Cystic Tumor Research Articles

Supratentorial hemangioblastoma: correlation between phenotype, gender and vascular territory affected.

Supratentorial hemangioblastomas are rare, vascular lesions. The presence of peri-tumoral cysts and edema has meaningful clinical, diagnostic and therapeutic implications. Nevertheless, the pathogenesis of both cyst and edema formation is not fully understood. This study sought to determine if the radiologic phenotype of supratentorial hemangioblastoma is affected by the different cerebral arterial circulations. Review of the English-language literature from 1973 to 2023 yielded 53 cases of parenchymal supratentorial hemangioblastomas eligible for analysis. Patients were divided by the vascular territorial distribution of the lesions: anterior circulation (n = 36) or posterior circulation (n = 17), and the groups were compared for demographic, clinical, radiologic and molecular variables. Univariate analyses yielded a significant difference between the groups in five variables. Cystic changes and "classic" radiological phenotype were associated with hemangioblastomas of the posterior circulation (OR = 0.19, p = 0.045 and OR = 0.287, p = 0.048, respectively), while female gender, significant peritumoral edema and purely solid phenotype were associated with hemangioblastomas of the anterior circulation (OR = 3.384, p = 0.045 and OR = 5.25, p = 0.05 and OR = 14.0, p = 0.015; respectively). On multivariate analysis, solid phenotype and female gender remained significantly associated with the anterior circulation (OR = 36.04, p = 0.014 and OR = 4.45, p = 0.045). The incidence of von-Hippel Lindau disease was higher in the anterior-circulation group. Cystic tumors were present in all females in the posterior-circulation group compared to 43.4% in the anterior-circulation group (OR = 20.714, 95% CI 1.061 to 404.122; p = 0.045). Based on historical cases of supratentorial hemangioblastoma, this study shows that different tumor phenotypes are associated with the different cerebral circulations. Gender was also associated with differences in tumor distribution and radiologic phenotype. These novel data may improve our understanding of unique vascular diseases of the central nervous system.

Cystic pancreatic lesions-indications, timing and reasons for surveillance

Cystic pancreatic lesions are detected incidentally at an increasing rate. Often, the patients present asymptomatically. Hence, the resulting clinical consequences remain challenging and unsettling for both physicians and patients. Status of current recommendations in handling cystic pancreatic lesions. Selective literature search of PubMed while taking current guidelines into account. Correct diagnostic classification of the cystic lesion is crucial since further action depends on the type of cystic lesion. Resection is generally recommended for mucinous cystic neoplasms (MCN), solid pseudopapillary neoplasms (SPN), and intraductal papillary mucinous neoplasms (IPMN) with relevant risk criteria such as prominent main-duct dilation. Surveillance is recommended for IPMN without risk criteria, as long as comorbidities and life expectancy of the patient will allow preventive resection over the years. SCNs are benign and only symptomatic SCNs require resection. Inflammatory pancreatic cysts should only be treated under certain circumstances.

MUCINOUS CYSTIC TUMOR OF LOW MALIGNANT POTENTIAL THOUGHT TO BE OF URACHAL ORIGIN: A CASE REPORT

Mucinous cystic tumor of low malignant potential (MCTLMP) is a very rare disease.The patient was a 50-year-old man. Contrast-enhanced computed tomography and magnetic resonance imaging showed a multiocular cystic lesion on the top of the bladder. We performed surgery to remove the tumor for definitive diagnosis. Intraoperative rapid pathological diagnosis of the cyst wall showed no malignant findings, so we performed combined resection of the peritoneum and part of the bladder wall.Based on imaging findings, tumor location, and pathological and immunostaining findings (CK20 and CDX2 positivity; β-catenin negativity), the patient was diagnosed with MCTLMP thought to be of urachal origin. After the operation, recurrence was not observed.

Cytokine Profiling of Cyst Fluid and Tumor-Associated Macrophages in Cystic Vestibular Schwannoma.

The vestibular schwannoma (VS) secretome can initiate monocyte recruitment and macrophage polarization to M1 (proinflammatory) and/or M2 (protumorigenic) phenotypes, which in turn secrete additional cytokines that contribute to the tumor microenvironment. Profiling cyst fluid and cerebrospinal fluid (CSF) in cystic VS provides a unique opportunity to understand mechanisms that may contribute to tumor progression and cyst formation. Cystic VSs secrete high levels of cytokines into cyst fluid and express abundant M1 and M2 macrophages. Tumor, CSF, and cyst fluid were prospectively collected from 10 cystic VS patients. Eighty cytokines were measured in fluid samples using cytokine arrays and compared with normal CSF from normal donors. Immunofluorescence was performed for CD80 + M1 and CD163 + M2 macrophage markers. Demographic, audiometric, and radiographic information was obtained through retrospective chart review. Cyst fluid expressed more osteopontin and monocyte chemotactic protein-1 (MCP-1; p < 0.0001), when compared with normal CSF. Cyst fluid also expressed more protein ( p = 0.0020), particularly MCP-1 ( p < 0.0001), than paired CSF from the same subjects. MCP-1 expression in cyst fluid correlated with CD80 + staining in VS tissue ( r = 0.8852; p = 0.0015) but not CD163 + staining. Cyst fluid from cystic VS harbored high levels of osteopontin and MCP-1, which are cytokines important in monocyte recruitment and macrophage polarization. MCP-1 may have a significant role in molding the tumor microenvironment, by polarizing monocytes to CD80 + M1 macrophages in cystic VS. Further investigations into the role of cytokines and macrophages in VS may lead to new avenues for therapeutic intervention.

Cyst fluid glycoproteins accurately distinguishing malignancies of pancreatic cystic neoplasm

Pancreatic cystic neoplasms (PCNs) are recognized as precursor lesions of pancreatic cancer, with a marked increase in prevalence. Early detection of malignant PCNs is crucial for improving prognosis; however, current diagnostic methods are insufficient for accurately identifying malignant PCNs. Here, we utilized mass spectrometry (MS)-based glycosite- and glycoform-specific glycoproteomics, combined with proteomics, to explore potential cyst fluid diagnostic biomarkers for PCN. The glycoproteomic and proteomic landscape of pancreatic cyst fluid samples from PCN patients was comprehensively investigated, and its characteristics during the malignant transformation of PCN were analyzed. Under the criteria of screening specific cyst fluid biomarkers for the diagnosis of PCN, a group of cyst fluid glycoprotein biomarkers was identified. Through parallel reaction monitoring (PRM)-based targeted glycoproteomic analysis, we validated these chosen glycoprotein biomarkers in a second cohort, ultimately confirming N-glycosylated PHKB (Asn-935, H5N2F0S0; Asn-935, H4N4F0S0; Asn-935, H5N4F0S0), CEACAM5 (Asn-197, H5N4F0S0) and ATP6V0A4 (Asn-367, H6N4F0S0) as promising diagnostic biomarkers for distinguishing malignant PCNs. These glycoprotein biomarkers exhibited robust performance, with an area under the curve ranging from 0.771 to 0.948. In conclusion, we successfully established and conducted MS-based glycoproteomic analysis to identify novel cyst fluid glycoprotein biomarkers for PCN. These findings hold significant clinical implications, providing valuable insights for PCN decision-making, and potentially offering therapeutic targets for PCN treatment.

Stereotactic Intracavitary Irradiation for Cystic Craniopharyngiomas with Rhenium-186

Abstract Objective The intracavitary irradiation of cystic tumors has been used as a therapeutic alternative modality in the management of cystic craniopharyngiomas. In the present study, we review our experience, considering the technical issues, outcomes, and complications associated with the use of stereotactic intracavitary irradiation (SICI) with colloidal rhenium-186 (186Re) for cystic craniopharyngioma. Material and Methods The records of 33 patients with cystic craniopharyngiomas treated by SICI with colloidal 186Re were retrospectively reviewed. The median radiation dose to the cyst wall was of 408 Gy (range: 175 Gy to 500 Gy). All tumors were composed of a large cyst cavity, and 9 (27.3%) also had a solid component. The mean follow-up period was of 3.7 years. Results After SICI, 31 (93.9%) patients showed radiological evidence of cyst regression, and, in 2 (6.1%), no response was observed. An improvement in the visual deficits was observed in 8 cases (24.2%), and an improvement in endocrinogical disturbances, in 2 cases (6.1%). We observed complications in 3 patients (9.1%): diabetes insupidus in 1 case (3%), aggravation of visual acuity in 1 case (3%), and severe headache after infusion of the colloid in 1 case (3%); and 1 patient (3%) died after meningitis. Conclusion Stereotactic intracavitary irradiation with colloidal 186Re is a safe procedure, with satisfactory results in the present series, and should be considered, in the management of cystic craniopharyngiomas, the first-intention therapy or as an adjuvant to other therapeutical modalities, with acceptable morbidity and mortality rates.

Localization of beta catenin across the domain of odontogenic lesions: A systematic review.

CTNNB1 gene encodes beta catenin, a transcriptional activator of Wnt pathway involved in the pathogenesis of odontogenic lesions. Though located intramembranously, its translocation into cytoplasm and nucleus could trigger cell proliferation, inhibition of apoptosis, invasion and migration of the tumour cell. Five electronic databases including MEDLINE by PubMed, Google scholar, Scopus, Trip, Cochrane library and EMBASE until 1 January 2023 without period restriction were thoroughly searched. Those articles that identified CTNNB1 mutation and beta catenin in odontogenic lesions were included for review. Risk of bias was analysed for each study using QUADAS 2 tool and Review Manager 5.3 was used to output its result. Thirty four published articles were included for data synthesis. A total of 1092 cases of odontogenic lesions were assessed for both CTNNB1 mutation and beta catenin expression. CTNNB1 mutation was observed in ameloblastoma, calcifying odontogenic cyst, calcifying cystic odontogenic tumour and all malignant odontogenic tumours. The beta catenin expression (nuclear and cytoplasmic) was maximum in odontogenic keratocyst and calcifying odontogenic cyst. The expression was variable in ameloblastomas, membranous in odontomas, calcifying cystic odontogenic tumour and nuclear in all malignant tumours. High recurrence of odontogenic keratocyst and aggressiveness of solid ameloblastoma and malignant odontogenic tumours could be associated with the nuclear translocation of beta catenin. Disparity between CTNNB1 mutation and beta catenin expression within odontogenic lesions suggests alternate routes of beta catenin activation. The review results support the unique localisation of beta catenin as a helpful diagnostic factor in the pathogenesis of odontogenic lesions.

Predictive clinical and imaging features of high-grade dysplasia in mucinous cystic neoplasms of the pancreas

Predictive clinical and imaging features of high-grade dysplasia in mucinous cystic neoplasms of the pancreas

The role of EUS in diagnosis and management of pancreatic cystic neoplasms: intention-to-treat analysis

The role of EUS in diagnosis and management of pancreatic cystic neoplasms: intention-to-treat analysis

Pancreatic cystic neoplasms: still high rates of preoperative misdiagnosis in the guidelines and EUS era

Pancreatic cystic neoplasms: still high rates of preoperative misdiagnosis in the guidelines and EUS era

OR2804 Endocrine And Vision Outcomes Following 90Yttrium Therapy For Cystic Sellar Lesions—A Prospective Cohort Study

Abstract Disclosure: M.A. MacLean: None. S. Ahmad: None. A.L. Hebb: None. A. Tahir: None. R. Greene: None. D.B. Clarke: None. S.A. Imran: None. Background: Untreated cystic sellar lesions can cause vision loss, endocrine dysfunction, and obstructive hydrocephalus related to growth and mass effect. Microsurgical resection, stereotactic aspiration, and radiation treatment strategies are limited by significant complications and high risk of recurrence. Stereotactic intracavitary irradiation with the beta-emitting isotope 90Yttrium (90Yt) has been proposed as an alternative to mitigate these challenges. Long term-efficacy data is lacking. Here, our objective was to prospectively assess the effect of 90Yt on cyst volume, endocrine, and vision outcomes. Methods: We conducted a Health Canada approved, single-centre, prospective cohort study. Clinical outcome measures included cyst volume measured on magnetic resonance imaging, formal visual field (VF) testing, and hypothalamic-pituitary (HP) hormonal function. All patients provided informed consent and underwent right frontal stereotactic insertion of 90Yt colloid (200 Gy cyst wall). Results: Twenty-two patients (55% females) received 90Yt therapy. Mean age was 63.5 (SD 15.4) years with no difference between genders (p = 0.055). Mean duration of follow-up was 52 months (range 5-113). Cystic lesions included: craniopharyngioma (86%), Rathke’s cleft cyst (9%) and cystic prolactinoma (5%). Mean tumor cyst volumes were reduced by 77% at 12-month follow-up (pre-operative: 5.2, SD 4.5 cc; 12 months post-operative: 1.2, SD 1.5 cc; p = 0.002). Males had larger tumor volumes at baseline (7.7, SD 5.0 cc vs. 3.2, SD 2.8; p = 0.02) and 3 months (4.7, SD 3.4 vs. 1.8, SD 2.0; p = 0.04) but these differences had resolved by 9-month follow-up. Pre-operative clinical features included: VF deficit (36%), VF deficit plus headache (36%), headache alone (9%), hydrocephalus (5%), and 14% were asymptomatic. HP hormone dysfunction was observed in 59% of patients pre-operatively (27% complete; 73% partial) and 68% post-operatively (p = 0.50); specifically, no differences were found pre- and post-operatively for secondary hypogonadism (50% vs. 55%), hypothyroidism (45% vs. 59%), hypoadrenalism (36% vs. 27%), growth hormone deficiency (27% vs. 23%), diabetes insipidus (23% vs. 27%), and hyperprolactinemia (36% vs. 36%) (all p &amp;gt; 0.05). Pre-operative VF deficits were found in 68% of patients, of which 32% normalized and 36% remained stable (p = 0.180). Worsened vision was detected in 9% of patients post-operatively. Treatment failure requiring conventional surgery occurred in 18% of patients. Conclusions:90Yt therapy significantly reduced tumor cyst size and stabilized both endocrine function and vision in patients with cystic lesions of the sellar region. Presentation: Sunday, June 18, 2023

Discrimination of Brain Abscess and Necrotic Brain Tumor with Proton MR Spectroscopy and Diffusion-Weighted Imaging

Objective: To compare the efficacy of MR spectroscopy and diffusion-weighted imaging in discriminating between cystic or necrotic tumors and pyogenic brain abscesses.Study Design: A retrospective study design.Place and Duration of Study: The Study was conducted at the Radiology Department of Nishtar Hospital Multan and General Hospital Lahore, Pakistan, from January 2022 to January 2023. Methods: A total ten patients were included in the study. Of 10 patients, 5 had pyogenic abscesses, and 5 had tumors. Tumors were metastases (2 patients), glioblastomas (2 patients), and anaplastic astrocytoma (1 patient). Proton MR spectroscopy and diffusion-weighted imaging were performed in all patients. Results: Results showed that significant resonance lines (creatine/phosphocreatine, N-acetyl aspartate, and choline) observed in normal brain parenchyma were missing in abscesses or necrosis. MR spectroscopy of abscess showed multiple resonance peaks. Diffusion-weighted images showed that all pyogenic abscesses had lower ADC values and were hyperintense compared to normal brains. Conclusion: Diffusion-weighted imaging is more accurate and less time consuming method for discrimination of brain lesions compared to MR spectroscopy.&#x0D; How to cite this: Saqib HA, Asghar A, Firdous A, Zahra M, Islam Z, Mushtaq S. Discrimination of Brain Abscess and Necrotic Brain Tumor with Proton MR Spectroscopy and Diffusion Weighted Imaging. Life and Science. 2023; 4(4): 432-437. doi: http://doi.org/10.37185/LnS.1.1.431

SAT557 Unexpected Whole Body Scan Finding

Abstract Disclosure: A. Arce Gastelum: None. C.Y. Liu: None. K. McCowen: None. A 41-year-old man presented with a neck mass. Following total thyroidectomy with central and bilateral lateral neck node dissection, he received a diagnosis of stage I T2N1bMx multifocal papillary thyroid cancer with extensive extrathyroidal extension, angioinvasion and 14/65 positive lymph nodes. Surgery was complicated by temporary post operative hypoparathyroidism. Lab testing one week post thyroidectomy, before radioiodine ablation showed a serum TSH 23 uIU/mL, thyroglobulin: 34.1 ng/mL, with thyroglobulin antibody: &amp;lt;0.9 [IU]/mL.Post RAIA Whole Body Scan revealed increased uptake in the right orbit, concerning for metastatic disease. Confirmatory MRI of the brain showed a right superior intraorbital cystic lesion. Although orbital metastases are infrequent, a metastatic lesion was suspected due to the aggressiveness of his thyroid cancer. The patient was referred to ophthalmology several months after surgery and underwent right orbitotomy with excision and biopsy of the mass. The pathology was consistent with a multilocular cystic tumor lined by bland cuboidal epithelium, containing proteinaceous concretions and entirely negative for metastasis. Extensive thyroid cancer is treated with surgery followed by radioactive iodine (I-131) in case of tissue remnants or extra nodal metastases. Although unusual, false-positive scans exhibiting the presence of 131I uptake in the absence of residual thyroid tissue can occur.Fibrotic lung conditions, pleural effusions and bronchiectatic lesions have been reported to concentrate iodine in the absence of thyroid cancer metastasis. One prior report of a conjunctival inclusion cyst also resulted in radioiodine uptake in the orbit. Unless identified as a false positive, radioiodine uptake may result in a diagnostic fallacy. The correlation of clinical signs and serum thyroglobulin trends with imaging techniques should be emphasized to prevent unnecessary additional therapy. Presentation Date: Saturday, June 17, 2023

Jejunal gastrointestinal stromal tumor that developed in a patient with neurofibromatosis type 1: a case report

BackgroundNeurofibromatosis type 1 (NF1) is known to be associated with the frequent occurrence of unique gastrointestinal stromal tumors (GISTs), preferably occurring in the small intestine, with no mutations in the c-kit proto-oncogene or platelet-derived growth factor receptor-alpha (PDGFRA), with a high tendency for multifocal development, indolent nature, with low proliferation activity and favorable prognosis.Case presentationA woman in her forties visited her local doctor complaining of menstrual pain; a large mass was detected in her lower abdomen, and she was referred to our hospital. The patient had hundreds of skin warts and café au lait spots. The patient’s mother had been diagnosed with type 1 neurofibromatosis. The patient met the diagnostic criteria for NF1 and was diagnosed with NF1. Ultrasonography showed a large heterogeneous cystic mass with various echo patterns, solid compartments and multiple septations. Magnetic resonance imaging showed a multilocular cystic mass with liquid content exhibiting various intensities, including that of blood. A small round solid mass was also observed close to the cystic tumor. Contrast-enhanced computed tomography showed that the round solid mass showed strong enhancement in the early phase, unlike the cystic tumor component. Open laparotomy revealed a multicystic exophytic tumor measuring 11.5 cm originating from the jejunal wall, 20 cm distal to the duodenojejunal flexure. A solid tumor measuring 2.1 cm was also found on the anal side of the large tumor. We resected the short segment of the jejunum, including the two lesions. Microscopic findings revealed that the cystic and solid tumors consisted of spindle-shaped tumor cells showing little atypia with a fascicular or bundle arrangement. Nuclear mitosis was scarce. Immunostaining of the tumor cells showed positive staining for KIT and DOG1 and negative staining for S100 and desmin. The NF1 patient was diagnosed with multiple GISTs accompanied by intratumoral hemorrhagic denaturation arising from the jejunum. The TNM staging was pT4N0M0, stage IIIA.ConclusionWe report a case of GISTs associated with NF1 that showed a jejunal origin, multifocal development and few mitotic figures. The recurrence risk, survival prognosis and need for adjuvant chemotherapy, particularly in cases where the initial GIST exhibits a very indolent pathology in NF1-related GISTs, remain to be elucidated.

Preoperative differentiation of pancreatic cystic neoplasm subtypes on computed tomography radiomics.

Serous cystic neoplasm (SCN), mucinous cystic neoplasm (MCN), and intraductal papillary mucinous neoplasm (IPMN) comprise a large proportion of pancreatic cystic neoplasms (PCNs). Patients with MCN and IPMN require surgery due to the potential of malignant transformation, whereas those with SCN require periodic surveillance. However, the differential diagnosis of patients with PCNs before treatment remains a great challenge for all surgeons. Therefore, the establishment of a reliable diagnostic tool is urgently required for the improvement of precision diagnostics. Between February 2015 and December 2020, 143 consecutive patients with PCNs who were confirmed by postoperative pathology were retrospectively included in the study cohort, then randomized into development and test cohorts at a ratio of 7:3. The predictors of preoperative clinical-radiologic parameters were evaluated by univariate and multivariable logistic regression analyses. A total of 1,218 radiomics features were computationally extracted from the enhanced computed tomography (CT) scans of the tumor region, and a radiomics signature was established by the random forest algorithm. In the development cohort, multi- and binary-class radiomics models integrating preoperative variables and radiomics features were constructed to distinguish between the 3 types of PCNs. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were used to evaluate the predictive efficiency of the model. An independent internal test cohort was applied to validate the classification models. All preoperative prediction models were built by integrating the radiomics signature with 13 diagnosis-related radiomics features and 3 important clinical-radiologic parameters: age, sex, and tumor diameter. The multiclass prediction model presented an overall accuracy of 0.804 in the development cohort and 0.707 in the test cohort. The binary-class prediction models displayed higher overall accuracies of 0.853, 0.866, and 0.928 in the development dataset and 0.750, 0.839, and 0.889 in the test dataset. In the test cohort, the binary-class radiomics models showed better predictive performances {AUC =0.914 [95% confidence interval (CI): 0.786 to 1.000], 0.863 (95% CI: 0.714 to 0.941), and 0.926 (95% CI: 0.824 to 1.000)} than the multiclass radiomics model [AUC =0.850 (95% CI: 0.696 to 1.000)], with a large net benefit in the decision curve analysis (DCA). The radiomics-based nomogram provided the correct predicted probability for the diagnosis of PCNs. The proposed radiomics models with clinical-radiologic parameters and radiomics features help to predict the accurate diagnosis among PCNs to advance personalized medicine.

Study on the application value of fluorescent laparoscopy in pancreatic tumor surgery.

Fluorescent laparoscopy is rarely used in pancreatic surgery. The aim of this study was to investigate the value of fluorescent laparoscopy in pancreatic tumor surgery. A total of 19 patients with pancreatic tumors who were treated in the Department of Hepatobiliary Surgery at the First Affiliated Hospital of Wannan Medical College from January 2021 to August 2022 were selected. Fluorescent laparoscopy was used intraoperatively, and the imaging characteristics of different tumors were recorded and analyzed. Among the 19 participants, postoperative pathology confirmed 12 cases of pancreatic cancer (8 cases of moderately differentiated adenocarcinoma, 3 cases of moderately-poorly differentiated adenocarcinoma, and 1 case of acinar cell carcinoma), 4 cases of pancreatic cystic tumors (1 case of microcystic serous cystadenoma, 1 case of serous cystadenoma, 1 case of solid pseudopapillary tumor, and 1 case of solid-cystic pseudopapillary tumor), 1 case of pancreatic neuroendocrine tumor (G1 stage), and 2 cases of inflammatory lesions. There were 8 cases of pancreaticoduodenectomy, 6 cases of distal pancreatectomy, 3 cases of middle pancreatectomy, 1 case of local pancreatectomy, and 1 case of duodenum-preserving pancreatic head resection. One minute after intravenous injection of indocyanine green (ICG), 10 of the 12 patients with pancreatic cancer showed tumor peritumor imaging; 2 cases of pancreatic serous cystic tumors did not show imaging; 2 cases of solid pseudopapillary tumors had tumor body imaging; 1 case of neuroendocrine tumor had tumor body imaging, with complete fluorescence imaging after specimen dissection; there were 2 cases pathologically confirmed as inflammatory lesions, 1 case with tumor body imaging, and 1 case with capsule imaging. By reasonably controlling the administration time and dose of ICG during surgery, some pancreatic tumors can be fluorescently imaged, which is beneficial for intraoperative tumor localization and margin determination.

S1964 Growth of a Mucinous Cystic Neoplasm During In vitro Fertilization

S1964 Growth of a Mucinous Cystic Neoplasm During In vitro Fertilization

Clinical Characteristics and Long-term Outcomes of Spinal Pilocytic Astrocytomas: A Multicenter Retrospective Study by the Neurospinal Society of Japan.

The characteristics, imaging features, long-term surgical outcomes, and recurrence rates of primary spinal pilocytic astrocytomas (PAs) have not been clarified owing to their rarity and limited reports. Thus, this study aimed to analyze the clinical presentation, radiological features, pathological findings, and long-term outcomes of spinal PAs. Eighteen patients with spinal PAs who were surgically treated between 2009 and 2020 at 58 institutions were included in this retrospective multicenter study. Patient data, including demographics, radiographic features, treatment modalities, and long-term outcomes, were evaluated. Among the 18 consecutive patients identified, 11 were women and 7 were men; the mean age at presentation was 31 years (3-73 years). Most PAs were located eccentrically, were solid or heterogeneous in appearance (cystic and solid), and had unclear margins. Gross total resection (GTR), subtotal resection (STR), partial resection (PR), and biopsy were performed in 28%, 33%, 33%, and 5% of cases, respectively. During a follow-up period of 65 ± 49 months, 4 patients developed a recurrence; however, the recurrence-free survival did not differ significantly between the GTR and non-GTR (STR, PR, and biopsy) groups. Primary spinal PAs are rare and present as eccentric and intermixed cystic and solid intramedullary cervical tumors. The imaging features of spinal PAs are nonspecific, and a definitive diagnosis requires pathological support. Surgical resection with prevention of neurological deterioration can serve as the first-line treatment; however, the resection rate does not affect recurrence-free survival. Investigation of relevant molecular biomarkers is required to elucidate the regrowth risk and prognostic factors.

Lymph node involvement is rare in mucinous cystic neoplasms of the pancreas: Role of minimally invasive surgery.

Mucinous cystic neoplasm (MCN) is a premalignant cystic tumor of the pancreas. Resection of MCN in the distal pancreas is a standard treatment; however, at present, there is no consensus on the necessity or extent of lymph node dissection, and minimally invasive pancreatectomy is commonly the preferred surgical technique. Thus, the present study aimed to assess the efficacy of minimally invasive surgery and the extent of lymph node metastasis as factors in determining an appropriate surgical treatment for MCN. The present study retrospectively analyzed 21 consecutive patients who underwent distal pancreatectomy (DP) for MCN under general anesthesia at Chiba University Hospital (Chiba, Japan) between April 2011 and July 2019. All 21 patients were female. DP with a splenectomy was performed in all the patients. A total of 14 patients underwent laparoscopic DP (LDP). No lymph node metastasis was found in any of the patients. The minimally invasive surgery group had lower operative blood loss and a shorter hospital stay than the open surgery group. There was no significant difference in the number of dissected lymph nodes between the open surgery group and the minimally invasive surgery group. Preoperative findings of malignancy in MCN included solid components on enhanced CT and endoscopic ultrasonography, high carbohydrate antigen 19-9 values and large tumor size. In conclusion, DP with spleen preservation, which is minimally invasive, may be preferentially considered as a surgical technique for MCN without malignant findings because lymph node metastases are rare in MCN and were not observed in the present study.

Pseudopapillary and Solid Tumors of the Pancreas: Case Report and Review of the Literature

The pseudopapillary and solid tumor of the pancreas (TPPSP) is characterized by a malignant potential attenuated with a low risk of local extension and rare metastatic evolution. We report an observation of TPPSP, in a 62-year-old man, revealed by chronic epigastralgia. The diagnosis of cystic tumor was made on the abdominal CT scan. Surgical treatment consisted of a left splenopancreatectomy. The histological study confirmed the diagnosis of TPPSP.