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Multifocal Branch Duct Intraductal Papillary Mucinous Neoplasm with 3 cm Lesion in Head of Pancreas
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Atsushi Oba, Robert J. Torphy, Richard D. Schulick, Marco Del Chiaro
Intraductal papillary mucinous neoplasm is a type of pancreatic cystic neoplasm which is increasingly being identified on cross-sectional imaging. Of all the pancreatic cystic neoplasms, the ones with malignant potential, namely main duct intraductal papillary mucinous neoplasm, branch duct type intraductal papillary mucinous neoplasm, and mucinous cystic neoplasm should be clearly identified [1].
Treatment considerations for high-grade appendiceal adenocarcinoma
Published in Wim P. Ceelen, Edward A. Levine, Intraperitoneal Cancer Therapy, 2015
Sean P. Dineen, Melissa Taggart, Richard E. Royal, Paul Mansfield, Keith F. Fournier
The definitive management of an adenoma is typically an appendectomy. However, it should be recalled that as many as 20% of patients will have associated primary malignancies in other locations within the GI tract, so a thorough workup should be performed, particularly a complete colonoscopy [5,6]. Appendiceal adenomas are common in patients with familial adenomatous polyposis syndrome and in patients with ulcerative colitis [7]. One lesion that remains controversial is the mucinous cystic neoplasm, which was previously designated as mucinous cystadenoma (or sometimes erroneously as mucoceles). These neoplastic lesions are mucin producing and typically present with appendicitis. The majority shows simplified epithelium with banal cytologic features. A minor subset may result in extra-appendiceal proliferation and mucin production, which, when severe, may result in pseudomyxoma peritonei (discussed in the succeeding text). Unfortunately, definitive criteria predicting which lesions will be cured with appendectomy and which may progress as pseudomyxoma peritonei are lacking. Therefore, we and others have used the term low-grade appendiceal mucinous neoplasm (LAMN) for these lesions [8].
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
As described throughout this review, the main strength of EUS-TTNB is the ability to accurately diagnose PCLs with a higher degree of precision. Even when other methods fail, this technique is capable of yielding a definitive diagnosis due to availability of both stroma and epithelium within the sample [50]. EUS-TTNB provides paramount clinical value when the morphology of the cyst is nonspecific. Exact identification of cyst characteristics is crucial for arriving at a diagnosis and informing the appropriate management strategies. This aspect of clinical care is particularly salient in patients with large unilocular/oligocystic PCLs that lack well-defined connections to the pancreatic ducts, as the management strategies are radically different depending of the PCL characteristics. Management requires invasive surgical intervention for mucinous cystic neoplasm and cystic neuroendocrine tumor, while a serous cystadenoma would not require further follow-up, nor any additional testing.
Trends in management and outcome of cystic pancreatic lesions – analysis of 322 cases undergoing surgical resection
Published in Scandinavian Journal of Gastroenterology, 2019
Kim Ånonsen, Mushegh A. Sahakyan, Dyre Kleive, Anne Waage, Caroline Verbeke, Truls Hauge, Trond Buanes, Bjørn Edwin, Knut Jørgen Labori
Final histological diagnoses are presented in Table 3. The most common diagnoses were intraductal papillary mucinous neoplasia (IPMN, 36.0%), serous cystic neoplasm (SCN, 23.9%), mucinous cystic neoplasm (MCN, 10.6%), pseudocyst (9.6%), solid pseudopapillary neoplasm (SPN, 7.8%), and cystic pancreatic neuroendocrine tumours (cPNET, 5.3%). During the intermediate period, the relative distribution of histopathological diagnosis of resected CPL changed. The most common resected lesion within the first period of the study was SCN, and this significantly decreased during the intermediate period (38.2% vs. 21.3% vs. 16.0%). The percentage of patients who underwent resection for IPMN increased in the last period of the study (31.5% vs. 30.6% vs. 44.0%). The relative proportion of resected MCN, SPN, cPNET, and pseudocysts did not change over time.
Neutrophil-to-lymphocyte ratio and mural nodule height as predictive factors for malignant intraductal papillary mucinous neoplasms
Published in Acta Chirurgica Belgica, 2018
Yusuke Watanabe, Yusuke Niina, Kazuyoshi Nishihara, Takafumi Okayama, Sadafumi Tamiya, Toru Nakano
To predict malignant IPMN and determine surgical indications, the ICG 2012 for the management of IPMN and mucinous cystic neoplasm suggested unique strategies according to the classification into two categories of the clinical and radiological preoperative findings that predict malignancy, namely high-risk stigmata and worrisome features [5]. Pancreatectomy is strongly recommended for patients with any high-risk stigmata because of high suspicion of malignant IPMN. Pancreatectomy is not automatically recommended for patients with worrisome features and further examinations, such as endoscopic ultrasonography (EUS) or endoscopic retrograde cholangiopancreatography, are recommended. High-risk stigmata was correlated with the prevalence of malignant IPMN with a high sensitivity; however, the specificity and positive predictive value for malignant IPMN are still unsatisfactory [6,7]. This diagnostic strategy might overestimate the preoperative risk of malignant IPMN. Therefore, a better preoperative predictive strategy for malignant IPMN is needed.