Neoplasms Of Pancreas Research Articles

Natural History and Optimal Treatment Strategy of Intraductal Papillary Mucinous Neoplasm of Pancreas

Background: With increasing detection of intraductal papillary mucinous neoplasms(IPMN), a tailored approach is needed. We explored the natural history of IPMN and suggest optimal treatment based on malignancy risk using nomogram and Markov decision model. Methods: Patients with IPMN, who underwent surveillance or surgery, were included. Change in worrisome features/high-risk stigmata and malignancy conversion rate was calculated through radiologic and pathologic reviews. Life expectancy and quality-adjusted life year (QALY) were compared using a nomogram predicting malignancy. Results: Overall, 2,006 patients with histologically confirmed or radiologically typical IPMN were enrolled. Of these, 1,773(88.4%) had branch duct(BD), 81(4.0%) had main duct and 152(7.6%) had mixed type at initial diagnosis. The cumulative risk of developing worrisome feature/ high-risk stigmata was 19.0% at 5-year and 35.0% at 10-year- follow-up. The progression of malignancy rate at 10-year follow-up was 79.9% for main and mixed type IPMN and 5.9% for BD-IPMN. Nomogram based malignancy risk prediction is well correlated with natural history based on pathologic biopsy and shows good stratification of the survival. Decision model recommends surgery to maximize overall survival and quality-adjusted life year for patients under 75-years old, especially those with over 35% malignancy risk Conclusion: Compared to the high risk of malignancy (79.9%) in main and mixed type IPMN, that (5.9%) of BD-IPMN are very indolent. The nomogram-based decision model suggests surgery rather than surveillance for patients with high malignancy rate. Optimal treatment strategy between surgery and surveillance should consider patient's health status, malignancy risk, and centre's experience.

Minimally invasive surgery for cystic neoplasms of pancreas - a single centre experience

Minimally invasive surgery for cystic neoplasms of pancreas - a single centre experience

Early venous intervention during resection of pancreatic neoplasms with SMV/PV occlusions

Introduction: Pancreatic neoplasms with superior mesenteric and/or portal vein (SMV/PV) occlusions present the significant (substantial) surgical challenge of mesenteric hypertension. We present a series of patients who underwent pancreas resection with complete SMV/PV occlusion. Methods: A retrospective review of patients diagnosed with pancreas tumors with concomitant SMV/PV occlusions, and underwent pancreas resection with vascular intervention in the form of portosystemic shunting, resection and thrombectomy was performed. Demographics, perioperative characteristics and outcomes were reviewed. Results: Eleven patients, with a median age of 56, underwent pancreas resection with vascular intervention for pancreas neoplasms with SMV/PV occlusion. The median follow-up was 26 months. Six patients were treated for pancreatic neuroendocrine tumor, two for pancreatic adenocarcinoma, two for solid pseudopapillary tumor and one for a cystic lesion believed to be a large cystic tumor (final pathology revealed sclerosing pancreatitis). Two underwent pancreaticoduodenectomy, 6 left sub- or near total pancreatectomy, and 3 total pancreatectomy. Six underwent early mesocaval shunting, with SMV/PV reconstruction following pancreas resection. Four underwent in-line SMV/PV reconstruction with conduit prior to the bulk pancreatic dissection/reconstruction, and one underwent early tumor thrombectomy. The internal jugular vein was graft of choice in nine patients. Median hospital length of stay was 11 days. Five patients developed complications with Clavien-Dindo grade >III. Six patients required readmission. There were no 90-day mortalities. Conclusion: Despite the technical challenges that arise from the sequelae of SMV/PV occlusion, early mesenteric decompression via mesocaval shunting or immediate in-line SMV/PV reconstruction with graft allows pancreatectomy in the face of SMV/PV occlusion to be performed safely.

Outcome of Surgical Management of Pancreas Neoplasms in a Large Community Hospital.

Outcomes of complex pancreatic procedures have been used as an index for quality, and higher volume has been associated with improved outcomes, leading to advocacy for referral to those centers. The aim of the study was to evaluate the outcomes of pancreaticoduodenectomy (PD) at a low-volume referral center. This retrospective study included patients who had a PD within a 7-year period. Operative performance parameters and outcomes were examined. Overall, there were 47 pancreatic resections, of which 38 met the inclusion criteria and were used for analyses. The overall median for blood loss, packed red blood cells units transfused, and postoperative days in hospital was as follows, respectively: 675mL (interquartile range [IQR] = 500-900), 0 units (IQR = 0-2), 12days (IQR = 9-18). Demographic characteristics, comorbidities, and complications align with the literature. The 30-day in-hospital mortality rate was 5%. Survival probability for those with pancreatic adenocarcinoma at 1year was 52% and 7% for years 2 and 3. As cases increased, significant improvement was noted in process outcomes including blood loss, blood transfusion rates, and length of stay (LOS). Survival was comparable to that in the literature, with limitation of not being adjusted for adjuvant therapy. Outcomes of complex pancreatic procedures, like PD, at a low-volume center with commitment and adequate support systems, can match those at high-volume centers.

Magnetic resonance (MR) for mural nodule detection studying Intraductal papillary mucinous neoplasms (IPMN) of pancreas: Imaging-pathologic correlation

PurposeMagnetic Resonance (MR) is recommended to diagnose Intraductal Papillary Mucinous Neoplasms (IPMN) and in the follow-up of borderline lesions. The purpose of this work is to evaluate the diagnostic accuracy of dynamic MR with Diffusion Weighted Imaging (DWI) in the identification of mural nodules of pancreatic IPMN by using pathological analysis as gold standard. Materials and methodsNinety-one preoperative MR with histopathological diagnosis of IPMN were reviewed by two radiologists. Presence, number and size of mural nodule, signal intensity of the nodule on T1-weighted imaging (T1-WI) after contrast medium administration and on DWI. Inter-observer agreement was evaluated. ResultsSignificant correlation (p < 0.0001) were found for presence of nodules > 5 mm on MR and pathological specimen, size and number of mural nodules evaluated on pathological review and degree of dysplasia, size and number of mural nodules evaluated on MR and tumoral dysplasia, presence of nodule > 5 mm with enhancement after contrast medium administration and hyperintensity on DWI and degree of dysplasia. Interobserver agreement was moderate for the presence of mural nodule (K = 0.56), for the presence of high signal intensity on DWI (K = 0.57) and enhancement of mural nodule (K = 0.58). Apparent Diffusion Coefficient (ADC) map histogram analysis showed a correlation between Entropy of the entire cystic lesion and the degree of dysplasia (p < 0.034). ConclusionsMR with dynamic and DWI sequences was an accurate method for the identification of ≥ 5 mm solid nodules of the IPMNs and correlate with the lesion malignancy. Entropy, calculated from the histogram analysis of the IPMN ADC map, correlated with the lesion dysplasia.

Аберрантная поджелудочная железа: диагностика и терапевтическая тактика. Клиническое наблюдение

Aberrant pancreas is a result of impaired embryogenesis. The clinical presentation varies and mimics different diseases. The diagnostics complexity makes specialists conduct the patients’ work-up more thoroughly. Chronic recurrent pancreatitis is one of pancreatic cancer risk factors. Tobacco and alcohol consumption significantly increases the risk of developing aberrant pancreas. The article presents a clinical case of a 37-year-old man with a 10-year history of chronic pancreatitis mainly highlighting the diagnostics of aberrant pancreas. The disease manifested with an episode of acute pancreatitis and pancreonecrosis treated in a hospital. Pancreatic pseudocysts were diagnosed four years later. However, only six years after, aberrant pancreas in stomach and cystic dystrophy of duodenal wall were diagnosed. Accurate diagnosis allowed tailored treatment and avoiding surgery.

Neuroendocrine neoplasms of lung, pancreas and gut: a morphology-based comparison.

The bronchopulmonary (BP) and gastroenteropancreatic (GEP) organ systems harbor the majority of the neuroendocrine neoplasms (NENs) of the body, comprising 20 and 70% of all NENs, respectively. Common to both NEN groups is a classification distinguishing between well- and poorly differentiated NENs associated with distinct genetic profiles. Differences between the two groups concern the reciprocal prevalence of well and poorly differentiated neoplasms, the application of a Ki67-based grading, the variety of histological patterns, the diversity of hormone expression and associated syndromes, the variable involvement in hereditary tumor syndromes, and the peculiarities of genetic changes. This review focuses on a detailed comparison of BP-NENs with GEP-NENs with the aim of highlighting and discussing the most obvious differences. Despite obvious differences, the principle therapeutical options are still the same for both NEN groups, but with further progress in genetics, more targeted therapy strategies can be expected in future.

Neutrophil to lymphocyte ratio and intraductal papillary mucinous neoplasms of the pancreas: what are we missing?

Neutrophil to lymphocyte ratio and intraductal papillary mucinous neoplasms of the pancreas: what are we missing?

Squamous Cell Carcinoma Of Pancreas: An Exceedingly Rare Entity In A Young Female

Abstract Introduction/Objective Squamous cell carcinoma(SqCC) of Pancreas is a vanishingly rare neoplasm with dismal survival. Only a handful of cases are ever reported as pure SqCC reportedly accounts for &amp;lt;1% of malignancies of exocrine pancreas. Although, few theories have been proposed in an attempt to explain origin of this tumor including the possibility of (1)common progenitor cell and (2)squamous metaplasia, none have been proven with concrete evidence. Methods Here, we are presenting a case of squamous cell carcinoma of pancreas in a 33-year-old female who presented with 2-year history of right upper quadrant abdominal pain and a palpable mass. The imaging showed a multi-lobulated cystic mass encasing cystic duct, portal vein, and superior mesenteric artery. Results Grossly the mass was 5.2 cm in the greatest dimension. The mass revealed solid and cystic areas and was filled with hemorrhagic debris. On microscopy, the cyst wall was infiltrated by malignant neoplasm composed of irregular tongues and cords of malignant cells with nests of central keratinization. The tumor was consistent with squamous cell carcinoma. Foci of high grade cells with oval to spindled hyperchromatic nuclei, with many prominent nucleoli were also noted. There was no evidence of glandular component despite adequate sampling. The differential diagnoses of pancreatoblastoma and metastatic squamous cell carcinoma were considered and excluded. Conclusion SqCC of Pancreas is an exceedingly rare neoplasm of Pancreas. The diagnosis is made after extensive work up, adequate sampling and ruling out other common primary tumors and the possibility of metastasis. It usually follows an aggressive course with resistance to conventional neoadjuvant therapy. During the recent years, survival rates have shown some improvement with respectability and low to intermediate grade emerging as favorable prognostic factors. However, to further validate such findings noted in published case reports of this rare entity, collaborative studies with pooled data are deemed necessary.

S0244 Risk of Gastrointestinal Malignancies in Dermatomyositis and Polymyositis: A Population-Based National Study

INTRODUCTION: Dermatomyositis (DM) and polymyositis (PM) are idiopathic inflammatory myopathies that have long been associated with various types of malignancies as possible paraneoplastic responses to oncogenesis. We conducted a population-based national study to evaluate the prevalence of pancreatic, gastric and colorectal cancer diagnosis simultaneously with or within 5 years after the diagnosis of DM or PM in the United States (US) utilizing a large database. METHODS: We queried a commercial database (Explorys Inc, OH), an aggregate of EHR data from 26 major integrated healthcare systems in the US from 1999 to 2020. Using Systematized Nomenclature of Medicine-Clinical Terms, we identified a cohort of eligible patients with a diagnosis of DM or PM between May 2015 and May 2020, followed by the diagnosis of primary malignant neoplasm of pancreas, stomach or large intestines the same day of or within 5 years after the diagnosis DM or PM. Patients with a history of any of these three malignancies were excluded. We also studied potential risk factors (age, gender, and race) for gastrointestinal (GI) malignancies among individuals with DM or PM. RESULTS: Of the 19,370 patients in the database diagnosed with DM or PM, 140 patients were diagnosed with pancreatic cancer, gastric cancer or colorectal cancer. The prevalence of these malignancies was 0.72% in comparison to 0.43% in the population without DM or PM, with OR of 1.71 (95% CI: 1.45–2.02, P < 0.0001). The prevalence is similar (both about 0.7%) with DM and PM when calculated separately. Moreover, individuals with DM or PM who were diagnosed with GI malignancies were more likely to be age > 65 years (OR 2.94, 95% CI: 2.04–4.25). We did not find gender or race to be associated with increased rate of GI malignancy (Table 1). Among patients age 50 years or above, the prevalence of GI malignancy at 10-year age interval are shown in Figure 1. CONCLUSION: We found that patients with DM or PM were almost twice as likely to be diagnosed with pancreatic, gastric or colorectal cancer at the time of or within 5 years after their DM or PM diagnosis. Our result could be an underestimate of this correlation as GI malignancy cases diagnosed before DM or PM were not included in our study. Among individuals with DM or PM, those age >65 years have a significantly increased rate of these malignancies.Table 1.: Potential risk factors (age, gender, and race) for GI malignancies among individuals with DM/PMFigure 1.: Prevalence of GI malignancy at 10-year age interval among DM/PM patients age 50 years or above.

S1448 Solid Pseudopapillary Neoplasm of Pancreas: A Rare Pancreatic Malignancy

INTRODUCTION: Solid pseudopapillary neoplasm of pancreas (SPN) is one of the rarest types of pancreatic tumors, <2% of all pancreatic malignancies, also known as a Hamoudi or Frantz tumor. SPNs usually presents asymptomatically in females in the third decade of life and found incidentally on radiological imaging. CASE DESCRIPTION/METHODS: Here, we present three proven SPN cases by histology. Case 1: A 42-year-old Hispanic female with no past medical history who presented with 1-day history of cough, incidentally found to have a 3 cm hypodense lesion in the pancreatic body on CT scan. Endoscopic ultrasound (EUS) with biopsy was performed and immunohistochemical (IHC) studies found tumor cells to be positive for B-catenin, progesterone receptor and neuron specific enolase, consistent with a diagnosis of SPN. Case 2: A 48-year-old African American female with a past medical history of GERD presented with intermittent right upper quadrant abdominal pain. CT demonstrated a large solid, periportal hepatic mass (19 × 17 × 19 cm) as well as a multi-cystic mass (14 × 7 × 10 cm) arising from the distal pancreatic tail. Exploratory laparotomy was performed and pathology showed a uniform population of small cells with pseudopapillary structures with IHC profile supporting the diagnosis of metastatic SPN. Case 3: A 31-year-old Hispanic female with no significant past medical history presented with 2 months history of post-prandial epigastric abdominal pain found to have a hypodense mass (4 × 4 cm) in the distal pancreatic tail. Surgical resection was performed. Pathology findings of neoplastic tumor cells with occasional groves, collections of histiocytes, and hyaline globules with positive IHC staining for vimentin, B-catenin and progesterone receptor, consistent with diagnosis of SPN. DISCUSSION: On imaging, SPN tumors typically appear as a well-defined mass, with a thick, enhancing capsule, often with peripheral or central calcification. Although most often solid, they can demonstrate variable internal hemorrhagic or cystic components. EUS is the modality of choice for further imaging and definitive diagnosis, as biopsy can be performed. Here, we describe three cases including a unique and rare case of metastatic SPN. Clinicians should be aware of this relatively rare pancreatic lesion as its presentation may be insidious and early imaging is key. Once diagnosed, physicians should pursue multidisciplinary discussions with early surgical management even in metastatic disease, as outcomes are excellent with a favorable prognosis.Figure 1.: MR Imaging - SPN.Figure 2.: Endoscopic US - SPN.Figure 3.: Histopathology - SPN.

Nutritional treatment is associated with longer survival in patients with pancreatic disease and concomitant risk of malnutrition

Pancreatic diseases involve complex nutritional challenges. Despite this, conflicting evidence exists regarding the clinical relevance of detecting the risk of malnutrition and implementing systematic nutrition support for these patients. Thus, our aims were to investigate whether screening for malnutrition risk and initiating nutrition support are predictive of mortality for hospitalized patients with pancreatic diseases. From 2008 to 2018, 34 prevalence surveys of nutrition were conducted at Haukeland University Hospital (HUH), Norway. Risk of malnutrition was defined by a score of ≥3 in Nutritional Risk Screening 2002 (NRS 2002). Primary outcomes included overall, one-year, and one-month mortality, and were compared according to malnutrition risk and nutrition support for adult patients with ICD-10 codes of K85: acute pancreatitis, K86: other diseases of pancreas, and C25: malignant neoplasm of pancreas. Length of hospital stay (LOS) was included as a secondary outcome. Of the 283 patients investigated, risk of malnutrition was present in 61.5%. Risk of malnutrition was associated with higher overall mortality (Hazard Ratio (HR)=1.67, 95% confidence interval (CI): 1.2-2.4, P=0.003) and one-year mortality (HR=1.89, 95% CI: 1.2-2.9, P=0.004) compared to patients not at risk. Not receiving nutrition support for at-risk patients was associated with higher overall mortality (HR=1.60, 95% CI: 1.1-2.4, P=0.019) and one-year mortality (HR=1.64, 95% CI: 1.04-2.6, P=0.034) compared to patients at risk who received nutrition support. Patients at risk of malnutrition had increased LOS (20.5 nights vs 15.2 nights, P=0.044) compared to patients not at risk of malnutrition. This study of hospitalized patients with pancreatic disease suggests that risk of malnutrition may be associated with higher mortality rates, whereas nutrition support may decrease mortality rates. Not registered.

S1440 A Case Series of Five Solid Pseudopapillary Neoplasm of Pancreas: Comparison of Four Putative Immunohistochemical Stains With Four Conventional Immunohistochemical Stains

INTRODUCTION: Solid pseudopapillary neoplasm (SPN), a rare exocrine tumor, accounts for 0.2-2.7% of primary pancreatic tumors occurs mostly in young females. The histologic origin is debatable and thus, it is important to identify the most sensitive and specific biomarkers. Through this case series, we are addressing the comparative analysis of four commonly used immunostains with 4 new putative immunohistochemical markers. CASE DESCRIPTION/METHODS: We performed an electronic search of pathology records for a 25 years-period (1994-2019) for SPN. Formalin-fixed, paraffin-embedded tissue blocks were retrieved and used for staining for four commonly used (CD-10, Beta- Catenin, Progesterone receptor, Alpha-1 antitrypsin) and four new (LEF-1, TFE-3, SOX-11 and AMACR) immunohistochemical markers.: In our case-series, female-to-male ratio is 4:1, with a mean age of 37.6 years. The tumor size ranged from 2.3 to 14 cm. Only one case showed aggressive features of necrosis, perineural invasion and lymphovascular invasion. None of the cases showed lymph node or distant metastasis. The results from the immunohistochemical staining are noted in Table 1. DISCUSSION: In our case series, lymphoid enhancer factor-1 (LEF-1) emerged out as the most sensitive new putative marker with 100% diffuse nuclear positivity among the other new markers. To the best of our knowledge, these novel results are noted for the first time in our case series. This significant finding is in congruence with the emerging molecular diagnostic finding that the long isoform of LEF-1 expresses b-catenin binding domain and functions as a transcriptional enhancer factor. It also emphasizes the involvement of Wnt/β-catenin signaling pathway in the histologic origin of this tumor. Further studies are needed to evaluate its specificity especially against SPN mimickers such as Acinar-cell carcinoma and pancreatic neuroendocrine tumors.Figure 1.: Figure 1: A. Solid pseudopapillary neoplasm H&E section at 200x. B. SPN TFE-3 stain at 200x C. SPN Alpha 1 antitrypsin 200x D. SPN AMACR stain at 400x E. SPN Beta Catenin at 400x F. SPN CD10 at 400x G. SPN LEF-1 stain at 400x H. SPN SOX-11 stain at 400x.Table 1.: Staining pattern and comparison of four conventional stains with 4 putative stains in 5 cases of Solid Pseudopapillary neoplasm of pancreas.

Solid Pseudo-Papillary Neoplasm of Pancreas with Venous Invasion in A 9 Year Old Girl: A Case Report and Literature Review

Solid Pseudo-papillary neoplasm of the pancreas (SPN) is a rare entity. It represents 0.2-2.7% of all pancreatic cancers. Predominantly occurs in young females in the second to third decades of life. The etiology of SPN involves mutations in the gene that encodes beta-catenin. SPNs are typically indolent tumors, usually confined to the pancreas. We report a case of SPN in a 9-year-old female presented with intermittent abdominal pain for four months. Imaging studies demonstrated a 2.8 cm mass in the tail of the pancreas. The patient underwent a distal pancreatectomy. Pathological evaluation was diagnostic for SPN in the tail of the pancreas. Our case is distinct because of the young age of the patient, peripancreatic soft tissue, perineural, and lymphovascular invasion. The tumor cells exhibited cytoplasmic and nuclear immunoreactivity for beta-catenin and progesterone receptors.

Streptozotocin - an antibiotic used to induce diabetes on experimental animals

Streptozotocin (STZ) is a cytostatic antibiotic produced by Streptomyces achromogenes. It is an inhibitor of DNA replication showing a special affinity for pancreatic β-cells DNA. It is used in medicine as an antineoplastic agent (indicated in the treatment of malignant neoplasms of pancreas) and in scientific research to induce hyperglycemia, insulitis, diabetes mellitus (DM), Alzheimer’s disease on experimental animals. Insulinopenia syndrome is called ‘streptozotocin diabetes’, caused by necrosis of the pancreatic β-cells. STZ induced DM offers a very cost-effective and expeditious technique in medical research.

Тромбоэмболия легочной артерии как раннее проявление злокачественного новообразования поджелудочной железы

Тромбоэмболия легочной артерии как раннее проявление злокачественного новообразования поджелудочной железы

Fate of Patients With Intraductal Papillary Mucinous Neoplasms of Pancreas After Resection According to the Pathology and Margin Status: Continuously Increasing Risk of Recurrence Even After Curative Resection Suggesting Necessity of Lifetime Surveillance.

This study evaluated the associated factors and prognosis according to pathology and margin after surgical resection of intraductal papillary mucinous neoplasms (IPMN). There is limited information on recurrence patterns according to pathology and margin in IPMN. Total 577 patients who underwent operation for IPMN at a tertiary center were included. Factors associated with recurrence, survival, and recurrence outcomes according to pathology and margin were analyzed. Among 548 patients analyzed, 353 had low-grade dysplasia (LGD), 78 had high-grade dysplasia (HGD), and 117 had invasive IPMN. Total 50 patients developed recurrences, with 4 resection margins, 10 remnant pancreas, 11 locoregional, and 35 distant recurrences. Invasive IPMN showed worse 5-year cumulative recurrence risk (LGD vs HGD vs invasive: 0.7% vs 4.3% vs 37.6%, P < 0.001) and 5-year survival rate (89.0% vs 84.0% vs 48.4%, P < 0.001). Recurrence risk increased after 5 years, even in LGD and HGD. Malignant margin (HGD and invasive) had worse 5-year cumulative recurrence rate (R0 vs LGD vs malignant: 8.3% vs 5.9% vs 50.6%, P < 0.001) and 5-year survival rate (80.7% vs 83.0% vs 30.8%, P < 0.001). Carbohydrate antigen 19-9 >37 ( P = 0.003), invasive IPMN ( P < 0.001), and malignant margin ( P = 0.036) were associated with recurrence. Invasive IPMN developed more recurrences and had worse survival than LGD or HGD, indicating the need for more efficient postoperative treatment strategies. Patients with LGD and HGD also need regular follow-up for recurrence after 5 years. Malignant margins need additional resection to achieve negative or at least LGD margin.

Yttrium-90 selective internal radiotherapy as bridge to curative hepatectomy for recurrent malignant solid pseudopapillary neoplasm of pancreas: case report and review of literature

Recurrent malignant solid pseudopapillary neoplasms of the pancreas (SPNP) are rare tumors with unpredictable clinical and histopathological features. There is a lack of consensus regarding utilization of adjuvant modalities in conjunction with or in lieu of curative metastatectomy. We present a remarkable case where Yttrium-90 selective internal radiation therapy (Y-90 SIRT) was successfully utilized to elucidate underlying tumor biology and aid resection of a large multifocal recurrent metastatic SPNP in the right hemi-liver of a 59-year-old female. Thus, in cases where curative metastatectomy remains the treatment goal in management of recurrent and/or metastatic SPNPs, Y-90 SIRT is a safe and effective adjunct treatment to facilitate curative resection.

Solid pseudopapillary tumour of pancreas

Solid Pseudopapillary tumor (SPT) is a tumor with low malignant potential and comprises around 1-2% of all tumors occurring in Pancreas. Pseudocyst of Pancreas, Microcystic adenoma, neuroendocrine tumor and mucinous cystic neoplasm are considered as challenging differentials of SPT. High suspicion followed by accurate diagnosis is key to management because SPT is known for its good prognosis and successive cure rate on surgical resection. 21-year-old female patient presented with complaints of abdominal pain and dyspnoea. Imaging studies revealed a retroperitoneal tumor. Surgical resection carried out. Gross examination of the specimen showed circumscribed lobular brown mass weighing around 468 gm with a measurement of 15x12x10 cm. On sectioning, the tumor had a variegated appearance containing multiple cysts varying from 1 - 3 cm in size. Microscopic examination revealed an encapsulated cellular neoplasm with individual tumor cells arranged in solid, pseudopapillae and cystic patterns. Tumor cells were round to oval with no distinct nucleoli. Mitotic figures were very few in number. Hyaline globules were noted. Mucinous changes were seen focally. Occasional areas exhibited clear cell change of tumor cells. Cystic areas were filled with heamorrhage. Vascular areas were unremarkable. Normal Pancreatic parenchyma was noted at the tumor edge. Morphology of SPTs are varied ranging from solid to cystic appearance. No definitive morphology is identified to differentiate benign from malignant SPT. SPT are known to mimic a wide range of pancreatic and retroperitoneal lesions that may pose a challenge to diagnostic pathologists as seen in this case.

Functional disorders of the biliary tract: modern diagnostic criteria and principles of pharmacotherapy

The review article presents current data on functional disorders of the biliary system, taking into account the latest recommendations of experts of the Rome Foundation (Rome Criteria IV, 2016) and the Russian Gastroenterological Association (specialized clinical recommendations, 2018). According to modern concepts, biliary dysfunction is a group of functional disorders of the biliary system caused by motor disorders and increased visceral sensitivity. According to the literature data, the prevalence of functional disorders of GB and OS is 10-15%, and violation of OS function is revealed in 30-40% of patients who underwent cholecystectomy (CE). The presence of biliary pain is an obligatory condition in the diagnosis of functional disorders of GB and OS. Bilirubin and serum transaminases (AST, ALT) levels may increase in biochemical blood analysis in patients with functional OS disorder of biliary type, and pancreatic amylase and lipase in case of functional OS disorder of pancreatic type. Ultrasound examination of abdominal organs is considered to be the priority among instrumental methods. This technique allows to exclude organic lesions of both the GB and visualized ducts, and adjacent organs (GSD, biliary tract, liver and pancreas neoplasms). Magnetic resonance cholangiopancreatography (MRCP) is used as a clarifying method, which allows to visualize the state of biliary ducts throughout. Ultrasonic cholecystography is used to assess the contractile activity of the GB. When duct dilation is detected and/or when liver/pancreatic enzyme levels are elevated in the absence of changes according to MRCP data, it is reasonable to perform an endoscopic ultrasound examination. According to the latest recommendations of the Russian Gastroenterological Association (2018), the foundation of pharmacotherapy for this group of diseases are antispasmodics and ursodeoxycholic acid (UDCA).