1
|
Takano Y, Azami T, Niiya F, Nagahama M. Numerous Pancreatic Cysts Associated with von Hippel-Lindau Disease. Intern Med 2022; 61:2079-2080. [PMID: 34866105 PMCID: PMC9334239 DOI: 10.2169/internalmedicine.8644-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Yuichi Takano
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Japan
| | - Tetsushi Azami
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Japan
| | - Fumitaka Niiya
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Japan
| | - Masatsugu Nagahama
- Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Japan
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Ciprani D, Weniger M, Qadan M, Hank T, Horick NK, Harrison JM, Marchegiani G, Andrianello S, Pandharipande PV, Ferrone CR, Lillemoe KD, Warshaw AL, Bassi C, Salvia R, Fernández-Del Castillo C. Risk of malignancy in small pancreatic cysts decreases over time. Pancreatology 2020; 20:1213-1217. [PMID: 32819844 PMCID: PMC8168401 DOI: 10.1016/j.pan.2020.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Received: 07/07/2020] [Accepted: 08/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pancreatic cysts <15 mm without worrisome features have practically no risk of malignancy at the time of diagnosis but this can change over time. Optimal duration of follow-up is a matter of debate. We evaluated predictors of malignancy and attempted to identify a time to safely discontinue surveillance. METHODS Bi-centric study utilizing prospectively collected databases of patients with pancreatic cysts measuring <15 mm and without worrisome features who underwent surveillance at the Massachusetts General Hospital (1988-2017) and at the University of Verona Hospital Trust (2000-2016). The risk of malignant transformation was assessed using the Kaplan-Meier method and parametric survival models, and predictors of malignancy were evaluated using Cox regression. RESULTS 806 patients were identified. Median follow-up was 58 months (6-347). Over time, 58 (7.2%) cysts were resected and of those, 11 had high grade dysplasia (HGD) or invasive cancer. Three additional patients had unresectable cancer for a total rate of malignancy of 1.7%. Predictors of development of malignancy included an increase in size ≥2.5 mm/year (HR = 29.54, 95% CI: 9.39-92.91, P < 0.001) and the development of worrisome features (HR = 9.17, 95% CI: 2.99-28.10, P = 0.001). Comparison of parametric survival models suggested that the risk of malignancy decreased after three years of surveillance and was lower than 0.2% after five years. CONCLUSIONS Pancreatic cysts <15 mm at the time of diagnosis have a very low risk of malignant transformation. Our findings indicate the risk decreases over time. Size increase of ≥2.5 mm/year is the strongest predictor of malignancy.
Collapse
Affiliation(s)
- D Ciprani
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - M Weniger
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - M Qadan
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - T Hank
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - N K Horick
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - J M Harrison
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - G Marchegiani
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - S Andrianello
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - P V Pandharipande
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - C R Ferrone
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - K D Lillemoe
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - A L Warshaw
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - C Bassi
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - R Salvia
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - C Fernández-Del Castillo
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
4
|
Shioyama E, Mitoro A, Ogawa H, Kubo T, Ozutsumi T, Kitagawa K, Yoshikawa M, Ueda S, Akahori T, Marugami NA, Hatakeyama K, Yamao J, Sho M, Ohbayashi C, Yoshiji H. A pancreatic mucinous cystic neoplasm undergoing intriguing morphological changes over time and associated with recurrent pancreatitis: A case report. Medicine (Baltimore) 2019; 98:e16435. [PMID: 31305468 PMCID: PMC6641744 DOI: 10.1097/md.0000000000016435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/01/2023] Open
Abstract
RATIONALE Mucinous cystic neoplasms (MCNs) are pancreatic mucin-producing cystic lesions with a distinctive ovarian-type stroma. The diagnosis is generally easy in typical cases; however, differential diagnosis is difficult in others such as in the case we report herein. PATIENT CONCERNS A 27-year-old woman with sudden onset of epigastric pain was referred to our hospital for suspected acute pancreatitis. Contrast-enhanced computed tomography revealed a 25-mm cystic lesion in the pancreas and a low density area with delayed enhancement at the right upper side of the cystic lesion. DIAGNOSES During its clinical course, the cystic lesion underwent various morphological changes. Eventually, it presented typical findings of MCNs, and could be accurately diagnosed. INTERVENTIONS Laparoscopic distal pancreatectomy was performed on the patient by preserving the spleen. OUTCOMES The patient revealed no symptoms till 1 year after the operation. LESSONS This case of MCN with intriguing short-term morphological changes was associated with recurrent pancreatitis. A combination of imaging modalities is essential for accurate diagnosis of MCNs, and follow-up with serial imaging might be useful for certain unusual lesions.
Collapse
Affiliation(s)
- Erika Shioyama
- Internal Medicine, Kokuho Central Hospital, Miyako, Tawaramoto-cho, Shiki-gun
| | | | - Hiroyuki Ogawa
- Internal Medicine, Kokuho Central Hospital, Miyako, Tawaramoto-cho, Shiki-gun
| | - Takuya Kubo
- Internal Medicine, Kokuho Central Hospital, Miyako, Tawaramoto-cho, Shiki-gun
| | - Takahiro Ozutsumi
- Internal Medicine, Kokuho Central Hospital, Miyako, Tawaramoto-cho, Shiki-gun
| | - Koh Kitagawa
- Internal Medicine, Kokuho Central Hospital, Miyako, Tawaramoto-cho, Shiki-gun
| | - Masaaki Yoshikawa
- Internal Medicine, Kokuho Central Hospital, Miyako, Tawaramoto-cho, Shiki-gun
| | - Shigehiko Ueda
- Internal Medicine, Kokuho Central Hospital, Miyako, Tawaramoto-cho, Shiki-gun
| | | | | | - Kinta Hatakeyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | | | | | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | | |
Collapse
|
5
|
Chadwick PW, Spitz FR, Kwa DM, Johnson WC, Heymann WR. Bullous pemphigoid associated with a lymphoepithelial cyst of the pancreas. Cutis 2016; 98:264-268. [PMID: 27874879] [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: 06/06/2023]
Abstract
Bullous pemphigoid (BP) is an acquired, autoimmune, subepidermal blistering disorder. A possible paraneoplastic association has been suggested; however, debate remains regarding the precise relationship of these neoplasms with BP. We present a case of recalcitrant BP in a 67-year-old man with a pancreatic neoplasm that was found to be a lymphoepithelial cyst. Immunoperoxidase staining of the cyst demonstrated C3d along the basement membrane of the stratified squamous epithelium, suggesting that the BP may have involved the lymphoepithelial cyst itself. Shortly after excision of the cyst, BP rapidly resolved without any immunosuppressive treatment, raising the possibility that the immunologic process involving the lymphoepithelial cyst of the pancreas was the inciting factor for the patient's cutaneous disease. Although rare, some cases of BP may be a paraneoplastic process. A thorough screening via patient history and directed laboratory studies may be warranted in recalcitrant cases.
Collapse
Affiliation(s)
- Preston W Chadwick
- Division of Dermatology, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Francis R Spitz
- Department of Surgery, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Daniel M Kwa
- Department of Pathology, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Waine C Johnson
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Warren R Heymann
- Division of Dermatology, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| |
Collapse
|
6
|
Abstract
Pancreatic lymphoepithelial cysts (LECs) are rare, benign lesions that are typically unexpected post-operative pathological findings. We aimed to review clinical, radiological and pathological features of LECs that may allow their pre-operative diagnosis. Histopathology databases of two large pancreatic units were searched to identify LECs and notes reviewed to determine patient demographic details, mode of presentation, investigations, treatment and outcome. Five male and one female patients were identified. Their median age was 60 years. Lesions were identified on computed tomography performed for abdominal pain in two patients, and were incidentally observed in four patients. Five LECs were located in the tail and one in the body of the pancreas, with a median cyst size of 5 cm. Obtaining cyst fluid was difficult and a largely acellular aspirate was yielded. The pre-operative diagnosis was mucinous cystic neoplasm in all patients. This series of patients were treated distal pancreatectomy and splenectomy. A retrospective review of radiological examinations suggested that LECs have a relatively low signal on T2 imaging and a high signal intensity on T1 weighted images. LECs appear more common in elderly males, and are typically incidental, large, unilocular cysts. Close attention to signal intensity on MRI may allow pre-operative diagnosis of these lesions.
Collapse
Affiliation(s)
- Julie Martin
- Departments of Pancreatic Surgery, St James's University Hospital, Leeds, UK.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Lee CL, binti Che Daud CZ, binti Ismail R. Intrapancreatic gastric duplication cyst-a rare cause of chronic abdominal pain in childhood. J Clin Ultrasound 2014; 42:42-44. [PMID: 23303464 DOI: 10.1002/jcu.22029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 11/30/2012] [Indexed: 06/01/2023]
Abstract
We report a rare case of a gastric duplication cyst in the tail of the pancreas in a child presenting with chronic abdominal pain which was cured by excision of the cyst and adjacent pancreas. This case report highlights the role of sonography as an excellent imaging tool for depiction of the bowel wall and, hence, in aiding diagnosis even when clinical picture and findings of other modalities are nonspecific.
Collapse
Affiliation(s)
- Chiew Leng Lee
- Sabah Women and Children Hospital, Kota Kinabalu, Sabah, Malaysia
| | | | | |
Collapse
|
8
|
Urata T, Naito Y, Izumi Y, Takekuma Y, Yokomizo H, Nagamine M, Fukuda S, Notohara K, Hifumi M. Localized type 1 autoimmune pancreatitis superimposed upon preexisting intraductal papillary mucinous neoplasms. World J Gastroenterol 2013; 19:9127-9132. [PMID: 24379640 PMCID: PMC3870568 DOI: 10.3748/wjg.v19.i47.9127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/20/2013] [Accepted: 11/05/2013] [Indexed: 02/06/2023] Open
Abstract
A 70-year-old woman was found to have 2 cystic lesions in the head of the pancreas on abdominal ultrasonography during a routine medical examination. Endoscopic ultrasonography (EUS) and magnetic resonance cholangiopancreatography showed multilocular cysts in the head of the pancreas without dilation of the main pancreatic duct. The patient was followed-up semiannually with imaging studies for suspected branch duct-type intraductal papillary mucinous neoplasm (IPMN). At 3 years after initial presentation, hypoechoic lesions were observed around each pancreatic cyst by EUS. Diffusion-weighted imaging showed high-intensity regions corresponding to these lesions. Therefore, a diagnosis of invasive carcinoma derived from IPMN could not be excluded, and subtotal stomach-preserving pancreaticoduodenectomy was performed. The macroscopic examination of the surgical specimen showed whitish solid masses in the head of the pancreas, with multilocular cysts within each mass. Microscopically, each solid mass consisted of inflammatory cells such as lymphocytes and plasma cells. Furthermore, immunochemical staining revealed immunoglobulin G4-positive cells, and many obliterating phlebitides were observed. The cysts consisted of mucus-producing epithelial cells and showed a papillary growth pattern. Based on these findings, we diagnosed multiple localized type 1 autoimmune pancreatitis occurring only in the vicinity of the branch duct-type IPMN.
Collapse
MESH Headings
- Aged
- Autoimmune Diseases/complications
- Autoimmune Diseases/diagnosis
- Autoimmune Diseases/surgery
- Biopsy
- Carcinoma, Pancreatic Ductal/complications
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/surgery
- Cholangiopancreatography, Magnetic Resonance
- Diffusion Magnetic Resonance Imaging
- Endosonography
- Female
- Humans
- Immunohistochemistry
- Neoplasms, Cystic, Mucinous, and Serous/complications
- Neoplasms, Cystic, Mucinous, and Serous/diagnosis
- Neoplasms, Cystic, Mucinous, and Serous/surgery
- Pancreatic Cyst/complications
- Pancreatic Cyst/diagnosis
- Pancreatic Cyst/surgery
- Pancreatic Neoplasms/complications
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/surgery
- Pancreaticoduodenectomy
- Pancreatitis/complications
- Pancreatitis/diagnosis
- Pancreatitis/surgery
- Treatment Outcome
Collapse
|
9
|
Abidov ÉAO. [Application of radiosurgical methods in the treatment of patients with pancreatic cysts complicated by intraabdominal hemorrhage]. Klin Khir 2013:31-33. [PMID: 24501985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In 2009 - 2013 yrs roentgensurgical interventions (RSI) were performed for pancreatic cysts, complicated by intraabdominal hemorrhage, in 26 patients to achieve the hemostasis objective. The hemorrhage recurrence in various terms after endovascular hemostasis have occurred in 6 (23.1%) patients, what have had demanded the intracavity operation performance (in 2) as well as a repeated RSI (in 4). Poor result after application of RSI was noted in 11.5% of observations.
Collapse
|
10
|
Anand N, Sampath K, Wu BU. Cyst features and risk of malignancy in intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Clin Gastroenterol Hepatol 2013; 11:913-21; quiz e59-60. [PMID: 23416279 DOI: 10.1016/j.cgh.2013.02.010] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [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: 11/15/2012] [Revised: 01/17/2013] [Accepted: 02/01/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS International guidelines for the management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas recommend surgical resection of those with specific characteristics. We performed a meta-analysis to evaluate the risk of malignancy associated with each of these features of IPMNs. METHODS We performed a comprehensive search of MEDLINE from January 1, 1996, to November 11, 2011, for studies that included any of the features mentioned in the consensus guidelines for surgical resection of main duct and branch duct IPMNs. Data were analyzed from 41 studies for the following features: cyst size greater than 3 cm, the presence of mural nodules, dilated main pancreatic duct, symptoms, and main duct vs branch duct IPMNs. Malignant IPMNs were defined as those with carcinoma in situ or more advanced histology. A separate meta-analysis was performed for each risk factor to calculate pooled odds ratios (ORs). A random-effects model was used, based on the assumption of variation among study populations. RESULTS The risks of malignancy associated with individual cyst features were as follows: cyst size greater than 3 cm (OR, 62.4; 95% confidence interval [CI], 30.8-126.3), presence of a mural nodule (OR, 9.3; 95% CI, 5.3-16.1), dilatation of the main pancreatic duct (OR, 7.27; 95% CI, 3.0-17.4), and main vs branch duct IPMN (OR, 4.7; 95% CI, 3.3-6.9). There was a moderate level of heterogeneity among studies (I(2) range, 34-67). CONCLUSIONS Based on a meta-analysis, cyst features proposed by the international guidelines for resection of IPMN were highly associated with malignancy. However, based on our findings, not all cyst features should be weighted equally when considering risk of malignancy; cyst size greater than 3 cm was associated most strongly with malignant IPMN.
Collapse
Affiliation(s)
- Neeraj Anand
- Center for Pancreatic Care, Southern California Permanente Medical Group, Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | | | | |
Collapse
|
11
|
Vasile TA, Socaciu M, Stan Iuga R, Seicean A, Iancu C, al Hajjar N, Zaharie T, Badea R. Added value of intravenous contrast-enhanced ultrasound for characterization of cystic pancreatic masses: a prospective study on 37 patients. Med Ultrason 2012; 14:108-114. [PMID: 22675710] [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: 06/01/2023]
Abstract
UNLABELLED The aim of this study was to evaluate the added value of contrast-enhanced ultrasound (CEUS) in the pancreatic cystic mass (PCM) diagnosis by using a qualitative and quantitative analysis in order to make a relevant characterization. PATIENTS AND METHOD Between December 2008 and November 2011, 37 patients with PCM discovered at ultrasound examination were prospectively followed. A qualitative and quantitative CEUS analysis was performed in order to differentiate etiologies of the PCM. In the quantitative analysis several parameters were followed: Peak Intensity (PI), Time to Peak (TTP), maximum ascending gradient (GRAD), Time to maximum gradient (TTG) and Area Under the Curve (AUC). Normalized ratios were also calculated. In all patients a definite cytological or histological diagnosis was obtained. RESULTS Thirty-seven patients were studied: 12 with pancreatitis-associated pseudocyst and 25 with cystic tumors (10 serous cystic adenoma, 5 mucinous cystic adenoma, 6 cystadenocarcinomas, 2 solid pseudopapillary tumors and 2 intraductal papillary mucinous neoplasms). There was a significant difference of the nAUC and nTTP between pseudocyst and cystic tumors, p=0.03 and p=0.01, respectively. A normalized TTP value above 7 sec was suggestive for the diagnosis of pseudocysts with 79.16 % accuracy. There was a significant difference of nTTP and nTTG between the benign and malignant lesions. nTTP < 9 sec and nTTG < 8.5 sec rules out malignant cysts in almost 90% of cases. CONCLUSION The CEUS is useful in the diagnosis of PCM. The quantitative analysis of the enhancement of the cystic wall may discriminate the different types of the PCM.
Collapse
Affiliation(s)
- Tudor Andrei Vasile
- Radiology Department, Regional Institute of Hepatology and Gastroenterology Octavian Fodor, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Nychytaĭlo MI, Skums AV, Lytvyn OI, Ostapyshen OM, Kostiuk MP, Sira HD. [Pancreatic head cyst complicated by aortic pseudoaneurism]. Klin Khir 2011:67-69. [PMID: 22295558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
13
|
Coelho DE, Ardengh JC, Lima-Filho ERD, Coelho JF. Different clinical aspects of Wirsungocele: case series of three patients and review of literature. Acta Gastroenterol Latinoam 2011; 41:230-233. [PMID: 22233001] [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
The association of Santorinicele with pancreas divisum has been described. This anatomic condition creates ideal conditions for acute pancreatitis episodes and chronic abdominal pain. Saccular dilation of main pancreatic duct has also been described as incidental finding and causing episodes of acute pancreatitis. However, there is no description of associated chronic abdominal pain. Three detailed cases of Wirsungocele demonstrated by endoscopic retrograde cholangiopancretography are presented. Two of them had episodes of acute pancreatitis and one had chronic abdominal pain. All patients were treated by endoscopic biliopancreatic sphincterotomy. After a follow-up for more than two years, none presents clinical recurrence. Endoscopic biliopancreatic sphincterotomy for symptomatic patients with this anatomic condition seems safe and effective.
Collapse
|
14
|
Gómez Mateo MDC, Muñoz Forner E, Sabater Ortí L, Ferrández Izquierdo A. Foregut cystic malformations in the pancreas. Are definitions clearly established? JOP 2011; 12:420-424. [PMID: 21737908] [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
CONTEXT Foregut cystic malformations are common lesions in the mediastinum but are rarely found in subdiaphragmatic locations. Only a few cases have been described within the pancreas where they can easily be misdiagnosed as cystic neoplasms. CASE REPORT We herein present the case of a 37-year-old female with acute cholangitis in whom a diagnostic work-up revealed a 1 cm solid-cystic heterogeneous lesion located at the head of the pancreas. The patient underwent a pancreaticoduodenectomy. Pathological evaluation demonstrated a cystic cavity lined by pseudostratified tall columnar ciliated epithelium with goblet cells, but lacking cartilage or smooth muscle bundles. Thus, the final diagnosis of the lesion was a ciliated foregut cyst of the pancreas. CONCLUSIONS A review of the cases published regarding these lesions shows great variability in the taxonomy and a lack of accuracy in the definitions of each different subtype. An easy to use algorithm for the diagnosis of foregut cystic malformations subtypes, based on epithelial lining and wall features, is presented.
Collapse
|
15
|
Sakorafas GH, Mahairas A, Smyrniotis V. Potential pitfalls in the management of primary pancreatic cystic neoplasms. Onkologie 2011; 34:332-336. [PMID: 21625189 DOI: 10.1159/000328791] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Primary pancreatic cystic neoplasms (PCN) have been increasingly recognized over the last 2 decades, mainly as a result of the widespread use of modern imaging techniques in patients with abdominal complaints. Biological behavior and management greatly differ between subgroups of PCN. Accurate preoperative diagnosis is required to select the optimal management strategy for each individual patient with PCN. An in-depth knowledge of the biological, imaging, macroscopic/microscopic features, and laboratory findings of each subtype of PCN is required on the part of the clinician, in order to select a cost-effective diagnostic evaluation of the patient. Clinical judgment is also required on the part of the surgeon to select the optimal procedure and to avoid severe pitfalls in the surgical management of these neoplasms.
Collapse
Affiliation(s)
- George H Sakorafas
- 4th Department of Surgery, Athens University Medical School, ATTIKON University Hospital, Athens, Greece.
| | | | | |
Collapse
|
16
|
Propp AR, Poluéktov VL, Lobanov VG, Arestovich RA, Prankevich NN, Astankov RA, Kuz'menko VV. [Methods of intraductal pancreatic hypertension elimination]. Khirurgiia (Mosk) 2011:32-37. [PMID: 21716216] [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: 05/31/2023]
Abstract
The study is devoted to the surgical treatment of benign pancreatic cysts. Results of the internal drainage of pancreatic duct ul system in 76 patients were analyzed. Pancreaticoenterostomy combined with partial pancreatic resection in 21 cases, was performed in 53 patients. The rest 23 patients required no enterostomy of the main pancreatic duct. The lateral pancreaticojejunostomy was performed in 48 patients, of whom 32 patients had an original reconstructive circulation of the intestinal loop applied. By the width of the pancreatic duct less then 5 mm, the original method of resection of the front surface of the pancreas was applied (n=5). The bilateral pancreaticojejunostomy was performed in 3 patients with the pancreatic duct width less then 5 mm and diastasis of the latter. There was no postoperative lethality; complicated postoperative period required reoperation in 5,3%. Long-term results were considered good in 74,6%, satisfactory in 16,4% and unsatisfactory in 9% of patients.
Collapse
|
17
|
Ruiz-Tovar J, López-Hervas P. Right hepatectomy extended to segment I and pancreatoduodenectomy in the same surgical act for pancreatic neuroendocrine tumor with liver metastases. Am Surg 2010; 76:1439-1440. [PMID: 21265370] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
18
|
Blom H, Bochner A, Vervloessem D, Desimpelaere J, Devière J, Veereman-Wauters G. A two-year old boy with recurrent bouts of acute abdominal pain. Acta Gastroenterol Belg 2010; 73:517-520. [PMID: 21299165] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In a small number of patients with pancreas divisum (with stenotic minor papilla) a relative obstruction to pancreatic exocrine secretory flow results in pancreatitis. We report a 2-year-old boy presenting with recurrent bouts of abdominal pain. The diagnosis of acute pancreatitis was made based on blood biochemistry results. Ultrasound, computed tomography and magnetic resonance imaging showed several abdominal pseudocysts, peritoneal exsudate and confirmed pancreatitis but initially failed to reveal the aetiology. Ascites and cysts contained pancreatic enzymes. After weeks of combined conservative and surgical treatment, a magnetic resonance cholangiopancreaticography with secretin, showed a pancreas divisum with a cyst between the ducts of Santorini and Wirsung. Based on these findings, two endoscopic papillotomies (minor and major papilla) were performed. Three years follow-up was uneventful. In a child with recurrent pancreatitis or pancreatitis with chronic recurrent abdominal pain it is crucial to search aggressively for congenital abnormalities, including pancreas divisum. Secretin-enhanced magnetic resonance cholangiopancreaticography or diffusion-weighted magnetic resonance imaging is a valuable diagnostic tool for visualizing pancreatic duct anatomy.
Collapse
Affiliation(s)
- H Blom
- Department of Paediatrics, Queen Paola Children's Hospital-ZNA, Antwerp, Belgium.
| | | | | | | | | | | |
Collapse
|
19
|
Javed A, Pal S, Chaubal GN, Dash NR, Garg PK, Sahni P, Chattopadhyay TK. Unusual cystic lesion of the pancreas. JOP 2010; 11:401-402. [PMID: 20601820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Amit Javed
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India.
| | | | | | | | | | | | | |
Collapse
|
20
|
Mlika M, Farah F, Jarboui S, Abdessalem M, Zaouche A, Jilani SB, Zermani R. A benign cystic mass of the pancreas mimicking a malignant lesion. Pathologica 2009; 101:261-262. [PMID: 20387716] [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: 05/29/2023] Open
Abstract
Herein, we highlight the diagnostic challenges of cystic pancreatic tumours, and report a case of chronic pancreatitis caused by a cystic tumour, which consisted in a canal dilatation--and not a pseudocyst. The case thus demonstrates a rare association between a cystic form of chronic pancreatitis and adrenal adenoma. We report the case of a 46-year-old patient with no particular past medical history who presented with long lasting symptoms consisting in an abdominal pain and deterioration in general health. Imaging findings (ultrasound, CT-scan, MRI) showed a 3-cm cystic lesion of the tail of the pancreas associated with a 3-cm adrenal mass. Because of the suspicion of a malignant disease, surgical treatment was performed. Pathological findings consisted in fibrotic chronic pancreatitis with canal dilatation and an adrenal adenoma. Pancreatic cystic lesions are rare tumours. Despite of the multiplicity of imaging techniques, differential techniques lack sensitivity and specificity. Final diagnosis must be based on pathological features.
Collapse
Affiliation(s)
- M Mlika
- Department of Pathology, Charles Nicolle Hospital, Bab Saadoun, Tunisia.
| | | | | | | | | | | | | |
Collapse
|
21
|
Sakagami J, Kataoka K, Suzuki N, Shinoda M, Sogame Y, Yasuda H, Yoshikawa T. [Antecedent medical imaging for the early detection of pancreas cancer]. Nihon Shokakibyo Gakkai Zasshi 2009; 106:1156-1162. [PMID: 19654462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Junichi Sakagami
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Japan.
| | | | | | | | | | | | | |
Collapse
|
22
|
Lee KH, Lee JS, Kim BJ, Lee JK, Kim SH, Kim SH, Lee KT. Pancreatic involvement in Korean patients with von Hippel-Lindau disease. J Gastroenterol 2009; 44:447-52. [PMID: 19333546 DOI: 10.1007/s00535-009-0021-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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] [Received: 11/04/2008] [Accepted: 11/29/2008] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to describe pancreatic involvement in von Hippel-Lindau (VHL) disease and to document the changes that occur in pancreatic lesions. METHODS We retrospectively analyzed the medical records and CT scans of 18 VHL patients who were diagnosed between 1994 and 2007 at the Samsung Medical Center. The clinical history with a detailed family history, biochemical test results, and imaging studies of the pancreas, adrenal glands, and kidneys were reviewed. Genetic analysis was performed in 12 patients. The changes in pancreatic lesions, such as an increase in cystic lesions, calcifications, and dilatation of the pancreatic duct, were analyzed in patients who had CT scans at least 1 year apart. RESULTS Pancreatic lesions existed in 89% (16/18) of the patients. All 16 patients had multiple cystic lesions. Two patients had co-existing neuroendocrine tumors (NET), and two patients had co-existing serous cystadenomas (SCA). At least one of three features of pancreatic lesions (cystic lesions, calcifications, and dilatation of the pancreatic duct) progressed in all nine patients who had CT scans 1 year apart. CONCLUSION Pancreatic involvement in VHL disease was relatively common in Korean patients. The most common type of pancreatic involvement was a multiple cystic lesion. NET and SCA existed in approximately 10% of VHL patients with pancreatic involvement. Pancreatic lesions in VHL disease progressed, at least according to radiological images.
Collapse
Affiliation(s)
- Kwang Hyuck Lee
- Department of Internal Medicine, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Gangnam-gu, Seoul, Korea
| | | | | | | | | | | | | |
Collapse
|
23
|
Hemandas AK, Jain G, Fong F, Stedman B, Jaynes E, Abu Hilal M. Feasibility of laparoscopic distal spleno-pancreatectomy following previous necrosectomy. A case report. JOP 2008; 9:644-648. [PMID: 18762697] [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: 05/26/2023]
Abstract
CONTEXT In recent years, laparoscopic approach to distal pancreatectomy has been increasingly favoured following several reports showing reductions in morbidity and hospital stay compared with open surgery. Previous major abdominal surgery is a relative contraindication for most laparoscopic procedures including distal pancreatectomy. CASE REPORT We present a case of a young woman in whom we attempted and accomplished safely, a laparoscopic distal pancreatectomy despite having had major pancreatic necrosectomy and discuss the feasibility of this approach. CONCLUSION It is possible to perform complex laparoscopic pancreatic resections safely in centres with special interest and expertise.
Collapse
Affiliation(s)
- Anil K Hemandas
- Hepatobiliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospital, Southampton, United Kingdom
| | | | | | | | | | | |
Collapse
|
24
|
Amiot A, Dokmak S, Sauvanet A, Vilgrain V, Bringuier PP, Scoazec JY, Sastre X, Ruszniewski P, Bedossa P, Couvelard A. Sporadic desmoid tumor. An exceptional cause of cystic pancreatic lesion. JOP 2008; 9:339-345. [PMID: 18469451] [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: 05/26/2023]
Abstract
CONTEXT Desmoid tumors are rare, benign soft tissue tumors, characterized by the proliferation of fibroblasts in an abundant collagen extra-cellular matrix. Intra-abdominal forms involve the mesentery and retroperitoneum and usually occur associated with familial adenomatous polyposis or Gardner's syndrome. Sporadic cases are more uncommon. Although desmoid tumors do not metastasize, their evolution can be life-threatening due to aggressive local invasion, such as mesentery involvement. CASE REPORT We herein report a very rare location of sporadic desmoid tumors involving the pancreatic tail, presenting as a cystic lesion. A 51-year-old woman presented with recurrent abdominal pain and weight loss. The diagnosis of mucinous cystadenocarcinoma was suspected preoperatively and the patient underwent a splenopancreatectomy with en-bloc resection of the left colonic flexure, duodenojejunal junction and part of the posterior gastric wall. Pathological analysis revealed fibroblastic proliferation arising in musculoaponeurotic structures consistent with a desmoid tumor. The diagnosis was confirmed by immunocytochemical analysis and the assessment of the beta-catenin gene mutation. Perioperative examination reported gastric and small-bowel invasion. No treatment was given postoperatively to prevent desmoid tumor recurrence. After a 1-year follow-up, no recurrence was observed. CONCLUSION Desmoid tumors are very rare in the pancreas and their diagnosis can be difficult, such as in our case where it presented as a cystic lesion. In contrast to intra-abdominal forms, sporadic pancreatic desmoid tumors are more frequent than those associated with familial adenomatous polyposis.
Collapse
Affiliation(s)
- Aurélien Amiot
- Pole of Digestive Diseases (PMAD), Gastroenterology and Nutrition Support, Beaujon Hospital, AP-HP, University of Paris 7 Denis Diderot, Paris, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Gupta R, Chettri D, Sharma A, Duseja A, Dhiman RK, Chawla YK, Kalra N, Gupta A, Behera A. Pancreatic cysts causing biliary obstruction in von Hippel Lindau syndrome. JOP 2008; 9:313-316. [PMID: 18469445] [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: 05/26/2023]
Abstract
CONTEXT Extrahepatic biliary obstruction secondary to pancreatic cysts is rare in patients with von Hippel Lindau syndrome. We describe a patient with von Hippel Lindau syndrome who had biliary obstruction due to pancreatic cysts who was initially managed endoscopically and then surgically. CASE REPORT A female patient with von Hippel Lindau syndrome which had been diagnosed ten years earlier based on the presence of pancreatic and renal cysts with retinal hemangiomas, presented with cholestatic jaundice of two months duration. On investigation, she was found to have lower end biliary obstruction caused by pancreatic cysts. The patient was initially managed with endoscopic retrograde cholangiography and a 7 French/10F/12F biliary plastic stent placement. Her cholestatic symptoms improved but required frequent stent exchange due to stent block; she finally underwent a hepaticojejunostomy and is doing well on follow-up. CONCLUSION This case highlights the fact that pancreatic involvement leading to biliary obstruction, although uncommon, can occur in patients with von Hippel Lindau syndrome. Endoscopic biliary stent placement and surgery are helpful in these patients.
Collapse
Affiliation(s)
- Rahul Gupta
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Ziginova TM, Fetiukov AI, Zotov PS, Kovchur OI. [Multiple complications of acute destructive pancreatitis]. Vestn Khir Im I I Grek 2008; 167:123-124. [PMID: 19241834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
|
27
|
Matsutani T, Sasajima K, Miyamoto M, Yokoyama T, Hiroi M, Maruyama H, Suzuki S, Tajiri T. Pancreatic cyst associated with pancreas divisum treated by laparoscopy-assisted cystgastrostomy in the intragastric approach: a case report and a review of the literature. J Laparoendosc Adv Surg Tech A 2007; 17:317-20. [PMID: 17570778 DOI: 10.1089/lap.2006.0091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/13/2022] Open
Abstract
A 39-year-old Japanese man was admitted to our hospital after experiencing recurrent episodes of pancreatitis over the previous 2 years. On the first episode, he had been admitted to our hospital with elevated serum amylase levels and epigastralgia. Abdominal computed tomography (CT) revealed a diffuse, uncircumscribed area with heterogeneous density in the pancreas. No previous history of pancreatitis, gallstones, drinking, or abdominal injury was elicited. Magnetic resonance cholangiopancreatography (MRCP) demonstrated that the Wirsung duct was unconnected to the Santorini's duct. Endoscopic retrograde cholangiopancreatography through the papilla of Vater and accessory papilla revealed an enlarged ventral pancreatic duct, pancreas divisum, and a cystic lesion in the pancreatic body. On the second and third episodes, endoscopic drainage of the pancreatic pseudocysts through the accessory papilla and ultrasonography-guided transmural drainage were unsuccessful. A follow-up CT and MRCP demonstrated that the pancreatic cyst had enlarged to 9 x 8 cm in diameter. A laparoscopy-assisted cystgastrostomy was performed with an intragastric approach. An anastomosis was performed using an endoscopic linear stapler through the small cystotomy and gastrotomy openings on the posterior wall of the stomach. The postoperative clinical course was uneventful. Over 6 months later, the patient remains well and with a good quality of life. A laparoscopy-assisted cystgastrostomy, using an intragastric surgical technique, offers a safe, less-invasive procedure for cyst drainage by the pancreas divisum.
Collapse
Affiliation(s)
- Takeshi Matsutani
- Department of Surgery, Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Castillo O, Kerkebe M, Vitagliano G, Arellano L. [Single-stage laparoscopic adrenalectomy and pancreatic cyst exsicion in a patient with von Hippel-Lindau disease]. Actas Urol Esp 2007; 31:292-4. [PMID: 17658161 DOI: 10.1016/s0210-4806(07)73638-0] [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] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Von Hippel-Lindau disease is a dominant autosomic hereditary condition, characterized by cerebellar hemangioblastomas, retinal animas and visceral cysts and tumors. We report a case of a patient with Von Hippel-Lindau in which we performed a single-stage laparoscopic adrenalectomy for a pheochromocytoma and pancreatic cyst excision. PATIENT AND METHOD A 20 year old male patient with Von Hippel Lindau disease underwent laparoscopic adrenalectomy for a 5 cm left adrenal mass. A 3 cm cystic lesion was found of the tail of the pancreas and was resected completely laparoscopically during the same operative procedure. RESULTS Total operative time was 120 minutes. There were no operative or postoperative complications. Blood loss was < 50 mL and hospital stay was 3 days. The histopathologic result was adrenal pheochromocytoma and pancreatic mucous microcystic cystoadenoma. CONCLUSION Laparoscopy allows surgical approach of patients with simultaneous lesions in several abdominal solid viscera, like Von Hippel Lindau disease. This case represents the first report of one-stage laparoscopic adrenalectomy and pancreatic cyst excision.
Collapse
Affiliation(s)
- O Castillo
- Unidad de Endourología y Laparoscopia Urológica Clínica Santa María, Universidad de Chile.
| | | | | | | |
Collapse
|
29
|
Berindoague R, Pernas JC, Targarona E. [Pancreatic mucinous cystadenocarcinoma]. Cir Esp 2007; 81:354. [PMID: 17553411 DOI: 10.1016/s0009-739x(07)71338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- René Berindoague
- Servicio de Cirugía General y del Aparato Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | |
Collapse
|
30
|
Ivicic J, Hermanová M, Vomela J. [Benign lymphoepithelial cyst of the pancreas: a case report]. Rozhl Chir 2007; 86:300-2. [PMID: 17695038] [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: 05/16/2023]
Abstract
Lymphoepithelial cyst of the pancreas represents an extremely rare and benign entity of undetermined pathogenesis. This lesion must be taken into consideration in the differential diagnosis of pancreatic cystic lesions. A case of resected lymphoepithelial cyst of pancreas in 59-year-old man with an attack of acute pancreatitis in anamnesis is reported. The postoperative period was uneventful, and the histolopathological examination revealed the structures of lymphoepithelial cyst. The aim of this report is to describe the clinical and pathological features of this unusual true cyst of the pancreas.
Collapse
Affiliation(s)
- J Ivicic
- Chirurgická klinika, Fakultní nemocnice Brno.
| | | | | |
Collapse
|
31
|
Affiliation(s)
- Rick R van Rijn
- Department of Radiology, Academic Medical Center/Emma Children's Hospital, Amsterdam, the Netherlands.
| | | | | | | | | |
Collapse
|
32
|
Aderounmu AOA, Oguntola AS, Lawal OO, Eziyi AK, Bello TO, Osinaike BB, Agodirin SO. Mirizzi syndrome caused by a bile pseudocyst. West Afr J Med 2007; 26:148-151. [PMID: 17939319] [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: 05/25/2023]
Abstract
BACKGROUND Mirizzi syndrome caused by bile pseudo cyst presents diagnostic and management challenges to the surgeon. OBJECTIVE To emphasize to clinicians the need to always recognize and correct associated liver derangements before surgery so as to prevent the usual accompanying high morbidity/mortality associated with Mirizzi syndrome. CASE REPORT We report an unusual and previously unreported pathology of post-cholecystectomy Mirizzi syndrome in a 35 year old female who developed a bile pseudo-cyst and which may possibly qualify for Mirizzi syndrome type 5--highlighting the need for maximum pre, -intra, and post-operative challenges for improved prognosis. The patient was lost from reactionary haemorrhage due to limited facilities. CONCLUSION There is a crying need in developing countries to have Critical Care centers and for Clinicians to recognize the necessity for adequate pre, intra and post-operative care of these high risk patients.
Collapse
Affiliation(s)
- A O A Aderounmu
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo.
| | | | | | | | | | | | | |
Collapse
|
33
|
Elli L, Buscarini E, Portugalli V, Reduzzi L, Reduzzi C, Brambilla G, Menozzi F, Bardella MT, Piodi LP, Caldato M, Zambelli A. Pancreatic involvement in von Hippel-Lindau disease: report of two cases and review of the literature. Am J Gastroenterol 2006; 101:2655-8. [PMID: 16952288 DOI: 10.1111/j.1572-0241.2006.00737.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 12/11/2022]
Abstract
BACKGROUND Von Hippel-Lindau (VHL) disease is an autosomal dominant multicancer syndrome caused by the germline mutation of a tumor suppressor gene. Affected individuals develop benign and malignant tumors of the central nervous system, kidneys, adrenal glands, pancreas, and reproductive system. Although VHL disease is mainly diagnosed after the detection of central nervous system tumors, they may not always be the first presentation. CASE REPORT We report the case of a patient presenting with pancreatic cysts for whom the final genetic diagnosis of VHL disease was formulated. During management, the use of endoscopic ultrasonography (EUS) proved to be valid in the characterization of the pancreatic lesions. Family screening also revealed the genetic mutation in the patient's son and imaging investigations showed the presence of multiple tumors. The diagnosis allowed us to plan appropriate follow-up for both, thus improving their life expectancy. CONCLUSIONS Gastroenterologists should be aware of the frequent pancreatic involvement in VHL disease and EUS can be useful in this setting.
Collapse
Affiliation(s)
- Luca Elli
- Department of Medical Sciences, University of Milan, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Tada M, Kawabe T, Arizumi M, Togawa O, Matsubara S, Yamamoto N, Nakai Y, Sasahira N, Hirano K, Tsujino T, Tateishi K, Isayama H, Toda N, Yoshida H, Omata M. Pancreatic cancer in patients with pancreatic cystic lesions: a prospective study in 197 patients. Clin Gastroenterol Hepatol 2006; 4:1265-70. [PMID: 16979953 DOI: 10.1016/j.cgh.2006.07.013] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.2] [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: 02/07/2023]
Abstract
BACKGROUND & AIMS K-ras mutation is frequently detected in pancreatic juice of patients with pancreatic small cystic lesions, as well as those with pancreatic cancer. Those cystic lesions are often found by chance with modern radiologic imaging modalities. In this study, we prospectively examined the prognosis of patients with pancreatic cystic lesions, focusing on pancreatic cancer development. METHODS A total of 197 patients with pancreatic cystic lesions, 80 with intraductal papillary mucinous neoplasm (IPMN) and 117 with non-IPMN cysts, were followed up for 3.8 years on average. Blood tests and imaging diagnosis were performed twice a year. The observed incidence of pancreatic cancer was compared with the expected incidence calculated on the basis of age- and gender-matched mortality of pancreatic cancer in the general Japanese population. RESULTS Pancreatic cancer developed in 7 patients during the observation period (0.95% per year), infiltrating ductal carcinoma in 5 and intraductal papillary mucinous carcinoma in 2. Three of the ductal cancer cases had pancreatic non-IPMN cyst as preexisting lesion. At least 2 of the carcinomas arose in regions remote from preexisting lesions. The observed incidence of pancreatic cancer was 22.5 times higher (95% confidence interval, 11.0-45.3) than expected mortality from this cancer among general population. CONCLUSIONS Patients with pancreatic cystic lesions are at a considerably high risk for pancreatic cancer, with a standardized incidence rate of 22.5. Cancer might develop in regions remote from the preexisting cystic lesion, suggesting diffuse pathologic changes predisposing to malignant transformation in the entire pancreas harboring cystic lesions.
Collapse
Affiliation(s)
- Minoru Tada
- Department of Gastroenterology, University of Tokyo, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Watanabe H, Ohtsubo K, Yamaguchi Y, Mouri H, Motoo Y, Noto M, Kitagawa H, Kayahara M, Ohta T, Gabata T, Sakamoto S, Sawabu N. Successful cystic fenestration for a macrocystic serous cystadenoma of the pancreas causing obstructive jaundice: report of a case. Surg Today 2006; 36:89-93. [PMID: 16378203 DOI: 10.1007/s00595-005-3079-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Accepted: 03/15/2005] [Indexed: 01/28/2023]
Abstract
A 72-year-old man was admitted to our hospital for investigation of jaundice. We made a preoperative diagnosis of macrocystic serous cystadenoma (SCA) of the pancreas, but did not perform palliative choledochojejunostomy because aspiration of the pancreatic cystic fluid caused the cysts to shrink and relieved the compressive stenosis of the common bile duct (CBD) during the operation. Frozen sections of the cyst wall taken by incision biopsy showed no signs of malignancy. Therefore, we performed fenestration of the cystic wall after fixing the inner epithelium of the cyst with 100% ethanol and aspirating the cystic fluid. Cholangiography after the cystic fenestration showed resolution of the CBD stenosis and abdominal computed tomography (CT) confirmed the disappearance of the pancreatic cysts. No recurrence of cystic swelling or obstructive jaundice has been detected by abdominal CT or laboratory data for more than 2 years since the cystic fenestration. Thus, cystic fenestration may be a better palliative option for treating benign compressive tumors such as macrocystic SCA of the pancreas causing obstructive jaundice.
Collapse
Affiliation(s)
- Hiroyuki Watanabe
- Department of Internal Medicine and Medical Oncology, Cancer Research Institute, Kanazawa University, Graduate School of Medical Science, Takaramachi 13-1, Kanazawa 920-8641, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
BACKGROUND Endoscopic ultrasound (EUS)-guided drainage of pancreatic pseudocysts has been well described but it is not an established therapy for malignant pancreatic cystic neoplasms. We report the first EUS-guided cystogastrostomy for the palliative treatment of a cystic pancreatic adenocarcinoma. CASE REPORT We describe a 70-year-old male with a nonresectable cystic pancreatic adenocarcinoma causing partial gastric outlet obstruction treated successfully with palliative EUS-guided cystogastrostomy stent placement. The diagnosis was confirmed by EUS-guided fine needle aspiration. Computerized tomography (CT) and EUS staging revealed vascular invasion precluding the patient from surgical resection. Cystogastrostomy was performed entirely under EUS guidance utilizing a 10-Fr double pigtail stent. After cystogastrostomy stent placement, the patient developed dramatic symptomatic improvement of gastric outlet obstructive symptoms, although subsequent imaging did not reveal complete collapse of the cystic structure. CONCLUSION EUS-guided cystogastrostomy can be considered in the palliative treatment of nonresectable pancreatic cystic neoplasms. Cyst decompression may result in significant symptomatic improvement, although the architecture of malignant cysts may prevent complete resolution.
Collapse
Affiliation(s)
- Rogelio G Silva
- Division of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | | | | |
Collapse
|
37
|
Li Destri G, Reggio E, Veroux M, Lanzafame S, Puleo S, Minutolo V. A rare cystic non-functioning neuroendocrine pancreatic tumor with an unusual presentation. Tumori 2006; 92:260-3. [PMID: 16869249] [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: 05/11/2023]
Abstract
This report describes a patient with a cystic non-functioning neuroendocrine glucagon cell pancreatic tumor presenting with demyelination of the optical nerve that had initially provoked marked monolateral reduced vision and had led to a suspected diagnosis of multiple sclerosis. Cystic degeneration is uncommon in endocrine pancreatic tumors due to their abundant vascular supply. Very few cases of cystic neuroendocrine non-functioning pancreatic tumors have been reported in the international literature. The presence of atypical neurological symptoms, such as sudden visual impairment, should be taken into account in the differential diagnosis for such tumors. The prognosis is poor, because most of these tumors are malignant and diagnosed at an advanced stage. The three-year disease-free survival of our patient, however, encourages the use of aggressive surgical treatment.
Collapse
Affiliation(s)
- Giovanni Li Destri
- Department of Surgical Sciences, Transplantation and Advanced Technologies, University Hospital, Catania, Italy
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
Heterotopic pancreas is normal pancreatic tissue located in an abnormal location. Heterotopic pancreas in the esophagus is a rare congenital anomaly. We present a unique case of pancreatitis and retention cyst in a heterotopic pancreas in the esophagus, outline the investigation and management of cystic lesions of the distal esophagus, and review the literature.
Collapse
|
39
|
Colović R, Micev M, Radak V, Grubor N, Stojković M, Colović N. [Bronchogenic cyst of the abdomen]. SRP ARK CELOK LEK 2006; 133:280-2. [PMID: 16392288 DOI: 10.2298/sarh0506280c] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A bronchogenic cyst is a rare congenital anomaly that appears in the thorax, usually the lungs or the mediastinum, being much rarer in the retrosternal space, within the pericardium or the diaphragm, as well as in the neck, while localisation within the abdomen is extremely rare, with only about 30 reported cases. We present the case of a 68-year-old woman. During an investigation for an epigastric pain, a cystic lesion in the area of the body and tail of the pancreas was found. During open surgery, a cystic lesion, spanning 95 x 75 x 70 mm, above the body and tail of the pancreas was excised. The wall of the cyst was 8-12mm thick; it contained viscous fluid, the culture of which stayed sterile. Histology determined that it was a bronchogenic cyst. After an early uneventful recovery, the patient developed a left colonic fistula, which healed spontaneously within 3 weeks, probably because of the unnoticed operative damage to the splenic flexure of the colon during splenectomy, which was adherent to the cystic mass and impossible to save during excision. Six months after surgery, the patient continued to remain symptom free.
Collapse
Affiliation(s)
- Radoje Colović
- Institute for Digestive System Disorders, Clinical Centre of Serbia, Belgrade
| | | | | | | | | | | |
Collapse
|
40
|
Dumaine A, Tayssir A, Gauclère V, Proust P, Legrand E, Rozière A, Bedock B. [A mixed acid-base disorder revealing a cystic dystrophy of aberrant pancreatic tissue]. ACTA ACUST UNITED AC 2005; 25:193-6. [PMID: 16332427 DOI: 10.1016/j.annfar.2005.08.026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2004] [Accepted: 08/31/2005] [Indexed: 11/29/2022]
Abstract
We report about a patient presenting with a mixed acid-base disorder. His blood gas analysis showed a metabolic acidosis caused by renal failure and lactic acidosis combined with a hypochloraemic alkalosis. The underlying pathology was a cystic dystrophy of aberrant pancreatic tissue leading to excessive vomiting, extracellular dehydration with a renal failure and hypochloraemia.
Collapse
Affiliation(s)
- A Dumaine
- Service de Réanimation, Centre Hospitalier d'Annonay, rue du Bon-Pasteur, BP 119, 07103 Annonay, France
| | | | | | | | | | | | | |
Collapse
|
41
|
Muraki T, Hamano H, Ochi Y, Arakura N, Takayama M, Komatsu K, Komiyama Y, Kawa S, Uehara T, Kiyosawa K. Corticosteroid-responsive pancreatic cyst found in autoimmune pancreatitis. J Gastroenterol 2005; 40:761-6. [PMID: 16082595 DOI: 10.1007/s00535-005-1622-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [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] [Received: 07/30/2004] [Accepted: 02/09/2005] [Indexed: 02/04/2023]
Abstract
There have been only a few reports of autoimmune pancreatitis complicated with pancreatic cyst and such cysts are rare, probably due to the absence of severe tissue necrosis and/or lack of stasis of the pancreatic juice in this condition. However, during a follow-up of 48 patients with this disease, we found 3 patients with pancreatic cysts, and this enabled us to evaluate their clinicopathological findings. Between September 1994 and July 2003, we treated and followed 48 patients with autoimmune pancreatitis, and found 3 patients with pancreatic cyst formation that was responsive to corticosteroid therapy. All of the patients with cysts had high serum IgG4 concentrations. After corticosteroid therapy, rapid resolution of the pancreatic cysts was observed. Immunostaining with goat polyclonal antibody for each IgG subclass showed severe infiltration of IgG4-positive plasma cells in the cyst wall in one patient. The high serum IgG4 concentration and favorable response to corticosteroid therapy suggests that a highly active state of the inflammatory process is closely associated with cyst formation, and that a corticosteroid-responsive pancreatic cyst is a characteristic feature of autoimmune pancreatitis.
Collapse
Affiliation(s)
- Takashi Muraki
- Department of Medicine, Gastroenterology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Mersich T, Zaránd A, Egyed Z, Dede K, Besznyák I, Jakab F. [Hemobilia as a rare vascular complication of chronic pancreatitis]. Magy Seb 2005; 58:187-9. [PMID: 16167474] [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: 05/04/2023]
Abstract
Hemobilia is one of the possible causes of upper GI tract bleeding of unknown origin. However hemobilia is usually iatrogenic or traumatic, it can originate as a result of inflammation or may be caused by tumors. Authors present the case of a 46-year-old man, who developed hemobilia as a vascular complication of chronic pancreatitis. Diagnosis was proved on angiography and surgical intervention was necessary because of the life-threatening hemorrhage. Cholecystectomy, T-drainage and cystoduodenostomy were performed. We describe symptoms, diagnostic and therapeutic approches and compare it to recent literature.
Collapse
Affiliation(s)
- Tamás Mersich
- Fovárosi Onkormányzat Uzsoki utcai Kórház Sebészet-Esebészeti Osztály, Osztály, Budapest
| | | | | | | | | | | |
Collapse
|
43
|
Fernández-Sein A, Correa-Rivas MS, Pratts K, Lugo-Vicente H. Renohepaticopancreatic dysplasia: diagnostic dilemma. P R Health Sci J 2005; 24:45-8. [PMID: 15895877] [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: 05/02/2023]
Abstract
We present the case of an eighteen day old baby boy hospitalized with an abdominal mass, renal insufficiency and jaundice. Multiple radiographic, radionuclear and surgical interventions were required to diagnose renohepaticopancreatic dysplasia, also known as Ivemark II syndrome. In spite of aggressive intensive care support, the patient developed multisystemic organ failure and died. Clinical presentation and autopsy findings are presented.
Collapse
Affiliation(s)
- Alicia Fernández-Sein
- Department of Pediatrics, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico.
| | | | | | | |
Collapse
|
44
|
|
45
|
Kamisawa T, Horiguchi SI, Hayashi Y, Funata N. Discrepancy between pancreatographic and histopathological findings in the ventral pancreas of pancreas divisum. JOP 2004; 5:480-3. [PMID: 15536285] [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: 05/01/2023]
Abstract
CONTEXT Pancreas divisum is a congenital anomaly in which the ventral and dorsal pancreatic ducts do not communicate. CASE REPORT Autopsy case of pancreas divisum with a history of heavy consumption of alcohol was presented. Pancreatography via the major duodenal papilla showed a short ventral pancreatic duct of 1 cm in length, and hypoplasia of the ventral pancreas was suspected. As large cysts were confined to the dorsal pancreas, isolated dorsal pancreatitis was also suspected. At autopsy, extensive fibrosis was detected in both the ventral and dorsal pancreas. Immunohistochemical examination revealed that PP-rich islets were scattered in the fibrotic area between the ventral pancreatic parenchyma and the neck of the pancreas, suggesting that this fibrotic area originated from the ventral pancreas. These facts suggest that the short ventral pancreatic duct was not induced by hypoplasia of the ventral pancreas but was shortened secondarily by the alcohol-induced fibrosis. CONCLUSIONS In pancreas divisum, a short ventral pancreatic duct resulting from secondary factors may be confused with that originating from hypoplasia of the ventral pancreas.
Collapse
Affiliation(s)
- Terumi Kamisawa
- Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
| | | | | | | |
Collapse
|
46
|
Meneghetti V, Lee C, Perry TL, Andrews G. An unusual structure near the porta hepatis: what's your diagnosis? CMAJ 2004; 171:1048-9. [PMID: 15505265 PMCID: PMC526328 DOI: 10.1503/cmaj.1040318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
MESH Headings
- Aged
- Aged, 80 and over
- Aneurysm, Infected/complications
- Aneurysm, Infected/diagnosis
- Autopsy
- Biopsy, Needle
- Diagnosis, Differential
- Disease Progression
- Fatal Outcome
- Humans
- Immunohistochemistry
- Male
- Mycobacterium Infections, Nontuberculous/complications
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium Infections, Nontuberculous/drug therapy
- Mycobacterium avium/isolation & purification
- Pancreatic Cyst/complications
- Pancreatic Cyst/diagnosis
- Pancreatic Cyst/pathology
- Pneumonia, Bacterial/drug therapy
- Pneumonia, Bacterial/microbiology
- Portal System/pathology
- Pulmonary Disease, Chronic Obstructive/complications
- Pulmonary Disease, Chronic Obstructive/diagnosis
- Pulmonary Disease, Chronic Obstructive/therapy
- Renal Artery
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- Victor Meneghetti
- Department of Pathology, University of British Columbia, Vancouver, BC
| | | | | | | |
Collapse
|
47
|
Abstract
BACKGROUND Complications from EUS-guided FNA of cystic lesions of the pancreas are infrequent. Although several studies have evaluated infectious complications of EUS-guided FNA in this setting, the frequency and the clinical significance of intracystic hemorrhage have not been determined. This study assessed the frequency of acute intracystic hemorrhage during EUS-guided FNA of pancreatic cystic lesions. The characteristic EUS appearance is described. METHODS EUS-guided FNA of pancreatic cyst lesions was performed in 50 patients (July 2000 to June 2003). Patients were followed prospectively for the development of complications. OBSERVATIONS Acute intracystic hemorrhage occurred during EUS-guided FNA at the site of aspiration in 3 patients (6%: 95% confidence interval [1.3%, 16.6%]). Endosonographically, the bleeding manifested as a small hyperechoic area at the puncture site that progressed gradually over a few minutes to involve the majority of the cyst cavity. EUS-guided FNA was terminated when bleeding was observed. One patient was asymptomatic, but two patients experienced abdominal pain transiently. All patients were treated with a short course of orally administered antibiotics and were observed as outpatients. Clinical history and laboratory parameters did not predict which patients were at risk for intracystic hemorrhage. CONCLUSIONS Acute intracystic hemorrhage is a rare complication of EUS-guided FNA; it has a characteristic EUS appearance. Recognition of this event is important, because it permits termination of the procedure and thereby minimizes the potential for more serious bleeding.
Collapse
Affiliation(s)
- Shyam Varadarajulu
- Division of Gastroenterology-Hepatology, University of Alabama at Birmingham, USA
| | | |
Collapse
|
48
|
Abstract
BACKGROUND Cystic tumours of the pancreas account for 5% of pancreatic neoplasms and are frequently misdiagnosed as pancreatic pseudocysts. The authors' experience of managing these tumours is presented here, highlighting the clinical presentation, diagnostic difficulties and operative treatment. METHODS This is a retrospective study of all patients diagnosed to have cystic tumours of the pancreas treated at The Mater Hospital, during a 5-year period from 1997 to 2002. Literature was reviewed and guidelines for the management of these tumours have been outlined. RESULTS Seven patients with cystic pancreatic tumours were treated over this time-period. All patients were women with a median age of 40. Two of these patients were initially diagnosed as having pseudocysts and were treated elsewhere by cystgastrostomy. The tumour was resected in all patients. All but one was benign. At follow up, ranging from 13 to 66 months, all patients were alive and well. CONCLUSIONS Cystic tumours of the pancreas are uncommon and generally slow growing. It is important not to assume that a cystic lesion in the pancreas, especially in middle-aged women, is a pseudocyst. Satisfactory surgical resection may be possible even after previous operative procedures on the pancreas. Prognosis after resection remains good.
Collapse
Affiliation(s)
- Damian McKay
- Surgical Unit, Mater Infirmorium Hospital, Belfast, Northern Ireland.
| | | | | | | |
Collapse
|
49
|
Abstract
Metallothionein (MT) is a low-molecular weight intracellular protein, rich in sulfhydryl residues, and able to bind bivalent metals. MT, like Zn, is a component of the diversified elements of antioxidant system. Recent studies have shown that reactive oxygen species play a role in the pathogenesis and development of chronic pancreatitis. The aim of the study was to identify immunohistochemically (LSAB2-HRP; DAKOCytomation) the localization of metallothionein and to determine MT expression in 9 patients with chronic pancreatitis. Our studies confirm that MT is present in exocrine and endocrine cells of patients with chronic pancreatitis and chronic pancreatitis with concomitant diabetes. They also indicate increased expression of MT, particularly in acinar cells of the pancreas. This suggests that MT is greatly involved in homeostasis of the pancreas and synthesis of pancreatic hormones.
Collapse
Affiliation(s)
- Halina Milnerowicz
- Metallothionein Research Laboratory, Department of Toxicology, Wroclaw University of Medicine, Wroclaw, Poland.
| | | | | | | | | | | |
Collapse
|
50
|
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.
Collapse
Affiliation(s)
- M Jouini
- Service de chirurgie et service de radiologie, hôpital La Rabta, Tunis, Tunisie
| | | | | | | | | | | |
Collapse
|