Pancreatic Mass Research Articles

Contrast-enhanced endoscopic ultrasound likely does not improve diagnostic adequacy during endoscopic ultrasound guided tissue acquisition: A systematic review and meta-analysis

Background and aimsSolid pancreatic masses are sampled through tissue acquisition by endoscopic ultrasound (EUS). Inadequate samples may significantly delay diagnosis, increasing costs and carrying risks to the patients. Aim: assess the diagnostic adequacy of tissue acquisition using contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) compared to conventional EUS. MethodsFive databases (PubMed, Embase, CENTRAL, Scopus and Web of Science) were searched in November 2023. Studies comparing diagnostic adequacy, accuracy and safety using CEH-EUS versus conventional EUS for tissue acquisition of solid pancreatic masses were included. Risk of bias was assessed using the Risk of Bias tool for randomized controlled trials (RoB2) and the Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tool for non-randomized studies, level of evidence using the GRADE approach, Odds Ratios (RR) with 95 % Confidence Intervals (CI) calculated and pooled using a random-effects model. I2 quantified heterogeneity. ResultsThe search identified 3858 records; nine studies (1160 patients) were included. OR for achieving an adequate sample was 1.467 (CI: 0.850–2.533), for randomized trials 0.902 (CI: 0.541–1.505), for non-randomized 2.396 (CI: 0.916–6.264), with significant subgroup difference. OR for diagnostic accuracy was 1.326 (CI: 0.890–1977), for randomized trials 0.997 (CI: 0.593–1.977) and for non-randomized studies 1.928 (CI: 1.096–3.393), significant subgroup difference (p = 0.0467). No differences were observed for technical failures or adverse events. Heterogeneity was low, risk of bias “low” to “some concerns” for most outcomes, mostly moderate for non-randomized studies. ConclusionNon-randomized studies indicated differences in favor of contrast-enhanced EUS, randomized studies showed no difference in diagnostic adequacy, accuracy or sensitivity when using CEH-EUS.

Inter-reader agreement of pancreatic adenocarcinoma resectability assessment with photon counting versus energy integrating detector CT.

To compare the inter-reader agreement of pancreatic adenocarcinoma resectability assessment at pancreatic protocol photon-counting CT (PCCT) with conventional energy-integrating detector CT (EID-CT). A retrospective single institution database search identified all contrast-enhanced pancreatic mass protocol abdominal CT performed at an outpatient facility with both a PCCT and EID-CT from 4/11/2022 to 10/30/2022. Patients without pancreatic adenocarcinoma were excluded. Four fellowship-trained abdominal radiologists, blinded to CT type, independently assessed vascular tumor involvement (uninvolved, abuts ≤ 180°, encases > 180°; celiac, superior mesenteric artery (SMA), common hepatic artery (CHA), superior mesenteric vein (SMV), main portal vein), the presence/absence of metastases, overall tumor resectability (resectable, borderline resectable, locally advanced, metastatic), and diagnostic confidence. Fleiss's kappa was used to calculate inter-reader agreement. CTDIvol was recorded. Radiation dose metrics were compared with a two-sample t-test. A p < .05 indicated statistical significance. 145 patients (71 men, mean[SD] age: 66[9] years) were included. There was substantial inter-reader agreement, for celiac artery, SMA, and SMV involvement at PCCT (kappa = 0.61-0.69) versus moderate agreement at EID-CT (kappa = 0.56-0.59). CHA had substantial inter-reader agreement at both PCCT (kappa = 0.67) and EIDCT (kappa = 0.70). For metastasis identification, radiologists had substantial inter-reader agreement at PCCT (kappa = 0.78) versus moderate agreement at EID-CT (kappa = 0.56). CTDIvol for PCCT and EID-CT were 16.9[7.4]mGy and 29.8[26.6]mGy, respectively (p < .001). There was substantial inter-reader agreement for involvement of 4/5 major peripancreatic vessels (celiac artery, SMA, CHA, and SMV) at PCCT compared with 2/5 for EID-CT. PCCT also afforded substantial inter-reader agreement for metastasis detection versus moderate agreement at EID-CT with statistically significant radiation dose reduction.

A rare case of exophytic pancreatic ductal adenocarcinoma with multiple metastases shown on 18F-FDG PET/CT

Exophytic pancreatic cancer is an extremely rare subtype of pancreatic cancer that has not been strictly defined but is based on morphological origin. Herein, we reported a 69-year-old man who presented with an unexplained elevation of CA199. He was diagnosed with exophytic pancreatic cancer by β-2-Fluoro-2-deoxy-D-Glucose (18F-FDG) Positron Emission Tomography (PET)/Computed Tomography (CT), which exhibited a high 18F-FDG-avid mass behind the body of the pancreas. In addition, multiple metastases, including liver, lung, and lymph nodes, were apparently detected. Finally, Pancreatic Ductal Adenocarcinoma (PDAC) was pathologically confirmed. A posterior pancreatic mass attached to the pancreas and accompanied by elevated CA199 and hyperglucose metabolism could be linked to exophytic pancreatic cancer, which is significant to be aware of for early diagnoses and treatment.

Computed tomography-guided percutaneous biopsy of pancreatic masses.

Computed tomography-guided percutaneous biopsy of pancreatic masses.

Transcriptomic profiling analysis of the effect of palmitic acid on 3D spheroids of β-like cells derived from induced pluripotent stem cells

Type 2 diabetes (T2D) is posing a serious public health concern with a considerable impact on human life and health expenditures worldwide. The disease develops when insulin plasma level is insufficient for coping insulin resistance, caused by the decline of pancreatic β-cell function and mass. In β-cells, the lipotoxicity exerted by saturated free fatty acids in particular palmitate (PA), which is chronically elevated in T2D, plays a major role in β-cell dysfunction and mass. However, there is a lack of human relevant in vitro model to identify the underlying mechanism through which palmitate induces β-cell failure. In this frame, we have previously developed a cutting-edge 3D spheroid model of β-like cells derived from human induced pluripotent stem cells. In the present work, we investigated the signaling pathways modified by palmitate in β-like cells derived spheroids. When compared to the 2D monolayer cultures, the transcriptome analysis (FDR set at 0.1) revealed that the 3D spheroids upregulated the pancreatic markers (such as GCG, IAPP genes), lipids metabolism and transporters (CD36, HMGSC2 genes), glucose transporter (SLC2A6). Then, the 3D spheroids are exposed to PA 0.5 mM for 72 h. The differential analysis demonstrated that 32 transcription factors and 135 target genes were mainly modulated (FDR set at 0.1) including the upregulation of lipid and carbohydrates metabolism (HMGSC2, LDHA, GLUT3), fibrin metabolism (FGG, FGB), apoptosis (CASP7). The pathway analysis using the 135 selected targets extracted the fibrin related biological process and wound healing in 3D PA treated conditions. An overall pathway gene set enrichment analysis, performed on the overall gene set (with pathway significance cutoff at 0.2), highlighted that PA perturbs the citrate cycle, FOXO signaling and Hippo signaling as observed in human islets studies. Additional RT-PCR confirmed induction of inflammatory (IGFBP1, IGFBP3) and cell growth (CCND1, Ki67) pathways by PA. All these changes were associated with unaffected glucose-stimulated insulin secretion (GSIS), suggesting that they precede the defect of insulin secretion and death induced by PA. Overall, we believe that our data demonstrate the potential of our spheroid 3D islet-like cells to investigate the pancreatic-like response to diabetogenic environment.

The impact of a graphic novel on anxiety and stress in patients undergoing endoscopic ultrasound with fine needle biopsy for pancreatic lesions: a pilot study protocol

The utilization of graphic novels in the realm of clinical medicine is an infrequent occurrence. However, there is a burgeoning interest in their application across a spectrum of pathological conditions with the ultimate aim of enhancing patient care. This study is a prospective pilot designed to assess the influence of graphic novels on the stress levels and behavioral responses of patients diagnosed with pancreatic lesions and who are to undergo endoscopic ultrasound-guided fine needle biopsy (EUS-FNB). Patients exhibiting radiological and clinical pancreatic lesions needing biopsy will be evaluated consecutively. The inclusion criteria encompass the presence of a solid pancreatic mass or a partially solid mass in the event of a cystic component. The exclusion criteria include patients with cognitive impairments, those currently on benzodiazepines or other psychotropic medications, and those with a prior diagnosis of cancer. The authors have developed a comic panel comprising a sequence of six vibrant vignettes, which delineate the standard procedure of EUS-FNB to the patient. Following hospital admission, patients who meet the enrolment criteria and consent to participate in the study will be randomly assigned to either the test or the control group. A graphic novel will be distributed to all patients in the test group, who will have the opportunity to peruse it while awaiting the procedure. Subsequent to the EUS-FNB, all enrolled patients will complete the Beck Anxiety Inventory (BAI) and a modified version of the Depression Anxiety Stress Scales-21 (termed mDASS-21 or mASS-14). The BAI, a 21-item self-report inventory, is employed to gauge the severity of anxiety in adults. The other questionnaire is a modified rendition of the DASS-21, which originally comprised 21 items segregated into three subscales (anxiety, stress, and depression) with seven items each. The anxiety subscale measures physiological arousal, situational anxiety, and the subjective experience of the effects of anxiety, while the stress subscale assesses chronic non-specific arousal, difficulty relaxing, nervous tension, irritability, agitation, and impatience.

Enfermedades inflamatorias de páncreas y vía biliar

Inflammatory involvement of the bile duct and pancreas can present in different ways depending on the etiology and place of involvement. These are rare diseases; the most common is autoimmune pancreatitis, which has two subtypes: type 1, which is considered the pancreatic manifestation of systemic IgG4-related disease (IgG4-RD) and type 2, which is considered a primarily pancreatic disease. The most common clinical presentation is in the form of jaundice and pancreatic masses with or without abdominal pain, which necessitates a differential diagnosis with pancreatic adenocarcinoma. Treatment is based on corticosteroids, with good response rates, but there is a non-negligible risk of recurrence which sometimes requires treatment with anti-CD20 (rituximab) or immunosuppressants. IgG4-RD can also affect the bile duct, in which case it is called IgG4-related sclerosing cholangitis, and treatment is similarly based on corticosteroids. Lastly, recurrent pyogenic cholangitis is a rare type of inflammatory disease of the bile duct characterized by the formation of recurrent intrahepatic and extrahepatic bile duct stones and recurrent episodes of cholangitis that often require endoscopic, radiological, or surgical treatment in addition to medical treatment.

Clinical predictors of significant findings on EUS for the evaluation of incidental common bile duct dilation

Although EUS is highly accurate for the evaluation of common bile duct (CBD) dilation, the yield of EUS in patients with incidental CBD dilation is unclear. Serial patients undergoing EUS for incidental, dilated CBD (per radiologist, minimum of >6mm objectively) from 2 academic medical centers without active pancreaticobiliary disease or significantly elevated liver function test results were evaluated. Multivariable logistic regression identified predictors of EUS with significant findings and a novel prediction model was derived from one center, internally validated with bootstrapping, and externally validated at the second center. Of 375 patients evaluated, 31 (8.3%) had significant findings, including 26 choledocholithiasis, 1 ampullary adenoma, and 1 pancreatic mass. Predictors of significant findings with EUS included age of≥70 years (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.5-10.0), non-biliary-type abdominal pain without chronic pain (OR, 6.1; 95% CI, 2.3-17.3), CBD diameter of≥15mm or≥17mm with cholecystectomy (OR, 6.9; 95% CI, 2.7-18.7), and prior ERCP (OR, 6.8; 95% CI, 2.1-22.5). A point-based novel clinical prediction model was created: age of≥70 years= 1, non-biliary-type abdominal pain without chronic pain= 2, prior ERCP= 2, and CBD dilation= 2. A score of<1 had 93% (development) and 100% (validation) sensitivity and predicted a<2% chance of having a significant finding in both cohorts while excluding the need for EUS in ∼30% of both cohorts. Conversely, a score of≥4 was >90% specific for the presence of significant pathology. Less than 10% of patients undergoing EUS for incidental CBD dilation had pathologic findings. This novel, externally validated, clinical prediction model may reduce low-yield, invasive evaluation in nearly one-third of patients.

An unusual case report of metastatic periampullary carcinoma

Pancreatic cancers usually metastasize through the lymphoid system to organs such as the lung, liver, bone and spleen. Ovarian metastasis in pancreatic cancers is extremely rare, hence, it is difficult to distinguish between primary and metastatic ovarian tumors, especially in tumors with a primary source from the GIT &amp; Hepatobiliary system. We present the case of a periampullary carcinoma with ovarian metastasis in a middle-aged female who presented with complaints of abdominal pain, constipation, yellowish discoloration of eyes and dark colored urine along with loss of appetite and weight loss for a duration of 6 to 8 weeks. Radiological examination revealed right adnexal lesion and nodular thickening along periampullary region. ERCP guided biopsy of the growth in periampullary region revealed moderately differentiated adenocarcinoma. She underwent pancreatico-duodenectomy with bilateral salpingo-oophorectomy. The histopathological examination revealed invasive carcinoma in both the ovaries, and moderately differentiated adenocarcinoma in periampullary and intra-ampullary region. As per the findings in previous studies, bilateral ovarian tumors of any size, or a unilateral tumor less than 10 cm likely represents metastatic disease rather than primary ovarian tumor. The rarity of co-presentation of pancreatic and adnexal mass makes the diagnosis tough however it is important to differentiate between primary ovarian mucinous cancers and ovarian metastasis from primaries in GIT for further treatment and follow up.

Follicular dendritic cell sarcoma arising from the lymph node of the pancreatic head: a case report with literature review.

A 72-year-old man was referred to our hospital for the examination of a pancreatic head mass. Abdominal computed tomography revealed a contrasted 8-cm-diameter tumor extending from the dorsal pancreatic head to the porta hepatis. The preoperative diagnosis was challenging due to the absence of specific imaging findings and the inability to perform a biopsy. Positron emission tomography/computed tomography and diffusion-weighted imaging suggested a malignant tumor originating from the organs surrounding the pancreatic head. Subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection was performed, as dissection from the pancreatic head proved unfeasible. Pathological examination identified the tumor as an enlarged lymph node consisting of pleomorphic large cells forming clusters, positive for follicular dendritic cell markers cluster of differentiation (CD) 21 and CD23. No evidence of tumor capsule infiltration, other organ infiltration, or metastasis to other lymph nodes was observed. The final diagnosis was nodal follicular dendritic cell sarcoma (FDCS) originating from the pancreatic head lymph nodes. No recurrence occurred at 3years postoperatively with no postoperative treatment. Intraperitoneal nodal FDCS is extremely rare, and occasionally, it can lead to postoperative recurrence and progression. It is crucial to differentiate neoplastic lymph node enlargement around the pancreatic head from nodal FDCS.

Abstract 4323: Deletion of the lipid kinase PIKfyve in Kras-driven pancreatic genetically engineered mouse model

Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) accounts for 95% of all pancreatic cancers and, as one of the most lethal cancers, has a five-year survival rate of approximately 6%. Autophagic processes have been reportedly elevated in PDAC; thus, the inhibition of autophagy leads to decreased tumor growth. Autophagic processes are catabolic mechanisms that recycle cellular components. Cells in stressful conditions, such as starvation, have elevated autophagy to redistribute energy to sustain cell survival; however, this can also lead to cell death when attempts to maintain cell viability fail. In addition, autophagy is known to promote immune evasion by tumors and cancer progression and appears to be required for the optimal development of PDAC. The lipid kinase PIKfyve converts phosphatidylinositol-3-phosphate to phosphatidylinositol 3,5-bisphosphate and is required in the late stage of the autophagic pathway. Blocking PIKfyve disrupts autophagic processes. However, the role of PIKfyve in PDAC development has not been fully understood. We investigated the role of PIKfyve in the progression of PDAC using a genetically engineered mouse model. Given the poor clinical outcomes of pharmacological inhibition of autophagy by chloroquine, we have evaluated the PIKfyve inhibitor ESK981 in the context of PDAC progression. Methods: The pancreatic-specific deletion of PIKfyve was established on a Kras G12D, Tp53 R172H, and p48 Cre (KPC) or Kras G12D and p48 Cre (KC) background. The ratio of pancreatic mass to body weight was monitored at various time points. Histopathology evaluations were conducted based on hematoxylin and eosin staining and immunohistochemistry of cytokeratin 19 staining. Pharmacological inhibition of PIKfyve was performed on KPC mice using ESK981 monotherapy. Four weeks after vehicle or ESK981 treatment, pancreatic tissues were collected intact and weighed. Histopathology evaluations were performed to evaluate the lesion. Conclusion: We demonstrated that the deletion of PIKfyve in pancreatic tissue significantly reduces the pancreatic mass weight compared to the PIKfyve wildtype counterpart and is coupled with less pancreatic intraepithelial neoplasia (PanIN) and PDAC development in KPC and KC mice. Compared to the vehicle treatment, pharmacological inhibition of PIKfyve by ESK981 on KPC mice resulted in a significant increase in the percentage of normal pancreatic tissue and reduced pancreatic lesion development. Citation Format: Sarah N. Yee, Xia Jiang, Caleb Cheng, Ahmet Korkaya, Rahul Mannan, Rohit Mehra, Yuanyuan Qiao, Arul M. Chinnaiyan. Deletion of the lipid kinase PIKfyve in Kras-driven pancreatic genetically engineered mouse model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4323.

Abstract 1137: Spatial expression profile of mucinous cystic neoplasm indicates a divergent malignant marker patterns in ductal and stromal regions

Abstract Mucinous cystic pancreatic neoplasms (MCPN), initially characterized as benign, present a unique challenge, with the five-year survival rate dropping from 100% to 57% if malignancy occurs. In this study, we using spatial genomic expression analysis of MCPN, and focus on the correlations between marker expression patterns in stroma and ductal region. Tissues obtained from surgical samples of a 69-year-old patient with a pancreatic head cystic mass and a history of pancreatitis (staged as T3N1Mx) were embedded in paraffin. These tissues were then sectioned, collected onto subbed slides, and subjected to probe hybridization, ligation, and extraction onto Visum slides following the manufacturer's instructions (10X Genomics). Genomic expression was extracted using established protocols, processed through SpaceRanger, and further visualized in Loupe Browser (10X Genomics). A comparison was conducted between the ductal and stromal regions, both with and without cystic involvement. Our study reveals a significant 5.1 log2 fold increase in MUC5AC expression in the ductal region, regardless of cystic involvement, suggesting implications for apoptosis regression and cadherin-dependent cell adhesion in MCPN progression. Further analysis indicates a significantly higher expression of TMSB4X exclusively in the ductal region, extending into the surrounding stroma, potentially stimulating MCPN progression by fostering pro-inflammatory cytokine environments. The novel marker IGKC, indicating favorable prognosis and PDAC treatment efficacy, shows high expression in the stroma (1.8 log2 fold higher). However, around the duct with cystic involvement, its expression is notably reduced (-1.7 log2 fold lower), suggesting pathways that may contribute to MCPN's progression towards a more invasive PDAC phenotype. Additionally, our study reveals a 1.9 log2 fold elevated expression of FN1, a biomarker associated with poor outcomes in PDAC patients, in the stroma around the cyst, hinting at a possible pathogenic role of FN1 in cell adhesion, migration, and progression of MCPN to PDAC. Co-expression of FN1 with COMP and TIMP3 within MCPN suggests a concerted effort in the microenvironment, influencing tissue development, maintenance, and extracellular matrix remodeling. Co-localization of FN1 with COMP and TIMP3, particularly within degenerating acinar cells, hints at a potential mechanism in the intricate progression of MCPN to PDAC. These findings contribute to a deeper understanding of the molecular landscape of MCPN, offering potential avenues for targeted interventions to thwart its progression to PDAC, guiding novel diagnostic and therapeutic strategies for pancreatic neoplasms. Further expression data will be presented. Citation Format: Arshia Ghodrati, Chirag S. Gopinath, Amin Parvizi, Manu Gnanamony, Lusine Demirkhanyan, Christopher S. Gondi. Spatial expression profile of mucinous cystic neoplasm indicates a divergent malignant marker patterns in ductal and stromal regions [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1137.

EUS-guided FNA and biopsy for cytohistologic diagnosis of gallbladder cancer: a multicenter retrospective study

EUS-guided FNA and biopsy (EUS-FNAB) is a standard diagnostic procedure for pancreatic masses but not gallbladder (GB) cancer (GBC). The aim of this study was to investigate the efficacy and safety of EUS-FNAB for patients with suspected GBC. Data were analyzed from patients who underwent EUS-FNAB for suspected GBC in 3 hospitals between 2010 and 2023. The diagnostic performance and safety of EUS-FNAB according to characteristic factors were calculated and compared. Of 170 patients, 163 had GBC. EUS-FNAB samples were obtained from the GB in 125 patients and sites other than the GB in 45 patients. The overall sensitivity, specificity, and accuracy were 83.4%, 100%, and 84.1%, respectively. The sensitivity and accuracy for patients with GB samples were 80.8% and 81.6%; for patients without GB samples, these values were 90.7% and 91.1%. The sensitivity and accuracy were higher with fine-needle biopsy needles than with FNA needles and with≤22-gauge needles than with 25-gauge needles. However, no significant differences were observed between the GB and lymph node samples. GB lesions<40mm in size, wall-thickening type, fundal location, absence of extensive liver invasion, and distant metastasis were more frequent in patients without GB samples than in patients with GB samples. Four mild bleeding events were the only reported adverse events. EUS-FNAB was safe and showed high diagnostic performance for patients with suspected GBC, regardless of the target site. When appropriate GB targeting is difficult, targeting the lymph nodes would be a good strategy with comparable outcomes.

IgG4-related disease presenting as a pancreatic mass: A case report

Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized fibroinflammatory condition with characteristic clinical, serological, and histopathological features. It might involve any organ in the body with a special predilection for lymph nodes, salivary glands, the pancreas, and the retroperitoneum. Due to the non-specific features of the disease and the capability of mimicking many other medical conditions, the diagnosis of IgG4-RD could be delayed. Herin, we describe a case of a middle-aged man who presented with obstructive jaundice due to a pancreatic mass. Further evaluation revealed multiple cervical and inguinal lymphadenopathy, bilateral wedge-shaped lesions in the kidneys and substantial thickening of the aortic wall that was suggestive of aortitis/periaortitis. A histopathological examination of an inguinal lymph node showed increased infiltration of nodal immunoglobulin G4 (IgG4) plasma cells (&gt;30/high-power field) with a high serum IgG4 immunoglobulin level. Based on that, the patient was diagnosed with IgG4-RD, and he was successfully treated with pulse steroid therapy with complete resolution of his symptoms and the radiological and laboratory findings. IgG4-RD is a protean condition with a large spectrum of clinical manifestations that could mimic many other serious medical conditions. Early recognition and management of immunosuppression are vital for complete recovery.

Consensus statements on endoscopic ultrasound-guided tissue acquisition. Guidelines from the Asian Endoscopic Ultrasound Group.

This consensus was developed by the Asian EUS Group (AEG), who aimed to formulate a set of practice guidelines addressing various aspects of endoscopic ultrasound-guided tissue acquisition (EUS-TA). The AEG initiated the development of consensus statements and formed an expert panel comprising surgeons, gastroenterologists, and pathologists. Three online consensus meetings were conducted to consolidate the statements and votes. The statements were presented and discussed in the first two consensus meetings and revised according to comments. Final voting was conducted at a third consensus meeting. The Grading of Recommendations, Assessment, Development, and Evaluation system was adopted to define the strength of the recommendations and quality of evidence. A total of 20 clinical questions and statements regarding EUS-TA were formulated. The committee recommended that fine-needle biopsy (FNB) needles be preferred over conventional fine-needle aspiration (FNA) needles for EUS-TA of subepithelial lesions. For solid pancreatic masses, rapid on-site evaluation is not routinely recommended when FNB needles are used. For dedicated FNB needles, fork-tip and Franseen-tip needles have essentially equivalent performance. This consensus provides guidance for EUS-TA, thereby enhancing the quality of EUS-TA.

Unveiling lipid-rich ("clear cell") pancreatic neuroendocrine tumor: A small series of two cases with literature review.

This study presents two cases of lipid-rich pancreatic neuroendocrine tumors (PanNETs), a rare variant posing significant diagnostic challenges in fine needle aspiration (FNA) cytology and small biopsies. The first case involves an elderly male with a pancreatic tumor, displaying distinct cytoplasmic vacuoles, while the second case is a middle-aged male present with a pancreatic tail mass exhibiting foamy cytoplasm and eccentric nuclei, infiltrating in the stroma. Both cases did not exhibit typical morphologic features of PanNET but demonstrated cytomorphologic features and infiltrative growth patterns that mimicked adenocarcinoma. Further work-up demonstrated that both tumors were immunoreactive for synaptophysin and chromogranin, and were interpreted as well-differentiated, PanNET, lipid-rich variant. The study highlights the overlapping morphological features between lipid-rich PanNETs and other pancreatic neoplasms and underscores the importance of comprehensive cytological and immunohistochemical analysis for accurately diagnosing this variant, particularly due to the risk of misinterpreting it as pancreatic adenocarcinoma. Recognizing lipid-rich PanNETs is crucial for appropriate clinical management, as their identification can significantly impact treatment decisions and patient outcomes.

Abstract 2117 Crosstalk between nutrient sensor proteins, O-GlcNAc Transferase and mTORC1, is key to regulation of pancreatic β-cell mass and function

Abstract 2117 Crosstalk between nutrient sensor proteins, O-GlcNAc Transferase and mTORC1, is key to regulation of pancreatic β-cell mass and function

Frantz Tumor, a Rare Indolent Pancreatic Neoplasm Entity: A Case Report and Brief Review

Solid pseudopapillary neoplasm (SPN) of the pancreas, also known as Frantz tumor, is an uncommon tumor with indolent clinical features that primarily affects young women. We are presenting a 27-year-old Caucasian female with an accidental finding with pancreatic SPN who underwent complete resection of the tumor using a distal pancreatectomy and splenectomy procedure. Immunohistochemistry revealed low-grade pancreatic SPN. Despite the rare appearance, it should be considered in the differential diagnosis of a young female with a large pancreatic mass.

Comparison of endoscopic ultrasound-guided fine-needle aspiration and fine-needle biopsy to generate pancreatic cancer organoids: Randomized trial.

Background and study aims The prognosis for pancreatic cancer remains poor. Molecular diagnostics and customized therapies are becoming increasingly important in clinical routine. Patient-derived, predictive model systems such as organoids have the potential to substantially increase the depth of information from biopsy material by functional and molecular characterization. We compared the extent to which the use of fine-needle aspiration needles (FNA, 22G) or fine-needle biopsy needles (FNB, 22G) influences the generation of pancreatic cancer patient-derived organoids (PDOs) to establish endoscopic standards of organoid technology. Patients and methods Endoscopic ultrasound (EUS)-guided punctures by EUS-FNA and EUS-FNB of pancreatic masses highly suspicious for adenocarcinoma (detected by computed tomography and/or magnetic resonance imaging) were prospectively evaluated. Consecutive patients received EUS-FNA and EUS-FNB in a randomized order without the need to exchange the needle shaft (only the inner needle type (FNA/-B) was exchanged) between the passes. With each needle type, the specimens for histological analysis and for PDOs were obtained separately. Results Fifty patients were enrolled in the study. Histology revealed malignancy in 42 of 50 cases (84%). In total PDOs were generated from 17 patients (34%). Of these, nine were established by FNB only, two by FNA only, and six by both FNA and FNB. Histology revealed malignancy in 13 of 17 PDO cases (76%). In two histologically false-negative cases, PDOs could be established. Conclusions EUS-FNB was superior to EUS-FNA in terms of successful generation of PDOs, although it failed to show statistical significance.

Primary pancreatic lymphoma: Histopathological pattern of 8 cases.

To report the histopathological pattern of primary pancreatic lymphoma (PPL) in 2 tertiary hospitals. The pathology slides and reports of all the cases diagnosed in pathology departments in 2 referral hospitals were reviewed. An additional immunohistochemistry study was done to reclassify lymphomas according to the current system. Eight patients with PPL have been identified. The ages ranged from 36 to 71 years. Clinical presentation includes abdominal pain, weight loss, jaundice, abdominal mass, nausea, and vomiting. Pathological evaluation revealed 5 diffuse large B-cell lymphomas, one high-grade B-cell lymphoma, one MALT lymphoma, and one follicular lymphoma. Primary pancreatic lymphoma is a very rare tumor without specific clinical, laboratory tests, or radiological findings. Abdominal pain is the most common clinical presentation. Diffuse large b-cell lymphoma is the most common pathological subtype. Primary pancreatic lymphoma should be taken into consideration when evaluating pancreatic mass to avoid unnecessary surgical resection.