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Objective:To investigate the clinical imaging features and prognosis of von Hippel-Lindau (VHL) syndrome associated with pancreatic lesions.Method:The retrospective case-control study was conducted. The clinicopathological data of 161 patients with VHL syndrome who were admitted to Peking University First Hospital from September 2010 to August 2022 were collected. There were 83 males and 78 females, with age of onset as 27.0(range, 8.0-66.0)years. Observation indicators: (1) imaging results of VHL syndrome associated with pancreatic lesions; (2) clinical characteristics of VHL syndrome associated with pancreatic lesions; (3) comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic cystic lesions; (4) comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic neuroendocrine neoplasms (pNENs). (5) Treatment and prognosis of patients with VHL syndrome associated with pancreatic lesions. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the non-parameter test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. Results:(1) Imaging results of VHL syndrome associated with pancreatic lesions. Of the 161 patients with VHL syndrome, there were 151 patients associated with pancreatic lesions and 10 patients not associated with pancreatic lesions. Of the 151 patients with VHL syndrome associated with pancreatic lesions, there were 136 patient with pancreatic cystic lesions and 34 patients with pNENs, 22 patients with both pNENs and pancreatic cystic lesions, and the type of pancreatic lesions could not be accurately determined in 3 cases. (2) Clinical characteristics of VHL syndrome associated with pancreatic lesions. The age of onset in 151 patients with VHL syndrome associated with pancreatic lesions was 33.0(range, 14.0-68.0)years. Cases with gene site mutation of exon 1, exon 2, exon 3 and other types of gene site was 51, 16, 43 and 41, respectively. There were 116 patients of VHL type 1 and 35 patients of VHL type 2. There were 92 patients with family history of VHL syndrome and 59 patients without family history of VHL syndrome. There were 127 patients combined with renal cell carcinoma, 112 patients combined with central nervous system lesions, 46 patients combined with retinal hemangioblastoma. Patients may combined with multiple lesions. (3) Comparison of clinicopathological factors in patients with VHL syndrome associated with pancreatic cystic lesions. The age of onset, VHL syndrome type (VHL1 type, VHL2 type) and cases combined with renal cell carcinoma were 32.5(range, 14.0-68.0)years, 110, 26 and 115 in 136 patients with VHL syndrome associated with pancreatic cystic lesions, versus 22.0(range, 8.0-64.0)years, 13, 12 and 14 in 25 patients with VHL syndrome not associated with pancreatic cystic lesions, showing significant differences in the above indicators between them ( Z=-3.384, χ2=9.770, 10.815, P<0.05). (4) Comparison of clinicopathological factors in patients with VHL syndrome associated with pNENs. The age of onset, gene mutation sites (exon 1, exon 2, exon 3, other types of gene site) and VHL syndrome type (VHL1 type, VHL2 type) were 33.5(range, 14.0-64.0)years, 12, 5, 14, 3 and 18, 16 in 34 patients with VHL syndrome associated with pNENs, versus 27.0(range, 9.0-66.0)years, 41, 12, 32, 42 and 105, 22 in 127 patients with VHL syndrome not associated with pNENs, showing significant differences in the above indicators between them ( Z=-4.030, χ2=8.814, 13.152, P<0.05). (5) Treatment and prognosis of patients with VHL syndrome associated with pancreatic lesions. Of the 161 patients with VHL syndrome, 3 patients underwent surgical treatment, and the remaining patients were followed up. All 161 patients with VHL syndrome were followed up for 6 (range, 1-12)years, in which 15 patients died and 146 patients alive during the follow-up. The follow-up time of 3 patients undergoing surgical treatment was 4, 14, 9 years, respectively, and all of them were alive. Conclusions:The clinical imaging features of pancreatic lesions related to VHL syndrome are cystic lesions and pNENs, which with the characteristics of multiple lesions and benign tumors. Such patients usually do not requiring surgical treatment and have good prognosis.
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<p><b>OBJECTIVE</b>To identify the predictive factors for differentiating pancreatic ductal adenocarcinoma (PDAC) from other neoplastic solid pancreatic lesions and assess the accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for diagnosis of PDAC.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of patients referred for EUS-FNA evaluation of pancreatic lesions in the Digestive Endoscopic Center of Nanfang Hospital between January, 2009 and May, 2016. The cases with unknown diagnosis, missing data, repeated punctures, cystic lesions and benign lesions were excluded from the analysis. The positivity rates of EUS-FNA were compared between patients with PDAC and those with non-PDAC lesions, and the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of EUS-FNA were assessed in the diagnosis of PDAC. Univariate and multivariate logistic regression analyses were used to identify the factors for differentiating PDAC from non-PDAC lesions based on the demographic characteristics, clinical presentations, laboratory data, and endoscopic ultrasonography imaging features of the patients.</p><p><b>RESULTS</b>Among the 75 patients with solid neoplastic pancreatic lesions, 54 (72.0%) were found to have PDAC and 21 (28.0%) had non-PDAC lesions. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA for the diagnosis of PDAC were 77.8%, 100.0%, 100.0%, 63.6% and 84.0%, respectively. No significant difference was found in the positivity rate of EUS-FNA between patients with PDAC and those with non-PDAC lesions (77.8% 76.2%, > 0.05). Multivariate regression analysis identified abdominal pain (=5.163, 95%: 1.093-24.389, =0.038), lesion size (=0.926, 95%: 0.877-0.978, =0.006), characteristics of the solid lesions (=7.105, 95%: 1.440-35.043, =0.016), and evidence of metastases (=6.165, 95%: 1.332-28.533, =0.020) as the independent factors for predicting PDAC.</p><p><b>CONCLUSIONS</b>The pretest characteristics including abdominal pain, evidence of metastases, and lesion size and lesion characteristics defined by endoscopic ultrasonography findings can reliably predict a diagnosis of PDAC. EUS-FNA has a high sensitivity and a high specificity for the diagnosis of PDAC.</p>
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Objective To study the feasibility,safety,indications and possible advantages of minimally invasive surgery over traditional open surgery in treating pancreatic body or tail lesions.Methods From December 2009 to December 2014,the clinical data of 71 patients with lesions in pancreatic body or tail who underwent minimally invasive distal pancreatectomy (MIDP) or open distal pancreatectomy (ODP) at the General Surgery of Huadong Hospital were retrospectively analyzed.There were 22 patients in the MIDP group and 49 patients in the ODP group.The operations in 15 patients in the MIDP group were performed by the Da Vinci robot-assisted surgical system and 7 patients by laparoscopic distal pancreatectomy.Results The MIDP group had a shorter time to pass first flatus [(MIDP (2.5 ± 1.0) d vs ODP (3.5 ±1.0)d,P ＜ 0.05],and shorter postoperative hospital stay [(MIDP (15.2 ± 7.9) d vs ODP (23.4 ±21.2) d,P ＜ 0.05] than the ODP group.There were no significant differences on total pancreatic fistula rate [MIDP 45.5％ (10/22) vs ODP 55.1％ (27/49),P ＞ 0.05] and symptomatic postoperative pancreatic fistula rate [MIDP 18.2％ (4/22) vs ODP 18.4％ (9/49),P ＞ 0.05] between the two groups.The MIDP group had a significant longer operative time [MIDP (246.3 ±75.3)min vs ODP (168.1 ±33.7)min,P＜0.05] than the ODP group.Conclusions Minimally invasive surgery is safe and feasible in treatment of lesions in pancreatic body or tail with less trauma and faster recovery.The application of robotic surgery has expanded the treatment options for lesions in pancreatic body or tail.
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Objective To evaluate the diagnostic value of the cell block (CB) with immunostaining method by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy for pancreatic lesions.Methods A total of 72 patients with pancreatic lesions underwent EUS-FNA at the First Affiliated Hospital of Guangxi Medical University from March 2012 to June 2013.The EUS-FNA samples of all patients were processed by conventional smear cytology,liquid-based cytology (LBC) and the cell block with immunostaining.Results There were 61 pancreatic patients who were finally diagnosed as having pancreatic tumors,including 55 cases of pancreatic cancer,2 pancreatic solid pseudopapillary tumor,4 pancreatic endocrine tumors (PETs),and 11 benign lesions:4 chronic pancreatitis,2 pancreatic tuberculosis,4 pancreatitis and 1 pancreatic mucinous cystadenoma.The diagnostic sensitivity of conventional smear cytology,liquid-based cytology and cell block with immuno-staining method were 68.9％ (42/61),75.4％ (46/61) and 90.2％ (55/61),respectively.The diagnostic specificity of three methods were all 100.0％.The diagnostic accuracy rates were 73.6％ (53/72),79.2％ (57/72) and 91.7％ (66/72),respectively.The diagnostic accuracy rate of the cell block with immunostaining was higher than those of conventional smear cytology (P ＜ 0.05) and the liquid-based cytology (P ＜ 0.05).Conclusion Endoscopic ultrasound-guided fine-needle aspiration is a safe and effective method with high sensitivity and specificity in the diagnosis of pancreatic lesions.Cell block method combining immunohistochemistry helps to increase the diagnosis and histological diagnosis of pancreatic lesions.The cell block has a greater clinical value in the diagnosis of pancreatic lesions.
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Correlacionar os achados citológicos obtidos por punção aspirativa por agulha fina ecoguiada com o seguimento clínico ou resultado histopatológico dos pacientes. Estudo transversal observacional com análise de 32 prontuários de pacientes com lesões pancreáticas submetidos à PAAF, sendo consideradas as variáveis: idade; sexo; topografia da lesão; diagnóstico citopatológico; resultado do exame histopatológico e de congelação por punção. Foi calculada a sensibilidade do método em diagnosticar malignidade e a sensibilidade, especificidade, VPP, VPN e acurácia para o diagnóstico de adenocarcinoma. A média de idade dos pacientes foi 64,9 anos com predomínio do sexo feminino; a cabeça do pâncreas foi a topografia mais acometida pelas lesões (64%); o diagnóstico mais freqüente foi de adenocarcinoma (78%). O método apresentou sensibilidade de 93% para malignidade e 92% para adenocarcinoma. A PAAF, na presente casuística, se mostrou rápida, segura e eficaz, tendo alta correlação com o exame histopatológico ou evolução clínica.
To correlate the cytological findings obtained by ultrasonically guided by fine needle aspiration and with clinical follow-up of patients. An observational cross-sectional study was done, on which 32 records of patients with pancreatic lesions underwent FNA were analyzed, considering the following variables: age, sex, topography of the lesion, diagnosis, descriptive diagnosis, result of histopathological and freezing by puncture. Were calculated the sensitivity of the method in diagnosing malignancy and the sensitivity, specificity, PPV, NPV and accuracy for diagnosing adenocarcinoma. The average age of patients was 64,9 years with a predominated of female, the head of the pancreas was most affected by the topography of lesions (64%), the most common diagnosis was adenocarcinoma (78%). The method had sensitivity for malignancy of 93% and 92% for adenocarcinoma. FNA, in this series, proved to be fast, safe and effective having high correlation with histopathology and clinical outcome in this study.
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Antecedentes: la ecoendoscopia combina la imagen endoscópica y la imagen del ultrasonido para visualizar la pared del tracto gastrointestinal y de sus estructuras adyacentes. Desde su introducción, hace más de una década, la ecoendoscopia con punción guiada con aguja fina ha sido la herramienta segura para la obtención de material en pacientes con malignidades del tracto gastrointestinal, pancreáticas y torácicas. Objetivos: correlacionar el diagnóstico ecoendoscópico con el diagnóstico histológico y evaluar el seguimiento de todos los pacientes. Resultados: 106 pacientes, 59 (55,7%) femeninos, 47 (44,3%) masculinos con edades entre los 18 y 84 años (media de 55μ15 años). Se diagnosticaron con la EE radial lesiones pancreáticas sólidas 35,8% (n=38), lesiones murales 17,9% (n=19), lesiones pancreáticas quísticas 14,2% (n=15), pancreatitis crónica y/o inmunológica 9,4% (n=10), nódulos linfáticos 8,5%(n=9) entre otras. Se diagnosticaron con la EE-FNA lesiones pancreáticas sólidas 39,6% (n=8), lesiones murales 18,9%(n=20), lesiones pancreáticas quísticas 14,2% (n=15), pancreatitis crónica y/o inmunológicas 8,5% (n=9), nódulos linfáticos 7,5% (n=8). Al comparar los resultados de la EE radial con la EE lineal el diagnóstico de la punción coincidió en un 96%. El diagnóstico histológico se reportó como positivo para malignidad en 53,8% (n=57), negativo para malignidad 32,1% (n=34), sospechoso para malignidad 5,7% (n=6), atipia celular y/o indeterminado 4,7% (n=5), muestra inadecuada 3,8% (n=4). En un 74,8% coincidieron los resultados de la EE lineal con el diagnóstico histológico. Un total de 58% (n=62) recibieron tratamiento y un 41,5% (n=44) no recibió ningún tratamiento; de 70 pacientes que no se operaron, actualmente el 23% de ellos (n=16) falleció y el 77% (n=54) vive y los que recibieron algún tratamiento 11% (n=4) falleció y un 89% (n=32) vive. Conclusiones: el diagnóstico por EE radial puede ser corroborado positivamente con la EE-FNA y este a su vez puede ser correlacionado con los resultados de la histología, formando parte fundamental de la precisión de la conclusión del diagnóstico histológico de la muestra obtenida por la punción.
Background: Echoendoscopy combines endoscopic and ultrasound image to visualize the wall of the gastrointestinal tract and its adjacent structures. Since its introduction more than a decade ago, endoscopic ultrasonographyguided fine-needle puncture has been a reliable tool for obtaining material in patients with gastrointestinal tract, pancreatic and chest malignancies. Objective: To correlate the ecoendoscopic diagnosis with histological diagnosis and evaluate the follow-up of all patients. Results: 106 patients, 59 (55.7%) female, 47 (44.3%) male aged 18 to 84 years (mean 55 μ 15 years). Radial EE helped diagnose solid pancreatic lesions 35.8% (n = 38), wall lesions 17.9% (n = 19), pancreatic cystic lesions 14.2% (n = 15), chronic and / or immunologic pancreatitis 9.4% (n = 10), lymph nodes 8.5% (n = 9) among others. With FNA- EE the results were solid pancreatic lesions 39.6% (n = 8), Wall lesions 18.9 (n = 20 ), pancreatic cystic lesions 14.2% (n = 15), chronic and / or immunologic pancreatitis 8.5% (n = 9), lymph nodes 7.5% (n = 8). Comparing linear EE with radial EE it was found that puncture diagnosis coincided 96%. The histological diagnosis was reported as positive for malignancy in 53.8% (n = 57), negative for malignancy 32.1% (n = 34), suspicious for malignancy 5.7% (n = 6), and cellular atypia / or undetermined 4.7% (n = 5), inappropriate sample 3.8% (n = 4). In 74.8% agreed the the EE linear finding coincided with the histological diagnosis. A total of 58% (n = 62) was treated, and 41.5% (n = 44) received no treatment; of 70 patients who were not currently operated 23% (n = 16) died and 77% ( n = 54) lives and in those who received some treatment 11% (n = 4) died and 89% (n = 32) lives. Conclusions: The diagnosis by radial EE can be corroborated positively with FNA -EE, and this in turn be correlated with the results of the histology becoming an essential part in the accuracy of the conclusion of the histological diagnosis of the sample obtained by puncture.