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pancreatic endometrial cyst mimics mucinous cystic neoplasm of the pancreas

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World Journal of Gastroenterology 2017年第6期23卷 1113-1118页

作者： Michael A Mederos Nicole Villafane Sadhna Dhingra Carlos Farinas Amy Mc Elhany William E Fisher George Van Buren II Department of General Surgery Baylor College of Medicine Department of Pathology Baylor College of Medicine Department of Radiology Baylor College of Medicine

pancreatic cysts include a variety of benign, premalignant, and malignant lesions. Endometrial cysts in the pancreas are exceedingly rare lesions that are difficult to diagnose pre-operatively. This report describes the findings in a 43-year-old patient with a recent episode of acute pancreatitis who presented with a large cyst in the tail of the pancreas. Imaging demonstrated a loculated pancreatic cyst, and cyst fluid aspiration revealed an elevated amylase and carcinoembryonic antigen. The patient experienced an interval worsening of abdominal pain, fatigue, diarrhea, and a 15-pound weight loss 3 mo after the initial episode of pancreatitis. With concern for a possible pre-malignant lesion, the patient underwent a laparoscopic distal pancreatectomy with splenectomy, which revealed a 16cm×12cm×4cm lesion. Final histopathology was consistent with an intra-pancreatic endometrial cyst. Here we discuss the overlapping imaging and laboratory features of pancreatic endometrial cysts and mucinous cystic neoplasms of the pancreas.

关键词： pancreatic cyst pancreatic endometrial cyst Endometriosis Mucinous cystic neoplasm of the pancreas Distal pancreatectomy

Increased incidence of indeterminate pancreatic cysts and changes of management pattern: Evidence from nationwide data

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Hepatobiliary & pancreatic Diseases International 2023年第3期22卷 294-301页

作者： Jaewoo Park Jinkyeong Park Yoon Suk Lee Kwangrok Jung In Ho Jung Jong-Chan Lee Jin-Hyeok Hwang Jaihwan Kim Department of Internal Medicine Seoul National University Bundang HospitalSeoul National University College of MedicineSeongnamKorea Department of Internal Medicine Kyung Hee University Hospital at GangdongSeoulKorea Department of Internal Medicine Inje University College of MedicineIlsan Paik HospitalGoyangKorea

Background:pancreatic cysts are ***,most studies are based on data collected from individual *** present study aimed to evaluate the changes of management patterns for pancreatic cystic lesions(PCLs)by analyzing large epidemiologic ***:Between January 2007 and December 2018,information regarding pancreatic cystic lesions was acquired from the nationwide Health Insurance Review and Assessment Service database in ***:The final number of patients with pancreatic cysts was 165277 among the total claims for reimbursement of 855983 associated with PCLs over 12 *** total number of claims were increased from 19453 in 2007 to 155842 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 24651 and the crude incidence rate of PCLs expanded from 19.96 per 100000 to 47.77 per *** to specific neoplasm codes(D136 or D377),the use of pancreatic cyst code(K862)has been remarkably increased and the most common since *** annual number of pancreatectomies increased from 518 to 861 between 2007 and 2012,and decreased to 596 until *** percentage of pancreatic cancer in patients who received pancreatectomy increased from 5.6%in 2007 to 11.7%in ***:The incidence of PCLs is rapidly *** 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.

关键词： pancreatic cyst Incidence Prevalence Pancreatectomy Big data

Analysis of clinical characteristics and treatment of pancreatic cystic tumors

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Chinese Journal of Cancer Research 2016年第5期28卷 519-527页

作者： Lei You Jianchun Xiao Zhe Cao Wanying Zhang Quan Liao Menghua Dai Taiping Zhang Yupei Zhao Department of General Surgery Peking Union Medical College HospitalChinese Academy of Medical Sciences

Objective： To summarize experience in the diagnosis and treatment of pancreatic cystic ***： This is a retrospective study of 207 patients who were diagnosed with pancreatic cystic tumors at Peking Union Medical College Hospital between Jan 2009 and Mar 2014. Clinical data, such as clinical manifestations, radiologieal and pathological images and surgical recordings, were collected. Results： Of the 207 included patients, females accounted for 76.81%, and the mean patient age was 52.04 years. Malignancy was more common in older patients who presented with marasmus and jaundice. Other risk factors included solid components in the tumor, a large tumor size, and elevated levels of tumor markers. Surgical treatment was required when a malignant tumor was suspected. The operation approach was selected based on the location, size and characteristics of the tumor. The position of the tumor relative to the pancreatic duct also played a significant role.

关键词： cystic tumor diagnosis pancreatic cyst treatment

Resection of pancreatic cystic neoplasms in recurrent acute pancreatitis prevents recurrent pancreatitis but does not identify more malignancies

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World Journal of Gastroenterology 2021年第15期27卷 1630-1642页

作者： Thiruvengadam Muniraj Harry R Aslanian Loren Laine Priya A Jamidar James F Farrell Kisha A Mitchell Ronald R Salem Section of Digestive Diseases Department of MedicineYale University School of MedicineNew HavenCT 06510United States Department of Pathology Yale University School of MedicineNew HavenCT 06510United States Department of Surgery Yale University School of MedicineNew HavenCT 06510United States

BACKGROUND Recurrent acute pancreatitis(RAP)may be a presenting feature of and an indication for resection of pancreatic cysts,including intra-ductal papillary mucinous neoplasm(IPMN).Few data are available regarding the prevalence of malignancy and post-operative RAP in this *** To study the role of resection to help prevent RAP and analyze if presentation as RAP would be a predictor for *** This retrospective study assessed 172 patients who underwent surgical resection of pancreatic cystic neoplasms at a university hospital between 2002 and *** prevalence of preoperative high-risk cyst features,and of neoplasia was compared between patients with and without *** identify the cause of pancreatitis,all the patients had a detailed history of alcohol,smoking,medications obtained,and had cross-sectional imaging(contrast-enhanced computed tomography/magnetic resonance imaging)and endoscopic ultrasound to look for gallstone etiology and other structural causes for *** incidence of RAP post-resection was the primary *** IPMN accounted for 101 cases(58.7%){[branch duct(BD)59(34.3%),main duct(MD)42](24.4%)}.Twenty-nine(16.9%)presented with RAP(mean 2.2 episodes):15 had BD-IPMN,8 MD-IPMN,5 mucinous cystic neoplasm and 1 serous cystic *** was similar among those with vs without RAP for all patients[6/29(20.7%)vs 24/143(16.8%)]and IPMN patients[6/23(26.1%)vs 23/78(29.5%)],although tended to be higher with RAP in BD-IPMN,[5/15(33.3%)vs 3/44(6.8%),P=0.04].At mean follow-up of 7.2 years,1(3.4%)RAP patient had post-resection *** mean episodes of acute pancreatitis before vs after surgery were 3.4 vs 0.02(Ppancreatic cystic neoplasms who have RAP compared to those without *** addition,specific cyst characteristics were not clearly associated with *** incidence of RAP was markedly decreased in almost all patients following cyst resect

关键词： pancreatic cyst pancreatic neoplasm Pancreatitis Malignancies

Updates in diagnosis and management of pancreatic cysts

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World Journal of Gastroenterology 2021年第34期27卷 5700-5714页

作者： Linda S Lee Division of Gastroenterology Hepatology and EndoscopyBrigham and Women's HospitalBostonMA 02115United States

Incidental pancreatic cysts are commonly encountered with some cysts having malignant *** most common pancreatic cystic neoplasms include serous cystadenoma,mucinous cystic neoplasm and intraductal papillary mucinous *** stratifying pancreatic cysts is important in deciding whether patients may benefit from endoscopic ultrasound(EUS)or surgical *** should be reserved for patients with malignant cysts or cysts at high risk for developing malignancy as suggested by various risk features including solid mass,nodule and dilated main pancreatic *** may supplement magnetic resonance imaging findings for cysts that remain indeterminate or have concerning features on *** cyst fluid markers including carcinoembryonic antigen,glucose,amylase,cytology,and DNA markers help distinguish mucinous from nonmucinous *** review will guide the practicing gastroenterologist in how to evaluate incidental pancreatic cysts and when to consider referral for EUS or *** presumed low risk cysts,surveillance strategies will be *** pancreatic cysts requires an individualized approach that is directed by the various guidelines.

关键词： pancreatic cyst Intraductal papillary mucinous neoplasm Endoscopic ultrasound-guided fine needle aspiration Serous cystadenoma Surveillance Carcinoembryonic antigen

Endoscopic ultrasound in the diagnosis and treatment of pancreatic disease

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World Journal of Gastroenterology 2014年第29期20卷 9976-9989页

作者： Christopher W Teshima Gurpal S Sandha Division of Gastroenterology University of AlbertaEdmontonAlberta T6G 2X8Canada

Endoscopic ultrasound(EUS)is an important part of modern gastrointestinal endoscopy and now has an integral role in the diagnostic evaluation of pancreatic ***,as EUS technology has advanced,it has increasingly become a therapeutic procedure,and the prospect of multiple applications of interventional EUS for the pancreas is truly on the near ***,this review focuses on the established diagnostic and therapeutic roles of EUS that are used in current clinical *** particular,the diagnostic evaluation of acute pancreatitis,chronic pancreatitis,cystic pancreatic lesions and solid masses of the pancreas are *** newer enhanced imaging modalities of elastography and contrast enhancement are evaluated in this *** main therapeutic aspects of pancreatic EUS are then considered,namely celiac plexus block and celiac plexus neurolysis for pain control in chronic pancreatitis and pancreas cancer,and EUS-guided drainage of pancreatic fluid collections.

关键词： Endoscopic ultrasonography Fine needle aspiration pancreatic cyst pancreatic neoplasms Pancreatitis

pancreatic intraductal papillary mucinous neoplasms:Current diagnosis and management

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 1880-1895页

作者： Beata Jabłońska PawełSzmigiel Sławomir Mrowiec Department of Digestive Tract Surgery Medical University of SilesiaKatowice 40-752Poland

Intraductal papillary mucinous neoplasms(IPMNs)represent approximately 1%of all pancreatic neoplasms and 25%of cystic *** are divided into three types:main duct-IPMN(MD-IPPMN),branch duct-IPMN(BD-IPMN),and mixed *** this review,diagnostics,including clinical presentation and radiological investigations,were *** resonance imaging is the most useful for most *** depends on the type and radiological features of *** is recommended for *** BD-IPMN,management involves surgery or surveillance depending on the tumor size,cyst growth rate,solid components,main duct dilatation,high-grade dysplasia in cytology,the presence of symptoms(jaundice,new-onset diabetes,pancreatitis),and CA 19.9 serum *** patient’s age and comorbidities should also be taken into ***,there are different guidelines regarding the diagnosis and management of *** this review,the following guidelines were presented:Sendai International Association of Pancreatology guidelines(2006),American Gastroenterological Association guidelines,revised international consensus Fukuoka guidelines(2012),revised international consensus Fukuoka guidelines(2017),and European evidence-based guidelines according to the European Study Group on cystic Tumours of the Pancreas(2018).The Verona Evidence-Based Meeting 2020 was also presented and discussed.

关键词： pancreatic cyst pancreatic cystic neoplasm Intraductal papillary mucinous neoplasm pancreatic cancer Pancreatectomy Guidelines

Role of endosonography in non-malignant pancreatic diseases

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World Journal of Gastroenterology 2007年第2期13卷 165-169页

作者： Kyung W Noh Surakit Pungpapong Massimo Raimondo Di-vision of Gastroenterology and Hepatology Mayo Clinic College of Medicine Jacksonville FL United States

Endoscopic ultrasound (EUS) has emerged as a valuable tool in the evaluation of benign and malignant pancreatic diseases. The ability to obtain high quality images and perform fine-needle aspiration (FNA) has led EUS to become the diagnostic test of choice when evaluating the pancreas. This article will review the role of EUS in benign pancreatic diseases.

关键词： Endosonography Chronic pancreatitis pancreatic cyst

Observation or resection of pancreatic intraductal papillary mucinous neoplasm:An ongoing tug of war

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World Journal of Gastrointestinal Oncology 2019年第12期11卷 1092-1100页

作者： Jan Rune Aunan Nigel B.Jamieson Kjetil Sφreide Department of Gastrointestinal Surgery HPB UnitStavanger University HospitalStavanger 4068Norway Wolfson Wohl Cancer Research Centre Institute of Cancer SciencesUniversity of GlasgowGlasgow G611BDUnited Kingdom West of Scotland pancreatic Unit Glasgow Royal InfirmaryGlasgow G40SFUnited Kingdom Gastrointestinal Translational Research Unit Laboratory for Molecular MedicineStavanger University HospitalStavanger 4068Norway Department of Clinical Medicine University of BergenBergen 5003Norway

An increasing number of patients are being referred to pancreatic centres around the world due to often incidentally discovered cystic neoplasms of the *** evaluation and management of pancreatic cystic neoplasms is a controversial topic and with existing guidelines based on a lack of strong evidence there is discordance between centres and guidelines with regard to when to offer surgery and when to favour *** frequency,duration and modality of surveillance is also controversial as this is resource-consuming and must be balanced against the perceived benefits and risks *** there is consensus that the risk of malignancy should be balanced against the lifeexpectancy and comorbidities,the indications for surgery and surveillance strategies vary among the ***,the tug of war between surveillance or resection *** we discuss the recommendations from guidelines with further accumulating data and emerging reports on intraductal papillary mucinous neoplasm in the literature.

关键词： Neoplasia pancreatic cancer pancreatic cyst Diagnosis Resection Surveillance Mutation Biomarker