Factores pronósticos de complicaciones en pacientes con pseudoquiste pancreático

Fundamento los pseudoquistes del páncreas se presentan como complicación en pancreatitis aguda y crónica, así como en el trauma pancreático. En ocasiones pasan inadvertidos, por su carácter asintomático en algunos casos, además del cuadro clínico poco definido. Los estudios orientados a esta temática permiten un manejo satisfactorio de los pacientes con diagnóstico de dicha entidad. Objetivo determinar los factores pronósticos de complicaciones en pacientes con pseudoquiste pancreático. Métodos se realizó un estudio descriptivo longitudinal, en pacientes con pseudoquistes pancreáticos atendidos en el Hospital Arnaldo Milián Castro, de Villa Clara, durante el período enero/2013-diciembre/2020. La muestra quedó definitivamente conformada por 45 pacientes. Resultados predominaron los pacientes con edades de 40-59 años (57,8 %), y del sexo masculino (62,2 %). La causa fundamental fue la pancreatitis aguda (51,1 %), y la localización más frecuente el cuerpo pancreático (37,8 %). El síntoma más observado fue el dolor abdominal (82,2 %). El manejo fue médico en la mayoría de los pacientes (75,6 %) y se realizó cistogastrostomía en el 13,3 %. Evolucionaron sin complicación el 68,9 %. Solo 3 pacientes fallecieron (6,7 %). La edad mayor de 52 años, el tiempo de formación mayor de seis semanas, el tamaño menor de 6 centímetros y la persistencia tuvieron valores de Odds Ratio: 1,214- IC(0,211-6,985); 7,250- IC(0,786-66,842); 4,688- IC(0,489-44,904); y 2,875- IC(0,479-17,239), respectivamente. Conclusiones la edad mayor de 52 años, la formación después de seis semanas, el tamaño menor de seis cm y la persistencia mayor de tres semanas constituyen factores de riesgo de complicaciones del pseudoquiste pancreático.

Background pseudocysts of the pancreas appear as a complication in acute and chronic pancreatitis, as well as in pancreatic trauma. Sometimes they go unnoticed, due to their asymptomatic nature in some cases, in addition to the poorly defined clinical picture. The studies oriented to this subject allow a satisfactory management of the patients diagnosed with said entity. Objective to determine the prognostic factors for complications in patients with pancreatic pseudocyst. Methods a longitudinal descriptive study was carried out in patients with pancreatic pseudocysts treated at the Arnaldo Milián Castro Hospital, in Villa Clara, from January/2013 to December/2020, 45 patients were the sample. Results patients aged 40-59 years old (57.8%), and males (62.2%) predominated. The fundamental cause was acute pancreatitis (51.1%), and the most frequent location was the pancreatic body (37.8%). The most observed symptom was abdominal pain (82.2%). Medical management was performed in most of the patients (75.6%) and cystogastrostomy in 13.3%. 68.9% evolved without complications. Only 3 patients died (6.7%). Age greater than 52 years old, formation time greater than six weeks, size less than 6 centimeters, and persistence had Odds Ratio values: 1.214- IC(0.211-6.985); 7,250- CI(0,786-66,842); 4.688-CI(0.489-44.904); and 2.875-CI(0.479-17.239), respectively. Conclusions age greater than 52 years old, formation after six weeks, size less than six cm, and persistence greater than three weeks are risk factors for complications of pancreatic pseudocyst.

Cystic pancreatic lesions: imaging versus anatomopathological findings-how to improve diagnostic accuracy? / Lesões císticas do pâncreas: imagens versus achados anatomopatológicos. como melhorar a acurácia diagnóstica?

ABSTRACT BACKGROUND: Pancreatic cystic lesions are a group of pancreatic neoplasms with different behavior and risk of malignancy. Imaging diagnosis and differentiation of these lesions remain a challenge. AIMS: The aim of this study was to evaluate the agreement between computed tomography and/or magnetic resonance imaging and post-operative pathologic diagnoses of Pancreatic cystic lesions in a University Hospital of São Paulo State. METHODS: A total of 39 patients with surgically diagnosed Pancreatic cystic lesions were enrolled, as a study cohort from 2009 to 2019. Preoperative radiological and final pathological diagnosis was correlated to measure computed tomography and/or magnetic resonance imaging diagnostic. Pancreatic adenocarcinoma, choledochal pancreatic cyst, mucinous cystadenoma, serous cystadenoma, intraductal papillary mucinous neoplasms, and pancreatic pseudocyst were classified as neoplastic cysts. RESULTS: It was noted that 27 patients (69.23%) had preoperative computed tomography and magnetic resonance imaging, 11 patients (28.20%) had preoperative computed tomography only, and 1 patient had preoperative magnetic resonance imaging only. The values for diagnoses made only with computed tomography (p=0.47) and from the combination of computed tomography+magnetic resonance imaging (p=0.50) did also point to moderate agreement with the anatomopathological findings. The values pointed to a fair agreement for the diagnosis of mucinous cystadenoma (p=0.3), moderate agreement for intraductal papillary mucinous neoplasms (p= 0.41), good agreement for serous cystadenoma (p=0.79), and excellent agreement for choledochal pancreatic cyst (p=1), pancreatic pseudocyst (p=0.84), and Frantz tumor (p=1) (p<0.05). CONCLUSIONS: The findings of computed tomography and/or magnetic resonance imaging have an equivalent diagnostic agreement with an anatomopathological diagnosis for differentiating benign from malignant Pancreatic cystic lesions and in suggesting a specific diagnosis. There is no statistical difference between the use of computed tomography alone and computed tomography+magnetic resonance imaging in the improvement of diagnostic accuracy.

RESUMO RACIONAL: Lesões císticas pancreáticas são um grupo de neoplasias pancreáticas com diferentes comportamentos e riscos de malignidade. O diagnóstico por imagem e a diferenciação dessas lesões constituem um desafio. OBJETIVOS: Avaliar a concordância entre o diagnóstico de imagem pré operatório obtido através da tomografia computadorizada e/ou da ressonância nuclear magnética e o diagnóstico anátomopatológico das lesões císticas pancreáticas, no Hospital de Base de São José do Rio Preto - SP. MÉTODOS: Trinta e nove pacientes com lesões císticas pancreáticas, comprovados cirurgicamente, foram incluídos para o estudo, de 2009 a 2019. O diagnóstico radiológico pré-operatório e o diagnóstico anatomopatológico final foram correlacionadas para medir a acurácia da tomografia computadorizada e/ou da ressonância nuclear magnética. O adenocarcinoma pancreático, o cisto pancreato-coledociano, o cistoadenoma mucinoso, o cistoadenoma seroso, a neoplasia mucinosa papilar intraductal, e o pseudocisto pancreático foram classificados como cistos neoplásicos. As informações foram comparadas e estatisticamente analisadas. RESULTADOS: Vinte e sete pacientes fizeram tomografia computadorizada e ressonância nuclear magnética pré-operatórios (69,23%), 11 pacientes fizeram apenas tomografia computadorizada (28,20%), e 1 paciente fez apenas ressonância nuclear magnética (2,57%). Os achados de tomografia computadorizada para diagnóstico (p=0,47) e para a combinação tomografia computadorizada+RM (p=0,50) mostraram moderada concordância com os achados anatomopatológicos. Houve leve concordância para o diagnóstico de cistoadenoma mucinoso (p=0,3), moderada concordância para intraductal papillary mucinous neoplasms (p=0,41), boa concordância para cistoadenoma seroso (p=0,79) e excelente concordância para pseudocisto pancreático (p=0,84), cisto pancreato-coledociano (p=1) e tumor de Frantz (p=1) (p<0,05). CONCLUSÕES: Os achados de imagem da tomografia computadorizada e/ou ressonância nuclear magnética apresentaram concordância diagnóstica com os exames anatomopatológicos na diferenciação de lesões císticas pancreáticas benignas e malignas, porém a diferença entre o uso apenas da tomografia computadorizada e tomografia computadorizada+ressonância nuclear magnética na melhora da acurácia diagnóstica não apresentou relevância estatística tal como a literatura.

Enfermedad poliquística: a propósito de un caso

RESUMEN La enfermedad renal poliquística autosómica recesiva es una de las grandes causas de insuficiencia renal crónica en la población adulta. Se reporta el caso de un paciente con este padecimiento, que presentó, además, poliquistosis hepática y quistes pancreáticos, con escasas manifestaciones clínicas de la esfera renal y síntomas dispépticos; hígado y riñones muy aumentados de tamaño e irregulares, producto de los abundantes y grandes quistes; fosfatasa alcalina elevada y comprobación imagenológica de la enfermedad. Todo esto unido lo hace un caso infrecuente.

ABSTRACT Autosomal recessive polycystic renal disease is one of the great causes of chronic renal failure in the adult population. We present the case of a patient with this condition, who also had liver and pancreatic cysts, with few clinical manifestations of the renal sphere and dyspeptic symptoms; very enlarged and irregular liver and kidneys due to profuse and large cysts; high alkaline phosphatase and imaging checking of the disease. All of these together make it an infrequent case.

Infarto esplénico masivo secundario a compresión de vasos esplénicos por un tumor quístico de páncreas / Massive splenic infarction secondary to compression of splenic vessels by a pancreatic cystic tumor

RESUMEN Los infartos esplénicos son una causa infrecuente de dolor abdominal. Son causados por una amplia variedad de patologías. Presentamos el caso de un paciente en el que se hizo diagnóstico de infarto esplénico masivo secundario a una compresión extrínseca de un tumor quístico de páncreas.

ABSTRACT Splenic infarctions, a rare cause of abdominal pain, may be due to several conditions. We report the case of a male patient with a massive splenic infarction secondary to extrinsic compression from a pancreatic cystic tumor.

Consenso chileno de diagnóstico y manejo de neoplasias quísticas pancreáticas. Club de páncreas Chile-SCHGE

Pancreatic cystic neoplasms (PCN) are frequently detected on abdominal images performed for non-pancreatic indications. Their prevalence in asymptomatic population ranges from 2.7 to 24.8%, and increases with age. There are several types of pancreatic cysts. Some may contain cancer or have malignant potential, such as mucinous cystic neoplasms, including mucinous cystadenoma (MCN) and intraductal papillary mucinous neoplasms (IPMN). In contrast, others are benign, such as serous cystadenoma (SCA). However, even those cysts with malignant potential rarely progress to cancer. Currently, the only treatment for pancreatic cysts is surgery, which is associated with high morbidity and occasional mortality. The Board of the Chilean Pancreas Club of the Chilean Gastroenterology Society developed the first Chilean multidisciplinary consensus for diagnosis, management, and surveillance of PCN. Thirty experts were invited and answered 21 statements with five possible alternatives: 1) fully agree; 2) partially agree; 3) undecided; 4) disagree and 5) strongly disagree. A consensus was adopted when at least 80% of the sum of the answers "fully agree" and "partially agree" was reached. The consensus was approved by the Board of Directors of the Chilean Pancreas Club for publication.

Cistoadenoma seroso de pâncreas. por que a acurácia é baixa aos exames de imagem? / Serous cystadenoma of pancreas: why there is low accuracy in imaging exams?

RESUMO - RACIONAL: Apesar da recomendação atual que o cistoadenoma seroso deva ser tratado de forma conservadora, significativa parte dos pacientes com essa condição ainda é operada por dúvida diagnóstica. OBJETIVO: Analisar causas da baixa acurácia diagnóstica do cistoadenoma seroso. MÉTODOS: Estudo retrospectivo de portadores de cistoadenoma seroso de um banco de dados de dois ambulatórios de cirurgia hepatopancreaticobiliar entre 2006 e 2020. Foram incluídos pacientes com lesões típicas de cistoadenoma seroso aos exames de imagem (tomografia computadorizada, ressonância magnética e ecoendoscopia) e pacientes que o anatomopatológico confirmasse esse diagnóstico. RESULTADOS: 27 pacientes foram incluídos. 85,18% eram do sexo feminino. A idade média foi de 63,4 anos. Apenas um apresentava sintomas típicos de pancreatite. A Ressonância magnética foi o exame mais realizado (62,9%). A lesão era única em 88,9% e o tamanho médio foi 4 cm. O aspecto típico microcístico foi encontrado em 66,6% dos casos, os demais foram considerados atípicos. A ecoendoscopia foi realizada em 29,6%. O valor médio de antígeno carcinoembrionário nos pacientes submetidos à punção do cisto foi de 198,25 ng/mL. O tratamento cirúrgico foi realizado em 10 casos (37%). Em 7, a causa cirúrgica foi a suspeita do cistoadenoma mucinoso mediante identificação de lesões atípicas (unilocular com ou sem septos e macrocística). Em 2, a suspeita de neoplasia papilar intraductal mucinosa com "fatores preocupantes" foi a indicação cirúrgica. O último foi submetido à cirurgia por lesão de aspecto sólido e suspeita de câncer. O índice de complicações > ou = Clavien-Dindo 2 foi 30%, o índice de fístula pancreática clinicamente relevante (B e C) foi 30%. A mortalidade foi nula. CONCLUSÃO: A apresentação morfológica atípica do cistoadenoma seroso, particularmente lesões uniloculares e macrocísticas, é a principal responsável pela indicação cirúrgica. Apenas a implementação de novos, eficientes e reprodutíveis métodos diagnósticos poderá reduzir o número de cirurgias desnecessárias nesses pacientes.

ABSTRACT - BACKGROUND: Many patients with serous cystadenoma of the pancreas (SCP) underwent surgery due to diagnostic doubt. AIM: The aim of this study was to analyze the causes of low accuracy in diagnosing SCP. METHODS: This is a retrospective study of patients with SCP from a database of two hepatopancreatic biliary surgery outpatient clinics between 2006 and 2020. Patients with typical SCP lesions in imaging exams (e.g., tomography, magnetic resonance imaging [MRI], and endoscopic ultrasound [EUS]) and patients whose pathological testing confirmed this diagnosis were included. RESULTS: A total of 27 patients were included in this study. Most patients were women (85.18%), and the mean age was 63.4 years. Only one patient had typical pancreatitis symptoms. MRI was the most performed method (62.9%). The lesion was single in 88.9%, and the average size was 4 cm. The typical microcystic aspect was found in 66.6%. EUS was performed in 29.6% of cases. The mean carcinoembryonic antigen value in patients undergoing cyst puncture was 198.25 ng/mL. Surgical treatment was performed in 10 cases (37%). The cause of surgery in seven of these cases was due to a suspicion of mucinous cystadenoma based on an identification of atypical lesions (unilocular with or without septa and macrocystic) in imaging exams. A suspicion of intraductal papillary mucinous neoplasm with "worrying factors" was the indication for surgery in two cases. The last case underwent surgical treatment for a solid-looking lesion which was suspected of cancer. The complication rate ≥Clavien-Dindo 2 was 30%, and the clinically relevant pancreatic fistula rate (B and C) was 30%. Mortality was nil. CONCLUSION: The atypical morphological presentation of SCP, particularly unilocular and macrocystic lesions, is the main indication for surgery. Only the implementation of new, efficient, and reproducible diagnostic methods can reduce the number of unnecessary surgeries among these patients.

Non-inflammatory pancreatic cysts: from diagnosis to treatment (97 cases series) / Cistos não inflamatórios de pâncreas: do diagnóstico ao tratamento (série de 97 casos)

ABSTRACT Objective: to describe the implications of the diagnosis and treatment of non-inflammatory pancreatic cysts in a series of patients. Methods: we included patients with pancreatic cysts ≥1.0 cm, excluding those with a presumptive diagnosis of a pseudocyst. Imaging tests, echoendoscopy, and histopathology determined the diagnosis of the type of cyst. We applied the guidelines of the International Association of Pancreatology, with some modifications, in patients with mucinous or indeterminate lesions. Results: 97 adult patients participated in the study. A cystic neoplasm of the pancreas was diagnosed in 82.5% of cases. Diagnosis was mainly made by magnetic resonance (46% of cases). The two most common diagnoses were intraductal papillary mucinous neoplasm (43.3%) and serous cystadenoma (26%). Twenty-nine patients underwent surgery (33.3%). The most common surgical procedure was distal pancreatectomy associated with splenectomy in 19 cases (65.5%). Among the operated patients, 11 were diagnosed with cancer. None of the followed, non-operated patients had a diagnosis of cancer. Conclusions: magnetic resonance showed good accuracy, particularly in the diagnosis of intraductal papillary mucinous neoplasm. The guidelines of the International Association of Pancreatology, as applied in this study, showed a negative predictive value for cancer of 100%. A development of better diagnostic tests can reduce the number of unnecessary operations.

RESUMO Objetivo: descrever as implicações do diagnóstico e tratamento dos cistos não inflamatórios do pâncreas em série de pacientes. Metódos: foram incluídos pacientes com cisto de pâncreas ≥1,0cm excluindo aqueles com diagnóstico presuntivo de pseudocisto. Exames de imagem, ecoendoscopia e anatomia-patológica determinaram o diagnóstico do tipo de cisto. As diretrizes da Associação Internacional de Pancreatologia foram aplicadas, com algumas modificações, nos pacientes com lesões mucinosas ou indeterminadas. Resultados: noventa e sete pacientes adultos participaram do estudo. A neoplasia cística de pâncreas foi diagnosticada em 82,5% dos casos. O diagnóstico foi feito principalmente por ressonância magnética (46% dos casos). Os dois diagnósticos mais frequentes foram a neoplasia papilar intraductal mucinosa (43,3%), e o cistoadenoma seroso (26%). Vinte e nove pacientes foram submetidos a operação (33,3%). O procedimento cirúrgico mais comum foi a pancreatectomia corpo-caudal associada à esplenectomia em 19 casos (65,5%). Entre os pacientes operados, 11 tiveram o diagnóstico de câncer. Nenhum dos pacientes seguidos teve o diagnóstico de câncer. Conclusões: a ressonância magnética apresentou boa acurácia, particularmente no diagnóstico da neoplasia papilar intraductal mucinosa. As diretrizes da Associação Internacional de Pancreatologia da forma que foram aplicadas no presente estudo, mostraram valor preditivo negativo para o câncer de 100%. O desenvolvimento de estratégias diagnósticas com melhor acurácia podem reduzir o número de cirurgias desnecessárias.

Neoplasia quística mucinosa gigante del páncreas tratada con pancreatectomía corporocaudal y preservación esplénica / Giant mucinous cystic neoplasm of the pancreas undergoing pancreatectomy with splenic preservation

RESUMEN: La neoplasia quística mucinosa del páncreas (NQMP) es un tumor infrecuente, que afecta predominantemente a mujeres (90-95 %), afectando especialmente entre la quinta y séptima década de la vida; cuyo descubrimiento suele ser incidental. Por lo general, son lesiones solitarias, sin compromiso del conducto pancreático principal; poco sintomáticas y asociadas a malignidad (10 % a 40 %). El objetivo de este manuscrito fue reportar un caso de neoplasia quística mucinosa gigante del páncreas intervenida quirúrgicamente y revisar la evidencia existente respecto de sus características morfológicas, terapéuticas y pronósticas. Mujer de 29 años, con masa abdominal poco sintomática. El diagnóstico se verificó por medio de ultrasonografía, tomografía axial computarizada y resonancia nuclear magnética. Se intervino quirúrgicamente, realizándose pancreatectomía corporocaudal con preservación esplénica, sin incidentes. La paciente fue dada de alta al quinto día, sin complicaciones, y evolucionó de forma adecuada, sin complicaciones postoperatorias. La NMQP es una lesión compleja, que puede asociarse a malignidad, pero el diagnóstico preoperatorio de malignidad no puede establecerse con seguridad. El pronóstico depende de un diagnóstico precoz y un tratamiento oportuno.

SUMMARY: Mucinous cystic neoplasm of the pancreas (MCNP) are variable types of tumors, which predominantly affect women (90-95 %), and usually appear incidentally in the 5th to 7th decade of life. They are generally solitary lesions, with no involvement of the main pancreatic duct, rarely symptomatic and are associated with malignancy (10 % to 40 %). The aim of this manuscript was to report a case of giant mucinous cystic neoplasm of the pancreas surgically treated and review the existing evidence regarding its morphological, therapeutic and prognosis characteristics. Patient: A 29-year-old woman with a slightly symptomatic abdominal mass. The diagnosis was verified with ultrasound, computed axial tomography and magnetic nuclear resonance. The patient underwent surgery; an uneventful corporocaudal pancreatectomy with splenic preservation was performed. She was discharged on the fifth day, and has evolved adequately, without postoperative complications. MCNP is a complex lesion, which can be associated with malignancy, but the preoperative diagnosis of malignancy cannot be established with certainty. Its prognosis depends on early diagnosis and timely treatment.

Duodenal Stricture due to Necrotizing Pancreatitis following Endoscopic Ultrasound-Guided Ethanol Ablation of a Pancreatic Cyst: A Case Report

The frequency of incidental detection of pancreatic cystic lesions (PCLs) is increasing because of the frequent use of cross-sectional imaging. The appropriate treatment for PCLs is challenging, and endoscopic ultrasound-guided ablation for PCLs has been reported in several studies. Although the feasibility and efficacy of this therapeutic modality have been shown, the safety issues associated with the procedure are still a concern. We present a case of a 61-year-old man who underwent ultrasound-guided ethanol ablation for PCL and needed repeated endoscopic balloon dilatation for severe duodenal stricture caused by necrotizing pancreatitis after the cyst ablation therapy.

Multiple Congenital Pancreatic Cysts in a Neonate

Congenital pancreatic cysts are rare in newborn babies, and this makes prenatal diagnosis difficult. Diagnosis can be delayed for a few months after birth until the infant presents with an abdominal mass, abdominal distension, or vomiting due to gastric outlet obstruction. Excision of the cyst is the treatment of choice. A congenital pancreatic cyst should be considered if the fetus has an abdominal cyst without a definite origin. A prompt diagnosis is crucial to prevent fatal complications such as cholangitis, pancreatitis, cyst rupture, and peritonitis. We report a case of neonate with multiple congenital pancreatic cysts suspected prenatally to be stomach diverticulum or duplication cysts of the intestine.

Updated Guidelines for the Management of Pancreatic Cystic Neoplasm / 대한내과학회지

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.

Mucinous Non-neoplastic Cyst of the Pancreas / 대한소화기학회지

Cystic neoplasms of the pancreas consist of a wide range of pathological entities and are being detected more frequently due to advances in cross-sectional imaging modalities and increasing numbers of periodic health checkups. The majority of pancreatic cystic neoplasms are intraductal papillary mucinous neoplasms, serous neoplasms, and mucinous cystic neoplasms, but recently, rare cases of mucinous non-neoplastic cyst of the pancreas (MNCP) have been reported, and despite the availabilities of modern imaging systems, such as MRI and CT, the differentiation of non-neoplastic and neoplastic cysts remains challenging. Herein, we report our experience of a 65-year-old male case with an MNCP.

Endoscopic Ultrasound-based Approach in the Diagnosis and Treatment for Pancreatic Cystic Lesions / 대한췌담도학회지

The accurate diagnosis of pancreatic cystic lesions (PCLs) is important because they determine the strategy of treatment or follow-up. Endoscopic ultrasound (EUS) has been widely used in diagnosis and treatment of PCLs. EUS can be used to obtain additional information in the case of an indeterminate cyst on computed tomography or magnetic resonance imaging, or in case of showing a worrisome feature. Contrast-enhanced EUS showed highly accurate for differential diagnosing of non-neoplastic cysts from neoplastic cyst, and it also useful for distinguishing mural nodules from mucin. EUS-guided fine needle aspiration can be used to analyze cytology, chemistry, and molecular markers in cystic fluid if there is insufficient evidence for the diagnosis by non-invasive modalities. Needle-based confocal laser endomicroscopy allows real time diagnosis of PCLs with good accuracy during EUS-guided fine needle aspiration by subcellular level imaging. Through-the-needle cystoscopy or through-the-needle forceps biopsy are also attempted in these days but the evidence for its effectiveness is insufficient. EUS-guided ablation procedures are emerging as a minimally invasive therapeutic methods for unmet needs in dichotomous treatment policy for PCLs. Large long-term follow-up observational studies have been reported on the feasibility and efficacy of EUS-guided ablation for PCLs with ethanol or in combination with chemoagent. Further study for the actual treatment effects or real clinical benefit would be needed. The use of EUS in the diagnosis and treatment of PCLs is expected to make much progress in the future.

One case report on VHL disease with multiple cysts of the pancreas as the main symptom / 中华内分泌外科杂志

Von Hippel-Lindau (VHL) disease is a benign or malignant tumor syndrome which involves multiple systems and organs.Recently,a patient was diagnosed and hospitalized with an initial clinical symptom of pancreatic multiple cystic space-occupying.Multidisciplinary examination and consultation confirmed that there were hemangioblastomas in cerebella,spinal cord and retina,but with no clinical symptoms;therefore,it was diagnosed as VHL disease.According to previous case reports,only a few single cases revealed lesions in so many parts of the central nervous system with typical imaging manifestations.We present an overview and aim to improve the diagnosis of VHL disease with the initial clinical symptom of pancreatic lesions.

Prevalence of pancreatic cystic neoplasms on imaging exams: association with signs of malignancy risk / Prevalência de lesões císticas pancreáticas em exames de imagem e associação com sinais de risco de malignidade

Abstract Objective: To analyze the prevalence of cystic lesions of the pancreas on imaging exams and their association with signs of malignancy risk. Materials and methods: This was an observational cross-sectional study, in which we evaluated 924 sequential computed tomography and magnetic resonance imaging scans of the abdomen. For all of the patients included in the study, we reviewed the demographic data available in the medical records and evaluated the images. Results: Cysts were observed in 4.5% of patients, the prevalence of cysts being highest (7.6%) in patients over 60 years of age. Lesions were detected at higher rates on magnetic resonance imaging and in patients with pancreatic symptoms (6.1% and 42.9%, respectively). Signs of malignancy risk were observed in 26.3% of the patients, more frequently in those who were male and over 60 years of age. Conclusion: The prevalence of pancreatic cysts was 4.5%. Signs of malignancy risk were observed in 26.3% of the cystic neoplasms identified.

Resumo Objetivo: Analisar a prevalência de lesões císticas do pâncreas em exames de imagem e sua associação com sinais de risco de malignização. Materiais e Métodos: Estudo observacional e transversal em que foram incluídos, sequencialmente, 924 exames de tomografia computadorizada e ressonância magnética abdominais. Foram revisados os dados demográficos disponíveis nos prontuários e as imagens de todos os pacientes incluídos no estudo. Resultados: Verificou-se a presença de cistos em 4,5% dos pacientes, com prevalência maior em pacientes com idade acima de 60 anos (7,6%). A detecção de lesões foi maior na ressonância magnética (6,1%) e em pacientes com queixas pancreáticas (42,9%). Sinais de risco para malignização foram observados em 26,3%, com maior frequência em pacientes do sexo masculino e acima de 60 anos. CONCLUSÃO: A prevalência de cistos pancreáticos foi 4,5%. Foram observados sinais de risco de malignidade em 26,3% dos cistos neoplásicos identificados.

Prevalência de lesões císticas pancreáticas incidentais em exames de tomografia computadorizada e ressonância magnética / Prevalence of incidential pancreatic cysts in computed tomography and magnetic resonance imaging

O objetivo deste estudo foi analisar a prevalência de lesões císticas incidentais do pâncreas visualizadas em exames de tomografia computadorizada e ressonância magnética. Realizado estudo observacional transversal, incluindo 875 exames de tomografia computadorizada e ressonância magnética abdominais. Foram revisados os dados demográficos disponíveis nos prontuários e as imagens de todos os pacientes incluídos no estudo. Verificou-se a presença de cistos em 2,4% pacientes, com maior prevalência em pacientes acima de 60 anos (4,5%). A ressonância magnética identificou cistos pancreáticos em 2,9% dos casos e a tomografia computadorizada em 1,9%. Houve predomínio de pacientes com cistos únicos, localizados na cabeça ou corpo do pâncreas, medindo entre 11 e 30 mm, sem dilatação ductal ou componente sólido associado.

The objective of this study was to analyze the prevalence of incidental cystic lesions of the pancreas visualized in computed tomography and magnetic resonance imaging. An observational crosssectional study was conducted, including 875 abdominal computed tomography and magnetic resonance imaging tests. We reviewed the demographic data available in the medical records and the images of all the patients included in the study. Pancreatic cysts were detected in 2.4% patients, with a higher prevalence in patients over 60 years (4.5%). Magnetic resonance imaging identified pancreatic cysts in 2.9% of cases and computed tomography in 1.9%. There was a predominance of patients with single cysts, located in the head or body of the pancreas, measuring between 11 and 30 mm, without ductal dilation or associated solid component.

Endoscopic Treatment for Pancreatic Cystic Lesions / 대한소화기학회지

The decision of the appropriate treatment for pancreatic cystic lesions (PCLs) is becoming increasingly important as the number of incidentally found PCLs increases. A range of modalities have been attempted because there has been an increasing demand for minimally invasive treatment for PCLs due to the large burden of a surgical resection. Endoscopic treatment using endoscopic ultrasonography (EUS), a representative of minimally invasive therapy, can be categorized into two types: ablation therapy by the injection of drugs and topical thermal coagulative therapy through the high topical energy. A number of studies reported the feasibility and efficacy of these treatments; the most common is EUS-guided ablation for PCLS with ethanol alone or in combination with anticancer drugs. Although ablation therapies with drug injection have proven safety and feasibility, there is no consensus regarding the actual treatment effects and indications of these modalities. EUS-guided radiofrequency ablation was recently attempted as a representative method of local thermal coagulation, but further studies will be needed because of the lack of evidence of its feasibility and safety. In addition, a range of treatments for malignant tumors rather than PCLs have been attempted, such as EUS-guided photodynamic therapy, EUS-guided neodymium-doped yttrium aluminum garnet laser, and high-intensity focused ultrasound, based on the data from animal experiments. Through further study, endoscopic treatment is expected to become established as a useful treatment modality for PCLs.

Recent advances on management of pancreatic cysts / 第二军医大学学报

Pancreatic cysts have many histological subtypes. With development of imaging techniques such as computed tomography and magnetic resonance imaging, detection rate of pancreatic cysts has been increasing. And standardized diagnosis and treatment of pancreatic cysts remains a clinical challenge. Due to insufficient understanding of imaging features and tumor markers of pancreatic cysts, a reasonable procedure of diagnosis and treatment has not been published so far. Several guidelines for the diagnosis and treatment of pancreatic cysts with high impact have been published, including international consensus guidelines, European experts consensus statement and American Gastroenterological Association guidelines. This review focused on the diagnosis and treatment strategies and suggestions proposed by the above guidelines, and application of endoscopic ultrasonography, so as to provid references for treatment of pancreatic cysts.

Laparoscopic treatment for pancreatic pseudocysts / 中华外科杂志

Pancreatic pseudocyst is the most common pancreatic cystic disease in clinical practice.In the surgical treatment of pancreatic pseudocysts, most surgeons preferred laparoscopic surgery in recent years.The options and the timing of laparoscopic surgery for pancreatic pseudocysts in different situations are explored in the paper.Pancreatic pseudocysts during the observation period, the imaging examination to detect whether the cyst has disappeared or increased, such as cysts found to be enlarged or still can not dissipate after 6 months, the largest diameter greater than 6 cm, and clinical symptoms, surgical drainage should be considered treatment.Surgery based on the location of the cyst and surgical experience of surgical options.Pancreatic cyst often choose laparoscopic cyst-gastric anastomosis, far from the stomach cyst should choose laparoscopic cyst-jejunal anastomosis.Laparoscopic surgery for the treatment of pancreatic pseudocyst has a unique advantage, short operation time, less bleeding, less trauma, less postoperative complications, rapid recovery, is a safe and effective treatment options.