scholarly journals Surgery for Cystic Pancreatic Lesions in the Post-Sendai Era: A Single Institution Experience

HPB Surgery ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Jörg Kleeff ◽  
Christoph Michalski ◽  
Bo Kong ◽  
Mert Erkan ◽  
Susanne Roth ◽  
...  
Keyword(s):  
Preoperative Diagnosis ◽  
Postoperative Morbidity ◽  
Intraepithelial Neoplasia ◽  
Cystic Tumor ◽  
Diagnostic Challenge ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Biological Behaviour ◽  
Risk Of Malignancy ◽  
Cystic Pancreatic Lesions

Introduction. The management of cystic pancreatic lesions has changed in recent years as a result of increasing knowledge of their biological behaviour, better diagnostic options, and international guidelines. Methods. Retrospective analysis of a cohort of 86 patients operated for cystic pancreatic lesions during a seven-year period (2007–2014). Results. Final histopathology revealed 53 intraductal papillary mucinous neoplasms (19 branch duct IPMNs, 15 mixed type IPMNs, and 19 main duct IPMNs), 14 serous and 13 mucinous cystic neoplasms, 3 solid pseudopapillary neoplasms, and 3 other lesions. 4 cases displayed high grade intraepithelial neoplasia and 2 cases displayed invasive cancer. A pylorus-preserving partial duodenopancreatectomy was carried out in 27 patients, a total pancreatectomy was carried out in 9 patients, a left resection was carried out in 42 patients, and segmental resections and enucleations were carried out in 4 patients each. Overall postoperative morbidity and mortality were 40% and 2.3%, respectively. The preoperative diagnosis of a specific cystic tumor was accurate in 79% of patients and 9 patients (10%) could have avoided surgery with the correct preoperative diagnosis. Conclusion. Cystic pancreatic lesions are still a diagnostic challenge, requiring a dedicated multidisciplinary approach. The rate of malignancy is relatively small, whereas postoperative morbidity is substantial, underscoring the importance of adequate patient selection considering both the risk of surgery and the long term risk of malignancy.

Lymphoepithelial Cyst of the Pancreas: Can Common Imaging Features Help to Avoid Resesction?

2021 ◽  
Author(s):  
Ekaterina Khristenko ◽  
Elena Esteban Garcia ◽  
Matthias M. Gaida ◽  
Thilo Hackert ◽  
Philipp Mayer ◽  
...  
Keyword(s):  
Clinical Data ◽  
Imaging Features ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Male Predominance ◽  
Unenhanced Ct ◽  
Aged Woman ◽  
Lymphoepithelial Cysts ◽  
Solid Lesions ◽  
Cystic Pancreatic Lesions

Abstract Background: Differentiation of cystic pancreatic neoplasms remains a challenging task for radiologists with main aim of characterizing malignant and premalignant conditions. Purpose: The study aimed to compare radiological features of lymphoepithelial cysts (LEC) with other cystic pancreatic lesions, which could help to differentiate them in order to avoid unnecessary resection and optimize surveillance.Material and Methods: We retrospectively reviewed 12 cases of resected and histopathological confirmed LECs in last 12 years, for 10 patients imaging studies were available. 20 patients with mucinous cystic neoplasms (MCN) and 20 patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) were selected consecutively to serve as control groups. Imaging findings as well as clinical data were analyzed. Results: Three imaging subtypes of LEC were identified: simple cystic morphology (20%) and mixed cystic-solid lesions (80%) with either diffuse subsolid component (30%) or mural nodule (50%). All lesions revealed exophytic location with strong male predominance (9:1). MCNs were presented exclusively in middle-aged woman and IPMN in both sexes showing slight male predominance (13:7). Mean patient age in IPMN (70.5+7.7 years) was significantly higher compared to other groups (p<0.001 for LEC, p=0.005 for MCN). Unenhanced CT-attenuation of LEC was higher than MCNs (p=0.025) and IPMNs (p=0.021). Conclusion: The present study provides three imaging subtypes of LEC with key features for the differentiation from other cystic pancreatic lesions such as increased native attenuation, absence of connection to main pancreatic duct (MPD) and exophytic location. Clinical data, such as male predominance in LEC, is crucial in differentiating cystic pancreatic lesions.

scholarly journals Branch Duct Intraductal Papillary Mucinous Neoplasms: Recommendations for Follow-Up and Surgery

2020 ◽  
Vol 109 (1) ◽  
pp. 34-41
Author(s):  
A. Caravati ◽  
S. Andrianello ◽  
T. Pollini ◽  
M. Biancotto ◽  
A. Balduzzi ◽  
...  
Keyword(s):  
High Volume ◽  
Cystic Neoplasm ◽  
Pancreatic Cysts ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Cystic Neoplasms ◽  
Increased Risk ◽  
Mucinous Neoplasms ◽  
Risk Of Malignancy

Background and Aims: Pancreatic cysts are increasingly diagnosed, mainly during abdominal imaging performed for other reasons. Between pancreatic cystic neoplasm, intraductal papillary mucinous neoplasms are the most common pre-malignant entities. Intraductal papillary mucinous neoplasms involving side branches overall harbor a low risk of malignancy, and in the recent past, a progressively more conservative approach has been consolidated. Purpose of this report is to summarize the evidence supporting the current practice for the management of branch duct intraductal papillary mucinous neoplasm and to offer a useful practical guide from first observation to post-operative follow-up. Materials and Methods: Review of the most important scientific literature on intraductal papillary mucinous neoplasms was made. In this review article, we also report the experience of a high volume center in managing Pancreatic cystic neoplasms. Results: The correct management during surveillance still is a matter of debate, since many guidelines have been published suggesting different clinical approaches. Recently, follow-up discontinuation has also been proposed in selected cases. Conclusion: Despite significant improvements made by the increase of evidence, selecting surgical candidates because of an increased risk of malignant progression remains an unsolved issue and a hot topic for pancreatologists.

scholarly journals Tubulocystic renal cell carcinoma: Report of a rare case

2015 ◽  
Vol 9 (9-10) ◽  
pp. 654 ◽  
Author(s):  
Aanchal Kakkar ◽  
Mehar C. Sharma ◽  
Manpreet Uppal ◽  
Sunil Chumber
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Histopathological Examination ◽  
Cystic Neoplasm ◽  
Diagnostic Challenge ◽  
Elderly Male ◽  
Diagnostic Dilemma ◽  
Cystic Neoplasms ◽  
Atypical Cells

Cystic neoplasms of the kidney are rare, and present a unique diagnostic challenge. We report the case of an elderly male who presented with a large cystic neoplasm, which was a diagnostic dilemma clinically and radiologically. Histopathological examination showed a tumour composed of variably sized tubules lined by atypical cells having large round nuclei with prominent nucleoli. Hobnailing was seen at places. Tumour cells were immunopositive for pancytokeratin, vimentin, CD10, CK19 and AMACR, confirming a diagnosis of tubulocystic renal cell carcinoma (TC-RCC).

scholarly journals Solid-Pseudopapillary Tumor of the Pancreas: A Single Center Experience

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Valentina Beltrame ◽  
Gioia Pozza ◽  
Enrico Dalla Bona ◽  
Alberto Fantin ◽  
Michele Valmasoni ◽  
...  
Keyword(s):  
Preoperative Diagnosis ◽  
Abdominal Ultrasound ◽  
Diagnostic Tools ◽  
Solid Pseudopapillary Tumor ◽  
Sufficient Information ◽  
Cystic Neoplasms ◽  
Single Center Experience ◽  
Positron Emission ◽  
Institutional Experience ◽  
Solid Pseudopapillary Tumors

Aim of this study was to review the institutional experience of solid-pseudopapillary tumors of the pancreas with particular attention to the problems of preoperative diagnosis and treatment. From 1997 to 2013, SPT was diagnosed in 18 patients among 451 pancreatic cystic neoplasms (3.7%). All patients underwent preoperative abdominal ultrasound, computed assisted tomography, and tumor markers (CEA and CA 19-9) determinations. In some instances, magnetic resonance, positron emission tomography, and endoscopic ultrasound with aspiration cytology were performed. There were two males and 16 females. Serum CA 19-9 was slightly elevated in one case. Preoperative diagnosis was neuroendocrine tumor (n=2), mucinous tumor (n=2), and SPT (n=14). Two patients underwent previous operation before referral to our department: one explorative laparotomy and one enucleation of SPT resulting in surgical margins involvement. All patients underwent pancreatic resection associated with portal vein resection (n=1) or liver metastases (n=1). One patient died of metastatic disease, 77 months after operation, and 17 are alive and free with a median survival time of 81.5 months (range 36–228 months). Most of SPT can be diagnosed by CT or MRI, and the role of other diagnostic tools is very limited. We lack sufficient information regarding clinicopathologic features predicting prognosis. Caution is needed when performing limited resection, and long and careful follow-up is required for all patients after surgery.

scholarly journals Complete appendiceal inversion with local high-grade intraepithelial neoplasia in an adult female: a case report

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Xinlu Liu ◽  
Ge Liu ◽  
Yanfeng Liu ◽  
Hongsheng Zhou ◽  
Liyu Yu ◽  
...  
Keyword(s):  
Preoperative Diagnosis ◽  
Rare Event ◽  
Intraepithelial Neoplasia ◽  
High Grade ◽  
Disease Entity ◽  
Normal Appendix ◽  
Tubulovillous Adenoma ◽  
Case Presentation ◽  
Intermittent Abdominal Pain ◽  
Specific Symptoms

Abstract Background Appendiceal inversion with neoplasia in adults is an extremely rare event with a reported incidence of < 0.01%. Preoperative diagnosis is very important for surgical treatment; however, it is very difficult to be exact. Case presentation The patient was a 60-year-old woman with complaints of intermittent abdominal pain. Computed tomography and colonoscopy revealed a cecal mass, which was diagnosed as a tubulovillous adenoma in the preoperative colonoscopic biopsy. At surgery, the appendix was found to be completely inverted into the cecum. The cecum was partially resected, and surgical pathology examination confirmed a tubulovillous adenoma of the appendix with local high-grade intraepithelial neoplasia. Conclusions Although preoperative diagnosis of appendiceal inversion with neoplasia may be often difficult due to its non-specific symptoms, clinicians should consider this disease entity when they encounter an intraluminal protruding cecal mass without visualization of the normal appendix on CT and colonoscopy.

scholarly journals Intraductal papillary mucinous neoplasm of the pancreas. Personal series and synthetic review

2012 ◽  
Author(s):  
F. Gallucci ◽  
D. Avolio ◽  
R. De Ritis ◽  
L. Ferrara ◽  
U. Valentino ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Mixed Type ◽  
Pancreatic Tumors ◽  
Malignant Degeneration ◽  
Main Duct ◽  
Branch Duct ◽  
Asymptomatic Patients ◽  
Risk Of Malignancy ◽  
Tumor Types

Intraductal papillary mucinous neoplasms (IPMNs) are rare pancreatic tumors, accounting for less than 1-2% of all neoplasms of the pancreas. The main characteristic of IPMNs is their favorable prognosis, as these pre-malignant or malignant lesions are usually slow-growing tumors and radical surgery is frequently possible. According to the localization of the lesions, three different tumor types have been identified: the main-duct IPMN, the branch-duct IPMN and the mixed-type IPMN (involving both the main pancreatic duct and the side branches). IMPNs do not present pathognomonic signs or symptoms. The obstruction of the main pancreatic duct system may cause abdominal pain and acute pancreatitis (single or recurrent episodes). The tumor may be incidentally discovered in asymptomatic patients, particularly in those with branch-duct IPMNs. In clinical practice, any non-inflammatory cystic lesion of the pancreas should be considered as possible IPMN. Computed tomography, magnetic resonance imaging with cholangiopancreatography and endoscopic ultrasonography can localize an IPMN and assess its morphology and size. The choice between non-operative and surgical management depends on the risk of malignancy and on the definitive distinction between benign and malignant IPMNs. Main-duct IPMNs have a high risk of malignant degeneration, especially in older patients. The clinical and radiological features, as well as treatment and outcome, of eight patients with IPMN (five with main-duct, two with branch-duct and one with mixed-type) observed by the authors over the last ten years are presented.

scholarly journals Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms

2020 ◽  
Vol 158 (1) ◽  
pp. 226-237.e5 ◽  
Author(s):  
Hiroki Oyama ◽  
Minoru Tada ◽  
Kaoru Takagi ◽  
Keisuke Tateishi ◽  
Tsuyoshi Hamada ◽  
...  
Keyword(s):  
Intraductal Papillary Mucinous Neoplasms ◽  
Branch Duct ◽  
Mucinous Neoplasms ◽  
Risk Of Malignancy

scholarly journals A Rare Cause of Colonic Obstruction “Colonic Intussusception”: Report of Two Cases

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Tayfun Yoldas ◽  
Avni Can Karaca ◽  
Safak Ozturk ◽  
Mutlu Unver ◽  
Cemil Calıskan ◽  
...  
Keyword(s):  
High Risk ◽  
Surgical Resection ◽  
Preoperative Diagnosis ◽  
Colonic Obstruction ◽  
Review Of The Literature ◽  
Benign Lesions ◽  
Anatomic Site ◽  
Risk Of Malignancy

Colocolic intussusceptions are rare clinical entities in adults and almost always caused by a leading lesion which often warrants resection. Mostly being malignant, the leading lesions are rarely benign lesions where intraluminal lipomas are the most frequent among them. Most adult intussusceptions require surgical resection owing to two major reasons: common presence of a leading lesion and significantly high risk of malignancy—reaching as high as 65% regardless of the anatomic site—of the leading lesion. Resection of the affected segment is usually the treatment of choice, since preoperative diagnosis of the lesion is usually ineffective and most leading lesions are malignant. This paper represents two cases of adult colocolic intussusception caused by intraluminal lipomas with a brief review of the literature.

scholarly journals Spectrum of Cribriform Proliferations of the Prostate: From Benign to Malignant

2018 ◽  
Vol 142 (8) ◽  
pp. 938-946 ◽  
Author(s):  
Thomas K. Lee ◽  
Jae Y. Ro
Keyword(s):  
Intraepithelial Neoplasia ◽  
Intraductal Carcinoma ◽  
Definitive Treatment ◽  
Diagnostic Challenge ◽  
Invasive Adenocarcinoma ◽  
Diagnostic Features ◽  
Carcinoma Of The Prostate ◽  
Gland Carcinoma ◽  
Malignant Lesions ◽  
The University

Context.— The presence of cribriform glands/ducts in the prostate can pose a diagnostic challenge. Cribriform glands/ducts include a spectrum of lesions, from benign to malignant, with vastly different clinical, prognostic, and treatment implications. Objective.— To highlight the diagnostic features of several entities with a common theme of cribriform architecture. We emphasize the importance of distinguishing among benign entities such as cribriform changes and premalignant to malignant entities such as high-grade prostatic intraepithelial neoplasia, atypical intraductal cribriform proliferation, intraductal carcinoma of the prostate, and invasive adenocarcinoma (acinar and ductal types). The diagnostic criteria, differential diagnosis, and clinical implications of these cribriform lesions are discussed. Data Sources.— Literature review of pertinent publications in PubMed up to calendar year 2017. Photomicrographs obtained from cases at the University of California at Irvine and authors' collections. Conclusions.— Although relatively uncommon compared with small acinar lesions (microacinar carcinoma and small gland carcinoma mimickers), large cribriform lesions are increasingly recognized and have become clinically and pathologically important. The spectrum of cribriform lesions includes benign, premalignant, and malignant lesions, and differentiating them can often be subtle and difficult. Intraductal carcinoma of the prostate in particular is independently associated with worse prognosis, and its presence in isolation should prompt definitive treatment. Patients with atypical intraductal cribriform proliferation, intraductal carcinoma of the prostate, or even focal cribriform pattern of invasive adenocarcinoma in biopsies would not be ideal candidates for active surveillance because of the high risk of adverse pathologic findings associated with these entities.

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