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Kim HS, Choi YH, Jo IH, Paik CN, Lee IS, Chang JH. Tracking incidentally discovered pancreatic cysts smaller than 30 mm: Natural course and predictors of malignancy. Dig Liver Dis 2024; 56:137-143. [PMID: 37455153 DOI: 10.1016/j.dld.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND AIMS The aim of this study was to assess the natural course and predictors of malignancy in incidentally detected small pancreatic cysts (PCs). METHOD We retrospectively included patients with PCs smaller than 30 mm followed up with the same cross-sectional imaging modality at least 12 months apart between January 2010 and December 2019 in three academic institutions. Cyst growth, pancreatic cancer incidence, and associated factors associated with pancreatic cancer were analyzed. RESULTS A total of 1109 patients were followed up for a median of 34 months (range, 12‒118 months). Cyst growth and rapid cyst growth (≥ 5 mm/2 years) during follow-up were observed in 20.7% and 8.3%, respectively, both with higher rates for 15‒30 mm sized PCs. Eight patients were diagnosed with pancreatic cancer. The standardized incidence ratio for pancreatic cancer in small PCs was calculated as 5.2 [95% Confidence interval (CI): 1.3‒20.5]. The development of pancreatic cancer was associated with rapid growth [hazard ratio (HR): 8.1, 95% CI: 1.5‒43.4, p = 0.015] and newly developed worrisome features (HR: 11.7, 95% CI: 1.7‒79.6, p = 0.012) in competing risk analysis. CONCLUSIONS One-fifth of small incidentally detected PCs increased in size. Rapid growth and newly developed worrisome features were predictors of malignancy.
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Affiliation(s)
- Hyo Suk Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Hoon Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ik Hyun Jo
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Nyol Paik
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In Seok Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Hyuck Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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2
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Ito H, Kojima S, Moriyama K, Omura Y, Makuuchi T, Chou T, Ito A, Fujimoto R, Tsuda S, Hirose S, Nagata J, Suzuki T. Relationship Between Pancreatic Cysts and Cysts in Other Organs in Patients Undergoing Medical Checkup. Tokai J Exp Clin Med 2023; 48:133-135. [PMID: 37981849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/04/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE We investigated the association between pancreatic cysts and cystic diseases of other organs using abdominal ultrasonography in patients undergoing medical checkup. METHODS Between April 2021 and March 2022, 4496 patients had a comprehensive medical checkup at our hospital, which included abdominal ultrasonography. RESULTS Among 4496 patients, 172 (3.8%), 1592 (35.4%), and 1425 (31.7%) had pancreatic, liver, and renal cysts, respectively. Multivariate analysis revealed that the significant factors were female sex and the presence of renal cysts. CONCLUSION Pancreatic cysts were more common in females. Renal cysts are relatively commonly detected on abdominal ultrasonography. If renal cysts are detected, comorbidities with pancreatic cysts should be considered.
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Affiliation(s)
- Hiroyuki Ito
- Department of Gastroenterology, Tokai University Hachioji Hospital, 1838 Ishikawamachi, Hachioji, Tokyo 192-0032, Japan.
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3
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Koopmann BDM, Dunnewind N, van Duuren LA, Lansdorp-Vogelaar I, Naber SK, Cahen DL, Bruno MJ, de Kok IMCM. The Natural Disease Course of Pancreatic Cyst-Associated Neoplasia, Dysplasia, and Ductal Adenocarcinoma: Results of a Microsimulation Model. Gastroenterology 2023; 165:1522-1532. [PMID: 37633497 DOI: 10.1053/j.gastro.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/19/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND & AIMS Estimates on the progression of precursor lesions to pancreatic cancer (PC) are scarce. We used microsimulation modeling to gain insight into the natural disease course of PC and its precursors. This information is pivotal to explore the efficacy of PC screening. METHODS A Microsimulation Screening Analysis model was developed in which pancreatic intraepithelial neoplasms and cysts can evolve from low-grade dysplasia (LGD) to high-grade dysplasia (HGD) to PC. The model was calibrated to Dutch PC incidence data and Japanese precursor prevalence data (autopsy cases without PC) and provides estimates of PC progression (precursor lesion onset and stage duration). RESULTS Mean LGD state durations of cysts and pancreatic intraepithelial neoplasms were 15.8 years and 17.1 years, respectively. Mean HGD state duration was 5.8 years. For lesions that progress to PC, the mean duration was 4.8-4.9 years for LGD lesions and 4.0-4.1 years for HGD lesions. In 13.7% of individuals who developed PC, the HGD state lasted less than 1 year. The probability that an individual at age 50 years developed PC in the next 20 years was estimated to be 1.8% in the presence of any cyst and 6.1% in case of an LGD mucinous cyst. This 20-year PC risk was estimated to be 5.1% for individuals with an LGD pancreatic intraepithelial neoplasm. CONCLUSIONS Mean duration of HGD lesions before development of PC was estimated to be 4.0 years. This implies a window of opportunity for screening, presuming the availability of a reliable diagnostic test. The probability that an LGD cyst will progress to cancer was predicted to be low.
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Affiliation(s)
- Brechtje D M Koopmann
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Niels Dunnewind
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Luuk A van Duuren
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Steffie K Naber
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Djuna L Cahen
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Inge M C M de Kok
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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4
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Cui M, Hu Y, Zhang Z, Chen T, Dai M, Xu Q, Guo J, Zhang T, Liao Q, Yu J, Zhao Y. Cyst fluid glycoproteins accurately distinguishing malignancies of pancreatic cystic neoplasm. Signal Transduct Target Ther 2023; 8:406. [PMID: 37848412 PMCID: PMC10582020 DOI: 10.1038/s41392-023-01645-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/26/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Abstract
Pancreatic cystic neoplasms (PCNs) are recognized as precursor lesions of pancreatic cancer, with a marked increase in prevalence. Early detection of malignant PCNs is crucial for improving prognosis; however, current diagnostic methods are insufficient for accurately identifying malignant PCNs. Here, we utilized mass spectrometry (MS)-based glycosite- and glycoform-specific glycoproteomics, combined with proteomics, to explore potential cyst fluid diagnostic biomarkers for PCN. The glycoproteomic and proteomic landscape of pancreatic cyst fluid samples from PCN patients was comprehensively investigated, and its characteristics during the malignant transformation of PCN were analyzed. Under the criteria of screening specific cyst fluid biomarkers for the diagnosis of PCN, a group of cyst fluid glycoprotein biomarkers was identified. Through parallel reaction monitoring (PRM)-based targeted glycoproteomic analysis, we validated these chosen glycoprotein biomarkers in a second cohort, ultimately confirming N-glycosylated PHKB (Asn-935, H5N2F0S0; Asn-935, H4N4F0S0; Asn-935, H5N4F0S0), CEACAM5 (Asn-197, H5N4F0S0) and ATP6V0A4 (Asn-367, H6N4F0S0) as promising diagnostic biomarkers for distinguishing malignant PCNs. These glycoprotein biomarkers exhibited robust performance, with an area under the curve ranging from 0.771 to 0.948. In conclusion, we successfully established and conducted MS-based glycoproteomic analysis to identify novel cyst fluid glycoprotein biomarkers for PCN. These findings hold significant clinical implications, providing valuable insights for PCN decision-making, and potentially offering therapeutic targets for PCN treatment.
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Affiliation(s)
- Ming Cui
- Department of General Surgery, Key Laboratory of Research in Pancreatic Tumor, State Key Laboratory of Complex Severe and Rare Disease, National Science and Technology Key Infrastructure on Translational Medicine in Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Ya Hu
- Department of General Surgery, Key Laboratory of Research in Pancreatic Tumor, State Key Laboratory of Complex Severe and Rare Disease, National Science and Technology Key Infrastructure on Translational Medicine in Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Zejian Zhang
- Department of Medical Research Center, State Key Laboratory of Complex Severe and Rare Disease, National Science and Technology Key Infrastructure on Translational Medicine in Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Tianqi Chen
- Department of Medical Research Center, State Key Laboratory of Complex Severe and Rare Disease, National Science and Technology Key Infrastructure on Translational Medicine in Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Menghua Dai
- Department of General Surgery, Key Laboratory of Research in Pancreatic Tumor, State Key Laboratory of Complex Severe and Rare Disease, National Science and Technology Key Infrastructure on Translational Medicine in Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Qiang Xu
- Department of General Surgery, Key Laboratory of Research in Pancreatic Tumor, State Key Laboratory of Complex Severe and Rare Disease, National Science and Technology Key Infrastructure on Translational Medicine in Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Junchao Guo
- Department of General Surgery, Key Laboratory of Research in Pancreatic Tumor, State Key Laboratory of Complex Severe and Rare Disease, National Science and Technology Key Infrastructure on Translational Medicine in Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Taiping Zhang
- Department of General Surgery, Key Laboratory of Research in Pancreatic Tumor, State Key Laboratory of Complex Severe and Rare Disease, National Science and Technology Key Infrastructure on Translational Medicine in Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Quan Liao
- Department of General Surgery, Key Laboratory of Research in Pancreatic Tumor, State Key Laboratory of Complex Severe and Rare Disease, National Science and Technology Key Infrastructure on Translational Medicine in Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Jun Yu
- Department of Medicine, Oncology, and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 21224, USA
- Pancreas center, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, China
| | - Yupei Zhao
- Department of General Surgery, Key Laboratory of Research in Pancreatic Tumor, State Key Laboratory of Complex Severe and Rare Disease, National Science and Technology Key Infrastructure on Translational Medicine in Peking Union Medical College Hospital, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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5
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Park J, Park J, Lee YS, Jung K, Jung IH, Lee JC, Hwang JH, Kim J. Increased incidence of indeterminate pancreatic cysts and changes of management pattern: Evidence from nationwide data. Hepatobiliary Pancreat Dis Int 2023; 22:294-301. [PMID: 35715339 DOI: 10.1016/j.hbpd.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/10/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pancreatic cysts are common. However, most studies are based on data collected from individual centers. The present study aimed to evaluate the changes of management patterns for pancreatic cystic lesions (PCLs) by analyzing large epidemiologic data. METHODS Between January 2007 and December 2018, information regarding pancreatic cystic lesions was acquired from the nationwide Health Insurance Review and Assessment Service database in Korea. RESULTS The final number of patients with pancreatic cysts was 165 277 among the total claims for reimbursement of 855 983 associated with PCLs over 12 years. The total number of claims were increased from 19 453 in 2007 to 155 842 in 2018 and the prevalence increased from 0.04% to 0.23%. For 12 years, 2874 (1.7%) had pancreatic cancer and 8212 (5.0%) underwent surgery, and 36 had surgery for twice (total 8248 pancreatectomy). After ruling out claims from the first 3 years of washout period, the incidence increased from 9891 to 24 651 and the crude incidence rate of PCLs expanded from 19.96 per 100 000 to 47.77 per 100 000. Compared to specific neoplasm codes (D136 or D377), the use of pancreatic cyst code (K862) has been remarkably increased and the most common since 2010. The annual number of pancreatectomies increased from 518 to 861 between 2007 and 2012, and decreased to 596 until 2018. The percentage of pancreatic cancer in patients who received pancreatectomy increased from 5.6% in 2007 to 11.7% in 2018. CONCLUSIONS The incidence of PCLs is rapidly increasing. Among PCLs, indeterminate cyst is increasing outstandingly. A trend of decreasing in the number of resections and increasing cancer rates among resected cysts may be attributed to the updated international guidelines.
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Affiliation(s)
- Jaewoo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jinkyeong Park
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Yoon Suk Lee
- Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Kwangrok Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - In Ho Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong-Chan Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin-Hyeok Hwang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jaihwan Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Tanaka H, Matsusaki S, Asakawa H, Tsuruga S, Nose K, Kumazawa H, Sakuno T, Isono Y, Sase T, Okano H, Saito T, Mukai K, Nishimura A. A Novel Scoring System to Improve the Detection Efficiency of Pancreatic Cystic Lesions in the General Population. Intern Med 2023; 62:335-344. [PMID: 35831108 PMCID: PMC9970811 DOI: 10.2169/internalmedicine.9104-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
Objective Pancreatic cystic lesions (PCLs) are known risk factors for pancreatic cancer. Therefore, this study explored the predictors identifying PCLs in a general population and developed a scoring system to help more efficiently diagnose these entities during medical checkups. Methods We reviewed 9,369 examinees of abdominal ultrasound (AUS) during medical checkups between January 2013 and November 2019. Predictors of PCLs were identified using a multivariate logistic regression analysis, and we constructed a scoring system based on these predictors. Results PCLs were detected in 118 (1.3%). Age 50-59 years old [odds ratio (OR) 2.52, 95% confidence interval (CI) 1.18-5.35], 60-69 years old (OR 3.91, 95% CI 1.86-8.26), and ≥70 years old (OR 10.5, 95% CI 5.03-21.7) as well as abdominal pain (OR 1.85, 95% CI 1.14-3.00), alcohol consumption (OR 1.72, 95% CI 1.03-2.89), a family history of pancreatic cancer (OR 2.41, 95% CI 1.09-5.34), and pre-diabetes or diabetes (OR 1.78, 95% CI 1.05-3.00) were predictors of PCLs. The following scores were assigned according to regression coefficients: age (50-59 years old, 1 point; 60-69 years old, 1.5 points; ≥70 years old, 2.5 points); abdominal pain, 1 point, alcohol consumption, 1 point; a family history of pancreatic cancer, 1 point; and pre-diabetes, 1 point. The PCL detection rate increased with the total score: 0.2% for total score 0 point, 5.4% for ≥4.0 points. The area under the curve of the scoring system was 0.75 (95% CI 0.70-0.79). Conclusion Our scoring system allows the risk of PCLs to be determined and may help more efficiently diagnose these entities.
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Affiliation(s)
- Hiroki Tanaka
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | | | - Hiroki Asakawa
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Satomi Tsuruga
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Kenji Nose
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | | | - Takashi Sakuno
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Yoshiaki Isono
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Tomohiro Sase
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Hiroshi Okano
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Tomonori Saito
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Katsumi Mukai
- Department of Gastroenterology, Suzuka General Hospital, Japan
| | - Akira Nishimura
- Department of Gastroenterology, Suzuka General Hospital, Japan
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Ito H, Kojima S, Moriyama K, Yokota M, Shinma Y, Ito A, Kodama T, Kawanishi A, Kagawa T, Watanabe N, Suzuki T. Analysis of Comorbidity for Patients with Pancreatic Cysts in Medical Checkup Screening. Tokai J Exp Clin Med 2022; 47:60-63. [PMID: 35801549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/17/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES We investigated whether there is a difference in the frequency of comorbidity between patients with pancreatic cysts and those without pancreatic cysts by abdominal ultrasonography in patients undergoing medical checkup screening. METHODS The subjects were 6,627 patients who underwent abdominal ultrasonography at Tokai University Hachioji Hospital's Health Screening Center between April 2019 and March 2020. RESULTS Of the total 6,627 patients, 158 (2.4%) were pointed out to have pancreatic cysts. Multivariate analysis revealed that the related factors were female sex, age 60 years or older, diabetes, lung cancer, and uterine/ovarian cancer. CONCLUSION Unlike pancreatic cancer, pancreatic cysts are more common in women. In addition, it is known that pancreatic cysts have a high complication rate of cancers of other organs; lung cancer and uterine/ovarian cancer were identified as high-risk factors in this study.
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Affiliation(s)
- Hiroyuki Ito
- Department of Gastroenterology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa 259-1193, Japan.
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Mallappa S, Pencavel T, Poo S, Gall T, Cunningham D, Tekkis P, Jiao LR. Pancreatic Incidentalomas on CT Colonography: Ignore, Follow up or Investigate? Chirurgia (Bucur) 2022; 117:278-285. [PMID: 35792538 DOI: 10.21614/chirurgia.2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 12/17/2023]
Abstract
Background: Increasing use of cross-sectional abdominal imaging such as CT colonography (CTC), has resulted in increased identification of incidental pancreatic cystic lesions. Such incidental findings are a cause for anxiety amongst patients and clinicians and can result in increased cost to healthcare delivery resultant from referral to subsequent investigations. Our study explored the prevalence of incidental cystic pancreatic lesions on CTC at a tertiary pancreatic centre, and their management. Methods: A detailed review of CTC reports and patient case notes between 2010-2016 was undertaken. Patients from both screening (National Bowel Cancer Screening) and non-screening cohorts were included in our study. Results: 136 of 4666 patients who underwent CTC had an incidental finding of a pancreatic lesion (2.9%) and 117 confirmed cystic pancreatic lesions (2.5%). Radiological diagnosis of intraductal papillary mucinous neoplasm (IPMN) was available in the CTC report for 71 patients. Twelve patients (0.2%) were found to have pancreatic ductal adenocarcinoma (PDAC) incidentally at CTC, 2 resectable and 10 unresectable with the diagnosis confirmed on biopsy. Follow-up surveillance imaging recommendations were made for 39.3% of patients within one year of the diagnosis of a cystic pancreatic lesion on CTC. One patient with pancreatic duct dilatation of 7mm was lost in follow-up and was found to develop PDAC at 21 months. Conclusions: Pancreatic lesions are increasingly found incidentally on CTC. All patients with pancreatic cystic tumour should be referred to pancreatic multidisciplinary team for discussion to determine management pathway.
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Firkins SA, Hart PA, Porter K, Chiang C, Cloyd J, Dillhoff M, Lara LF, Manilchuk A, Papachristou GI, Pawlik TM, Tsung A, Conwell DL, Krishna SG. Incidence and Risk Factors for New-Onset Diabetes Mellitus After Surgical Resection of Pancreatic Cystic Lesions: A MarketScan Study. Pancreas 2022; 51:427-434. [PMID: 35858183 PMCID: PMC9388590 DOI: 10.1097/mpa.0000000000002054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES There is a paucity of literature evaluating new-onset diabetes mellitus (NODM) after resection of pancreatic cystic lesions (PCLs). We sought to characterize the incidence and risk factors associated with NODM after partial pancreatectomy for PCLs. METHODS We utilized the IBM MarketScan Database (2012-2018) to identify all nondiabetic adults who underwent partial pancreatectomy for PCLs. Patients with any other pancreatic disease were excluded. We performed Kaplan-Meier analysis and multivariable Cox proportional hazards regression to define the incidence and risk factors of postoperative NODM. RESULTS Among 311 patients, the overall risk (95% confidence interval) of NODM was 9.1% (6.3-12.9%), 15.1% (11.3-20.2%), and 20.2% (15.3-26.4%) at 6, 12 and 24 months, respectively. Multivariable analysis (adjusted hazard ratio; 95% confidence interval) revealed that older age (1.97; 1.04-3.72; 55-64 vs 18-54 years), obesity (2.63; 1.35-5.12), hypertension (1.79; 1.01-3.17), and cardiovascular disease (2.54; 1.02-6.28) were independent predictors of NODM. Rates of NODM were similar after distal pancreatectomy versus pancreaticoduodenectomy. CONCLUSIONS Within 2 years, 1 in 5 patients without any other pancreatic disease will develop NODM after partial pancreatectomy for PCLs. Those with advanced age, metabolic syndrome features, and/or cardiovascular disease may benefit from preoperative counseling and intensive postoperative monitoring, education, and treatment for diabetes mellitus.
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Affiliation(s)
- Stephen A. Firkins
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Phil A. Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kyle Porter
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - ChienWei Chiang
- Social and Behavioral Sciences, Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - Jordan Cloyd
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mary Dillhoff
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Luis F. Lara
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Andrei Manilchuk
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Georgios I. Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Timothy M. Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Allan Tsung
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Darwin L. Conwell
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Somashekar G. Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH
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Nakhaei M, Bligh M, Chernyak V, Bezuidenhout AF, Brook A, Brook OR. Incidence of pancreatic cancer during long-term follow-up in patients with incidental pancreatic cysts smaller than 2 cm. Eur Radiol 2022; 32:3369-3376. [PMID: 35013764 DOI: 10.1007/s00330-021-08428-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/07/2021] [Accepted: 10/21/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE To assess the long-term malignancy risk of incidental small pancreatic cysts. MATERIALS AND METHODS In this HIPAA-compliant, IRB-approved, retrospective, multi-institutional study, the long-term incidence of pancreatic cancer was compared between patients with and without small pancreatic cysts. Patients with incidental pancreatic cysts ≥ 0.5 and < 2.0 cm in maximal diameter, detected on MRI performed between 1999 and 2011, represented the "small pancreatic cyst" group. Patients that underwent MRI between 2005 and 2011 and had no reported pancreatic cysts represented the comparison "no cyst" group. RESULTS The "small pancreatic cyst" group included 267 patients, ages 63.4 ± 11.8 years, 166/267 (62%) women with a mean follow-up of 8.6 ± 4.3 years, median 9.2 years; the "no cyst" group included 1,459 patients, ages 64.6 ± 12 years, 794/1,459 (54%) women with a mean follow-up of 7.0 ± 4.2 years, median 7.8 (p values 0.12, 0.02, < 0.001, respectively). Two/267 (0.7%) patients developed pancreatic cancer at a separate location from the known cyst in the "small pancreatic cyst" group, with a cancer rate of 0.9 (95% CI 0.1-3.1) cases per 1,000 patient-years. In the "no cyst" cohort, 18/1,459 (1.2%) patients developed pancreatic cancer, with a cancer rate of 1.8 (95% CI 1.2-3.1) cases per 1,000 patient-years (p = 0.6). The all-cause mortality was similar in both groups: 57/267 (21%) vs. 384/1,459 (26%) (p = 0.09). CONCLUSION The long-term risk of pancreatic malignancy in asymptomatic patients with incidental pancreatic cysts less than 2 cm is 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts. These very few pancreatic cancers developed at a separate location from the known cyst. KEY POINTS • After a median of 9.2 years of follow-up, the risk of pancreatic malignancy in patients with an asymptomatic small pancreatic cyst was 0.9 cases per 1,000 patient-years of follow-up, similar to those without pancreatic cysts. • Very few pancreatic cancer cases developed in the location separate from the known pancreatic cyst.
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Affiliation(s)
- Masoud Nakhaei
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Mathew Bligh
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Victoria Chernyak
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Department of Radiology, Montefiore, Bronx, NY, USA
| | | | - Alexander Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA.
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Anand GS, Youssef F, Liu L, Bustamante R, Earles A, Vege SS, Savides T, Fehmi SA, Kwong WT, Gupta S. Pancreas Cancer Incidence and Pancreas Cancer-Associated Mortality Are Low in National Cohort of 7211 Pancreas Cyst Patients. Dig Dis Sci 2022; 67:1065-1072. [PMID: 33783688 PMCID: PMC8956522 DOI: 10.1007/s10620-021-06923-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/23/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Pancreatic cancer incidence and mortality among patients with pancreas cysts are unclear. The aims of this study are to evaluate incidence of pancreatic cancer and cause-specific mortality among patients with pancreatic cysts using a large national cohort over a long follow-up period. METHODS We conducted a retrospective cohort study of US Veterans diagnosed with a pancreatic cyst 1999-2013, based on International Classification of Diseases, 9th edition (ICD9) coding within national Department of Veterans Affairs (VA) data. Pancreatic cancer incidence was ascertained using VA cancer registry data, ICD-9 codes, and the National Death Index, a national centralized database of death records, including cause-specific mortality. RESULTS Among 7211 Veterans with pancreatic cysts contributing 31,501 person-years of follow-up (median follow-up 4.4 years), 79 (1.1%) developed pancreatic cancer. A total of 1982 patients (27.5%) died during the study follow-up period. Sixty-three patients (3.2% of deaths; 0.9% of pancreas cyst cohort) died from pancreatic cancer, but the leading causes of death in the cohort were non-pancreatic cancer (n = 498, 25% of deaths) and cardiovascular disease (n = 398, 20% of deaths). CONCLUSIONS Pancreas cancer incidence and pancreatic cancer-associated mortality are very low in a large national cohort of VA pancreatic cyst patients with long-term follow-up. Most deaths were from non-pancreas cancers and cardiovascular causes, and only a minority (3.2%) were attributable to pancreas cancer. Given death from pancreas cancer is rare, future research should focus on identifying criteria for selecting individuals at high risk for death from pancreatic cancer for pancreatic cyst surveillance.
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Affiliation(s)
- Gobind S. Anand
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive MC 111D, San Diego, CA 92161 USA
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Fady Youssef
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Lin Liu
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive MC 111D, San Diego, CA 92161 USA
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Ranier Bustamante
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive MC 111D, San Diego, CA 92161 USA
| | - Ashley Earles
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive MC 111D, San Diego, CA 92161 USA
| | | | - Thomas Savides
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Syed Abbas Fehmi
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Wilson T. Kwong
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
| | - Samir Gupta
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Drive MC 111D, San Diego, CA 92161 USA
- University of California San Diego, 9500 Gilman Drive, La Jolla, CA USA
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12
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Chon HK, Moon SH, Park SW, Paik WH, Paik CN, Son BK, Song TJ, Ahn DW, Lee ES, Lee YN, Lee YS, Lee JM, Jeon TJ, Park CH, Cho KB, Lee DW. Current trends in the management of pancreatic cystic neoplasms in Korea: a national survey. Korean J Intern Med 2022; 37:63-72. [PMID: 33045809 PMCID: PMC8747915 DOI: 10.3904/kjim.2020.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/23/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND/AIMS The study aimed to investigate the current practice patterns in the management of pancreatic cystic neoplasms in Korea. METHODS An electronic survey was systematically distributed by email to members of the Korean Pancreatobiliary Association from December 2019 to February 2020. RESULTS In total, 115 (110 gastroenterologists, five surgeons) completed the survey, 72.2% of whom worked in a tertiary/academic medical center. Most (65.2%) followed the 2012/2017 International Association of Pancreatology guidelines for the management of pancreatic cystic neoplasms. A gadolinium-enhanced magnetic resonance imaging/magnetic resonance cholangiopancreatography was the most common first-line diagnostic modality (42.1%), but a contrast-enhanced computed tomography scan was preferred as a subsequent surveillance tool (58.3%). Seventy-four percent of respondents routinely performed endoscopic ultrasound-guided fine needle aspiration for pancreatic cystic neoplasms with suspicious mural nodules. Endoscopic ultrasound-guided fine needle aspiration cytology (94.8%) and cystic fluid carcinoembryonic antigen (95.7%) were used for cystic fluid analysis. Most (94%) typically recommended surgery in patients with high-risk stigmata, but 18.3% also considered proceeding with surgery in patients with worrisome features. Most (96.5%) would continue surveillance of pancreatic cystic neoplasms for more than 5 years. CONCLUSION According to this survey, there was variability in the management of pancreatic cystic neoplasms among the respondents. These results suggest that the development of evidence-based guidelines for pancreatic cystic neoplasms that fit the Korean practice is needed to create an optimal approach to the management of pancreatic cystic neoplasms.
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Affiliation(s)
- Hyung Ku Chon
- Department of Internal Medicine, Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Sung Hoon Moon
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Sang Wook Park
- Department of Internal Medicine, Kwangju Christian Hospital, Gwangju, Korea
| | - Woo Hyun Paik
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Nyol Paik
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Byoung Kwan Son
- Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Tae Jun Song
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Won Ahn
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eaum Seok Lee
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yun Nah Lee
- Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Yoon Suk Lee
- Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Jae Min Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Tae Joo Jeon
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Chang Hwan Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kwang Bum Cho
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Wook Lee
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
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Abstract
OBJECTIVES Using large-sample, real-world administrative claims data, we evaluated the prevalence of putatively asymptomatic pancreatic cysts, the historical growth in their incident diagnosis, and their risk of malignant progression. METHODS Data were sourced from IBM MarketScan administrative claims databases of more than 200 million patients. Period prevalence was assessed using 700,000 individuals without conditions that predispose to pancreatic cyst. The standardized cumulative incidence was compared with the cross-sectional abdominal imaging rate from 2010-2017. The risk of progression to pancreatic cancer for 14,279 newly diagnosed patients with a cyst was estimated using Kaplan-Meier analysis. RESULTS Standardized prevalence increased exponentially with age and was 1.84% (95% confidence interval, 1.80%-1.87%) for patients older than 45. Standardized incidence nearly doubled from 2010-2017 (6.3 to 11.4 per 10,000), whereas the imaging rate changed from only 8.0% to 9.4%. The cumulative risk of pancreatic cancer at 7 years was 3.0% (95% confidence interval, 2.4%-3.5%), increasing linearly (R2 = 0.991) with an annual progression risk of 0.47%. CONCLUSIONS Using large-sample data, we show a significant burden of asymptomatic pancreatic cysts, with an annual risk of progression to cancer of 0.47% for 7 years. Rapid growth in cyst diagnosis over the last decade far outpaced increases in the imaging rate.
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Affiliation(s)
- Adam B Schweber
- From the Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center
| | - Emil Agarunov
- Division of Gastroenterology and Hepatology, New York University, New York, NY
| | - Christian Brooks
- Larner College of Medicine, University of Vermont, Burlington, VT
| | - Chin Hur
- From the Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center
| | - Tamas A Gonda
- From the Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center
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14
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Sun L, Wang W, Zhu H, Jiang F, Peng L, Jin G, Jin Z. High-Risk Characteristics Associated with Advanced Pancreatic Cystic Lesions: Results from a Retrospective Surgical Cohort. Dig Dis Sci 2021; 66:2075-2083. [PMID: 32705437 DOI: 10.1007/s10620-020-06481-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/04/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM The management of pancreatic cystic lesions (PCLs) remains controversial. We performed a retrospective study to determine characteristics associated with advanced PCLs (A-PCLs) and whether these characteristics vary in different pathological types of PCLs. The additional diagnostic value of endoscopic ultrasound (EUS) was also evaluated. METHODS Patients who underwent surgical resection for an identified PCLs by imaging modalities were included. A logistic regression model was developed to identify significant characteristics for A-PCLs. EUS data was assessed separately. RESULTS Three hundred and fifty-three patients were included, and 125 patients (35.4%) were A-PCLs. The presence of main pancreatic duct (MPD) diameter ≥ 10 mm (odds ratio [OR], 11.7; 95% confidence interval [CI], 1.53-89.2; P = 0.018), mural nodules ≥ 5 mm (OR, 11.67; 95% CI, 2.3-59.05; P = 0.003), solid components within cysts (OR, 30.87; 95% CI, 7.23-131.7; P < 0.0001) and high serum CA19-9 levels (OR, 1.006; 95% CI, 1.001-1.011; P = 0.02) were independently associated with the presence of A-PCLs. The presence of septa was independently associated with the presence of non-A-PCLs (OR, 0.147; 95% CI, 0.04-0.6; P = 0.008). Males who had a history of tobacco abuse (P < 0.0001) and had a greatly dilated MPD (P < 0.0001) were more common in advanced intraductal papillary mucinous neoplasms (IPMC) patients. Solid pseudopapillary neoplasm (SPT) often occurred in young women (P < 0.0001), mostly asymptomatically (P < 0.0001) and with lower serum CA19-9 levels (P < 0.0001). In the 124 patients who underwent EUS-guided fine-needle aspiration (EUS-FNA), five additional characteristics (4 mural nodules and 1 MPD involvement) were identified by EUS imaging and 17 patients were identified with abnormal cytological results (13 atypical cells and 4 suspicious for malignancy cells) by EUS-FNA. CONCLUSION On the basis of a retrospective study with large sample size, the presence of MPD ≥ 10 mm, mural nodules, solid components, and high serum CA19-9 levels were independently associated with the presence of A-PCLs. The high-risk characteristics may vary across different types of A-PCLs. EUS and EUS-FNA could provide additional diagnostic information for PCLs.
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Affiliation(s)
- Liqi Sun
- Department of Gastroenterology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Wei Wang
- Department of Gastroenterology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Huiyun Zhu
- Department of Gastroenterology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Fei Jiang
- Department of Gastroenterology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Lisi Peng
- Department of Gastroenterology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Gang Jin
- Department of Hepatobiliary Pancreatic Surgery, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, Navy Military Medical University, Shanghai, China.
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15
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Lee BS, Nguyen AK, Tekeste TF, Chang K, Girgis A, Adeyemo M, Hanna MS, Yao JF, Kwok KK, Giap AQ, Hunt GC, Chaya CT, Kao KT, Attam R, Ko A, Pio JR, Tovar S, Lim BS. Long-term follow-up of branch-duct intraductal papillary mucinous neoplasms with No change in first 5 Years of diagnosis. Pancreatology 2021; 21:144-154. [PMID: 33309223 DOI: 10.1016/j.pan.2020.10.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 09/01/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Discontinuation of branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) surveillance after 5 years of no change remains controversial. Long-term outcomes of BD-IPMN without significant changes in the first 5 years were evaluated. METHODS We performed a multi-center retrospective analysis of patients with BD-IPMN diagnosis from 2005 to 2011 (follow-up until 2017). Significant changes were defined as pancreatic cancer (PC), pancreatectomy, high-risk stigmata (HRS), worrisome features (WF) and worrisome EUS features (WEUS). RESULTS Of 982 patients who had no significant changes, 5 (0.5%), 7 (0.7%), 99 (10.1%), 4 (0.4%) patients developed PC, HRS, WF, WEUS, respectively, post-5 years. PC and HRS/WF/WEUS incidences at 12 years were 1.0% and 29.0%, respectively. Patients that developed HRS/WF/WEUS had larger cyst size in first 5 years compared to those that did not [16 (12-23) vs. 12 (9-17) mm, p = 0.0001], cyst size of >15 mm having higher cumulative incidence of HRS/WF/WEUS. PC mortality was 0.8%; all-cause mortality was 32%. Incidence of mortality due to PC was higher in HRS/WF/WEUS group, p < 0.0001. The mortality rate at 12 years for ACCI (age-adjusted Charlson Comorbidity Index) of ≤3, 4-6, and ≥7 were 3.5%, 19.9%, and 57.6% (p < 0.0001), respectively. CONCLUSIONS Incidence of PC in patients with BD-IPMN without significant changes in first 5 years of diagnosis remains low at 1.0%. Incidence of HRS/WF/WEUS was higher at 29.0%. PC-related mortality was higher in HRS/WF/WEUS group. These risks should be weighed against patients' overall mortality (utilizing scoring systems such as ACCI) when making surveillance decision of BD-IPMN beyond 5 years.
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Affiliation(s)
- Brian S Lee
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Andrew K Nguyen
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Timnit F Tekeste
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Karen Chang
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Agathon Girgis
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Mopelola Adeyemo
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Maryam S Hanna
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Janis F Yao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Karl K Kwok
- Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Andrew Q Giap
- Department of Gastroenterology, Kaiser Permanente Orange County Medical Center, Anaheim, CA, USA
| | - Gordon C Hunt
- Department of Gastroenterology, Kaiser Permanente San Diego Medical Center, San Diego, CA, USA
| | - Charles T Chaya
- Department of Gastroenterology, Kaiser Permanente Riverside Medical Center, Riverside, CA, USA
| | - Kevin T Kao
- Department of Gastroenterology, Kaiser Permanente Downey Medical Center, Downey, CA, USA
| | - Rajeev Attam
- Department of Gastroenterology, Kaiser Permanente Downey Medical Center, Downey, CA, USA
| | - Albert Ko
- Department of Surgery, Kaiser Permanente Riverside Medical Center, Riverside, CA, USA
| | - Jose R Pio
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Stephanie Tovar
- Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Brian S Lim
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA; Department of Gastroenterology, Kaiser Permanente Riverside Medical Center, Riverside, CA, USA.
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16
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Lanke G, Lee JH. Similarities and differences in guidelines for the management of pancreatic cysts. World J Gastroenterol 2020; 26:1128-1141. [PMID: 32231418 PMCID: PMC7093312 DOI: 10.3748/wjg.v26.i11.1128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/21/2020] [Accepted: 02/29/2020] [Indexed: 02/06/2023] Open
Abstract
Accurate diagnosis of Pancreatic cysts (PC) is key in the management. The knowledge of indications for surgery, the role of endoscopic ultrasound-guided fine needle aspiration, cyst fluid analysis, imaging, and surveillance of PC are all important in the diagnosis and management of PC. Currently, there are many guidelines for the management of PC. The optimal use of these guidelines with a patient-centered approach helps diagnose early cancer and prevent the spread of cancer.
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Affiliation(s)
- Gandhi Lanke
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Jeffrey H Lee
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
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17
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Vaalavuo Y, Antila A, Ahola R, Siiki A, Vornanen M, Ukkonen M, Sand J, Laukkarinen J. Characteristics and long-term survival of resected pancreatic cystic neoplasms in Finland. The first nationwide retrospective cohort analysis. Pancreatology 2019; 19:456-461. [PMID: 30808537 DOI: 10.1016/j.pan.2019.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/09/2019] [Accepted: 02/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pancreatic cystic neoplasms (PCN) are being found increasingly in imaging studies. Even though the characteristics of PCN lesions have been studied extensively in single and multicentre settings, nationwide data is lacking. The aim of this study was to determine the nationwide epidemiologic characteristics and long-term survival of all resected PCNs. METHODS For this retrospective cohort analysis, all PCNs operated on in Finland during the period 2000-2008 were identified. Data was collected from all patients: on demographics, comorbidities, symptoms, radiological findings, surgical procedures, complications, histopathological diagnoses and survival. Incomplete pathology reports and any uncertain diagnoses were re-assessed. Survival data was collected after a five-year follow-up period. RESULTS The final database included 225 patients with operated PCN. After reviewing the incomplete pathology reports, in 44 cases the original diagnosis was changed, mostly from MCN to IPMN. The most common histopathological diagnoses were IPMN (94/225; 50/225 MD-IPMN, 30/225 MX-IPMN and 14/225 BD-IPMN), SCN (41/225) and MCN (40/225). Overall, 53/225 (23.6%) of the tumours were malignant. Malignancy was detected in MD-IPMN 29/50 (58%), MX-IPMN 10/30 (33.3%), MCN 12/40 (30%), BD-IPMN 2/14 (14.3%) patients. Median 5-year survival for all patients was 77%: 87% in patients without malignancy, 77% with HGD and 27% in patients with a malignant resected PCN. CONCLUSION One fourth of the PCNs operated on nationwide were malignant, with a five-year survival of 27%, compared to overall survival of 87% in patients with non-malignant disease and 77% in those with HGD. Detecting - and operating on - a PCN before the malignant transfer remains a great challenge.
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Affiliation(s)
- Yrjö Vaalavuo
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Anne Antila
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Reea Ahola
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Antti Siiki
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Martine Vornanen
- Dept. of Pathology, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland
| | - Mika Ukkonen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Juhani Sand
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; Päijäthäme Central Hospital, Lahti, Finland
| | - Johanna Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Finland.
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18
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Zerboni G, Signoretti M, Crippa S, Falconi M, Arcidiacono PG, Capurso G. Systematic review and meta-analysis: Prevalence of incidentally detected pancreatic cystic lesions in asymptomatic individuals. Pancreatology 2019; 19:2-9. [PMID: 30503370 DOI: 10.1016/j.pan.2018.11.014] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/18/2018] [Accepted: 11/27/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Pancreatic cystic lesions (PCLs) are frequent incidental findings. As most PCLs require costly diagnostic evaluation and active surveillance, it is important to clarify their prevalence in asymptomatic individuals. We therefore aimed at performing a systematic review and meta-analysis to determine it. METHODS a systematic search was conducted and studies meeting inclusion criteria were included. The prevalence of PCLs was pooled across studies. A random effect model was used with assessment of heterogeneity. RESULTS 17 studies, with 48,860 patients, were included. Only 3 were prospective; 5 studies were conducted in the US, 7 in Europe, 4 in Asia and 1 in Brazil. The pooled prevalence of PCLs was 8% (95% CI 4-14) with considerable heterogeneity (I2 = 99.5%). This prevalence was higher in studies of higher quality, examining older subjects, smaller cohorts, and employing MRCP (24.8% vs 2.7% with CT-scan). The pooled rate of PCLs was four times higher in studies conducted in the US than in Asia (12.6% vs 3.1%). 7 studies reported the prevalence of mucinous lesions, with a pooled rate of 4.3% (95% CI 2-10; I2 = 99.2%), but of 0.7% only for worrisome features or high risk stigmata. CONCLUSION The rate of incidentally detected PCLs is of 8%. Mucinous lesions are the most common incidentally detected PCLs, although they rarely present with potential indication for surgery. The observed different rates in the US and other geographic Areas suggest that different protocols might be necessary to help balancing costs and effectiveness of follow-up investigations in asymptomatic subjects.
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Affiliation(s)
- Giulia Zerboni
- Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marianna Signoretti
- Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Stefano Crippa
- Pancreatic Surgery Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- PancreatoBiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Gabriele Capurso
- PancreatoBiliary Endoscopy and EUS Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy.
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19
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Liu K, Joshi V, van Camp L, Yang QW, Baars JE, Strasser SI, McCaughan GW, Majumdar A, Saxena P, Kaffes AJ. Prevalence and outcomes of pancreatic cystic neoplasms in liver transplant recipients. World J Gastroenterol 2017; 23:8526-8532. [PMID: 29358860 PMCID: PMC5752712 DOI: 10.3748/wjg.v23.i48.8526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 11/30/2017] [Accepted: 12/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the prevalence, characteristics and clinical course of pancreatic cystic neoplasms (PCNs) in liver transplantation (LT) recipients.
METHODS We retrospectively studied consecutive patients who underwent LT between January 1998 to April 2016. Clinical and laboratory data were obtained from patient medical records. Imaging findings on computed tomography and magnetic resonance cholangiopancreatography were reviewed by two radiologists.
RESULTS During the study period, 872 patients underwent cadaveric LT. Pancreatic cysts were identified in 53/872 (6.1%) and 31/53 (58.5%) were PCNs [28 intraductal papillary mucinous neoplasm (IPMN), 2 mucinous cystic neoplasm (MCN), 1 serous cystadenoma]. Patients with PCNs exhibited less male predominance (55% vs 73%, P = 0.03) compared to patients without pancreatic cysts. Thirteen patients (42%) were diagnosed with PCN pre-LT while 18 patients (58%) developed PCN post-LT. The median size of PCNs was 13mm [interquartile range (IQR) 10-20 mm]. All IPMNs were side-branch type. Most PCNs were found in the head and body of pancreas (37% each), followed by the tail (25%). Five patients underwent further evaluation with endoscopic ultrasound. Progress imaging was performed on 81% of patients. PCNs remained stable in size and number in all but 2 patients. During a median follow up of 39 mo (IQR 26-58 mo), the 2 (6%) patients with MCN underwent pancreatectomy. No PCN patient developed pancreatic adenocarcinoma, while 5 died from illnesses unrelated to the PCN. Among patients without PCN, 1/841 (0.1%) developed pancreatic adenocarcinoma.
CONCLUSION The prevalence of PCNs in LT recipients was similar to the general population (3.6%, 31/872). Side-branch IPMNs do not appear to have accelerated malignant potential in post-LT patients, indicating the current surveillance guidelines are applicable to this group.
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Affiliation(s)
- Ken Liu
- Arthur Kaffes, Sydney Medical School, The University of Sydney, NSW 2006, Australia
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Vikram Joshi
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Louise van Camp
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Qi-Wei Yang
- Arthur Kaffes, Sydney Medical School, The University of Sydney, NSW 2006, Australia
| | - Judith E Baars
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Simone I Strasser
- Arthur Kaffes, Sydney Medical School, The University of Sydney, NSW 2006, Australia
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Geoffrey W McCaughan
- Arthur Kaffes, Sydney Medical School, The University of Sydney, NSW 2006, Australia
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Avik Majumdar
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Arthur J Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
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20
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Odake Y, Fukuoka H, Yamamoto M, Arisaka Y, Konishi J, Yoshida K, Matsumoto R, Bando H, Suda K, Nishizawa H, Iguchi G, Yamada S, Ogawa W, Takahashi Y. Cross-sectional prevalence of pancreatic cystic lesions in patients with acromegaly, a single-center experience. Pituitary 2017; 20:509-514. [PMID: 28540626 DOI: 10.1007/s11102-017-0810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Acromegaly is a disease associated with an increased risk for several kinds of neoplasms including colon and thyroid cancer. Although the association between acromegaly and pancreatic neoplasms has not been elucidated, it has recently been reported that GNAS gene mutations were found in 58% of intraductal papillary mucinous neoplasms (IPMNs), which are representative pancreatic cystic lesions, suggesting a link between IPMNs and acromegaly. To assess the prevalence of pancreatic cystic lesions in patients with acromegaly, we performed a retrospective cross-sectional single institute study. METHODS Thirty consecutive acromegalic patients (20 females and 10 males; mean age, 60.9 ± 11.9 years) who underwent abdominal contrast-enhanced computed tomography or magnetic resonance imaging between 2007 and 2015 at Kobe University Hospital were recruited. We also analyzed the relationship between presence of pancreatic cystic lesions and somatic GNAS mutations in pituitary tumors. RESULTS Seventeen of 30 (56.7%) patients studied had pancreatic cystic lesions. Nine of 17 patients (52.9%) were diagnosed with IPMNs based on imaging findings. These results suggest that the prevalence of IPMNs may be higher in acromegalic patients in acromegalic patients than historically observed in control patients (up to 13.5%). In patients with pancreatic cystic lesions, the mean patient age was higher and the duration of disease was longer than in those without pancreatic cystic lesions (67.0 ± 2.3 vs. 53.0 ± 2.7 years, p < 0.001, 15.5 ± 2.4 vs. 7.3 ± 2.8 years, p = 0.04). There were no differences in serum growth hormone levels or insulin-like growth factor standard deviation scores between these two groups (21.3 ± 6.4 vs. 23.0 ± 7.4 ng/ml, p = 0.86, 6.6 ± 0.5 vs. 8.0 ± 0.6, p = 0.70). Neither the presence of somatic GNAS mutation in a pituitary tumor nor low signal intensity of the tumor in T2 weighted magnetic resonance imaging was associated with the presence of pancreatic cystic lesions. CONCLUSIONS These data demonstrate that old or long-suffering patients with acromegaly have a higher prevalence of pancreatic cystic lesions. Moreover, the prevalence of pancreatic cystic lesions may be increased in acromegalic patients.
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Affiliation(s)
- Yukiko Odake
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Masaaki Yamamoto
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshifumi Arisaka
- Department of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Konishi
- Department of Medical and Healthcare Systems, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichi Yoshida
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryusaku Matsumoto
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hironori Bando
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kentaro Suda
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hitoshi Nishizawa
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Genzo Iguchi
- Division of Diabetes and Endocrinology, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shozo Yamada
- Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo, Japan
| | - Wataru Ogawa
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Takahashi
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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21
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Chang YR, Park JK, Jang JY, Kwon W, Yoon JH, Kim SW. Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals: Large-scale, single-center cohort study. Medicine (Baltimore) 2016; 95:e5535. [PMID: 28002329 PMCID: PMC5181813 DOI: 10.1097/md.0000000000005535] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although incidental pancreatic cystic neoplasms are being diagnosed with increasing frequency, little is known about the accurate prevalence of pancreatic cysts in the general population. The aims of this study were to evaluate the crude prevalence rate of pancreatic cystic neoplasms in asymptomatic healthy adults, and calculate the age- and sex-adjusted nationwide prevalence rate.A total of 21,745 asymptomatic individuals who underwent abdominal computed tomography (CT) as a health screening examination were enrolled between 2003 and 2013 at the Seoul National University Hospital Healthcare System Gangnam Center. Nationwide population data of 2010 were collected from the National Statistical Office, Korea.Incidental pancreatic cystic neoplasms were found in 457 individuals whose mean age was 58.7 years. The types of neoplasms were reviewed by 2 separate designated radiologists and the final diagnosis was made as follows: intraductal papillary mucinous neoplasm: 376 (82%), serous cystic neoplasm: 19 (4%), mucinous cystic neoplasm: 7 (2%), and indeterminate cysts: 55 (12%). Eight cases underwent operation. The crude prevalence rate was 2.1% and the age- and sex-adjusted expected nationwide prevalence was 2.2%. The prevalence increased with age.Here, we reported the first large-scale study among the healthy population to find out the prevalence rate of pancreatic cystic neoplasms; the age- and sex-adjusted prevalence was 2.2%, and increased with age. Further investigations regarding the clinical implications of incidental pancreatic neoplasms are necessary.
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Affiliation(s)
- Ye Rim Chang
- Department of Surgery, Seoul National University College of Medicine, Seoul
- Department of Surgery, Dankook University College of Medicine, Cheonan
| | - Joo Kyung Park
- Department of Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul National University College of Medicine
- Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Young Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul
| | - Wooil Kwon
- Department of Surgery, Seoul National University College of Medicine, Seoul
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Whe Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul
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22
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Graversen M, Mortensen MB. [Diagnosis and treatment of pancreatic cysts]. Ugeskr Laeger 2015; 177:941-945. [PMID: 26535432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Incidental cystic lesions of the pancreas are often detected due to the increased use of cross-sectional imaging. Since mucinous cysts have a malignant potential, whereas pseudocysts and serous cystadenomas are benign, the distinction is of key clinical importance. Current recommendations advocate the use of multiple imaging modalities (CT/MRI/endoscopic US/endoscopic US & fine-needle aspiration) during evaluation and follow-up. This review describes the most frequent cystic lesions of the pancreas and suggests a simple investigation and treatment algorithm.
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MESH Headings
- Algorithms
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/epidemiology
- Carcinoma, Pancreatic Ductal/therapy
- Cystadenocarcinoma, Mucinous/diagnosis
- Cystadenocarcinoma, Mucinous/epidemiology
- Cystadenocarcinoma, Mucinous/therapy
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/epidemiology
- Cystadenoma, Serous/pathology
- Cystadenoma, Serous/therapy
- Humans
- Pancreatic Cyst/diagnosis
- Pancreatic Cyst/epidemiology
- Pancreatic Cyst/pathology
- Pancreatic Cyst/therapy
- Pancreatic Pseudocyst/diagnosis
- Pancreatic Pseudocyst/epidemiology
- Pancreatic Pseudocyst/therapy
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23
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de Oliveira PB, Puchnick A, Szejnfeld J, Goldman SM. Prevalence of incidental pancreatic cysts on 3 tesla magnetic resonance. PLoS One 2015; 10:e0121317. [PMID: 25798910 PMCID: PMC4370618 DOI: 10.1371/journal.pone.0121317] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/30/2015] [Indexed: 12/28/2022] Open
Abstract
Objectives To ascertain the prevalence of pancreatic cysts detected incidentally on 3-Tesla magnetic resonance imaging (MRI) of the abdomen and correlate this prevalence with patient age and gender; assess the number, location, and size of these lesions, as well as features suspicious for malignancy; and determine the prevalence of incidentally detected dilatation of the main pancreatic duct (MPD). Methods Retrospective analysis of 2,678 reports of patients who underwent abdominal MRI between January 2012 and June 2013. Patients with a known history of pancreatic conditions or surgery were excluded, and the remaining 2,583 reports were examined for the presence of pancreatic cysts, which was then correlated with patient age and gender. We also assessed whether cysts were solitary or multiple, as well as their location within the pancreatic parenchyma, size, and features suspicious for malignancy. Finally, we calculated the prevalence of incidental MPD dilatation, defined as MPD diameter ≥ 2.5 mm. Results Pancreatic cysts were detected incidentally in 9.3% of patients (239/2,583). The prevalence of pancreatic cysts increased significantly with age (p<0.0001). There were no significant differences in prevalence between men and women (p=0.588). Most cysts were multiple (57.3%), distributed diffusely throughout the pancreas (41.8%), and 5 mm or larger (81.6%). In 12.1% of cases, cysts exhibited features suspicious for malignancy. Overall, 2.7% of subjects exhibited incidental MPD dilatation. Conclusions In this sample, the prevalence of pancreatic cysts detected incidentally on 3T MRI of the abdomen was 9.3%. Prevalence increased with age and was not associated with gender. The majority of cysts were multiple, diffusely distributed through the pancreatic parenchyma, and ≥ 5 mm in size; 12.1% were suspicious for malignancy. An estimated 2.7% of subjects had a dilated MPD.
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Affiliation(s)
- Patricia Bedesco de Oliveira
- Department of Imaging Diagnosis, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
- * E-mail:
| | - Andrea Puchnick
- Department of Imaging Diagnosis, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Jacob Szejnfeld
- Department of Imaging Diagnosis, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Suzan Menasce Goldman
- Department of Imaging Diagnosis, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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24
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Graversen M, Mortensen MB. [Diagnosis and treatment of pancreatic cysts]. Ugeskr Laeger 2014; 176:V06140359. [PMID: 25394925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Incidental cystic lesions of the pancreas are often detected due to the increased use of cross-sectional imaging. Since mucinous cysts have a malignant potential, whereas pseudocysts and serous cystadenomas are benign, the distinction is of key clinical importance. Current recommendations advocate the use of multiple imaging modalities (CT/MRI/endoscopic US/endoscopic US & fine-needle aspiration) during evaluation and follow-up. This review describes the most frequent cystic lesions of the pancreas and suggests a simple investigation and treatment algorithm.
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MESH Headings
- Algorithms
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/epidemiology
- Carcinoma, Pancreatic Ductal/therapy
- Cystadenocarcinoma, Mucinous/diagnosis
- Cystadenocarcinoma, Mucinous/epidemiology
- Cystadenocarcinoma, Mucinous/therapy
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/epidemiology
- Cystadenoma, Serous/pathology
- Cystadenoma, Serous/therapy
- Humans
- Pancreatic Cyst/diagnosis
- Pancreatic Cyst/epidemiology
- Pancreatic Cyst/pathology
- Pancreatic Cyst/therapy
- Pancreatic Pseudocyst/diagnosis
- Pancreatic Pseudocyst/epidemiology
- Pancreatic Pseudocyst/therapy
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Affiliation(s)
- Martin Graversen
- Kirurgisk Afdeling A, Odense Universitetshospital, Sdr. Boulevard 29, 5000 Odense. /
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25
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26
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Pongpornsup S, Piyapittayanan S, Charoensak A. MDCT imaging findings for characterization pancreatic cystic lesion: differentiation between benign and malignant pattern. J Med Assoc Thai 2011; 94:369-378. [PMID: 21560846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The purpose of the present study was to determine the characteristic imaging findings for diagnosis of the benign or malignant nature of pancreatic cystic lesions by 64 slice multidetector computed tomography (MDCT) for further investigation or treatment. MATERIAL AND METHOD A retrospective study was performed in 33 patients with pancreatic cystic lesion who underwent 64 slice MDCT to characterize and establish the diagnosis. The patients were enrolled between January 2004 and March 2009. The MDCT scan of abdomen from patients with pancreatic cystic lesion was retrospectively evaluated by two gastrointestinal radiologists without knowledge of the patient's history, clinical data, and final diagnosis. Sensitivity, specificity, accuracy, PPV, and NPV of CT scan for discriminate benign and malignant pancreatic cystic lesion were calculated. Weighted-kappa statistics were used to estimate agreement between readers. RESULTS Thirty-three patients with pancreatic cystic lesion were included in the present study. Benign pancreatic cystic lesion are pancreatic pseudocyst (n = 16), serous cystadenoma (n = 4) and benign intraductal papillary mucinous neoplasms IPMN (n = 2). Premalignant and malignant pancreatic cystic tumor are mucinous cystic tumor (n = 5) and include solid pseudopapillary epithelial neoplasm of pancreas (n = 3) and malignant intraductal papillary mucinous neoplasms IPMN (n = 3). The final diagnosis was established either by pathological diagnosis (20 patients), EUS with FNA (11 patients) or F/U clinical and imaging findings (2 patients). Pseudopod sign is a helpful finding for diagnosis pancreatic pseudocyst (3/16) and not observed in other types pancreatic cystic lesions. Type of cyst (unilocular, multilocular microcystic, multilocular macrocystic and solid component) is the only finding that has statistical significance for differentiating between the benign and malignant groups (p < 0.005). The overall sensitivity, specificity and accuracy of 64-slice MDCT to discriminate benign and malignant pancreatic cystic lesion were 36.3%, 100% and 78.8%, respectively. In addition, the PPV and NPV were 100% and 75.9%, respectively. CONCLUSION The 64 sliced MDCT is a noninvasive method that can be used for discriminating between benign and malignant pancreatic cystic lesions, which is an important finding for further investigation and proper treatment.
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Affiliation(s)
- Sopa Pongpornsup
- Department of Radiology, Siriraj Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand.
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27
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Feria-Feria G, Carrera-Mayor EC, Hernández-Ramírez DA, Romero-Hernández T, Ramírez-Aceves R, García-Álvarez KG. [Cystic neoplasm of the pancreas: a ten years experience]. Rev Med Inst Mex Seguro Soc 2011; 49:185-190. [PMID: 21703146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Pancreatic cystic lesions (PCL) are identified in 1 % of patients who undergo abdominal computed tomography scans, because it is difficult to discriminate clinically between benign and malignant PCL. The PCL must be distinguished from inflammatory pseudocysts, which can have a similar radiographic appearance. The aim of this study was to review the incidence of PCL during 10 years. METHODS Nineteen consecutive patients who underwent surgical resection of a cystic lesion of the pancreas during a 10-year period were reviewed. RESULTS From 1998, 434 patients underwent to pancreatic surgery, 103 (25.75%) resulted with neoplasm of the pancreas and a PCL was diagnosed in 19 of them (18.44%). They were more common in women (n=15, 79%). The pathologic diagnosis was mucinous cystadenoma (n=6, 31.5%) followed by serous cystadenoma and solid cystic papilar tumor (n=4, 21%). Mucinous cystadenocarcinoma was diagnosed in a 77 year-old man and a serous cystadenocarcinoma was diagnosed in a 53 years-old woman; cystic degeneration of two insulinomas were diagnosed in a 71 year-old woman and a 32 year-old man (5.26%). CONCLUSIONS PCLs represent a spectrum of associated diseases. The incidence of serous cystadenoma is lower in our experience.
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Affiliation(s)
- Gabriela Feria-Feria
- Servicio de Gastrocirugía, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, Mexico
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28
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Girometti R, Intini SG, Cereser L, Bazzocchi M, Como G, Del Pin M, Baccarani U, Toniutto P, Zuiani C. Incidental pancreatic cysts: a frequent finding in liver-transplanted patients as assessed by 3D T2-weighted turbo spin echo magnetic resonance cholangiopancreatography. JOP 2009; 10:507-514. [PMID: 19734626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT The increasing frequency of incidental pancreatic cysts at imaging is a challenging topic due to the uncertainty of the aggressiveness of these lesions, especially small ones. To date, no data exist about their prevalence in a population of liver-transplanted patients. OBJECTIVE To determine the prevalence of incidental pancreatic cysts in liver-transplanted patients using magnetic resonance cholangiopancreatography. DESIGN A retrospective, single center case series. SETTING A tertiary referral centre. Interventions and patients Seventy-two examinations were performed over a two-year period in 47 liver-transplanted patients suspected for biliary complications. MAIN OUTCOME MEASURES Prevalence of incidental pancreatic cysts; proportion of cyst evolution over time; association of cysts with clinical and imaging features. RESULTS The prevalence of pancreatic cysts was 59.6%. Analysis showed a mean diameter of 5.4 mm and the presence of 1-3 cysts in 78.6% of patients (22/28). Communication with the main pancreatic duct was identified for 28 relatively larger cysts (up to 14 mm) in 14 subjects. An "intraductal papillary mucinous neoplasia-like pattern" was observed in 12 patients with cysts, based on the number of cysts, dimensions, and distribution. Out of the 15 patients who underwent additional MRCPs to monitor biliary findings, only one patient with proven intraductal papillary mucinous neoplasia showed modification of the cysts at follow-up. Among the evaluated pre- or post-transplantation factors (sex, age, etiology of cirrhosis, pre-transplant hepatocarcinoma, pancreatic abnormalities other than cysts, type of pancreaticobiliary channel/biliary anastomosis, presence of biliary complications, lithiasic biliary complications, transplant-examination interval), only the alcoholic etiology of cirrhosis was associated with the prevalence of pancreatic cysts (P=0.006). CONCLUSIONS Incidental pancreatic cysts are frequent in liver-transplanted patients. Clinical significance, relation to transplant, impact on patient management before and after transplant are still under debate and a matter for further investigation.
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Affiliation(s)
- Rossano Girometti
- Institute of Radiology, Department of Medical and Morphological Research, University of Udine, Udine, Italy.
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29
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Achkasov EE, Pugaev AV, Kharin AL. [Puncture method for the treatment of postnecrotic pancreatic cysts]. Khirurgiia (Mosk) 2007:33-7. [PMID: 17828124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Results of treatment of 39 patients with false pancreatic cysts with fine needle aspiration punctures are analyzed. Diagnostic and treatment value of method is discussed; technical aspects of puncture treatment are described. Aspiration puncture method was effective at 59% cases that permitted to reduce the number of external and internal drainage operations at the patients with false pancreatic cysts.
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Abstract
Cystic neoplasms of the pancreas represent the best example of a malignant precursor in the pancreas. There are many parallels between pancreatic cystic neoplasms and the colon polyp-cancer sequence. In the past, cystic neoplasms of the pancreas were thought to be relatively rare, composing less than 10% of cancers of the pancreas. With the greater use of cross-sectional imaging, an increasing number of these neoplasms are being seen.
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Affiliation(s)
- William R Brugge
- Massachusetts General Hospital, Gastrointestinal Unit, Blake 4, Boston, 02114, USA.
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31
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Jouini M, Bedioui H, Nouira K, Menif E, Haouet S, Slim R. Kyste lymphoépithélial inhabituel du pancréas. À propos d'un cas. ACTA ACUST UNITED AC 2004; 129:293-6. [PMID: 15220105 DOI: 10.1016/j.anchir.2004.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2003] [Accepted: 02/20/2004] [Indexed: 11/29/2022]
Abstract
Lymphoepithelial cyst of the pancreas is a benign and rare pathology. Its histogenesis is still unknown. The diagnosis is difficult to establish before surgery. We report a new case of a 20-year-old woman admitted for abdominal pain and vomiting. Radiologic investigations described a multilocular cystic tumor of the tail of the pancreas. The patient underwent a left pancreatectomy with splenectomy. Histologic investigations revealed pancreatic cysts lined by squamous epithelium surrounded by dense lymphoid tissue. The diagnosis of lymphoepithelial cyst of the pancreas was done.
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Affiliation(s)
- M Jouini
- Service de chirurgie et service de radiologie, hôpital La Rabta, Tunis, Tunisie
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32
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Capitanich P, Iovaldi ML, Medrano M, Malizia P, Herrera J, Celeste F, Boerr LAR, Obiol CM, Mezzadri NA. Lymphoepithelial cysts of the pancreas: case report and review of the literature. J Gastrointest Surg 2004; 8:342-5. [PMID: 15019932 DOI: 10.1016/j.gassur.2003.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The aim of this report was to describe the clinical and pathologic features of lymphoepithelial cysts of the pancreas, establish the differential diagnosis of other pancreatic cysts, and review the literature. A 53-year-old man was incidentally diagnosed with a pancreatic lesion after an abdominal CT scan. This study showed a solid mass in the tail of the pancreas not enhanced by helical CT. Endoscopic ultrasound examination revealed a low-density tissue mass on the surface of the pancreas, less echogenic than the surrounding parenchyma. Distal pancreatectomy and splenectomy were performed with a suspected diagnosis of mucinous cystic tumor. The patient has had an uneventful postoperative period, and the pathologic finding was a lymphoepithelial cyst of the pancreas. Lymphoepithelial cyst of the pancreas is an unusual and benign entity that must be taken into consideration when evaluating a cystic lesion of the pancreas because a different therapeutic approach may be required.
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Affiliation(s)
- Pablo Capitanich
- Department of Surgery, Hospital Alemán, Av. Pueyrredon 1640, C1118AAT Buenos Aires, Argentina.
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Ahmad NA, Kochman ML, Brensinger C, Brugge WR, Faigel DO, Gress FG, Kimmey MB, Nickl NJ, Savides TJ, Wallace MB, Wiersema MJ, Ginsberg GG. Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions. Gastrointest Endosc 2003; 58:59-64. [PMID: 12838222 DOI: 10.1067/mge.2003.298] [Citation(s) in RCA: 219] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the degree of agreement among endosonographers for EUS diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions and the specific type of cystic lesion. METHODS Videotapes of EUS procedures from 31 consecutive cases of a range of histopathologically proven lesions, including mucinous cystic neoplasm, serous cystadenoma, neuroendocrine tumor, intraductal papillary mucinous tumor, and pseudocyst, were used to make a study videotape, which was reviewed by 8 experienced endosonographers. The reviewers, blinded to clinical and surgical histopathology results, reviewed each case for the presence or absence of the following features: abnormality of pancreatic duct and parenchyma, margins, solid component, debris, and septations. They were asked to identify each lesion as neoplastic or non-neoplastic and to give a specific diagnosis for each lesion. RESULTS There was fair agreement between endosonographers for diagnosis of neoplastic versus non-neoplastic lesions (kappa = 0.24). Agreement for individual types of lesions was moderately good for serous cystadenomas (kappa = 0.46) but fair for the remainder. Agreement was moderately good for presence or absence of solid component (kappa = 0.43); fair for presence or absence of abnormal pancreatic duct (kappa = 0.29), debris (kappa = 0.21), and septations (kappa = 0.30); and slight for presence or absence of margins (kappa = 0.01) and abnormal pancreatic parenchyma (kappa = 0.01). Accuracy rates of EUS for the diagnosis of neoplastic versus non-neoplastic lesions ranged from 40% to 93%. CONCLUSIONS There is little more than chance interobserver agreement among experienced endosonographers for diagnosis of neoplastic versus non-neoplastic, specific type, and EUS features of pancreatic cystic lesions.
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Affiliation(s)
- Nuzhat A Ahmad
- Gastroenterology Division, Department of Medicine, Hospital of University of Pennsylvania, Philadelphia VAMC, University of Pennsylvania School of Medicine, 19104-4283, USA
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34
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Abstract
The cystic tumors of the pancreas constitute a considerable diagnostic challenge because of their overlapping clinical, radiologic, and pathologic features. They may be difficult to differentiate from one another and from benign lesions such as pseudocysts. Because many of the tumors in this group are potentially curable, correct diagnosis is essential for proper patient management. Even when correctly diagnosed, thorough microscopic evaluation is required for the mucin-producing tumors to correctly determine their degree of malignant progression in any given case. Most recently, molecular analysis of these tumors has demonstrated definitively that the serous and mucinous types of cystic neoplasms of the pancreas are unrelated pathogenetically. Conversely, molecular data indicate similarities between the mucinous types of cystic tumors and ductal adenocarcinoma of the pancreas, but the essential molecular differences that underlie the differences in biological behavior are as yet undetermined.
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MESH Headings
- Cyst Fluid/cytology
- Cystadenoma, Mucinous/classification
- Cystadenoma, Mucinous/epidemiology
- Cystadenoma, Mucinous/pathology
- Cystadenoma, Serous/classification
- Cystadenoma, Serous/epidemiology
- Cystadenoma, Serous/pathology
- DNA, Neoplasm/genetics
- Diagnosis, Differential
- Histological Techniques/methods
- Humans
- Immunohistochemistry/methods
- Incidence
- Molecular Diagnostic Techniques/methods
- Mutation/genetics
- Pancreatic Cyst/classification
- Pancreatic Cyst/epidemiology
- Pancreatic Cyst/pathology
- Pancreatic Neoplasms/classification
- Pancreatic Neoplasms/epidemiology
- Pancreatic Neoplasms/pathology
- Papilloma, Intraductal/classification
- Papilloma, Intraductal/epidemiology
- Papilloma, Intraductal/pathology
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Affiliation(s)
- Carolyn C Compton
- Department of Pathology, McGill University, Office of the Chairman, 3775 University Street, Montreal, Quebec H3A 2B4, Canada.
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35
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Abstract
Neoplastic cysts of the pancreas have been recognized since the nineteenth century, and although differences between neoplastic and proliferative cysts were acknowledged, they were treated similarly, first by marsupialization and later by internal drainage. Increased awareness of the malignant potential of neoplastic cysts, as well as advances in surgical techniques, made excision the preferred treatment for these lesions as early as the 1940s, but errors in diagnosis were frequent, and even to this date, continue to account for cases of pancreatic cystic tumors treated by drainage.
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MESH Headings
- Adenocarcinoma, Mucinous/diagnosis
- Adenocarcinoma, Mucinous/epidemiology
- Adenocarcinoma, Mucinous/surgery
- Boston/epidemiology
- Cystadenoma, Mucinous/diagnosis
- Cystadenoma, Mucinous/epidemiology
- Cystadenoma, Mucinous/surgery
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/epidemiology
- Cystadenoma, Serous/surgery
- Diagnosis, Differential
- Diagnostic Errors
- Drainage/methods
- Drainage/standards
- Hospitals, General
- Humans
- Pancreatectomy/methods
- Pancreatectomy/standards
- Pancreatectomy/statistics & numerical data
- Pancreatic Cyst/diagnosis
- Pancreatic Cyst/epidemiology
- Pancreatic Cyst/surgery
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/epidemiology
- Pancreatic Neoplasms/surgery
- Papilloma, Intraductal/diagnosis
- Papilloma, Intraductal/epidemiology
- Papilloma, Intraductal/surgery
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Carlos Fernández-del Castillo
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, ACC/336, Boston, MA 02114, USA.
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36
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Abstract
This article discusses serous cystadenomas, the most common of the nonmucinous cystic lesions of the pancreas. These microcystic lesions were previously known as "glycogen-rich" cystadenomas because of the presence of glycogen within the cyst epithelium. A small percentage of these lesions are macrocystic, and it may be difficult to differentiate them from mucinous lesions; however, endoscopic ultrasound guided fine needle aspiration can provide diagnostic material from the cyst fluid. The second most common nonmucinous cyst, the islet cell tumor, is also discussed. These rare cystic tumors may or may not be accompanied by excess hormone production. The prognosis for the rare cystic tumors is good if they are resected successfully.
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MESH Headings
- Adenoma, Islet Cell/diagnosis
- Adenoma, Islet Cell/epidemiology
- Adenoma, Islet Cell/surgery
- Biopsy, Needle/methods
- Biopsy, Needle/standards
- Carcinoma, Islet Cell/diagnosis
- Carcinoma, Islet Cell/epidemiology
- Carcinoma, Islet Cell/surgery
- Cystadenoma, Serous/diagnosis
- Cystadenoma, Serous/epidemiology
- Cystadenoma, Serous/surgery
- Diagnosis, Differential
- Endosonography/methods
- Endosonography/standards
- Humans
- Pancreatic Cyst/diagnosis
- Pancreatic Cyst/epidemiology
- Pancreatic Cyst/surgery
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/epidemiology
- Pancreatic Neoplasms/surgery
- Prognosis
- Ultrasonography, Interventional/methods
- Ultrasonography, Interventional/standards
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Affiliation(s)
- Michelle A Anderson
- Endoscopic Ultrasound Program, Division of Gastroeterology, Department of Internal Medicine, University of Michigan Medical Center, 3912 Taubman Center/0362, Ann Arbor, MI 48109-0632, USA
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37
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Abstract
PURPOSE To evaluate single-shot fast spin-echo (SE) magnetic resonance (MR) imaging for depiction of pancreatic cysts in a large number of patients and to analyze cyst prevalence with respect to patient age and sex and other clinical information. MATERIALS AND METHODS Single-shot fast SE images of the pancreas were obtained in 1,444 patients. The images were reviewed for presence of pancreatic cysts, which were classified as simple and nonsimple types, and cyst diameters were measured. kappa statistic, Fisher exact, McNemar Q, and Pearson product moment correlation tests were performed. RESULTS Two hundred eighty-three (19.6%) patients had at least one pancreatic cyst. The prevalence of pancreatic cysts increased with age (r = 0.96). The percentages of male and female patients with pancreatic cysts (20.4% vs 18.8%) were not significantly different. Two hundred seventy-one (18.8%) patients had simple cysts, and 147 (10.2%) had nonsimple cysts. Of 283 patients with pancreatic cysts, 158 (55.8%) had only one pancreatic cyst. The number of patients with multiple cysts increased with age after 70 years. Four hundred fifteen (83.8%) cysts were 10 mm in diameter or smaller; 56 (11.3%), 11-20 mm in diameter; and 24 (4.9%), 21 mm in diameter or larger. Sixteen (5.7%) patients with pancreatic cysts had malignant pancreatic tumors, and 75 (26.5%) patients had pancreatitis. CONCLUSION The prevalence of pancreatic cysts at single-shot fast SE MR imaging-especially cysts with a diameter smaller than 10 mm-is similar to that of pancreatic cysts at autopsy and higher than that of pancreatic cysts at transabdominal ultrasonography. Prevalence is especially high in patients with pancreatitis.
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Affiliation(s)
- Xiao-Ming Zhang
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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38
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Abstract
A 9-year-old boy was admitted with acute abdomen, and a cystic mass in the pancreas was coincidentally detected by ultrasonography. Definitive diagnosis of hydatid disease of the pancreas could be made only at operation, and surgical therapy was effective.
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Affiliation(s)
- A Erdener
- Ege Universitesi Tip Fakültesi, Cocuk Cerrahisi AD, Izmir, Turkey
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39
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Abstract
We report a case of lymphoepithelial cyst of the pancreas with non-specific elevation of CA 19.9 and CEA. Pre-operative diagnosis by conventional means proved elusive, and only surgical resection and histopathology revealed the diagnosis. The origin and diagnosis are discussed by literature review.
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Affiliation(s)
- S P Chan
- Department of Upper Gastro-intestinal Surgery, Repatriation General Hospital Concord, Sydney, Australia
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40
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Abstract
Cystic lesions of the pancreas are relatively uncommon. We describe the case of a young man with a complex cystic mass located within the head of the pancreas. The patient underwent exploration with resection of the mass. Pathology revealed a ciliated epithelial cyst, a rare cystic lesion of the pancreas.
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Affiliation(s)
- I A Munshi
- Department of Surgery, University of Miami Medical Center, Florida
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41
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Affiliation(s)
- A Strapko
- Department of Medicine, State University of New York-Health Science Center, Syracuse, USA
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Ishikawa I, Chikamoto E, Nakamura M, Asaka M, Tomosugi N, Yuri T. High incidence of common bile duct dilatation in autosomal dominant polycystic kidney disease patients. Am J Kidney Dis 1996; 27:321-6. [PMID: 8604699 DOI: 10.1016/s0272-6386(96)90353-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Two autosomal dominant kidney disease (ADPKD) patients with cholecystitis or communicating extrahepatic dilatation of the common bile duct accompanied by tiny common bile duct stones prompted us to examine the incidence of gall stone disease and dilatation of the common bile duct in ADPKD patients. Computed tomography scans were examined retrospectively in 55 ADPKD patients and 55 age-, gender-, and duration of dialysis-matched non-ADPKD patients. The incidence of calcium-containing gall stones found on tomography scans was the same: eight of the 55 ADPKD patients and nine of the 55 non-ADPKD patients. However, common bile duct dilatation, defined as measuring more than 7 mm in diameter at the pancreatic head on CT scans, was found more frequently in the ADPKD patients (22 patients; 40.0%) than in the non-ADPKD patients (5 patients; 9.1%) (P = 0.0002). These results suggest that the high incidence of intrapancreatic common bile duct dilatation in ADPKD is a previously undescribed sign of extracellular matrix remodeling in ADPKD.
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Affiliation(s)
- I Ishikawa
- Division of Nephrology, Department of Internal Medicine, Kanazawa Medical University, Uchinada, Japan
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43
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Abstract
To determine the causes of death in autosomal dominant polycystic kidney disease (ADPKD) patients and to examine whether the extrarenal manifestations of ADPKD influence the causes of death, the medical records of 129 patients who died between 1956 and 1993 were reviewed; 58% of the 129 patients had an autopsy performed. Seventy-seven percent died after reaching ESRD. The mean age at death increased from 51 yr for those who died before 1975 to 59 yr for those who died after 1975, reflecting the introduction of renal replacement therapies. The most common cause of death before 1975 was infection (30%), followed by uremia (28%) and cardiac disease (21%); after 1975, these were cardiac disease (36%) and infection (24%). Infection was equally prevalent before and after 1975, presenting as sepsis in 94% and directly relating to ADPKD in 47% of these patients. Underlying factors for cardiac death were cardiac hypertrophy, seen in 89% of all autopsied patients, and coronary artery disease, seen in 81%. A neurologic event was the cause of death in 12% of patients; these were ruptured intracranial aneurysm in 6%, hypertensive intracranial hemorrhage in 5%, and ischemic stroke in 1%. The mean age of those who died of ruptured intracranial aneurysm was 37 yr. No patient died of renal cancer. Liver cysts were the most common extrarenal manifestation, seen in 70% of the autopsied cases; cysts in other organs were very rare. Colonic diverticula were found in 21%. Thus, the renal and extrarenal manifestations of ADPKD are important contributors to morbidity and mortality.
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Affiliation(s)
- G M Fick
- University of Colorado Health Sciences Center, Denver 80262, USA
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44
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Ikeda M, Sato T, Morozumi A, Fujino MA, Yoda Y, Ochiai M, Kobayashi K. Morphologic changes in the pancreas detected by screening ultrasonography in a mass survey, with special reference to main duct dilatation, cyst formation, and calcification. Pancreas 1994; 9:508-12. [PMID: 7937699 DOI: 10.1097/00006676-199407000-00014] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Subclinical morphologic changes in the pancreas detected by screening ultrasonography of 130,951 subjects were analyzed in relation to their incidence and background factors. Main pancreatic duct (MPD) dilatation, cystic lesion, and calcification were found in 644 (0.49%), 271 (0.21%) and 65 (0.05%) patients, respectively. The incidence of MPD dilatation and calcification was significantly higher in men (p < 0.0001), whereas cystic lesion was significantly more frequent in women (p < 0.01). Age-dependent increase in the incidence of MPD dilatation and cystic lesion was observed in both sexes whereas that of calcification was observed only in men. Further detailed examinations for 312 randomly selected patients with these findings revealed that 97% of MPD dilatation, 95% of cystic lesion, and 86% of calcification were correctly identified by ultrasonography. Finally, 18 (5.8%) patients with chronic pancreatitis, 16 (5.1%) with neoplastic cysts, 3 with mucin-producing tumors, and 3 with carcinomas (0.96%, respectively) were detected. On the other hand, in 84.0% of MPD dilatation, 87.4% of cystic lesion, and 50.0% of calcification, we could not attribute their etiology to any known pancreatic disease. It is indicated that aging and gender are major clinically related factors of these changes.
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Affiliation(s)
- M Ikeda
- Department of Gastroenterology, Osaka National Hospital, Japan
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45
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Abstract
Since 1987, we have used the TA-stapler for 15 partial resections of the spleen. The cases included 5 second- to third-degree traumatic ruptures, 4 splenic cysts, 3 injuries resulting from accidents during upper-abdominal surgery, 2 diagnostic resections, and 1 intralienal pancreatic cyst. The TA-55 stapler was used 14 times and the TA-90 once. No patient developed postoperative bleeding or required further surgery. Postoperative laboratory chemistry and scintigraphy findings were within the limits indicative of normal function in all cases. The TA-stapler expands the technical possibilities for organ-conserving splenic surgery.
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Affiliation(s)
- S Uranüs
- Department of Surgery, University Surgical Clinic, Karl-Franzens University, Graz, Austria
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46
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Hough DM, Stephens DH, Johnson CD, Binkovitz LA. Pancreatic lesions in von Hippel-Lindau disease: prevalence, clinical significance, and CT findings. AJR Am J Roentgenol 1994; 162:1091-4. [PMID: 8165988 DOI: 10.2214/ajr.162.5.8165988] [Citation(s) in RCA: 167] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The purposes of this study were to determine the nature, prevalence, and CT findings of pancreatic lesions in patients with von Hippel-Lindau disease and to determine whether identification of pancreatic cysts and neoplasms is important in establishing the diagnosis of von Hippel-Lindau disease. SUBJECTS AND METHODS The medical records and radiologic images of 52 patients with von Hippel-Lindau disease who were evaluated at our institution between 1976 and 1992, and who at some stage underwent abdominal CT, sonography, or MR imaging, were reviewed. The nature, prevalence, and CT findings of the pancreatic lesions were determined, and the role of the pancreatic abnormalities in establishing the diagnosis of von Hippel-Lindau disease was studied. RESULTS Twenty-nine (56%) of the 52 patients had pancreatic lesions. Nineteen patients had pancreatic cysts and no other pancreatic lesion. Four patients had islet cell tumors only, one had a microcystic adenoma only, and three had indeterminate pancreatic masses. One patient had cysts and an islet cell tumor, and another patient had cysts, an islet cell tumor, and a microcystic adenoma. In six patients (12%), pancreatic lesions were the only abdominal manifestation of von Hippel-Lindau disease. In three patients screened because of a family history of von Hippel-Lindau disease, no CNS abnormalities were present, and the only abdominal lesions were in the pancreas (cysts in two cases, islet cell carcinoma in the other). Thus, the pancreatic lesion was an important factor in establishing a diagnosis of von Hippel-Lindau disease in these patients. CONCLUSION Pancreatic lesions may be the only abdominal manifestation of von Hippel-Lindau disease. CT findings include cysts, islet cell tumors, and microcystic adenomas. Pancreatic lesions, including cysts, may precede any other manifestation of von Hippel-Lindau disease by several years, and recognition permits earlier diagnosis in patients being screened for von Hippel-Lindau disease.
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Affiliation(s)
- D M Hough
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905
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47
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Sperti C, Cappellazzo F, Pasquali C, Militello C, Catalini S, Bonadimani B, Pedrazzoli S. Cystic neoplasms of the pancreas: problems in differential diagnosis. Am Surg 1993; 59:740-5. [PMID: 7694532 DOI: pmid/7694532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
From 1970 to 1990 we observed 18 patients with histologically proven pancreatic cystic tumors. The average duration of symptoms prior to diagnosis was 14.1 months. A presumptive diagnosis was made preoperatively in nine patients. CT-guided fine needle cytology performed in three cases correctly showed a benign lesion in one patient and malignancy in two patients. Amylase and tumoral marker levels (CEA, CA19-9) were low in cystic fluid of two patients with cystadenomas who underwent preoperative percutaneous aspiration. Intraoperative biopsy of the cystic wall failed to detect epithelial lining in two cases; one patient had internal drainage for cystadenocarcinoma mistaken for pancreatic pseudocyst. Sixteen patients underwent surgery, two of whom died. Of the seven patients with a malignant condition, resection for cure was performed on three. The preoperative diagnosis of these very rare tumors remains difficult. Fine-needle cytology and cystic fluid examination may be a promising technique, but resection of all suspected lesions, whenever possible, is the procedure of choice for diagnosis and treatment.
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Affiliation(s)
- C Sperti
- Department of Surgery, University of Padua, Italy
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48
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Chehter EZ, Pinheiro e Coelho ME, Guarita DR, Mott CDB, da Cunha JE, Machado MC, Laudanna AA. [Cavity effusions in patients with chronic pancreatitis]. Rev Hosp Clin Fac Med Sao Paulo 1993; 48:60-8. [PMID: 8235275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In Brazil, the incidence of IPF due to alcohol-induced CP seems to be higher than in other countries. The authors analysed some general, epidemiologic, laboratory and radiologic features in 98 patients with CP, all of them alcoholics, divided in two groups: 49 patients without IPF (I) and 49 patients with IPF (II). The authors first analysed the following parameters in each group and then comparatively in both groups: age, sex, race, smokers and daily consumption of cigarettes, daily consumption of alcoholic beverages, years of alcohol consumption, and mortality. The authors concluded that pancreatic fistula plays in effusions the main role, secondary to cysts disruption or necrosis of the main pancreatic duct.
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Affiliation(s)
- E Z Chehter
- Departamente de Gastroenterologia, Faculdade de Medicina, Universidade de São Paulo
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49
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Abstract
The pathologic and clinical classification, as well as the behavior, of cystic tumors of the pancreas has been the subject of controversy. We retrospectively reviewed 50 patients with a diagnosis of cystic tumor of the pancreas observed at The Johns Hopkins Hospital from 1984 to 1991. These tumors were classified into three broad groups: I, cystadenoma; II, cystadenocarcinoma; and III, adenocarcinoma with mucin production or an associated cyst. The three groups did not differ with respect to age or sex. The most common clinical presentation was abdominal pain. Symptoms and signs among the three groups were similar except that patients with cystadenomas were less likely (p less than 0.05) to be jaundiced and more likely (p less than 0.05) to be asymptomatic. Radiologic findings on computerized tomography, cholangiography, and arteriography also overlapped, making precise preoperative determination of tumor type difficult. Operative classification was also often not possible. The resectability rate (Group I, 91%; Group II, 67%; Group III, 53%) and 5-year survival rate (Group I, 90%; Group II, 72%; Group III, 14%) correlated with careful pathologic determination. Cystic tumors of the pancreas represent a spectrum of disease ranging from benign cystadenoma to adenocarcinoma masquerading as cystadenocarcinoma. We recommend resection whenever possible, even when preoperative evaluation suggests benign disease.
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Affiliation(s)
- M A Talamini
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
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50
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Matsumoto K, Honzumi M, Nakazawa M. Solid and cystic tumor of the pancreas. J Clin Gastroenterol 1991; 13:240-1. [PMID: 2033234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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