Quiste hidatídico primario de páncreas: reporte de caso

Introducción. El quiste hidatídico puede localizarse en cualquier órgano del cuerpo. El quiste hidatídico en el páncreas (QHP)se presenta con una prevalencia menor a 1%, la localización más frecuente es la cabeza en 61% a 69%, en el cuerpo y cola en 31% a 39%. No es fácil diferenciar el quiste hidatídico pancreático de otros tumores quísticos del páncreas, por lo que esta patología debe tenerse en cuenta en el diagnóstico diferencial de lesiones quísticas pancreáticas. Caso Clínico. Paciente femenino de 66 años quien desde el año 2016 se encontraba en control por una tumoración quística de la cola pancreática de 1,7 cm, diagnosticada en forma incidental. La paciente cursó asintomática y se controló en forma anual. El año 2021 la lesión alcanzó un tamaño de 4,7 cm. En este contexto se decide la resección quirúrgica por vía laparoscópica. Se resecó una pieza quirúrgica de 8 cm de longitud que incluye la cola del páncreas y el quiste. La histología describe la membrana prolígera y múltiples escólex viables. Conclusión. La localización primaria en la cola del páncreas de un quiste hidatídico confunde el diagnóstico con un tumor quístico mucinoso. El tratamiento quirúrgico actual en los quistes distales debería ser la resección laparoscópica.

Introduction. The hydatid cyst can be located in any organ of the body. The hydatid cyst in the pancreas occurs with a prevalence of less than 1%, the most frequent location is the head in 61% to 69%, the body and tail in 31% to 39%. It is not easy to differentiate the pancreatic hydatid cyst from other cystic tumors of the pancreas, so this pathology must be taken into account in the differential diagnosis of pancreatic cystic lesions. Clinical Case. The present report discusses a 66-year-old female patient who had been in control since 2016 for a 1.7 cm cystic tumor of the pancreatic tail. The patient was asymptomatic and was controlled annually. In 2021, the lesion reached a size of 4.7 cm. In this context, laparoscopic surgical resection was decided. An 8 cm long surgical specimen was resected, including the tail of the pancreas and the cyst. Histology describes prolific membrane and multiple viable scolexes. Conclusion. The primary location in the tail of the pancreas of a hydatid cyst confuses the diagnosis with a mucinous cystic tumor. The current surgical treatment for distal cysts should be laparoscopic resection.

Intraductal tubular papillary neoplasm (ITPN), a novel entity of pancreatic epithelial neoplasms and precursor of cancer: A case report and review of the literature.

BACKGROUND: Intraductal tubular papillary neoplasm (ITPN) displays a very rare subtype of epithelial neoplasms of the pancreas. ITPN is characterized by intraductal tubulopapillary growth and cellular dysplasia. In contrast to intraductal papillary neoplasm (IPMN) no overt epithelial mucin production is observed. To date, little is known about ITPN and particularly about pancreatic cancer arising in this tumor entity. CASE PRESENTATION: A 68-year-old male presented at our hospital with a distal bile duct occlusion suspicious for adenocarcinoma of the pancreatic head. Preoperative staging revealed no signs of distant metastasis. The patient was surgically explored and pylorus preserving duodenopancreatectomy was performed for a solid pancreatic head tumor. Final histopathology surprisingly revealed an ITPN with an associated invasive carcinoma pT3, pN0 (0/12), R0, G2. DISCUSSION: Patients with ITPN frequently present with jaundice suspicious for a bile duct stenosis or a malignant tumor of the pancreatic head. Although, it is possible to diagnose ITPN by endoscopic retrograde cholangiopancreaticography, many tumors are found not before histopathological examination. Differential diagnosis includes ductal adenocarcinoma of the pancreas, neuroendocrine tumors, IPMN, distal bile duct tumors, and solid pseudopapillary neoplasms. Using immunohistochemistry, other entities of pancreatic tumors can be ruled out. In case of R0 resection oncological prognosis is described to be more favorable when compared to regular ductal adenocarcinoma. CONCLUSION: ITPN displays a rare entity of pancreatic neoplasms. As shown in the present case report, there is a relevant potential of malignant transformation and therefore radical surgical resection and oncologic follow-up is warranted.

64-Slice spiral computed tomography and three-dimensional reconstruction in the diagnosis of cystic pancreatic tumors.

The present study aimed to describe the characteristics of cystic pancreatic tumors using computed tomography (CT) and to evaluate the diagnostic accuracy (DA) of post-imaging three-dimensional (3D) reconstruction. Clinical and imaging data, including multi-slice spiral CT scans, enhanced scans and multi-faceted reconstruction, from 30 patients with pathologically confirmed cystic pancreatic tumors diagnosed at the Linyi People's Hospital between August 2008 and June 2014 were retrospectively analyzed. Following the injection of Ultravist® 300 contrast agent, arterial, portal venous and parenchymal phase scans were obtained at 28, 60 and 150 sec, respectively, and 3D reconstructions of the CT images were generated. The average age of the patients was 38.4 years (range, 16-77 years), and the cohort included 5 males and 25 females (ratio, 1:5). The patients included 8 cases of mucinous cystadenoma (DA), 80%]; 9 cases of cystadenocarcinoma (DA, 84%); 6 cases of serous cystadenoma (DA, 100%); 3 cases of solid pseudopapillary tumor (DA, 100%); and 4 cases of intraductal papillary mucinous neoplasm (DA, 100%). 3D reconstructions of CT images were generated and, in the 4 cases of intraductal papillary mucinous neoplasm, the tumor was connected to the main pancreatic duct and multiple mural nodules were detected in one of these cases. The DA of the 3D-reconstructed images of cystic pancreatic tumors was 89.3%. The 64-slice spiral CT and 3D-reconstructed CT images facilitated the visualization of cystic pancreatic tumor characteristics, in particular the connections between the tumor and the main pancreatic duct. In conclusion, the 3D reconstruction of multi-slice CT data may provide an important source of information for the surgical team, in combination with the available clinical data.

Neoplasia mucinosa gigante de páncreas: presentación de caso clínico y revisión de la literatura / Giant mucinous neoplasm of the pancreas: presentation of a case and review of the literature

Female, 34 year-old patient with diffuse abdominal pain, bloating, and early satiety. Results from a study performed show a complex cystic mass in the pancreas with positive pancreatic mucinous cystadenoma histology. Cystadenoma/Mucinous cystadenocarcinoma represent 10 percent of cystic tumors within the pancreas, which occurr almost exclusively in women. Grossly they are uni or multilocular and contain dense, rich in mucinous matter. Histologically they exhibit columnar epithelium with presence of ovarian stroma. They vary in size, with a 10 cm average. Given their malignancy risk, surgical resection is recommended. Ultrasonography (US) helps to identify these lesions, however fails to provide a definitive diagnosis. Computed tomography (CT) and Magnetic resonance imaging (MRI) have higher accuracy, helping to identify aggressive nature in 75-90 percent. MRI is the test of choice for its resolution capacity. Endoscopic US allows for better characterization and for conducting fine-needle aspiration (FNA) for biochemical and cytological analysis of the liquid, achieving a significant increase in the diagnosis specificity. The differential diagnosis must be performed with other cystic lesions, considering that the final diagnosis is histological. The American College of Radiology suggests the use of surgical resection of mucinous neoplasms of the pancreas, Intraductal papillary or mucinous tumors the IPMT main duct and branch (if symptomatic, growing progressively, > 3 cm, have solid component and/or main duct dilation associated)...

Paciente 34 años, femenino, con dolor abdominal difuso, meteorismo y saciedad precoz. Se realiza estudio con imágenes que demuestran una gran masa quística compleja del páncreas cuya histología fue positiva para cistoadenoma mucinoso de páncreas. Los cistoadenomas/cistoadenocarcinomas mucinosos representan el 10 por ciento de los tumores quísticos del páncreas y se presentan casi exclusivamente en mujeres. Macroscópicamente son uni o multicavitados y contienen material denso, rico en mucina. Histológicamente presentan epitelio cilíndrico con presencia de estroma ovárico. Su tamaño es variable con promedio de 10 cm. Dado el riesgo de malignización se prefiere resección quirúrgica. La ultrasonografía (US) identifica estas lesiones, sin embargo, no llega a diagnóstico definitivo. La tomografía computarizada (TC) y la resonancia magnética (RM), presentan una precisión mayor, ayudando a diferenciar el carácter agresivo en 75-90 por ciento. La RM es el examen de elección por su capacidad de resolución. La US endoscópica permite una mejor caracterización y la realización de punción-aspiración con aguja fina (PAAF) para el estudio bioquímico y citológico del líquido, consiguiendo aumentar considerablemente la especificidad del diagnóstico. El diagnóstico diferencial debe realizarse con otras lesiones quísticas, teniendo en cuenta que el diagnóstico definitivo es histológico. El American College of Radiology sugiere resección quirúrgica de las neoplasias mucinosas de páncreas, y de los tumores papilares mucinosos intraductales (TPMI) de ducto principal y de rama (si son sintomáticos, crecen en forma progresiva, presentan un diámetro > 3 cm, presentan componente sólido y/o se asocian dilatación del conducto principal)...

Early detection and prevention of pancreatic cancer: is it really possible today?

Pancreatic cancer is the 4(th) leading cause of cancer-related death in Western countries. Considering the low incidence of pancreatic cancer, population-based screening is not feasible. However, the existence of a group of individuals with an increased risk to develop pancreatic cancer has been well established. In particular, individuals suffering from a somatic or genetic condition associated with an increased relative risk of more than 5- to 10-fold seem to be suitable for enrollment in a surveillance program for prevention or early detection of pancreatic cancer. The aim of such a program is to reduce pancreatic cancer mortality through early or preemptive surgery. Considering the risk associated with pancreatic surgery, the concept of preemptive surgery cannot consist of a prophylactic removal of the pancreas in high-risk healthy individuals, but must instead aim at treating precancerous lesions such as intraductal papillary mucinous neoplasms or pancreatic intraepithelial neoplasms, or early cancer. Currently, results from clinical trials do not convincingly demonstrate the efficacy of this approach in terms of identification of precancerous lesions, nor do they define the outcome of the surgical treatment of these lesions. For this reason, surveillance programs for individuals at risk of pancreatic cancer are thus far generally limited to the setting of a clinical trial. However, the acquisition of a deeper understanding of this complex area, together with the increasing request for screening and treatment by individuals at risk, will usher pancreatologists into a new era of preemptive pancreatic surgery. Along with the growing demand to treat individuals with precancerous lesions, the need for low-risk investigation, low-morbidity operation and a minimally invasive approach becomes increasingly pressing. All of these considerations are reasons for preemptive pancreatic surgery programs to be undertaken in specialized centers only.

Tumores quísticos del páncreas: visión quirúrgica y cohorte de pacientes / Cystic tumors of the pancreas: surgical vision and a patient cohort

Se presenta una cohorte retrospectiva de diez pacientes con tumores quísticos del páncreas, intervenidos en su mayoría – algunos por laparoscopia –, haciendo énfasis en su estudio, diagnóstico y tratamiento quirúrgico, mostrando algunas de las variables evaluadas en su manejo y con especial mención de su enfoque quirúrgico con base en una revisión sistemática de la literatura.

We present a retrospective study of a cohort of ten patients with cystic tumors of the pancreas, most of whom underwent surgery. The study emphasizes study, diagnosis, and treatment of the four who underwent laparoscopic surgery. It presents some of the variables analyzed in their management and pays special attention to their surgery treatment. A systematic review of the literature is also included.