Growth Rate Of Cysts Research Articles

Ultrasound study of natural progression of ovarian endometrioma.

To determine the natural progression of ovarian endometrioma in women who are managed expectantly. This was a retrospective cohort study of 83 women with evidence of ovarian endometrioma who were managed expectantly between April 2007 and May 2022. The study was conducted in the Department of Women's Health, University College London Hospitals and The Gynecology Ultrasound Centre, London, UK. We searched our ultrasound clinic databases to identify women aged 18 years or older with evidence of ovarian endometrioma who were managed expectantly for ≥ 6 months. All women attended for a minimum of two ultrasound scans performed by a single expert ultrasound operator. In addition to patient demographics, we recorded the number, mean diameter and location of each cyst. The cyst growth rate was expressed as annual change in the mean diameter. A total of 1922 women who attended our gynecology clinic during the study period were found to have evidence of moderate or severe endometriosis on pelvic ultrasound examination. Of those, 83 women had evidence of ovarian endometrioma and were managed expectantly. The median age of women was 39 (range, 26-51) years at the initial visit. Each woman had at least two ultrasound scans performed by a single expert operator at a minimum interval of ≥ 6 months. Of 83 women diagnosed with endometrioma, 50 (60% (95% CI, 49-71%)) had a single cyst and the remainder had multiple cysts. The median number of endometriomas per patient was 1 (range, 1-5) and the median follow-up time was 634 (range, 187-2984) days. A total of 39/83 (47% (95% CI, 36-58%)) women experienced an overall reduction in size of cysts, in 18/83 (22% (95% CI, 13-32%)) the cysts increased in size and in 26/83 (31% (95% CI, 22-42%)) women, no meaningful change in size was observed. The median change in mean cyst diameter per woman during the study period was -2.7 (range, -57.7 to 39.3) mm, with a median annual regression rate of -1.7 (range, -24.6 to 42.0) mm/year/woman. Overall, when compared with the initial visit, cysts were significantly smaller at follow-up (median diameter, 22.3 (range, 6.7-77.0) mm vs 18.5 (range, 5.0-72.0) mm; P = 0.009). We did not identify any clinical characteristics that could reliably predict the chance of endometrioma progression. In the majority of women with an ultrasound diagnosis of ovarian endometrioma, the cysts do not increase in size significantly over time and they could be managed expectantly. This evidence may help clinicians when counseling asymptomatic or minimally symptomatic women about management of ovarian endometrioma. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Optimal Surveillance Interval of Branch Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas

Despite the increasing prevalence of intraductal papillary mucinous neoplasm (IPMN), data on the growth and malignant conversion rates based on long-term surveillance cohorts are limited. Many international guidelines recommend surveillance for benign lesions, but the optimal interval and duration are unclear. To determine the optimal surveillance protocol for IPMN and propose which patients may be exempted from surveillance. This large-scale, international cohort study examined data of 3825 patients with IPMN treated at 5 tertiary pancreatic centers. Included were patients with branch duct (BD) IPMN who underwent surveillance or surgery between January 1, 1988, and December 31, 2020. After a thorough review, 3656 patients were included in the analytic sample. Changes in cyst size, worrisome features or high-risk stigmata, and malignant conversion rates were assessed. Patients who underwent surveillance over 5 years were compared to suggest discontinuation of surveillance protocol. Clinical data collection began in January 1, 2021, and the mean (SD) follow-up duration was 84 (47.7) months. The data analysis was performed from May 2, 2022, through September 14, 2022. The patients with BD-IPMN were followed up based on International Association of Pancreatology guidelines. Patients with suspicious malignant neoplasms during surveillance underwent surgical resection. The main outcome of this study was the optimal follow-up interval and duration of BD-IPMN surveillance. The association among cyst size, growth rate, and progression was examined using descriptive statistics. Of the 3656 patients with BD-IPMN in the analytic sample (1973 [54.0%] female; mean [SD] age, 63.7 [10.2] years), 172 (4.7%) were confirmed to have malignant lesions through surgery. Considering cyst growth, the time to develop worrisome features, and malignant conversion, a 1.5-, 1-, and 0.5-year surveillance interval could be optimal for cysts smaller than 20 mm, 20 to 30 mm, and 30 mm, respectively, after initial short-term (6-month) follow-up. Patients with cysts smaller than 20 mm, no worrisome features, and no growth during 5-year surveillance did not show malignant conversion after 5 years of follow-up and had time to progression of greater than 10 years. These findings suggest that BD-IPMN surveillance may depend on the size of the cyst and morphologic changes at the initial 6-month follow-up. For patients with small cysts (ie, <20 mm) with no morphologic changes during the initial 5-year surveillance period, surveillance may be discontinued for those unfit for surgery or who have a limited life expectancy of 10 years or less.

Pancreatic cyst features predict future development of pancreatic cancer: results of a nested case-control study

Risk factors for pancreatic cancer among patients with pancreatic cysts are incompletely characterized. The primary aim of this study was to evaluate risk factors for development of pancreatic cancer among patients with pancreatic cysts. We conducted a retrospective case-control study of U.S. veterans with a suspected diagnosis of branch-duct intraductal papillary mucinous neoplasm from 1999 to2013. Age (hazard ratio [HR], 1.03 per year; 95% confidence interval [CI], 1.00-1.06), larger cyst size at cyst diagnosis (HR, 1.03 permm; 95% CI, 1.01-1.04), cyst growth rate (HR, 1.22 permm/y; 95% CI, 1.14-1.31), and pancreatic duct dilation (5-9.9mm: HR, 3.78; 95% CI, 1.90-7.51;≥10mm: HR, 13.57; 95% CI, 5.49-33.53) were found to be significant predictors for pancreatic cancer on multivariable analysis. Age, cyst size, cyst growth rate, and high-risk or worrisome features were associated with a higher risk of developing pancreatic cancer. Applying current and developing novel strategies is required to optimize early detection of pancreatic cancer after cyst diagnosis.

Thirst intensity survey in ADPKD patients.

With increased fluid intake and tolvaptan treatment, the growth rate of cysts can be theoretically decelerated in autosomal polycystic kidney disease. In this prospective study, it was planned to evaluate thirst sensation in these patients and the parameters affecting its intensity. Forty-one ADPKD patients on tolvaptan and 40 ADPKD patients not on tolvaptan as the control group were evaluated for thirst distress sensation and intensity. The feeling of thirst and the discomfort caused by excessive fluid intake was assessed with Thirst Distress Scale-HF 12 questions (60/12). Thirst intensity was evaluated with a 100mm visual scale. Of the whole group, 35.8% (29) were males, and 64.2% (52) were females. The mean age of the tolvaptan group was 39.17 ± 9.35years and for the control group, it was 41.95 ± 12.29years. There was a negative correlation between the thirst distress score of the patients and an increase in creatinine level after a year of tolvaptan treatment (r = -0.335, p = 0.035). The patients not taking thiazide had higher thirst intensity scores (p = 0.004). There was no impact of tolvaptan dosage, total kidney volume, serum sodium, urinary osmolarity or eGFR on thirst distress and thirst intensity scores. Only thiazide co-treatment had a positive impact on thirst distress and intensity when given tolvaptan. Thirst Distress Scale for ADPKD patients can be used to classify patients before and during tolvaptan treatment.

Microtubule cytoskeleton inhibition induced by taxol and vinorelbine affects encystation, proliferation, morphology, and gene expression of Cryptocaryon irritans protomont

Cryptocaryon irritans protomont is important for encystation and division to continue the reinfection events. Microtubules play a determinant role in multiple cell processes such as: motility, intracellular transport, division, encystation and excystation. To evaluate the significance of microtubule cytoskeleton in Cryptocaryon irritans encystation and cyst proliferation, taxol (a tubulin polymerizing agent) and vinorelbine (a tubulin depolymerizing agent) were used. Using a structure-activity approach, their effects on the regulation of encystment, cyst proliferation, division, morphology, and encystment-related gene expression were assessed. Following collection, protomonts were exposed to serial concentrations of taxol (25, 50, 100, 250, and 500 μM) and vinorelbine (100, 250, 500, 750, and 1000 μM) for 1, 2, 3, and 12 h. Survival, encystation rate, excystation number of theronts, and theront body size decreased with varying degrees of time and concentration. Furthermore, the effects of anti-tubulins on the micro- and ultrastructure of protomonts were examined using the most feasible concentrations of 250 μM taxol and 500 μM vinorelbine. Microstructure observations for one cell cycle revealed delayed/incomplete encystation, change in cell symmetry, and delayed excystation process. Ultrastructure observations showed aggregation of microtubule bundles and disruption of microtubule assembly in the cytoplasm and around the cell wall of taxol- and vinorelbine-treated protomonts respectively. Inhibited microtubules altered ultrastructure resulting in fragile/fragmentary cyst wall formation. mRNA expression of α- and β-tubulin in the taxol-treated cells was significantly up-regulated when compared with the control (P˂0.05). In contrast, vinorelbine treatment markedly down-regulated mRNA expression levels of α- and β-tubulin at one and four hours (P˂0.05). mRNA level of EF-1α was enhanced in taxol-treated protomonts, but reduced in vinorelbine-treated cells when compared with the control (P˂0.05). While mRNA level of actin-cytoplasmic1 remained almost stable after treatment with both anti-tubulin drugs, mRNA expressions of other targeted genes- Rab-7, 40s ribosomal protein, and cathepsin were insignificantly down-regulated in both treatments when compared with control (P > 0.05). In general, target-specific taxol and vinorelbine were found to disturb the rate of encystation, cyst growth, and morphology. In addition, these drugs caused irregular mRNA expression of α- and β-tubulins. This study elucidates the constructive role of tubulins in protomont encystation and cyst proliferation.

Autosomal Dominant Polycystic Kidney Disease: Role of Imaging in Diagnosis and Management.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disorder with progressive renal function decline, and disease severity is determined based on the type of genetic mutation. The diagnosis is usually established at imaging, primarily at US, and is based on age-dependent criteria and the number of visible cysts. ADPKD is classified into class 1 (typical) and class 2 (atypical) according to the Mayo Clinic Imaging Classification (MCIC) system. Height-adjusted total kidney volume (TKV) has emerged as a predictor of future renal function decline and renal failure in ADPKD, and several methods can be used for estimation. MCIC class 1 ADPKD is further subdivided into five types based on height-adjusted TKV (A, B, C, D, and E). Patients with a larger height-adjusted TKV (ie, MCIC 1C-E) are at high risk for progression to end-stage renal disease and will potentially benefit from vasopressin receptor antagonists, which have been shown to reduce the rate of cyst growth and slow renal function decline. Other renal complications primarily relate to hemorrhage within cysts or cyst infections. Subtraction images are key for assessment of complex cysts when malignancy is suspected, as the presence of protein and blood can limit the assessment for an enhancing component. The radiologist has a central role in establishing a diagnosis, excluding mimics, identifying complications, assessing severity, and predicting future renal failure. Interventional radiologists play a therapeutic role in management of complications by cyst drainage, sclerotherapy, or embolization. © RSNA, 2022 Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

Accuracy of Magnetic Resonance Imaging in Prenatal Diagnosis of Choledochal Cysts: A Single-Center Retrospective Analysis.

Background The purpose of this study is to evaluate the accuracy of prenatal MRI in diagnosing choledochal cysts (CDC), evaluate the sensitivity and specificity of MRI signs in the diagnosis of fetal CDC, and first compare the trend of size of CC between prenatal and postpartum. Methods A total of 18 fetal who were diagnosed with CDCs through prenatal MRI were enrolled in the study. We summarized and analyzed the prenatal clinical data and prognosis information of prenatal and postpartum surgery, then compared the sensitivity, specificity, and diagnostic accuracy of various signs of MRI and postpartum MRCP diagnosis of CC. Finally, we tried to compare the earliest prenatal detection of common bile duct cysts with the size of surgery, and calculated the growth rate of common bile duct cysts for the first time. Results All 18 patients were delivered in our institution. Among these patients, 14 were confirmed with CDCs after postpartum surgery, two patients had CDCs that disappeared, and two patients were confirmed with cystic biliary atresia (CBA) through the Kasai operation. Furthermore, 13 patients with CDCs and two patients with CBA underwent MRCP before the operation, and one patient with CDCs ruptured at birth and underwent ultrasound diagnosis. The sensitivity and diagnostic compliance of prenatal MRI signs for the location were higher when compared to postnatal MRCP (100% vs. 76.9% and 83.3% vs. 66.7%): the cyst was located at the porta hepatis, which was higher than the lowest edge of the liver, and parallel to the hepatoduodenal ligament. Conclusion Prenatal MRI is higher than that of US for diagnosing CDCs, specifically in identifying the location of the cyst and confirming the origin of the cyst. The length, width, and size of the CDC become slightly bigger in our study.

Radiologic Characteristics of Spinal Hemangioblastomas in von Hippel Lindau Disease as Guidance in Clinical Interventions

Hemangioblastomas in the central nervous system are the most common manifestation of von Hippel-Lindau (VHL) disease. Because the growth rate of hemangioblastomas is unpredictable, regular follow-up is mandatory, focusing on clinical symptoms and imaging of the central nervous system. However, clinical symptoms may be subtle and nonspecific, and data about the relationship between the radiologic findings and clinical symptoms are sparse. This study aims to evaluate if and how findings of magnetic resonance imaging (MRI) regarding spinal hemangioblastomas are associated with symptoms of VHL disease, with special attention to peritumoral edema and spinal cysts. Serial spinal MRI scans of 43 genetically or clinically established VHL patients with at least 2 years of follow-up were reevaluated to examine the volume, growth rate, and location of spinal hemangioblastomas and the presence, size, and growth rate of peritumoral edema and cysts. Findings were compared with clinical symptoms using the Fisher exact test. We observed a total of 77 spinal hemangioblastomas in 28 patients. Eight of the 28 patients showed peritumoral edema and spinal cysts, and 1 patient showed peritumoral edema without cyst formation; 6 of these 9 patients showed clinical symptoms. Both peritumoral edema and spinal cysts were associated with clinical symptoms (P= 0.023 and P= 0.011, respectively). The presence of peritumoral edema and/or spinal cysts shown on MRI in VHL patients with spinal hemangioblastomas is associated with symptoms in more than half of the patients and may alert the clinician to intensify clinical and radiologic surveillance.

A Comprehensive Immune Cell Atlas of Cystic Kidney Disease Reveals the Involvement of Adaptive Immune Cells in Injury-Mediated Cyst Progression in Mice.

Inducible disruption of cilia-related genes in adult mice results in slowly progressive cystic disease, which can be greatly accelerated by renal injury. To identify in an unbiased manner modifier cells that may be influencing the differential rate of cyst growth in injured versus non-injured cilia mutant kidneys at a time of similar cyst severity, we generated a single-cell atlas of cystic kidney disease. We conducted RNA-seq on 79,355 cells from control mice and adult-induced conditional Ift88 mice (hereafter referred to as cilia mutant mice) that were harvested approximately 7 months post-induction or 8 weeks post 30-minute unilateral ischemia reperfusion injury. Analyses of single-cell RNA-seq data of CD45+ immune cells revealed that adaptive immune cells differed more in cluster composition, cell proportion, and gene expression than cells of myeloid origin when comparing cystic models with one another and with non-cystic controls. Surprisingly, genetic deletion of adaptive immune cells significantly reduced injury-accelerated cystic disease but had no effect on cyst growth in non-injured cilia mutant mice, independent of the rate of cyst growth or underlying genetic mutation. Using NicheNet, we identified a list of candidate cell types and ligands that were enriched in injured cilia mutant mice compared with aged cilia mutant mice and non-cystic controls that may be responsible for the observed dependence on adaptive immune cells during injury-accelerated cystic disease. Collectively, these data highlight the diversity of immune cell involvement in cystic kidney disease.

The Use of a Mobile Application to Disseminate Guidelines on Cystic Neoplasms of the Pancreas: A Snapshot Study of 1000 Case-Simulations

Introduction: The existence of pancreatic cystic neoplasm (PCN) management guidelines is acknowledged by the European scientific community. However, no data exist on their actual application in clinical practice. Our aim is to implement PCN guidelines dissemination through a mobile application. Methods: iCyst is a digital tool providing access to the three main existing guidelines (European evidence-based, IAP, and AGA). Through a case simulation system, for one year, the app prospectively registered users’ guideline choice. Results: During the study period, 276 users downloaded iCyst and entered 1,020 completed simulations. Most users were European (88%) and were either surgeons (69%) or gastroenterologists (29%). Six different representative scenarios were identified among the simulated cases. Overall, the European guidelines were the most commonly preferred guidelines (52%). In 16% of cases, the users did not choose any of the available guidelines. The rate of users not following any of the guidelines markedly increased in scenarios pertaining to unfitness for surgery or cyst growth rate (p < 0.05). Conclusion: Digital apps can be used to disseminate guidelines in clinical practice. Guideline dissemination might serve as the basis for future research lines on specific clinical scenarios that iCyst identifies as critical among practitioners involved in pancreatic cystic neoplasm treatment.

Pancreatic intraductal papillary mucinous neoplasms: Current diagnosis and management.

Intraductal papillary mucinous neoplasms (IPMNs) represent approximately 1% of all pancreatic neoplasms and 25% of cystic neoplasms. They are divided into three types: main duct-IPMN (MD-IPPMN), branch duct-IPMN (BD-IPMN), and mixed type-IPMN. In this review, diagnostics, including clinical presentation and radiological investigations, were described. Magnetic resonance imaging is the most useful for most IPMNs. Management depends on the type and radiological features of IPMNs. Surgery is recommended for MD-IPMN. For BD-IPMN, management involves surgery or surveillance depending on the tumor size, cyst growth rate, solid components, main duct dilatation, high-grade dysplasia in cytology, the presence of symptoms (jaundice, new-onset diabetes, pancreatitis), and CA 19.9 serum level. The patient’s age and comorbidities should also be taken into consideration. Currently, there are different guidelines regarding the diagnosis and management of IPMNs. In this review, the following guidelines were presented: Sendai International Association of Pancreatology guidelines (2006), American Gastroenterological Association guidelines, revised international consensus Fukuoka guidelines (2012), revised international consensus Fukuoka guidelines (2017), and European evidence-based guidelines according to the European Study Group on Cystic Tumours of the Pancreas (2018). The Verona Evidence-Based Meeting 2020 was also presented and discussed.

Clinical Management of Pancreatic Premalignant Lesions

Clinical Management of Pancreatic Premalignant Lesions

Risk Factors for the Development of High-risk Stigmata in Branch-duct Intraductal Papillary Mucinous Neoplasms

Objective Strict follow-up is recommended for branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) to avoid missing the development of high-risk stigmata (HRS) at a premalignant stage. This study explored the risk factors associated with the development of HRS during follow-up. Methods We performed a retrospective analysis of 283 patients with BD-IPMN, treated at Okayama University Hospital in Japan between January 2009 and December 2016. Only patients with imaging studies indicative of classical features of BD-IPMN without HRS and followed for over one year were included in the study. We performed radiological follow-up every six months and collected patients' demographic data, cyst characteristics, and clinical outcomes and used univariate logistic regression models to determine the odds of developing HRS. Results Ten patients (3.5%) developed HRS after a median surveillance period of 55.8 months. The main pancreatic duct (MPD) size (5-9 mm) and cyst growth rate (>2.5 mm/year) were both suggested to be possible risk factors for the development of HRS [odds ratio, 14.2; 95% confidence interval (CI), 3.1-65.2, p=0.0006, and odds ratio, 6.1; 95% CI 1.5-25.5, p=0.014]. Regarding the number of worrisome features (WFs), the rate of HRS development was 2.0% (4/199) in cases with no WF, 1.6% (1/62) in cases with single WF and 22.7% (5/22) in cases with multiple WFs, respectively. The rate of HRS development was significantly higher in cases with multiple WFs than in the other cases (p<0.0001). Conclusion MPD dilation, rapid cyst growth, and multiple WFs were significant risk factors for the development of HRS. In the presence of such features, it is necessary to closely follow the development of HRS and avoid missing the best opportunity to perform surgical intervention.

Guidelines on Pancreatic Cystic Neoplasms: Major Inconsistencies With Available Evidence and Clinical Practice— Results From an International Survey

Guidelines on Pancreatic Cystic Neoplasms: Major Inconsistencies With Available Evidence and Clinical Practice— Results From an International Survey

S0106 Imaging Resource Utilization in the Surveillance of Presumed Branched Duct Intraductal Papillary Mucinous Neoplasm (BD-IPMN)

INTRODUCTION: Presumed mucinous cystic lesions are at increased (albeit low) risk of malignant transformation and require regular imaging for ongoing surveillance. A cost-effective evaluation of imaging resource utilization (IRU) is understudied due to a paucity of actual clinical utilization data and lack of consensus among current guidelines. We assessed the value proposition of IRU in surveillance of BD-IPMN, by defining populations utilizing high volumes of imaging, and identifying the predictors of high IRU. METHODS: This is a single-center cross-sectional study, of patients with presumed BD-IPMN under active surveillance as of January 2018. Patients were identified from a prospectively maintained pancreatic cyst neoplasm (PCN) database. Presumed diagnosis of mucinous cysts with identification of worrisome features (WF) and high-risk stigmata (HRS), was made based on the accepted criteria from the literature. IRU was calculated based on both noninvasive (CT/MRI) and minimally invasive (EUS) imaging used per month during surveillance. For analysis, the “High Resource Utilization” (HRU) group is defined as the top 10% of the population consuming higher imaging resources and compared them with rest of the surveillance population: “Low Resource Utilization” (LRU) group. The clinical variables were compared using chi-square analysis and student’s t test between two groups. RESULTS: 409 patients with presumed BD-IPMNs were followed for 41.60 ± 32.24 months. By definition, the rate of surveillance imaging utilization per month in HRU group was higher, 0.74 ± 0.42 vs 0.16 ± 0.09 (P < 0.001). Similarly, the rate of non-invasive imaging and EUS utilization was also higher in HRU group. The HRU group have a higher initial cyst size (18.33 ± 14.31 mm vs. 12.90 ± 9.08 mm) (P < 0.001), higher proportion of cysts with WF (17.5% vs 13.82%) (P < 0.001), or with HRS (7.5% vs 1.36%) (P < 0.001), compared with LRU group. Cyst growth rate per year (30.00% vs 4.88% (P < 0.001)) and per two years (35.00% vs 13.82% (P < 0.001)) displayed higher proportions of fast-growing cysts (>5 mm threshold) in the HRU group compared with LRU group. CONCLUSION: Higher IRU was found in a subset of presumed BD-IPMN population undergoing active surveillance using actual prospective clinical data. Predictors of this included larger initial cyst size, rapid cyst growth rate over one and two years, and the presence of WF and HRS. Further refinement of imaging guidelines is needed for accurate long term PCN surveillance balanced by cost-effective IRU.Table 1

2936 Use of Endoscopic Ultrasound for Pancreatic Cyst Surveillance

INTRODUCTION: Endoscopic ultrasound (EUS) is recommended by several society's guidelines for evaluation of asymptomatic pancreatic cysts. Though relatively low-risk, the procedure is costly and EUS-guided FNA has a low sensitivity for detecting malignant cytology. We evaluated a cohort of patients with pancreatic cysts who underwent EUS to determine if 1) EUS was warranted and 2) where EUS changed management. METHODS: We evaluated patients who underwent EUS for pancreatic cysts at our medical center. Cysts were evaluated for size, worrisome features and high risk stigmata. The primary outcomes, based on the Fukuoka guidelines, were whether the initial EUS was recommended and if the EUS procedure resulted in a change in clinical management (shortened surveillance interval, lengthened surveillance interval, or surgical intervention). RESULTS: 204 patients were included in the study and the baseline characteristics are listed in Table 1. We found that EUS was warranted in only 30.9% of patients, all of whom had acute pancreatitis or worrisome features* seen on prior imaging. Though its use led to a change in management for 130 patients, it lengthened the surveillance interval in 70% of these cases (see Figure 1). In patients in whom shortened intervals were recommended, this was mostly due to worrisome features seen in 43.3% (see Figure 2). Additionally, benign cytology was found in 47.7% of cases, and was read as hypocellular or insufficient in 16.7% of cases (N = 174) (see Table 2). *Worrisome features are defined by the 2012 Fukuoka guidelines as: pancreatitis, cyst ≥3 cm, enhancing mural nodule &lt;5 mm, thickened/enhancing cyst walls, main duct size 5-9 mm, abrupt change in caliber of pancreatic duct with distal pancreatic atrophy, lymphadenopathy, increased serum level of CA 19-9, or cyst growth rate ≥5 mm/2 years. CONCLUSION: Our findings demonstrate the overutilization of endoscopic ultrasound in the management of pancreatic cysts, suggesting that if worrisome features are not present, follow up can be determined by cyst size alone.

"Trivial" Cysts Redefine the Risk of Cancer in Presumed Branch-Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Potential Target for Follow-Up Discontinuation?

The management of small and incidental branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) still is of concern. The aim is assessing the safety of a surveillance protocol through the evaluation of their progression to malignancy. All presumed BD-IPMNs observed from 2000 to 2016 were included. Only patients presenting without worrisome features (WFs) and high-risk stigmata (HRS) at diagnosis were included. Development of WF, HRS, pancreatic cancer (PC), and survival were analyzed. BD-IPMNs were defined as trivial in the continuing absence of WF/HRS after 5 years of surveillance. The age-specific standardized incidence ratio of PC in the general population was used for comparison. A total of 1,036 BD-IPMNs without WF/HRS at diagnosis were included, 4.2% developed WF or HRS, and 1.1% developed PC after a median of 62 months. The median cyst growth rate was 0 mm/yr. A growth rate ≥2.5 mm/yr and the development of WF resulted independent predictors of PC. The standardized incidence ratio of PC for trivial BD-IPMN (n = 378) was 22.45 (95% confidence interval 8.19-48.86), but considering only patients aged >65 years (n = 198), it decreased to 3.84 (95% confidence interval 0.77-11.20). Surveillance of the vast majority of presumed BD-IPMNs is safe, as the risk of PC is comparable to postoperative mortality of pancreatic surgery. A growth rate ≥2.5 mm/yr is the main predictor of PC, reinforcing the role of repeated observations. A trivial BD-IPMN in patients aged >65 years might not increase the risk of developing PC compared with general population, identifying potential targets for follow-up discontinuation.

Renal hypertrophic signaling triggers activation of kidney immune response and accelerates cystogenesis in polycystic kidney disease

BackgroundAutosomal dominant polycystic kidney disease (ADPKD) is the most common genetic kidney disease with the predominant form resulting from mutations in the gene, PKD1. The disease severity is highly variable even among families with the same PKD1 gene mutation and factors other than genetics may affect cystogenesis. Protein load or unilateral nephrectomy (UNx: 1K) results in glomerular hyperfiltration and renal hypertrophy which both accelerates kidney cyst growth in PKD mice. Children with PKD that exhibit glomerular hyperfiltration were shown to have a higher rate of cyst growth and faster decline in kidney function. Thus, hypertrophic signaling in PKD may clinically be a risk factor to accelerate cystogenesis.MethodsTo test the effect of renal hypertrophy in PKD, we used adult tamoxifen inducible Pkd1flox/flox mice with or without CAGG‐cre. Three weeks after cre induction, first group of mice underwent sham surgery or UNx to accelerate cyst formation and observed for 3 or 6 weeks. The second group of mice were fed with either high protein (60%), normal protein (18%) or low protein diet (6%) for a total of 6 weeks. Mice from both UNx and modified protein diet group were sacrificed at the end of the experiment and kidneys were harvested for RNA‐seq, histology, inflammatory cytokines and flow cytometry for kidney immune cell sorting.ResultsAnalysis of RNA sequencing data revealed that 1K compared to intact two kidney (2K) Pkd1 deficient mice show differentially expressed genes involved in activating/recruiting macrophages and production of pro‐inflammatory cytokines during the hypertrophic signaling. 1K compared to 2K Pkd1 mice had increased number of resident macrophage (CD11blo, F4/80 hi) but not infiltrating macrophages (CD11bhi, F4/80lo), increased inflammatory cytokine production, and severe cystic kidneys. Pkd1 deficient mice that were given a high protein diet compared to a low protein diet, resulted in activation of kidney immune cells, recruitment of inflammatory cytokines and worsening kidney cysts.ConclusionsRenal hypertrophic signaling triggered by either UNx or protein load in adult Pkd1 mice activates kidney immune cells, inflammatory cytokine production and accelerates cyst growth.Support or Funding InformationNIH K08DK106465, P30 DK074038, T32AI007051This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Growth of thymic epithelial tumors and thymic cysts: Differential radiological points.

BackgroundThe growth rate of thymic epithelial tumors (TETs) and thymic cysts was investigated to determine whether they can be differentiated and clinico‐radiological predictors of interval growth was identified.MethodsThis retrospective study included 122 patients with pathologically proven thymic cysts (n = 56) or TETs (n = 66) who underwent two serial chest computed tomography scans at least eight weeks apart. Average diameters and attenuation were measured, volume‐doubling times (VDTs) were calculated, and clinical characteristics were recorded. VDTs were compared using the log‐rank test. Predictors of growth were analyzed using the log‐rank test and Cox regression analysis.ResultsThe frequency of growth did not differ significantly between TETs and thymic cysts (P = 0.279). The VDT of thymic cysts (median 324 days) was not significantly different from that of the TETs (median 475 days; P = 0.808). Water attenuation (≤ 20 Hounsfield units) predicted growth in thymic cysts (P = 0.016; hazard ratio 13.2, 95% confidence interval 1.6–107.3), while lesion size (> 17.2 mm) predicted growth in TETs (P = 0.008 for size, P = 0.029 for size*time). For the growing lesions, the positive and negative predictive values of water attenuation for thymic cysts were 93% and 80%, respectively.ConclusionThe frequencies of interval growth and VDTs were indistinguishable between TETs and thymic cysts. Water attenuation and lesion size predicted growth in thymic cysts and TETs, respectively. Among the growing lesions, water attenuation was a differential feature of thymic cysts.

CRITERIA FOR THE SELECTION OF TECHNOLOGIES FOR THE SURGICAL TREATMENT OF CHILDREN WITH NONPARASITIC SPLEEN CYSTS

In the period from 2000 to 2017, 52 children aged from 2 to 17 years, were operated for non-parasitic spleen cysts. Along with general clinical examination, the preoperative observation included enzyme immunoassay with Echinococcus diagnostics, determination of the serum level of carbohydrate antigen CA19-9, ultrasound, CT scan or MRI, spleen angiography. Evaluation of treatment results, along with clinical examination, was based on echographic monitoring using spleen mass ratio calculation technology and laboratory tests, including the study of serum immunoglobulins A, E, M, G. Depending on the location and pool of vascularization, 4 clinical and morphological variants of spleen cysts were selected - the upper, middle and lower parts of the organ, the region of the spleen's collar. Quantitative estimates of the pathological formation included small (up to 50 ml), medium (50-150 ml), large (150-300 ml) and giant (more than 300 ml) volumes of the cyst cavity. Three main minimally invasive surgical technologies are being introduced:- navigational interventions in which access to the pathological focus and therapeutic effects on the internal structures of the cyst were carried out under the control of an ultrasound image;- combined interventions with access to the pathological focus and therapeutic effect on the internal structures of the cyst under the control of an ultrasound image in combination with endovascular occlusion of the vessels of the spleen parenchyma with X-Ray control;- laparoscopic operations, including access to pathological foci and therapeutic effects on the internal structures of the cyst, provided by the endotelevision visualization. Recovery was achieved in 47 (90.4%) patients as a result of single interventions. Repeated surgeries completed with the recovery were required in 5 (9.6%) clinical observations. Subsequent follow-up with a duration of up to 3 years of disease recurrence did not show relapses. The choice of tactics of surgical treatment of children with NCC was shown to have to be based on the results of multifactorial planning, taking into account the anatomical and topographical features of the localization and growth rate of spleen cysts. The high reparative potential of the spleen in childhood determines the postoperative recovery of the organ’s morphofunctional characteristics, regardless of the volume of the cyst present. The use of quantitative parameters to estimate the mass of the spleen makes it possible to objectify the course of the postoperative period, the effectiveness of the intervention and the adequacy of the reparative regeneration processes.