HASTE, Half-Fourier acquisition single-shot turbo spin-echo
- IPMN, Intraductal papillary mucinous neoplasia
- MCA, Mucinous cystadenoma
- MCB, Mucinous cystic borderline tumor
- MCC, Mucinous cystadenocarcinoma
- MCN, Mucinous cystic neoplasm
- MPD, Main pancreatic duct
- MPR, Multi-planar reformation
- MRA, MR angiography
- MRCP, MR cholangiopancreatography
- MRI, Magnetic resonance imaging
- MSCT, Multi-slice helical computed tomography
- PACS, Picture archiving and communicating system
- PCN, Cystic neoplasms of the pancreas
- PDAC, Pancreatic ductal adenocarcinoma
- PET, Positron emission computed tomography
- Pancreatic cystic lesions
- Pancreatic ductal adenocarcinoma
- Pancreatic neoplasm
- ROI, Region of interest
- SCA, Serous cystadenoma
- SMA, Serous microcystic adenoma
- US, Ultrasonography
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Affiliation(s)
- Rajesh Kumar Yadav
- Second Affiliated Hospital, Department of Radiology, Sun Yat-sen University, Guangzhou 510000, China
- Corresponding author: Current Address: Novus Health Wellness, 4808 Munson St NW, OH 44718 USA.
| | - Xinhua Jiang
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jianyu Chen
- Second Affiliated Hospital, Department of Radiology, Sun Yat-sen University, Guangzhou 510000, China
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The Role of Positron Emission Tomography in Clinical Management of Intraductal Papillary Mucinous Neoplasms of the Pancreas. Cancers (Basel) 2020; 12:cancers12040807. [PMID: 32230809 PMCID: PMC7226258 DOI: 10.3390/cancers12040807] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 02/05/2023] Open
Abstract
Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a heterogeneous group of tumors, increasingly diagnosed in clinical practice. An early differential diagnosis between malignant and benign lesions is crucial to patient management and the choice of surgery or observation. The therapeutic approach is currently based on a patient’s clinical, biochemical, and morphological characteristics. The latest published International Consensus Guidelines (ICG) make no mention of the role of metabolic assessments of IPMNs. The aim of this study was to review the current literature, examining the role of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in IPMN management. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and 10 articles were analyzed in detail, focusing on the value of PET as opposed to other standard imaging criteria. Data were retrieved on 419 patients. The 18-FDG-PET proved more sensitive, specific, and accurate than the ICG criteria in detecting malignant IPMNs (reaching 80%, 95%, and 87% vs. 67%, 58%, and 63%, respectively). Metabolic assessments may be used as an additional tool for the appropriate management of patients with doubtful imaging findings.
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Zhong L, Chai N, Linghu E, Li H, Yang J, Tang P. A prospective study on endoscopic ultrasound for the differential diagnosis of serous cystic neoplasms and mucinous cystic neoplasms. BMC Gastroenterol 2019; 19:127. [PMID: 31311499 PMCID: PMC6636106 DOI: 10.1186/s12876-019-1035-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/24/2019] [Indexed: 12/21/2022] Open
Abstract
Background To provide criteria for the differential diagnosis of serous cystic neoplasms (SCNs) and mucinous cystic neoplasms (MCNs) by analyzing the imaging features of these two neoplasms by endoscopic ultrasound (EUS). Methods From April 2015 to December 2017, a total of 69 patients were enrolled in this study. All patients were confirmed to have MCNs (31 patients) or SCNs (38 patients) by surgical pathology. All patients underwent EUS examination. The observation and recorded items were size, location, shape, cystic wall thickness, number of septa, and solid components. Results Head/neck location, lobulated shape, thin wall and > 2 septa were the specific imaging features for the diagnosis of SCNs. When any two imaging features were combined, we achieved the highest area under the curve (Az) (0.824), as well as the appropriate sensitivity (84.2%), specificity (80.6%), positive predictive value (PPV) (84.2%), and negative predictive value (NPV) (80.6%). Body/tail location, round shape, thick wall and 0–2 septa were the specific imaging features for the diagnosis of MCNs. When any three imaging features were combined, we obtained the highest Az value (0.808), as well as the appropriate sensitivity (77.4%), specificity (84.2%), PPV (80.0%) and NPV (82.1%). Conclusions Pancreatic cystadenomas that meet any two of the four imaging features of head/neck location, lobulated shape, thin wall and > 2 septa could be diagnosed as SCNs, and those that meet any three of the four imaging features of body/tail location, round shape, thick wall and 0–2 septa could be considered as MCNs. Trial registration The study was registered at the Chinese Clinical Trial Registry. The registration identification number is ChiCTR-OOC-15006118. The date of registration is 2015-03-20.
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Affiliation(s)
- Lisen Zhong
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ningli Chai
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
| | - Huikai Li
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Jing Yang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ping Tang
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
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Abstract
We report a case of a 29-year-old woman with a pancreatic lymphangioma who presented clinically as a case of acute pancreatitis. Lymphangiomas are benign tumors of vascular origin with lymphatic differentiation, most commonly found in the head and neck. Pancreatic lymphangiomas are extremely rare, accounting for only 1% of abdominal lymphangiomas, with approximately 60 cases reported in the literature. Although imaging findings are characteristic and can point to the diagnosis, confirmation with fine needle aspiration and histopathologic correlation is necessary. Although these lesions are benign, they can often present a diagnostic dilemma and can be mistaken for other cystic pancreatic lesions, namely, pseudocysts, cysts, cystadenomas, and cystadenocarcinomas.
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Abstract
Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring <40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter ≥40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.
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Heneidy H, Yosef W, Badr S. Cystic pancreatic lesions; CT characterization and pathological evaluation. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Jiang L, Cui L, Wang J, Chen W, Miao L, Jia J. Solid pseudopapillary tumors of the pancreas: Findings from routine screening sonographic examination and the value of contrast-enhanced ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:277-282. [PMID: 25502923 DOI: 10.1002/jcu.22259] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 11/16/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Solid pseudopapillary tumors (SPTs) are rare neoplasms of the pancreas. We describe the features of these small tumors identified on routine screening sonographic (US) examination and the potential value of using contrast-enhanced ultrasound (CEUS) scanning. METHODS We retrospectively reviewed records from 17 patients who had undergone screening via US examination at Peking University Third Hospital between January 2000 and June 2011. Each of these patients had been confirmed by a pathologist to have an SPT. Six patients had undergone CEUS prior to surgery. We recorded all features on both gray-scale US and CEUS. RESULTS All patients (4 men and 13 women; ages 23-35 years; mean age, 27.2 years) were initially screened by US. The largest mass identified was 5.0 cm in diameter (mean diameter, 4.2 cm), and most tumors showed homogeneous hypoechogenicity. A hyperechoic rim was detected in four masses. CEUS showed peripheral-rim hyperenhancement in the arterial phase of all six masses. CONCLUSIONS Routine screening US examinations are capable of identifying small (<5.0 cm) SPTs. These screening examinations allow diagnosis on the basis of typical imaging features, such as a homogeneously hypoechoic mass with a hyperechoic rim. CEUS shows greater detail of the rim and cystic areas in the tumor, which significantly improves the proper diagnosis.
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Affiliation(s)
- Ling Jiang
- Department of Diagnostic Ultrasound, Peking University Third Hospital, Beijing, 100191, China
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12
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An Update of Clinical CT Imaging of Pancreatic Neoplasm: Tips, Tricks, and Pitfalls. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Hammond NA, Miller FH, Day K, Nikolaidis P. Imaging features of the less common pancreatic masses. ACTA ACUST UNITED AC 2014; 38:561-72. [PMID: 22711184 DOI: 10.1007/s00261-012-9922-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Contrast-enhanced multiphase CT and dynamic gadolinium-enhanced MR have been validated in the literature as outstanding modalities for the evaluation of pancreatic pathology. In addition to the more frequently seen pancreatic adenocarcinoma, neuroendocrine tumors of the pancreas and cystic lesions such as serous and mucinous cystadenomas and IPMNs, a variety of benign and malignant lesions may occur in the pancreas. The purpose of this pictorial essay is to review the imaging findings of a variety of uncommon, benign and malignant, pancreatic neoplasms.
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Affiliation(s)
- Nancy A Hammond
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Chicago, IL 60611, USA.
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SHERIDAN MB, MANOHARAN P. Neoplasms of the pancreas. IMAGING 2013. [DOI: 10.1259/imaging/20369618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Incidentally discovered benign pancreatic cystic neoplasms not communicating with the ductal system: MR/MRCP imaging appearance and evolution. Radiol Med 2012; 118:163-80. [PMID: 22744342 DOI: 10.1007/s11547-012-0837-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 10/11/2011] [Indexed: 12/18/2022]
Abstract
PURPOSE The authors sought to determine magnetic resonance/magnetic resonance cholangiopancreatography (MR/MRCP) imaging features of incidentally discovered benign, noncommunicating cystic neoplasms (BNCNs) of the pancreas to assess their evolution over time and identify MR/MRCP imaging features predictive of tumour growth. MATERIAL AND METHODS This was a retrospective study, so informed consent was waived. Sixty-two patients with a diagnosis of BNCN were assessed. Inclusion criteria were incidentally discovered cystic neoplasm of the pancreas with nonmeasurable walls, no mural nodules and no communication with the pancreatic ductal system and who underwent ≥ 1 MR/MRCP examination. Image analysis, performed at diagnosis and during follow-up, included macroscopic pattern (microcystic/macrocystic/mixed), number of cysts (unicystic/oligocystic/multicystic), BNCN maximum diameter and tumour growth rates. RESULTS A total of 64 BNCNs was detected. Macroscopic pattern was mixed in 31/64 (48%), microcystic in 28/64 (44%) and macrocystic in 5/64 (8%). BNCNs appeared multicystic in 38/64 (59%) cases, oligocystic in 22/64 (35%) and unicystic in 4/64(6%). All qualitative parameters remained unchanged during follow-up. At diagnosis, the median maximum BNCN diameter was 35.0 mm and 38.0 mm at the final examination (p<0.001). BNCNs showed a tumour growth rate of 2 mm/year. CONCLUSIONS Mixed and microcystic patterns were the most common, accounting for 48% and 44% of cases, respectively, and showed no change over time. MR/MRCP features predictive of lesion enlargement were a mixed/ macrocystic pattern, and lesion size was >3 cm (both p<0.001).
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Prospective evaluation of reader performance on MDCT in characterization of cystic pancreatic lesions and prediction of cyst biologic aggressiveness. AJR Am J Roentgenol 2011; 197:W53-61. [PMID: 21700995 DOI: 10.2214/ajr.10.5866] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Our objective was to evaluate the accuracy of MDCT features of pancreatic cystic lesions in cyst characterization and in predicting cyst biologic aggressiveness. SUBJECTS AND METHODS In this prospective study, 114 patients (40 men and 74 women; age range, 23-89 years) with 130 cystic lesions (size range, 31-160 mm) in the pancreas underwent contrast-enhanced dual-phase (n = 92) and portal phase (n = 22) examinations with 16- or 64-MDCT scanners. Using defined morphologic features of cystic lesions on MDCT, two readers performed blinded evaluations for cystic characterization and predicting biologic aggressiveness (invasive lesions, carcinoma in situ, and moderate grade dysplasias) before pancreatic surgery. Receiver operating characteristic analysis was performed to assess the accuracy of MDCT using pathologic evaluation of the surgical specimen as a reference standard. RESULTS On the basis of MDCT features, the radiologic accuracy (reader 1 and reader 2) for stratifying lesions into mucinous and nonmucinous subtypes was 85% and 82% and for recognizing cysts with aggressive biology was 86% and 85%, respectively. Predictive values of MDCT were superior for lesions > 30 mm and nonmucinous lesions. Features favoring aggressive biology were main pancreatic duct dilation > 10 mm (p < 0.0001), biliary obstruction (p=0.01), mural nodule (p < 0.0001), main-duct intraductal papillary mucinous neoplasm (p < 0.0001), and advanced age (p = 0.0001). Sensitivity of detecting morphologic features was higher with the dual-phase pancreatic protocol CT. CONCLUSION Morphologic features of pancreatic cystic lesions on MDCT allow reliable characterization into mucinous and nonmucinous subtypes and enable prediction of biologic aggressiveness.
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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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Abstract
OBJECTIVE The purpose of our study was to retrospectively investigate the MRI findings (diameter, location, contour and margin, signal intensity characteristics, and enhancement patterns) in a series of eight patients with pathologically proven colloid carcinoma of the pancreas. CONCLUSION Colloid carcinomas of the pancreas appear as masses with lobulating contours, indiscrete margins, and hyperintensity on T2-weighted images (n = 8). In addition, all patients who underwent dynamic studies (n = 4) showed peripheral and internal sponge-like or mesh-like progressive delayed contrast enhancement.
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Yoon SE, Byun JH, Kim KA, Kim HJ, Lee SS, Jang SJ, Jang YJ, Lee MG. Pancreatic ductal adenocarcinoma with intratumoral cystic lesions on MRI: correlation with histopathological findings. Br J Radiol 2009; 83:318-26. [PMID: 19620175 DOI: 10.1259/bjr/69770140] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to evaluate intratumoral cystic lesions of pancreatic ductal adenocarcinoma (PDAC) depicted on MRI, and to correlate these cystic lesions with their histopathological findings. This study included 12 patients (7 males and 5 females; mean age, 59 years) with intratumoral cystic lesions of PDAC detected on a retrospective MRI review. We reviewed the histopathological findings of the cystic lesions within PDACs and analysed the MRI findings, focusing on the appearance of the intratumoral cystic lesions, i.e. the size, number, margin and intratumoral location, and on the ancillary findings of PDAC, i.e. peripancreatic infiltration, upstream pancreatic duct dilatation and distal parenchymal atrophy. Intratumoral cystic lesions were classified as neoplastic mucin cysts (n = 7, 58%) or cystic necrosis (n = 5, 42%) according to the histopathological findings; they ranged in greatest dimension from 0.5 cm to 3.4 cm (mean, 1.7 cm). Seven patients had only one cystic lesion each, while the remaining five had multiple cystic lesions. Most of the neoplastic mucin cysts had smooth margins (n = 6, 86%) and eccentric locations (n = 6), whereas most cystic necroses had irregular margins (n = 4, 80%) and centric locations (n = 4). The most common ancillary findings of PDAC were peripancreatic infiltration, distal pancreatic atrophy and upstream pancreatic duct dilatation (92%, 75% and 58%, respectively). The intratumoral cystic lesions of PDACs on MRI were classified as either neoplastic mucin cysts with smooth margins and eccentric locations or cystic necroses with irregular margins and centric locations.
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Affiliation(s)
- S E Yoon
- Departments of Radiology, University of Ulsan College of Medicine,Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, Korea
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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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Bauer A, Kleeff J, Bier M, Wirtz M, Kayed H, Esposito I, Korc M, Hafner M, Hoheisel JD, Friess H. Identification of malignancy factors by analyzing cystic tumors of the pancreas. Pancreatology 2008; 9:34-44. [PMID: 19077453 DOI: 10.1159/000178873] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM The diversity in the aggressiveness of cystic tumors of the pancreas - ranging from the usually benign serous cystadenoma to lesions of variable degrees of malignancy - was utilized for the identification of molecular factors that are involved in the occurrence of malignancy. METHODS We analyzed the transcript profiles of different cystic tumor types. The results were confirmed at the protein level by immunohistochemistry. Also, functional studies with siRNA silencing were performed. RESULTS Expression variations at the RNA and protein level were identified that are closely correlated with the degree of malignancy. Besides, all tumors could be classified effectively by this means. Many of the identified factors had not previously been known to be associated with malignant cystic lesions. siRNA silencing of the gene with the most prominent variation - the anti-apoptotic factor FASTK (Fas-activated serine/threonine kinase) - revealed a regulative effect on several genes known to be relevant to the development of tumors. CONCLUSION By a molecular analysis of rare types of pancreatic cancer, which are less frequent in terms of disease, variations could be identified that could be critical for the regulation of malignancy and thus relevant to the treatment of also the majority of pancreatic tumors.
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Affiliation(s)
- Andrea Bauer
- Division of Functional Genome Analysis, Deutsches Krebsforschungszentrum, Heidelberg, Germany.
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Lai ECH, Lau WY. Diagnosis and management strategy for cystic neoplasm of the pancreas. Int J Surg 2008; 7:7-11. [PMID: 18977189 DOI: 10.1016/j.ijsu.2008.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Accepted: 09/30/2008] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This article aimed to propose a management strategy for cystic neoplasm of the pancreas based on the available evidence in the medical literature. METHODS A Medline search was undertaken to identify articles from 1988 to 2008 using the keywords 'pancreatic cyst', 'pancreatic neoplasms', and 'cystic neoplasm of pancreas'. Additional papers were identified by a manual search of the references from the key articles. COMMENTS The optimal management of cystic neoplasms of pancreas remains controversial and should be individualized based on the balance between the risk and benefit. Multiple factors such as patient's comorbidity, performance status, life expectancy, and surgical risk, should be weighed against the malignant potential of the cyst.
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Affiliation(s)
- Eric C H Lai
- Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
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23
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Macrocystic pancreatic lesions: differentiation of benign from premalignant and malignant cysts by CT. Eur J Radiol 2008; 71:122-8. [PMID: 18448299 DOI: 10.1016/j.ejrad.2008.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 03/09/2008] [Accepted: 03/12/2008] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess useful CT features for differentiating benign from premalignant and malignant macrocystic pancreatic lesions. METHODS Seventy-four patients with pathologically proven macrocystic pancreatic lesions were enrolled: 17 benign cysts (macrocystic serous cystadenoma, n=12; congenital cyst; n=5) and 57 premalignant and malignant cysts (mucinous cystic neoplasm, n=28; intraductal papillary mucinous neoplasm of branch duct type, n=20; tumor with cystic change, n=9). Size, location, shape (lobulated, round or oval, or complex cystic with tubular cyst), wall thickness (thin, < or =1mm; thick, >1mm), internal surface (smooth or irregular), and other findings were analyzed with multiphasic CT with thin-section (2.5-3mm) images. CT features between two groups were compared using univariate and multivariate stepwise logistic regression analyses. RESULTS On univariate analysis, the differences for the shape (p=0.007), wall thickness (p=0.011), and internal surface (p=0.012) between benign and premalignant and malignant cysts were significant. A lobulated shape, a thin wall and a smooth internal surface were more frequent in benign cysts, whereas a round or oval shape or a complex cystic shape with tubular cyst, a thick wall and an irregular internal surface were more frequent in premalignant and malignant cysts. On multivariate analysis, the shape (p=0.002) and wall thickness (p=0.025) were significant CT features for differentiating benign from premalignant and malignant cysts. CONCLUSION Shape and wall thickness are the main CT features for differentiating benign from premalignant and malignant macrocystic pancreatic lesions.
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Abstract
OBJECTIVE The purpose of this article is to illustrate the varied CT appearances of serous cystadenoma of the pancreas and of masses that mimic serous cystadenoma. CONCLUSION Serous cystadenomas of the pancreas have a wide range of CT findings. Familiarity with the varied CT appearances and awareness of the diagnostic limitations of CT are important for accurate diagnosis and management of serous cystadenoma of the pancreas.
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Lewin M, Hoeffel C, Azizi L, Lacombe C, Monnier-Cholley L, Raynal M, Arrivé L, Tubiana J. Imagerie des lésions kystiques du pancréas de découverte fortuite. ACTA ACUST UNITED AC 2008; 89:197-207. [DOI: 10.1016/s0221-0363(08)70395-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Alcalá-Galiano A, Borruel Nacenta S, Jiménez-Arranz S, Martín-Medina P. [Serous oligocystic adenoma of the pancreas]. RADIOLOGIA 2007; 49:427-9. [PMID: 18021674 DOI: 10.1016/s0033-8338(07)73814-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Serous oligocystic or macrocystic adenoma of the pancreas is a very uncommon morphological variant of what was classically termed microcystic adenoma of the pancreas. This is a benign neoplasm; however, its radiological appearance mimicks that of potentially malignant mucinous neoplasms of the pancreas. Therefore, radiologists need to be familiar with this entity to ensure the most appropriate therapeutic management and help to avoid unnecessary surgery.
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Affiliation(s)
- A Alcalá-Galiano
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España.
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27
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Younus S, Bleibel W, Bleibel H, Hernady N. Lymphoepithelial cyst of the pancreas. Dig Dis Sci 2007; 52:3136-9. [PMID: 17909972 DOI: 10.1007/s10620-005-9055-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2005] [Accepted: 09/16/2005] [Indexed: 12/09/2022]
Affiliation(s)
- Sumera Younus
- Department of Internal Medicine, Caritas Carney Hospital/Tufts University School of Medicine, Dorchester, Massachusetts 02124, USA
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28
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Song SJ, Lee JM, Kim YJ, Kim SH, Lee JY, Han JK, Choi BI. Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. J Magn Reson Imaging 2007; 26:86-93. [PMID: 17659551 DOI: 10.1002/jmri.21001] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To compare the diagnostic performance of multirow-detector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the differentiation of intraductal papillary mucinous neoplasms (IPMNs) from other pancreatic cystic masses. MATERIALS AND METHODS A total of 53 patients with pathologically proven pancreatic cystic lesions who had undergone MDCT and MRI were included in this study. Two radiologists analyzed the morphologic features of the lesions and graded the lesion conspicuity on each examination. The readers assigned their confidence level regarding the differentiation of IPMN from other lesions and predicting ductal communication of the lesion. The radiologists' diagnostic confidence was compared using receiver operating characteristic (ROC) analysis. RESULTS The Az values for each observer for predicting ductal communication of the lesion and differentiating IPMN from other lesions were as follows: For MRI they were respectively 0.949 and 0.995 for reader 1, and 0.916 and 0.932 for reader 2. For MDCT they were respectively 0.790 and 0.875 for reader 1, and 0.774 and 0.850 for reader 2. In addition, for differentiating IPMNs from other lesions, MRI was significantly more accurate than MDCT (P < 0.05) for one observer, but for the other observer there was no significant difference between the two examinations (P = 0.059). For predicting ductal communication of the cystic lesions for both observers, MRI was significantly more accurate than MDCT (P < 0.05). The weighted kappa values indicate good agreement (kappa = 0.61) between observers for MDCT, and excellent agreement (kappa = 0.82) for MRI. CONCLUSION Pancreatic MRI shows better diagnostic performance than MDCT for differentiating IPMNs from other cystic lesions of the pancreas.
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Affiliation(s)
- Su Jin Song
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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29
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D'Onofrio M, Zamboni G, Faccioli N, Capelli P, Pozzi Mucelli R. Ultrasonography of the pancreas. 4. Contrast-enhanced imaging. ACTA ACUST UNITED AC 2007; 32:171-81. [PMID: 16838218 DOI: 10.1007/s00261-006-9010-6] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The introduction of contrast-enhanced ultrasonography (CEUS) has lead to great developments in the diagnostic capabilities of ultrasound. Second generation contrast media, characterized by harmonic responses at low mechanical index of the ultrasound beam, have already proven usefulness in the study of the liver but other abdominal organs can take advantage from the dynamic study during continuous ultrasonographic scans. The dynamic observation of the enhancement allows the perfect evaluation of the abdominal organs perfusion. The perfusion of the pancreas is well correlated to the semeiology of the gland parenchymography at CEUS. The study of the pancreas is a new and promising application of CEUS. CEUS can be used to better identify pancreatic lesions respect to conventional Ultrasound (US) or to characterize pancreatic lesions already visible at US. Moreover the staging of some pancreatic lesions can be improved by the use of contrast media. This article will review the clinical application of CEUS in the different pancreatic pathologies.
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Affiliation(s)
- M D'Onofrio
- Department of Radiology, G.B. Rossi Hospital, University of Verona, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
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Ito K, Perez A, Ito H, Whang EE. Pancreatic pseudocysts: is delayed surgical intervention associated with adverse outcomes? J Gastrointest Surg 2007; 11:1317-21. [PMID: 17674114 DOI: 10.1007/s11605-007-0237-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 06/30/2007] [Indexed: 01/31/2023]
Abstract
BACKGROUND Nonsurgical interventions are increasingly applied for pancreatic pseudocysts. We hypothesized that surgical therapy applied after failure of percutaneous or endoscopic therapies for pseudocysts is associated with poorer outcomes than cases in which surgery is the initial intervention. MATERIALS AND METHODS Medical records of all 284 patients admitted with pancreatic pseudocysts at our institution (1/1990-9/2005) were analyzed. Forty-six patients underwent surgery as the initial intervention (group A). Among 162 patients who underwent percutaneous or endoscopic drainage as the initial intervention, 75 patients required subsequent surgery after failure of nonsurgical intervention (group B). RESULTS Groups were comparable in demographic variables and in location, number, and size of pseudocysts. Forty-two percent of group B patients developed infection within their pseudocysts after their nonsurgical interventions. Compared to group A patients, group B patients had higher rates of overall perioperative morbidity (47.8% vs 73.3%, p = 0.01) and postoperative readmission (24.0% vs 44.7%, p = 0.04). Five (6.7%) group B patients died in the perioperative period; there were no perioperative deaths among group A patients. CONCLUSION Delayed surgical intervention for pancreatic pseudocysts is associated with higher incidences of postoperative complications, readmission, morbidity, and mortality. The increasing application of nonsurgical interventions needs to be reevaluated.
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Affiliation(s)
- Kaori Ito
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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31
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Irie H, Yoshimitsu K, Tajima T, Asayama Y, Hirakawa M, Ishigami K, Ushijima Y, Honda H. Imaging Spectrum of Cystic Pancreatic Lesions: Learn from Atypical Cases. Curr Probl Diagn Radiol 2007; 36:213-26. [PMID: 17765800 DOI: 10.1067/j.cpradiol.2007.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The classic radiologic findings of cystic pancreatic masses have been well recognized; however, diagnosing those lesions is still challenging since many cases show unusual radiologic findings. We reviewed the computed tomography, magnetic resonance, and endoscopic retrograde cholangiopancreatography findings of many pathologically proven cystic pancreatic masses and selected various atypical but instructive cases as well as rare pathologic cases from the past 10 years in our institution. This article presents atypical as well as rare pathologic cases of cystic pancreatic masses and correlates them with pathologic findings to obtain diagnostic clues to perform a correct diagnosis.
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Affiliation(s)
- Hiroyuki Irie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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32
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García Figueiras R, Villalba Martín C, García Figueiras A, Otero Echart M, Requejo Isidro I, Pazos González G, Rosario A. The Spectrum of Cystic Masses of the Pancreas: Imaging Features and Diagnostic Difficulties. Curr Probl Diagn Radiol 2007; 36:199-212. [PMID: 17765799 DOI: 10.1067/j.cpradiol.2007.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Cystic masses of the pancreas comprise a diverse group of pathologic entities ranging from pseudocysts to cystic tumors. Although their presentations may be similar, the appropriate treatment and patient management can differ greatly. There is an overlap in radiologic features, but the clinical context and some imaging findings are useful in differentiating among these entities; the differential diagnosis could be considerably reduced and it is generally possible to reach the correct diagnosis. In this article, we review imaging characteristics and radiologic patterns of both common and uncommon cystic masses of the pancreas. An algorithmic approach for the management of cystic pancreatic lesions is proposed.
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Affiliation(s)
- Roberto García Figueiras
- Department of Radiology, Complexo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela 15706, Spain.
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Horton KM, Hruban RH, Yeo C, Fishman EK. Multi-detector row CT of pancreatic islet cell tumors. Radiographics 2006; 26:453-64. [PMID: 16549609 DOI: 10.1148/rg.262055056] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Pancreatic islet cell tumors (ICTs) are neuroendocrine neoplasms that produce and secrete hormones to a variable degree. These neoplasms can present a diagnostic challenge, both clinically and radiologically. ICTs can be classified as either syndromic or nonsyndromic on the basis of their clinical manifestations. Multi-detector row computed tomography (CT) plays an important role in the diagnosis and staging of both syndromic and nonsyndromic ICTs. In general, syndromic ICTs are less than 3 cm in size. They are typically hyperenhancing and are usually best seen on CT scans obtained during the arterial phase. Nonsyndromic ICTs tend to be larger than syndromic ICTs at presentation and are more likely to be cystic or necrotic. It is important for the radiologist to be familiar with appropriate CT protocol for the evaluation of patients with suspected pancreatic ICT and to understand the variable CT appearances of these neoplasms.
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Affiliation(s)
- Karen M Horton
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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34
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Imaging of Cystic and Intraductal Pancreatic Lesions: Self-Assessment Module. AJR Am J Roentgenol 2006. [DOI: 10.2214/ajr.06.0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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35
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Vargas-Serrano B, Domínguez-Ferreras E, Chinchón-Espino D. Four cases of solid pseudopapillary tumors of pancreas: Imaging findings and pathological correlations. Eur J Radiol 2006; 58:132-9. [PMID: 16377114 DOI: 10.1016/j.ejrad.2005.11.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Revised: 11/22/2005] [Accepted: 11/23/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Solid pseudopapillary tumor of the pancreas (SPTP tumor) is a rare pancreatic neoplasm with low malignant potential, which usually affects female patients in the second or third decades of life. It is a non-functional, slow-growing neoplasm that very often reaches considerable size before the first symptoms appear. Symptomatology is frequently related to tumor size. Surgical excision is usually curative in most cases. Infrequently the tumor can appear in male patients or in aged women, which can make the diagnosis more difficult. Some patients develop liver metastases in the follow-up that can be resected. Our purpose is to review the radiological and pathological findings of SPTP with emphasis on these infrequent cases. SUBJECTS AND METHODS The medical records and radiological findings of patients who underwent surgery for SPTP between 2000 and 2005 were retrospectively reviewed. Study eligibility required that patients had undergone surgical resection and that a SPTP had been pathologically proved. RESULTS Four cases of solid pseudopapillary tumor of the pancreas were diagnosed and treated in our institution in the study period. Two of the patients, developed on follow-up liver metastases, and peritoneal, hepatic, and nodal metastases, respectively. CONCLUSION Solid pseudopapillary tumors are well-encapsulated neoplasms that usually have a good prognosis after surgical excision. A malignant behavior is uncommon and in this case lymph node involvement, hepatic metastases and occasionally peritoneal invasion may also occur. Resection of liver metastases can prolong the long-term survival of the patients.
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Affiliation(s)
- Blanca Vargas-Serrano
- Servicio de Radiología, Hospitales Universitarios Virgen del Rocío, Avda Manuel Siurot s/n, Sevilla 41013, Spain
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36
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Park MS, Kim KW, Lim JS, Lee JH, Kim JH, Kim SY, Yu JS, Kim MJ. Unusual cystic neoplasms in the pancreas: radiologic-pathologic correlation. J Comput Assist Tomogr 2005; 29:610-6. [PMID: 16163029 DOI: 10.1097/01.rct.0000172561.62810.6c] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cystic neoplasms in the pancreas encompass a broad spectrum of benign, borderline, and malignant lesions that either are primarily cystic or result from the cystic degeneration of solid tumors. Although these lesions show different histologic findings, the overlap of the radiologic findings for many pancreatic cystic lesions makes differentiation difficult, and the clinical manifestations can also overlap. Therefore, some of the pancreatic cystic lesions, especially uncommon lesions, can cause diagnostic confusion, and this may result in unnecessary surgery or inappropriate follow-up. In this article, we discuss and illustrate the radiologic features of unusual cystic neoplasms and the unusual findings of the relatively common cystic neoplasms in the pancreas. We also correlate the radiologic findings with the findings on pathologic analysis.
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Affiliation(s)
- Mi-Suk Park
- Department of Diagnostic Radiology, YongDong Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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37
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Green DE, Woodward PJ. The management of indeterminate incidental findings detected at abdominal CT. Semin Ultrasound CT MR 2005; 26:2-13. [PMID: 15771259 DOI: 10.1053/j.sult.2004.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Abdominal computed tomography (CT) scans often have findings that are incidental to the reason the study was ordered. Several recent studies and reviews have addressed how these findings should be managed. This article summarizes current management strategies for several types of lesions that are commonly encountered. Some of these findings can be characterized without additional imaging (including simple renal cyst, angiomyolipoma, hepatic steatosis). Other findings are indeterminate. While some of these indeterminate incidental findings can be ignored based on statistical arguments (for example, a sharply circumscribed homogeneous low-attenuation renal lesion under 1 cm in patients without a predisposition to develop renal cell carcinoma), many may need additional imaging studies to either characterize them or demonstrate stability over time. Adhering to these strategies will hopefully reduce overutilization of imaging services while directing attention to those findings which need diagnostic or therapeutic interventions.
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Affiliation(s)
- Douglas E Green
- Department of Radiology, The University of Utah, Health Sciences Center, Salt Lake City, Utah 84132, USA
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38
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Hariri A, Siegelman SS, Hruban RH. Duodenal diverticulum mimicking a cystic pancreatic neoplasm. Br J Radiol 2005; 78:562-4. [PMID: 15900065 DOI: 10.1259/bjr/52543195] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Duodenal diverticula occur very commonly, with a prevalence as high as 22%. They are most frequently located in the second or third portions of the duodenum, and by nature of their proximity to the head of the pancreas, can be mistaken for cystic pancreatic neoplasms by diagnostic imaging. Patients with presumed cystic neoplasms of the pancreas often receive pancreaticoduodenectomies, which at high volume medical centres carry mortality and morbidity rates of 2-4% and 29-44%, respectively. Although most duodenal diverticula are recognized in single or repeat CT scans by the presence of air or contrast medium within the diverticula, we present a case in which serial CTs failed to yield any clue to the diverticulum's true nature and pancreaticoduodenectomy was performed. For presumed cystic lesions adjacent to the duodenum, barium studies, endoscopy, and/or endoscopic ultrasound-guided aspiration should therefore be pursued in addition to all available CT evidence prior to surgery.
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Affiliation(s)
- A Hariri
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Bachmann A, Ruszat R, Wyler S, Casella R, Langer I, Gasser TC, Sulser T. Pitfall in renal cyst surgery: serous cystadenoma of pancreas mimicking renal cyst. Urology 2005; 65:799. [PMID: 15833547 DOI: 10.1016/j.urology.2004.10.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Accepted: 10/28/2004] [Indexed: 11/17/2022]
Abstract
Pancreatic lesions, particularly cysts, can simulate various diseases. We report a case of a 43-year-old woman with a large, symptomatic, retroperitoneal cyst misdiagnosed as a "renal cyst." During the retroperitoneoscopic marsupialization, the correct diagnosis of a pancreatic cyst was made, leading to an open pancreas tail resection. Histologic evaluation revealed serous cystadenoma. Especially in large retroperitoneal cysts on the left side, the correct diagnosis of a pancreatic cyst can be difficult.
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Abstract
CASE HISTORY A 5-year-old neutered male Cornish Rex cat was presented for evaluation with a history of vomiting over the previous 5 days. CLINICAL FINDINGS An abdominal mass was palpated, which was shown to be cystic by ultrasound examination. Exploratory surgery revealed this to be associated with the pancreas and it was duly resected. Histopathology was performed on the cystic mass. DIAGNOSIS Pancreatic cyst with associated chronic active inflammation. CLINICAL RELEVANCE This is the first report of a true pancreatic cyst in a cat.
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Affiliation(s)
- M G Coleman
- Veterinary Specialist Group, 97 Carrington Rd, UNITEC, Auckland, New Zealand.
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41
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Abstract
A 72-year-old man with right lower lobe squamous cell carcinoma of the lung-status, post resection-and prostate carcinoma was referred for restaging with whole-body PET using F-18 FDG. PET images, in addition to the presence of moderate hypermetabolic activity seen in the left lower paratracheal and bilateral hilar regions, revealed a large hypometabolic space-occupying lesion in the abdomen. The appearance of this lesion was highly suggestive of a pancreatic pseudocyst. Further review of a CT scan performed 3 years ago confirmed the presence of a pancreatic pseudocyst. However, this information was not available to the nuclear medicine physician at the time of the PET examination.
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Affiliation(s)
- Brady Huang
- University of Rochester Medical Center, Department of Radiology, Division of Nuclear Medicine, Rochester, New York, USA
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42
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Fukushima N, Sato N, Prasad N, Leach SD, Hruban RH, Goggins M. Characterization of gene expression in mucinous cystic neoplasms of the pancreas using oligonucleotide microarrays. Oncogene 2005; 23:9042-51. [PMID: 15489895 DOI: 10.1038/sj.onc.1208117] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Mucinous cystic neoplasms (MCNs) of the pancreas are uncommon neoplasms usually located in the body or tail of the pancreas and usually in females (>90% of cases). Clinically, they are often misdiagnosed as non-neoplastic pseudocysts leading to failed opportunities for curative resection. To better understand the biology of MCNs and to identify markers of the disease, we performed global gene expression profiling of MCNs using oligonucleotide microarrays. Using laser capture microdissection applied to frozen sections, RNA was extracted from the neoplastic epithelium of MCNs, from the adjacent 'ovarian-type' stroma of MCNs, from histologically normal pancreatic ductal epithelium, from pancreatic acinar tissue and from fibrous stroma in pancreata affected by chronic pancreatitis. Each RNA sample was subjected to two rounds of linear amplification followed by hybridization with U133A gene chips (Affymetrix). The expression patterns of selected genes were confirmed by quantitative RT-PCR and by immunohistochemistry using tissue microarrays containing 19 resected MCNs. A total of 114 known genes were overexpressed in the neoplastic epithelium compared to normal pancreatic ductal epithelium (>3-fold) including S100P, PSCA, c-myc, STK6/STK15, cathepsin E and pepsinogen C. Activation of the Notch pathway in the epithelial component of MCNs was evident by the demonstration of overexpression of Jagged1 and the downstream Notch pathway member Hes1. In the 'ovarian-type' stroma, several genes involved in estrogen metabolism were overexpressed including STAR and ESR1 genes. Some of the genes identified as overexpressed in these neoplasms may be useful as markers that can distinguish MCNs from non-neoplastic pancreatic cystic lesions.
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Affiliation(s)
- Noriyoshi Fukushima
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA
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43
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Stade M, Sasson AR, Oleynikov D, Stothert J, Thompson J. Influence of pre-operative diagnosis and frozen section on operative management of pancreatic cystic lesions. HPB (Oxford) 2005; 7:235-7. [PMID: 18333197 PMCID: PMC2023959 DOI: 10.1080/13651820510037648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Frozen section analysis of cyst wall has been advocated as standard of care prior to surgical drainage of pancreatic pseudocysts. Recent studies have indicated that frozen section may be unreliable. Our aim was to investigate the role and accuracy of frozen section analysis of the cyst wall in the operative management of pancreatic cystic lesions. METHODS A retrospective review was performed of 44 patients who underwent operation for a cystic lesion of the pancreas. RESULTS Of the 25 patients with a diagnosis of pseudocyst, 9 patients had frozen section intra-operatively. Eight frozen sections demonstrated pseudocyst, and correlated with final pathology. One frozen section demonstrated a true cyst. Twenty-three patients had a final diagnosis of pseudocyst. Nineteen patients had a diagnosis of cystic neoplasm, and six patients had frozen sections. Three frozen sections were consistent with cystic neoplasm and correlated with final pathology. Three frozen sections demonstrated characteristics of pseudocyst, two correlated with final pathology, and one showed cystic neoplasm on final pathology. CONCLUSION Routine use of frozen section may not be necessary; however, frozen section is useful when the intra-operative appearance does not correlate with pre-operative diagnosis.
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Affiliation(s)
- Melissa Stade
- Department of Surgery, University of Nebraska Medical CenterOmaha NEUSA
| | - Aaron R. Sasson
- Department of Surgery, University of Nebraska Medical CenterOmaha NEUSA
| | - Dimitry Oleynikov
- Department of Surgery, University of Nebraska Medical CenterOmaha NEUSA
| | - Joseph Stothert
- Department of Surgery, University of Nebraska Medical CenterOmaha NEUSA
| | - Jon Thompson
- Department of Surgery, University of Nebraska Medical CenterOmaha NEUSA
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Tunaci M. Multidetector row CT of the pancreas. Eur J Radiol 2004; 52:18-30. [PMID: 15380844 DOI: 10.1016/j.ejrad.2004.03.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2004] [Revised: 03/15/2004] [Accepted: 03/18/2004] [Indexed: 01/21/2023]
Abstract
Multidetector CT (MDCT) has gained a great role in clinical imaging practice in a short time. Its major advantages are faster image acquisition and improved z-axis resolution. In spite of the advent of other imaging modalities CT is still the gold standard for the evaluation of pancreatic pathology. In this article, a review of the utility of MDCT in pancreatic applications is given with emphasis on acquisition techniques tailored to contrast material pharmacokinetics to improve lesion detection and characterization.
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Affiliation(s)
- Mehtap Tunaci
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, 34390 CAPA, Istanbul, Turkey.
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Levy MJ, Clain JE. Evaluation and management of cystic pancreatic tumors: emphasis on the role of EUS FNA. Clin Gastroenterol Hepatol 2004; 2:639-53. [PMID: 15290655 DOI: 10.1016/s1542-3565(04)00235-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cystic lesions of the pancreas are increasingly recognized and usually represent pseudocysts or cystic pancreatic tumors (CPTs), but also include congenital cysts, acquired cysts, extrapancreatic cysts, or cystic degeneration of solid tumors. It is important to distinguish CPT lesions given their varied prognosis and therapy. Mucinous varieties of CPTs (mucinous cystic neoplasms and intraductal papillary mucinous tumors) are premalignant or malignant, and surgical resection is generally recommended in good operative candidates. In contrast, nonmucinous CPTs include serous cystadenomas with a very low malignant potential, or pseudocysts, which are always benign. As a result, nonmucinous CPTs are generally resected only when inducing symptoms or complications. Review of the clinical, imaging, laboratory, and pathology information may clarify the specific tumor type. The relatively limited accuracy of any one modality requires that we consider the combined results when making management decisions.
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MESH Headings
- Biopsy, Fine-Needle
- Endosonography
- Female
- Histocytological Preparation Techniques
- Humans
- Male
- Middle Aged
- Neoplasms, Cystic, Mucinous, and Serous/diagnostic imaging
- Neoplasms, Cystic, Mucinous, and Serous/pathology
- Neoplasms, Cystic, Mucinous, and Serous/therapy
- Pancreatic Neoplasms/diagnostic imaging
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/therapy
- Pancreatic Pseudocyst/diagnostic imaging
- Pancreatic Pseudocyst/pathology
- Pancreatic Pseudocyst/therapy
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Affiliation(s)
- Michael J Levy
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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D'Onofrio M, Caffarri S, Zamboni G, Falconi M, Mansueto G. Contrast-enhanced ultrasonography in the characterization of pancreatic mucinous cystadenoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:1125-1129. [PMID: 15284474 DOI: 10.7863/jum.2004.23.8.1125] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Mirko D'Onofrio
- Department of Radiology, Policlinico G. B. Rossi, University of Verona, 37134 Verona, Italy.
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Abstract
Cystic pancreatic neoplasms are being diagnosed with growing frequency due to improving imaging technologies and increasing clinician awareness. Distinguishing cystic neoplasms from pseudocysts and discriminating among the various cystic neoplasms is essential to appropriate management. The backbone of diagnosis of these tumors continues to be cross-sectional imaging by CT and MRI. Despite refinements in technology and significant progress in characterizing these lesions, the overall accuracy of CT and MR is limited. EUS, especially as means of FNA, will have an increasing role in the evaluation of selected cases as experience grows. No radiologic investigation can reliably distinguish cystic neoplasms from pseudocysts nor differentiate among cystic neoplasms in all cases. For uncertain lesions, surgeons should favor either careful observation with serial imaging or surgical resection.
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Affiliation(s)
- Brendan C Visser
- Department of Surgery, University of California-San Francisco, 513 Parnassus Avenue, Room S-343, San Francisco, CA 94143-0470, USA.
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Gong JS, Xu JM. Role of curved planar reformations using multidetector spiral CT in diagnosis of pancreatic and peripancreatic diseases. World J Gastroenterol 2004; 10:1943-7. [PMID: 15222042 PMCID: PMC4572236 DOI: 10.3748/wjg.v10.i13.1943] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To investigate the role of curved planar reformations using multidetector spiral CT (MSCT) in diagnosis of pancreatic and peripancreatic diseases.
METHODS: From October 2001 to September 2003, 47 consecutive patients with pancreatic or peripancreatic diseases, which were confirmed by operation, endoscopic retrograde cholangiopancreatography and clinical follow-up, were enrolled in this study. CT scanning was performed at a MSCT with four rows of detector. A set of images with an effective thickness of 1.0-2.0 mm and a gap of 0.5-1.0 mm (50% overlap) were acquired in all patients for post-processing. Curved planar reformations were carried out by drawing a curved line on transverse source images, coronal or sagittal multiplanar reformations according to certain anatomic structures (such as cholangiopancreatic ducts or peripancreatic vessels) and the position of lesion.
RESULTS: With thin collimation, MSCT could acquire high-quality curved planar reformations to display the profile of the whole pancreas, to trace the cholangiopancreatic ducts and peripancreatic vessels, and to show the relationship of lesions with pancreas and peripancreatic anatomic structures in one curved plane, which facilitates diagnosis and rapid communication of diagnostic information with referring physicians.
CONCLUSION: MSCT with thin collimation could be used to create high-quality curved planar reformations in evaluating pancreatic and peripancreatic diseases with pertinent anatomic information and relative pathologic signs to facilitate the diagnosis and enhance communication with the referring physician. Curved planar reformations can serve as supplements for transverse images in diagnosis and management of pancreatic and peripancreatic diseases.
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Affiliation(s)
- Jing-Shan Gong
- Department of Radiology, Shenzhen People's Hospital (Second Affiliated Hospital, School of Medicine, Jinan University), Shenzhen 518020, Guangdong Province, China.
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Abstract
Pancreatic adenocarcinoma is the fourth most frequent cause of cancer-related death. The incidence is increasing and the overall survival has altered little in recent years. Moreover, patients usually present late with inoperable disease and curative resection by standard pancreatico-duodenectomy (Whipple's procedure) is associated with significant morbidity. It should only be attempted in that small group of patients lacking radiological evidence of advanced disease. Despite the recent advances in body magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS), computed tomography (CT) is the mainstay of staging in most centres and the recent development of multidetector CT machines (MDCT) has raised hope of an improvement in preoperative staging. This review focuses on the CT of pancreatic adenocarcinoma with particular emphasis on examination technique and on those criteria that determine resectability.
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Affiliation(s)
- S L Smith
- The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK.
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