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Von Hippel−Lindau Syndrome
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Found in up to 70% of patients, with a mean onset age of 36 years, pancreatic cyst and neuroendocrine tumor are slow-growing and hormonally inactive, and their mass effect on the intestine or bile duct may be problematic at times [23]. In addition, through replacement of pancreatic parenchyma, these lesions may contribute to exocrine or endocrine deficiency. In 8% of patients, PNET may become malignant and metastatic.
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Published in V.K. Kapoor, Hans G. Beger, Acute Pancreatitis, 2017
A true pancreatic cyst is lined with epithelium (cf. pseudocyst which has a wall of inflammatory granulation and fibrous tissue without an epithelial lining). A true cyst needs excision (cf. drainage for pseudocyst).
Effectiveness of steroid therapy for pancreatic cysts complicating autoimmune pancreatitis and management strategy for cyst-related complications
Published in Scandinavian Journal of Gastroenterology, 2019
Yasuhiro Kuraishi, Takayuki Watanabe, Takashi Muraki, Norihiro Ashihara, Makiko Ozawa, Akira Nakamura, Keita Kanai, Hideaki Hamano, Shigeyuki Kawa
The cause and risk factors of cysts associated with AIP have not been fully elucidated. Two reports have addressed the mechanism of pancreatic cyst formation in AIP. Kubota et al. described that cyst development was significantly associated with peripancreatic vascular involvement and gastrointestinal varices, showing that the highly active inflammation of the pancreatic parenchyma and left-sided portal hypertension caused by peripancreatic involvement were responsible for AIP cysts [14]. On the other hand, Matsubayashi et al. suggested a mechanism of severe stricture in the main pancreatic duct leading to the upstream stasis of pancreatic juice [15]. Steroid therapy was highly effective since the rapid improvement of pancreatic duct narrowing by treatment released the pancreatic juice stasis. Similar effects on pancreatic cysts have also been observed as steroids caused the shrinkage and disappearance of pancreatic cysts in AIP [8,10,16]. However, surgical resection or endoscopic intervention is occasionally selected without steroid therapy [7,10,13]. Thus, there is insufficient consensus on the therapeutic strategy for pancreatic cysts in AIP, which has been complicated by several reports of cysts that were unresponsive to steroid treatment [7,14] or disappeared spontaneously [11]. As there have been no direct comparative studies between pancreatic cysts in AIP with and without steroid therapy, it is controversial whether drugs are actually effective and regarding the optimal method for candidate selection.
Pancreatic echinococcosis
Published in Baylor University Medical Center Proceedings, 2019
Priti Soin, Pranav Sharma, Puneet Singh Kochar
Imaging plays an important role in diagnosis. Abdominal ultrasonography is a very sensitive imaging modality for diagnosing hydatid cysts. Characteristic sonographic findings include floating membranes and hydatid sand and daughter cysts; however, the sensitivity is low due to the deep retroperitoneal location and overlying bowel gas.7 Floating membranes and daughter cysts within a larger mother cyst can also be seen on CT and MRI to suggest diagnosis.5 Endoscopic ultrasound can better evaluate the nature of the pancreatic cyst. Floating membranes within the cyst as serpentine linear structures are highly specific for hydatid disease.9 Additionally, guided aspiration of cystic fluid can help to exclude pancreatic cystic neoplasms and pseudopancreatic cysts.2 Magnetic resonance cholangiopancreatography is helpful in evaluating the biliary tract and pancreatic duct when the cystic mass is located in the pancreatic head.10 Numerous blood tests are available for detecting specific serum antibodies and echinococcal antigens.1 The ELISA test for echinococcal antigen is usually positive, with a sensitivity of 93.5%, specificity of 89.7%, and diagnostic accuracy of 92.3%.11 Newer ELISA techniques have sensitivity and specificity of 98.0% and 96.2%, respectively.12
Through-the-needle biopsy of pancreatic cystic lesions: current evidence and implications for clinical practice
Published in Expert Review of Medical Devices, 2021
Antonio Facciorusso, Daryl Ramai, Paraskevas Gkolfakis, Alexandra Shapiro, Marianna Arvanitakis, Andrea Lisotti, Konstantinos Triantafyllou, Pietro Fusaroli, Ioannis S Papanikolaou, Stefano Francesco Crinò
A salient component of this research investigated the number of biopsy samples required to reach the desired advantages. Findings indicated that two EUS-TTNB samples led to a correct specific diagnosis of the pancreatic cyst in 74% of patients, and demonstrated that collection of a third specimen did not provide any additional information [22]. This finding represents an important step toward outlining use of EUS-TTNB technique in clinical practice. However, larger prospective studies are needed to confirm this result.