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Rogowska J, Semeradt J, Durko Ł, Małecka-Wojciesko E. Diagnostics and Management of Pancreatic Cystic Lesions-New Techniques and Guidelines. J Clin Med 2024; 13:4644. [PMID: 39200786 PMCID: PMC11355509 DOI: 10.3390/jcm13164644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Pancreatic cystic lesions (PCLs) are increasingly diagnosed owing to the wide use of cross-sectional imaging techniques. Accurate identification of PCL categories is critical for determining the indications for surgical intervention or surveillance. The classification and management of PCLs rely on a comprehensive and interdisciplinary evaluation, integrating clinical data, imaging findings, and cyst fluid markers. EUS (endoscopic ultrasound) has become the widely used diagnostic tool for the differentiation of pancreatic cystic lesions, offering detailed evaluation of even small pancreatic lesions with high sensitivity and specificity. Additionally, endoscopic ultrasound-fine-needle aspiration enhances diagnostic capabilities through cytological analysis and the assessment of fluid viscosity, tumor glycoprotein concentration, amylase levels, and molecular scrutiny. These detailed insights play a pivotal role in improving the clinical prognosis and management of pancreatic neoplasms. This review will focus mainly on the latest recommendations for the differentiation, management, and treatment of pancreatic cystic lesions, highlighting their clinical significance.
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Affiliation(s)
- Jagoda Rogowska
- Department of Digestive Tract Diseases, Medical University of Lodz, 90-647 Lodz, Poland; (J.S.); (Ł.D.); (E.M.-W.)
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Boicean A, Prisca D, Bratu DG, Bacila CI, Tanasescu C, Chicea R, Fleaca SR, Birsan SA, Ichim C, Mohor CI, Roman MD, Cristian AN, Todor SB, Mohor CI, Moisin A, Hasegan A. Uncommon Presentation of Gastric Duplication Cyst with Left-Sided Portal Hypertension: A Case Report and Literature Review. Diagnostics (Basel) 2024; 14:675. [PMID: 38611587 PMCID: PMC11011661 DOI: 10.3390/diagnostics14070675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/14/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Gastric duplication cysts (GDCs) in adults are exceedingly rare, with only a few documented cases in medical literature. The spectrum of clinical presentations varies widely, ranging from asymptomatic to severe symptoms such as hematemesis, vomiting or abdominal pain. Among the less common complications associated with GDCs, segmental portal hypertension is a notable rarity. We present a compelling case report of a patient exhibiting signs of segmental portal hypertension, where ultrasound and echo-endoscopy revealed a sizable gastric duplication cyst as the underlying etiology. Recognizing the scarcity of literature on GDCs in adult patients, we conducted a thorough review to underscore the diagnostic significance of ultrasonography and endoscopic ultrasound (EUS) in accurately identifying these congenital anomalies. This case report and comprehensive literature review emphasize the pivotal role of EUS and abdominal ultrasound in achieving an accurate diagnosis of GDCs. By shedding light on the diagnostic and therapeutic intricacies, we aim to raise awareness among clinicians regarding this rare pathology and the importance of multimodal imaging approaches for optimal patient management.
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Affiliation(s)
- Adrian Boicean
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Diana Prisca
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Ciprian Ionut Bacila
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Ciprian Tanasescu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Radu Chicea
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Sorin Radu Fleaca
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Sabrina Andreea Birsan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Cristian Ichim
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Calin Ilie Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Mihai Dan Roman
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Adrian Nicolae Cristian
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Samuel Bogdan Todor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Cosmin Ioan Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Andrei Moisin
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
| | - Adrian Hasegan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.B.); (C.I.B.); (C.T.); (R.C.); (S.R.F.); (S.A.B.); (C.I.); (C.I.M.); (M.D.R.); (A.N.C.); (S.B.T.); (C.I.M.); (A.M.); (A.H.)
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Wang R, Lu H, Yu J, Huang W, Li J, Cheng M, Liang P, Li L, Zhao H, Gao J. Computed tomography features and clinical characteristics of gastritis cystica profunda. Insights Imaging 2022; 13:14. [PMID: 35072798 PMCID: PMC8786983 DOI: 10.1186/s13244-021-01149-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background The diagnostic evidence of gastritis cystica profunda (GCP) are not adequately described due to its extremely low morbidity. This study aimed to analyze and summarize the comprehensive CT features and clinical characteristics of patients with GCP. Results Nineteen patients were enrolled, including eight men and eleven women, with a mean age of 55.53 years. Only one patient had the history of gastric polypectomy. Among the nineteen cases, two cases were in the gastric cardia, four in the gastric fundus, eight in the gastric body and five in the gastric antrum. The shapes were sphere in thirteen patients, hemisphere in five patients and diffuse in one patient. The mean size of eighteen local lesions was 1.63 cm. The cystic changes in submucosa were detected in fifteen patients. Compared with the pancreas, most GCP lesions were hypo-attenuated on unenhanced CT (n = 8), in arterial phase (AP) (n = 17) and venous phase (VP) (n = 11). Fifteen patients had the peak enhancement in VP and two in AP. The rim-like enhancement with central low attenuation was clearly observed in thirteen patients. For the GCP accompanied by adenocarcinoma, the enhancement peak was present in AP and the gradual expansion of enhancement area was in VP. All patients underwent surgical or endoscopic resection. Sixteen cases had remission of symptoms and no recurrence. Conclusions The careful analysis of CT features and clinical characteristics can provide support for deepening the understanding of the GCP. However, a more accurate diagnosis depends on histopathological features.
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Díaz JC, Cardona-Núñez U, Sanz AM, Cortés A, Zuluaga M. Quiste de duplicación gástrico en paciente adulto: Reporte de caso y revisión de la literatura. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. Los quistes gástricos de duplicación son malformaciones congénitas muy infrecuentes del tracto gastrointestinal. Se definen como una lesión quística tapizada por epitelio gastrointestinal que comparte una capa de músculo liso con la pared gástrica. Se han propuesto diferentes teorías sobre su patogénesis, sin embargo, los eventos embriológicos que conducen a la malformación no han logrado ser dilucidados. Debido a su localización y presentación clínica, el diagnóstico se realiza con mayor frecuencia durante los primeros años de vida y existen pocos casos reportados en adultos, en quienes el hallazgo suele ser incidental.
Caso clínico. Se presenta el caso de una mujer de 65 años quien consultó por dolor abdominal crónico y síntomas digestivos inespecíficos. Por medio de Tomografía Axial Computarizada se evidenció una lesión quística en contacto con el páncreas y la pared gástrica. Se realizó exploración quirúrgica que, junto con los hallazgos histopatológicos, confirmó el diagnosticó de quiste de duplicación gástrico.
Discusión. Los quistes de duplicación gástrica son anomalías excepcionales que se localizan más frecuentemente en la curvatura mayor. Su tratamiento es quirúrgico y la confirmación del diagnóstico se realiza mediante la histología.
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