ABSTRACT
Recently， the International Association of Pancreatology published a revised edition of the guidelines for the management of intraductal papillary mucinous neoplasm （IPMN） of the pancreas. The guidelines mainly focus on five topics， i.e.， revision of “high-risk stigmata” and “worrisome features”， surveillance of unresected IPMN， surveillance after resection of IPMN， revision of pathological aspects， and research on molecular markers in cyst fluid， in order to provide the best evidence-based reference for clinical practice. This article makes an excerpt of the key points in the guidelines.
ABSTRACT
Intraductal papillary mucinous neoplasm (IPMN) is one of the precancerous lesions of the pancreas. Currently there is controversial over the management and follow-up strategy of IPMN, including the timing of surgery. The core problem lies in the accurate preoperative assessment of the nature of the lesions and the risk of malignant transformation. Cumulation of high-quality evidence and development of efficient evaluation methods are vital for the establishment of standardized decision-making system and the improvement of clinical benefits to patients. This review aims to summarize the consensus and controversies on surgical evaluation standards in the latest guidelines and representative literatures, and to look forward to the development direction of IPMN diagnosis and treatment decisions in combination with the progress of related evaluation techniques.
ABSTRACT
The pancreatic neuroendocrine tumors (PanNETs) most commonly present as solid neoplasms; however, very rarely, they may present primarily as cystic neoplasms. Most of the cystic PanNETs are non-secreting tumors, and the radiological features are not well defined. Hence pre-operative diagnosis is usually challenging and the tumors are misdiagnosed as mucinous cystic neoplasms, intraductal papillary mucinous neoplasms, serous cystic neoplasms, solid pseudopapillary neoplasms, and non-neoplastic cysts. However, the management depends on the accurate diagnosis of these cystic lesions, which poses a dilemma. Herein, we report the case of a cystic PanNET in the tail of the pancreas, which was clinically and radiologically misdiagnosed as a mucinous cystic neoplasm. This case is reported to highlight this issue to the medical community regarding the diagnostic difficulty in such rare non-functioning pancreatic neuroendocrine tumors.
Subject(s)
Humans , Male , Middle Aged , Pancreatic Cyst/diagnosis , Neuroendocrine Tumors/diagnosis , Pancreatic Intraductal Neoplasms/diagnosis , Pancreas/pathology , Neoplasms, Cystic, Mucinous, and Serous/diagnosis , Rare Diseases , Diagnostic ErrorsABSTRACT
Studies have demonstrated a strong correlation between chronic inflammation and tumor initiation and progression.Chronic intlammation is mainly involved in tumor progression through intrinsic and extrinsic pathways,and transcription factors such as NF-κB and STAT3 play important roles.Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies.Chronic inflammation can promote the development of PDAC in cooperation with mutation of protooncogene.Inflammation signaling pathway plays an important role in malignant transformation in the PDAC,in which NF-κB and STAT3 are two major transcription factors.Targeting the key regulator points based on the crosstalk between inflammation signaling and PDAC may potentially represent a novel for PDAC prevention and treatment.This article briefly reviews the role of chronic inflammation in the development of PDAC,the PDAC-related inflammatory signal network caused by chronic inflammation,and crosstalk between NF-κB and JAK/STAT3 signaling pathways.
ABSTRACT
Pancreatic cystic neoplasms are becoming increasingly frequent, presenting a number of challenges in clinical practice. While several guidelines have been published to address these, they are largely composed of expert opinions based on relatively low-level evidence. Their recommendations are similar in general, but there are many differences in detail. Pancreatic neoplasms have differing malignant potential, based on the histologic type and clinical and radiological features of the cysts. It is necessary to stratify the malignancy risk of each cyst, using proper evaluation methods, and to manage it appropriately, with surgical resection or surveillance. In addition, risks associated with surgical resection, costs associated with long-term follow-up, and patient discomfort and anxiety must be considered in the proper management of pancreatic cystic neoplasms. In this review, we introduce four recently published guidelines.