Mucinous Cystic Neoplasms of the Pancreas: Definition of Preoperative Imaging Criteria for High-Risk Lesions

Pancreatology ◽  
2011 ◽  
Vol 11 (5) ◽  
pp. 495-499 ◽  
Author(s):  
Yann Le Baleur ◽  
Anne Couvelard ◽  
Marie Pierre Vullierme ◽  
Alain Sauvanet ◽  
Pascal Hammel ◽  
...  
Keyword(s):  
High Risk ◽  
Preoperative Imaging ◽  
Cystic Neoplasms ◽  
Mucinous Cystic Neoplasms ◽  
Definition Of

Genomic Characterization of Low- and High-Grade Pancreatic Mucinous Cystic Neoplasms Reveals Recurrent KRAS Alterations in “High-Risk” Lesions

Pancreas ◽  
2017 ◽  
Vol 46 (5) ◽  
pp. 665-671 ◽  
Author(s):  
James R. Conner ◽  
Adrián Mariño-Enríquez ◽  
Mari Mino-Kenudson ◽  
Elizabeth Garcia ◽  
Martha B. Pitman ◽  
...  
Keyword(s):  
High Risk ◽  
High Grade ◽  
Cystic Neoplasms ◽  
Mucinous Cystic Neoplasms ◽  
Genomic Characterization

Mucinous Cystic Neoplasms of the Pancreas: Are we Overestimating Malignant Potential?

2014 ◽  
Vol 80 (10) ◽  
pp. 915-919 ◽  
Author(s):  
David Nguyen ◽  
David W. Dawson ◽  
O. Joe Hines ◽  
Howard A. Reber ◽  
Timothy R. Donahue
Keyword(s):  
International Association ◽  
The Body ◽  
Age At Diagnosis ◽  
Preoperative Imaging ◽  
Low Grade ◽  
Cystic Neoplasms ◽  
Prognostic Features ◽  
Mucinous Cystic Neoplasms ◽  
Almost All ◽  
Mural Nodules

Surgical resection is recommended for all mucinous cystic neoplasms (MCNs) of the pancreas as a result of: 1) lack of an accurate tumor marker for invasive cancer; 2) young age at diagnosis; and 3) historical studies revealing 36 per cent incidence of malignancy in resected lesions. This study compares the clinicopathologic and prognostic features of our series of resected MCNs to recent studies using the current International Association of Pancreatology (IAP) system. Thirty-eight resected MCNs were identified. Almost all patients were female (97.4%); median age at diagnosis was 53.5 years (interquartile range [IQR], 41.3 to 61.0). The majority occurred in the body/tail of the pancreas (86.8%); median size on computed tomography/magnetic resonance imaging was 5.0 cm (IQR, 3 to 8.8). Comparison of the five high-grade (HG, 13.2%) and 33 low-grade (86.8%) MCNs revealed that 1) patients were similar in age (55.0 vs 52.0 years, respectively) and 2) HG lesions were significantly larger on preoperative imaging (9.9 vs 3.5 cm) and final pathology (10.9 vs 3.5 cm). These data, taken together with five recent studies that adhere to the 2012 IAP criteria (385 total MCNs), reveal that a cutoff of less than 3 cm without mural nodules would have only missed one (0.26%) HG lesion. Surveillance of these lesions may be appropriate for some patients.

An Unusual Case of Mucinous Cystic Neoplasms of the Pancreas at Pregnancy

2020 ◽  
Vol 03 (03) ◽  
Author(s):  
Misgav Rottenstreich ◽  
Reut Rotem ◽  
Menahem Ben-Haim ◽  
Sorina Grisaru-Granovsky ◽  
Orna Reichman A ◽  
...  
Keyword(s):  
Unusual Case ◽  
Cystic Neoplasms ◽  
Mucinous Cystic Neoplasms

Mesenteric and Retroperitoneal Mucinous Cystic Neoplasms: A Case Series

2021 ◽  
pp. 106689692199353
Author(s):  
Benjamin J. Van Treeck ◽  
Rachel K. Horton ◽  
Hee Eun Lee ◽  
Christophe Rosty ◽  
Rish K. Pai ◽  
...  
Keyword(s):  
Case Reports ◽  
Primordial Germ Cells ◽  
Case Series ◽  
Cystic Neoplasms ◽  
Mucinous Cystic Neoplasms ◽  
Abdominal Tumors ◽  
Keratin 19 ◽  
Liver And Pancreas ◽  
Mucinous Epithelium ◽  
Keratin 7

Aims. Mucinous cystic neoplasms (MCNs) are cystic neoplasms with mucinous epithelium surrounded by ovarian-like stroma. Extraovarian MCN occurring in the liver and pancreas have been well characterized. However, only rare case reports of MCN arising outside of these locations have been reported. MCNs arising in unusual locations should enter the differential diagnosis of mucinous intra-abdominal tumors and must be distinguished from more common mimics. Therefore, we aimed to examine a series of MCNs of the retroperitoneum and mesentery to characterize the clinicopathologic features of this entity. Methods and results. Seven MCNs arising in the abdominal mesentery or retroperitoneum were retrospectively identified. A clinicopathologic, histologic, and immunohistochemical (keratin 7, keratin 19, keratin 20, calretinin, inhibin-α, steroidogenic factor-1 (SF-1), estrogen receptor (ER), progesterone receptor (PR), PAX8, CDX2, and CD10) analysis was performed. All 7 MCNs were from females with a median age of 41 years old and a median size of 8 cm. All cases demonstrated mucinous with or without concomitant non-mucinous epithelium overlying spindle cell ovarian-like stroma. Luteinized cells were noted. The epithelium was positive for keratin 7 and keratin 19 in all 7 cases, while the stroma expressed ER, PR, and SF-1 in all cases stained. Calretinin was focally positive in the stroma of 3 of 7 cases, while inhibin-α was focally expressed in 5 of 6 cases. Conclusions. These results highlight the clinicopathologic, histologic, and immunophenotypic similarities between MCNs of the mesentery, retroperitoneum, pancreas, and liver. Overlapping features suggest a common histogenesis for all MCNs, which could include periductal fetal mesenchyme, aberrant migration of primordial germ cells, or abnormal differentiation or metaplasia of the embryonic coelomic epithelium.

scholarly journals Experience-based surgical approach to pancreatic mucinous cystic neoplasms with ovarian-type stroma

2017 ◽  
Author(s):  
Chang Kang ◽  
Akira Matsushita ◽  
Ho Hwang ◽  
Yoko Matsuda ◽  
Hyunki Kim ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Cystic Neoplasms ◽  
Mucinous Cystic Neoplasms

Sendai and Fukuoka Consensus Guidelines Identify Advanced Neoplasia in Patients With Suspected Mucinous Cystic Neoplasms of the Pancreas

2015 ◽  
Vol 13 (10) ◽  
pp. 1808-1815 ◽  
Author(s):  
Pavlos Kaimakliotis ◽  
Brian Riff ◽  
Kamron Pourmand ◽  
Vinay Chandrasekhara ◽  
Emma E. Furth ◽  
...  
Keyword(s):  
Consensus Guidelines ◽  
Cystic Neoplasms ◽  
Advanced Neoplasia ◽  
Mucinous Cystic Neoplasms

Intralobular Distribution of Ovarian-like Stroma in Pancreatic Mucinous Cystic Neoplasms: Hypothesis on Its Tumorigenesis

2021 ◽  
Author(s):  
Yuki Fukumura ◽  
Yuko Kinowaki ◽  
Yoko Matsuda ◽  
Masaru Takase ◽  
Momoko Tonosaki ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Wnt Pathway ◽  
Smooth Muscle Actin ◽  
Mucinous Cystic Neoplasm ◽  
Cystic Neoplasm ◽  
Pancreatic Ducts ◽  
Low Grade ◽  
Muscle Actin ◽  
Cystic Neoplasms ◽  
Mucinous Cystic Neoplasms

Abstract Pancreatic mucinous cystic neoplasm (MCN) harbors two histological components, tumor epithelia and ovarian-like stroma (OLS). To examine the tumorigenesis of pancreatic MCNs, this study analyzed the distribution, amount, immunohistochemical phenotype, presence of theca cells of the OLS, and the alteration of tumor epithelium of 29 surgically resected MCN cases and compared them with tumor sizes. Non-mucinous type epithelium was present in all low-grade MCNs but its ratio decreased with tumor size (p < 0.05), suggesting that epithelial mucinous changes are a progression phenomenon. The intralobular distribution of OLS was observed in 27.6 % of MCN cases and its existence related to a smaller size (p< 0.05), suggesting intralobular generation of MCNs. Nuclear expression of β-catenin was observed for OLS of everywhere, suggesting consistent activation of the Wnt pathway for OLS. Three MCN cases (10.3%) contained a-smooth muscle actin (SMA)-negative OLS, where OLS surrounding dilated pancreatic ducts or MCN cysts were a-SMA-positive and otherwise negative, suggesting that a-SMA-positivity is an acquired phenomenon of OLS. With this study, we could hypothesize that pancreatic MCNs may generate intralobularly. Epithelial mucinous change and a-SMA-positivity of OLS may be progression phenomena. This is the first study to show the intralobular distribution of OLS.

Ultra-high-risk paradigm: lessons learnt and new directions

2018 ◽  
Vol 21 (4) ◽  
pp. 131-133 ◽  
Author(s):  
Patrick D McGorry ◽  
Cristina Mei
Keyword(s):  
High Risk ◽  
Mental Disorders ◽  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Evidence Base ◽  
Ultra High Risk ◽  
Underlying Mechanisms ◽  
Staging Model ◽  
Definition Of ◽  
New Generation

Within the embryonic early psychosis field in the early 1990s, the conceptualisation and definition of an at-risk or ultra-high-risk (UHR) mental state for psychosis was a breakthrough which transformed the clinical and research landscape in psychiatry. Twenty-five years later, we have a new evidence base that has illuminated the neurobiology of the onset phase of psychotic disorder, delivered Cochrane level 1 evidence showing that the onset of full-threshold sustained psychotic disorder can be at least delayed, and is paving the way to a new generation of transdiagnostic research. Here, we document the contribution of the UHR approach to understanding the underlying mechanisms of psychosis onset as well as the long-term outcomes. Particularly, we highlight that psychosis onset can be delayed in those meeting UHR criteria and that these criteria have a higher valence for subsequent psychotic disorders and some valence for persistent non-psychotic syndromes. Critiques have helped to identify some of the limitations of this paradigm, which are acknowledged. These include evidence that psychotic disorders can emerge more acutely and from other, as yet undefined, precursor states. Rather than defending, or alternatively questioning the value of, the UHR approach, we propose a broader, transdiagnostic staging model that is consistent with the pluripotent and variably comorbid trajectories for mental disorders. This approach moves beyond psychosis to capture a wider range of subthreshold symptoms and full-threshold disorders, thus enhancing prediction for the emergence and progression of a range of mental disorders, as well as providing new avenues for early intervention and prevention.

Expanding insurance coverage for in vitro fertilisation with preimplantation genetic testing: putting the cart before the horse

2021 ◽  
pp. medethics-2020-106940
Author(s):  
Emily C Lisi
Keyword(s):  
Genetic Testing ◽  
High Risk ◽  
Diagnostic Tool ◽  
Insurance Coverage ◽  
Genetic Services ◽  
In Vitro Fertilisation ◽  
Genetic Condition ◽  
Preimplantation Genetic Testing ◽  
Definition Of

Madison Kilbride recently argued that insurance (eg, Centers for Medicare & Medicaid Services (CMS)) should cover in vitro fertilisation with preimplantation genetic testing (IVF-PGT) services for couples at high risk of having a child affected with a genetic condition. She argues that IVF-PGT meets CMS’s definition of ‘medically necessary care’, where such care includes ‘services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms’. Kilbride argues that IVF-PGT satisfies this definition in two ways: as a diagnostic tool and as a treatment. Contradicting Kilbride, however, I argue that IVF-PGT provides neither diagnosis nor treatment under CMS’s definition. Thus, as long as we accept CMS’s definition of medically necessary care—which Kilbride does, explicitly—it follows that IVF-PGT does not count as medically necessary care. Still, there may be other reasons to conclude that IVF-Preimplantation genetic testing should be covered, and so, it would be a mistake to reject Kilbride’s conclusion altogether. The problem is simply that Kilbride’s argument—that the procedure should be covered because it is medically necessary per CMS’s definition—is not sound. I conclude by discussing a number of other genetic services that are not currently being covered despite the fact that (unlike IVF-PGT) they do seem to satisfy CMS’s definition of ‘medically necessary diagnosis or treatment’. These services, I argue, should be provided under CMS before we consider expanding coverage to include elective procedures such as IVF-PGT.

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