Pancreatic Mucinous Cystadenoma Research Articles

ABCD1 as a Novel Diagnostic Marker for Solid Pseudopapillary Neoplasm of the Pancreas.

The diagnosis of solid pseudopapillary neoplasm of the pancreas (SPN) can be challenging due to potential confusion with other pancreatic neoplasms, particularly pancreatic neuroendocrine tumors (NETs), using current pathological diagnostic markers. We conducted a comprehensive analysis of bulk RNA sequencing data from SPNs, NETs, and normal pancreas, followed by experimental validation. This analysis revealed an increased accumulation of peroxisomes in SPNs. Moreover, we observed significant upregulation of the peroxisome marker ABCD1 in both primary and metastatic SPN samples compared with normal pancreas and NETs. To further investigate the potential utility of ABCD1 as a diagnostic marker for SPN via immunohistochemistry staining, we conducted verification in a large-scale patient cohort with pancreatic tumors, including 127 SPN (111 primary, 16 metastatic samples), 108 NET (98 nonfunctional pancreatic neuroendocrine tumor, NF-NET, and 10 functional pancreatic neuroendocrine tumor, F-NET), 9 acinar cell carcinoma (ACC), 3 pancreatoblastoma (PB), 54 pancreatic ductal adenocarcinoma (PDAC), 20 pancreatic serous cystadenoma (SCA), 19 pancreatic mucinous cystadenoma (MCA), 12 pancreatic ductal intraepithelial neoplasia (PanIN) and 5 intraductal papillary mucinous neoplasm (IPMN) samples. Our results indicate that ABCD1 holds promise as an easily applicable diagnostic marker with exceptional efficacy (AUC=0.999, sensitivity=99.10%, specificity=100%) for differentiating SPN from NET and other pancreatic neoplasms through immunohistochemical staining.

Mucinous Cytadenoma of the Pancreas: A Case Report with Review of the Literature

Mucinous cystadenomas are a rare entity of cystic lesions of the pancreas, often discovered incidentally and posing a preoperative diagnostic challenge. Women are more often affected than men and these lesions are often asymptomatic, discovered by imaging and biological means. Benign pancreatic mucinous cystadenomas have a very high cure rate with a reduced rate of degeneration. Simple excision of benign pancreatic cysts is considered safe and effective with a very low recurrence rate.

Pancreatic mucinous cystadenoma with atypical clinical presentation

Pancreatic mucinous cystadenoma with atypical clinical presentation

Retroperitoneal Cystic Lymphangioma : case report

Lymphangiomas, cystic hygroma or macrocystic lymphatic malformation are a rare and benign congential malformations of the lymphatic system. Adults are affected rarely and less than children, and the abdominal location even less. Here, we discuss the case of a 56years old woman admitted and operated for a 7cm cystic mass of the tail of the pancreas, whom per operative exploration showed a retroperitoneal polycystic mass and histopathology concluded a lymphangioma. Less than 1% affect the retroperitoneum, they typically occur in spaces surrounded by loose connective tissue, the are difficult to differentiate from a mucinous cystic neoplasm of the pancreas by imaging since both have the appearance of multilocular cysts. Ultrasonography is very sensitive and relatively specific for evaluation of abdominal cystic masses. Laparoscopic removal has certain advantages over classical laparotomy, complete excision is recommended to protect the patient from subsequent recurrences even though cystic lymphangiomas are low-grade malignancies. The diagnosis of CL often is facilitated by means of modern imaging. Differential diagnosis include pancreatic pseudocysts, mucinous and serous cystadenomas, other congenital cysts and pancreatic ductal carcinoma with cystic degeneration. If symptomatic lesions or complications arise, complete surgical excision is a must.

Pancreatic Serous Cystic Neoplasms and Mucinous Cystic Neoplasms: Differential Diagnosis by Combining Imaging Features and Enhanced CT Texture Analysis.

ObjectiveTo establish a diagnostic model by combining imaging features with enhanced CT texture analysis to differentiate pancreatic serous cystadenomas (SCNs) from pancreatic mucinous cystadenomas (MCNs).Materials and MethodsFifty-seven and 43 patients with pathology-confirmed SCNs and MCNs, respectively, from one center were analyzed and divided into a training cohort (n = 72) and an internal validation cohort (n = 28). An external validation cohort (n = 28) from another center was allocated. Demographic and radiological information were collected. The least absolute shrinkage and selection operator (LASSO) and recursive feature elimination linear support vector machine (RFE_LinearSVC) were implemented to select significant features. Multivariable logistic regression algorithms were conducted for model construction. Receiver operating characteristic (ROC) curves for the models were evaluated, and their prediction efficiency was quantified by the area under the curve (AUC), 95% confidence interval (95% CI), sensitivity and specificity.ResultsFollowing multivariable logistic regression analysis, the AUC was 0.932 and 0.887, the sensitivity was 87.5% and 90%, and the specificity was 82.4% and 84.6% with the training and validation cohorts, respectively, for the model combining radiological features and CT texture features. For the model based on radiological features alone, the AUC was 0.84 and 0.91, the sensitivity was 75% and 66.7%, and the specificity was 82.4% and 77% with the training and validation cohorts, respectively.ConclusionThis study showed that a logistic model combining radiological features and CT texture features is more effective in distinguishing SCNs from MCNs of the pancreas than a model based on radiological features alone.

Mucinous Cystadenoma of the Pancreas – A Case Series

Purpose: This study intends to describe our center’s experience in the management of Pancreatic Mucinous Cystadenomas. These are rare cystic tumors of the pancreas, usually seen in peri-menopausal women, typically located in the pancreas’ body or tail. They carry low, yet not despicable, malignant potential, hence the importance in further characterizing its biological behavior. Method: We performed retrospective revision and descriptive analysis of all surgically treated Pancreatic Mucinous Cystadenomas between January 1996 and December 2020 in our tertiary hospital. Results: We present a case series of 15 patients with a median age of 51 years, 13 of which were women. The majority (86,7%) presented a lesion involving either the pancreatic body or tail. All were surgically treated, and laparoscopic approach was used in 40,0% of cases, with an associated conversion rate to open procedure of 50,0%. The surgery related morbidity rate was 26,7% and no mortality cases are to be reported. Areas of mucinous cystadenocarcinoma were identified in one patient’s specimen histopathological analysis (6,7%). Conclusion: Current recommendations advise towards surgical resection of pancreatic mucinous cystadenomas in all surgically fit patients at the time of diagnosis. In non-invasive cysts, resection is routinely curative. Although some low-risk predictor factors have been suggested, these cyst’s natural history remains unclear and the prevalence of invasive carcinoma is described as up to 15%, reinforcing the need for a better understanding on malignancy related factors.

Pancreatic mucinous cystadenoma complicated by intestinal bleeding

Mucinous cystadenoma is a cystic tumor of the pancreas absolutely requiring surgical intervention. The authors report successful surgical treatment of a patient with mucinous pancreatic cystadenoma complicated by severe intestinal bleeding.

Clinical diagnosis and management of pancreatic mucinous cystadenoma and cystadenocarcinoma: Single-center experience with 82 patients.

BACKGROUNDMucinous cystic neoplasm (MCN) of the pancreas is characterized by mucin-producing columnar epithelium and dense ovarian-type stroma and at risk for malignant transformation. Early diagnosis and treatment of MCN are particularly important.AIMTo investigate the clinical characteristics of and management strategies for pancreatic mucinous cystadenoma (MCA) and mucinous cystadenocarcinoma (MCC).METHODSThe clinical and pathological data of 82 patients with pancreatic MCA and MCC who underwent surgical resection at our department between April 2015 and March 2019 were retrospectively analyzed.RESULTSOf the 82 patients included in this study, 70 had MCA and 12 had MCC. Tumor size of MCC was larger than that of MCA (P = 0.049). Age and serum levels of tumor markers carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and CA12-5 were significantly higher in MCC than in MCA patients (P = 0.005, 0.026, and 0.037, respectively). MCA tumor size was positively correlated with serum CA19-9 levels (r = 0.389, P = 0.001). Compared with MCC, MCA had a higher minimally invasive surgery rate (P = 0.014). In the MCA group, the rate of major complications was 5.7% and that of clinically relevant pancreatic fistula was 8.6%; the corresponding rates in the MCC group were 16.7% and 16.7%, respectively.CONCLUSIONTumor size, age, and serum CEA, CA19-9, and CA12-5 levels may contribute to management of patients with MCN. Surgical resection is the primary treatment modality for MCC and MCA.

Differential diagnosis of pancreatic serous cystadenoma and mucinous cystadenoma: utility of textural features in combination with morphological characteristics

BackgroundTexture analysis of medical images has been reported to be a reliable method for differential diagnosis of neoplasms. This study was to investigate the performance of textural features and the combined performance of textural features and morphological characteristics in the differential diagnosis of pancreatic serous and mucinous cystadenomas.MethodsWe retrospectively reviewed 59 patients with pancreatic serous cystadenoma and 32 patients with pancreatic mucinous cystadenoma at our hospital. A three-dimensional region of interest (ROI) around the margin of the lesion was drawn manually in the CT images of each patient, and textural parameters were retrieved from the ROI. Textural features were extracted using the LifeX software. The least absolute shrinkage and selection operator (LASSO) method was applied to select the textural features. The differential diagnostic capabilities of morphological features, textural features, and their combination were evaluated using receiver operating characteristic (ROC) analysis, and the area under the receiver operating characteristic curve (AUC) was used as the main indicator. The diagnostic accuracy based on the AUC value is defined as follows: 0.9–1.0, excellent; 0.8–0.9, good; 0.7–0.8, moderate; 0.6–0.7, fair; 0.5–0.6, poor.ResultsIn the differential diagnosis of pancreatic serous and mucinous cystadenomas, the combination of morphological characteristics and textural features (AUC 0.893, 95% CI 0.816–0.970) is better than morphological characteristics (AUC 0.783, 95% CI 0.665–0.900) or textural features (AUC 0.777, 95% CI 0.673–0.880) alone.ConclusionsIn conclusion, our preliminary results highlighted the potential of CT texture analysis in discriminating pancreatic serous cystadenoma from mucinous cystadenoma. Furthermore, the combination of morphological characteristics and textural features can significantly improve the diagnostic performance, which may provide a reliable method for selecting patients with surgical intervention indications in consideration of the different treatment principles of the two diseases.

Discrimination of Pancreatic Serous Cystadenomas From Mucinous Cystadenomas With CT Textural Features: Based on Machine Learning.

Objectives: This study was designed to estimate the performance of textural features derived from contrast-enhanced CT in the differential diagnosis of pancreatic serous cystadenomas and pancreatic mucinous cystadenomas.Methods: Fifty-three patients with pancreatic serous cystadenoma and 25 patients with pancreatic mucinous cystadenoma were included. Textural parameters of the pancreatic neoplasms were extracted using the LIFEx software, and were analyzed using random forest and Least Absolute Shrinkage and Selection Operator (LASSO) methods. Patients were randomly divided into training and validation sets with a ratio of 4:1; random forest method was adopted to constructed a diagnostic prediction model. Scoring metrics included sensitivity, specificity, accuracy, and AUC.Results: Radiomics features extracted from contrast-enhanced CT were able to discriminate pancreatic mucinous cystadenomas from serous cystadenomas in both the training group (slice thickness of 2 mm, AUC 0.77, sensitivity 0.95, specificity 0.83, accuracy 0.85; slice thickness of 5 mm, AUC 0.72, sensitivity 0.90, specificity 0.84, accuracy 0.86) and the validation group (slice thickness of 2 mm, AUC 0.66, sensitivity 0.86, specificity 0.71, accuracy 0.74; slice thickness of 5 mm, AUC 0.75, sensitivity 0.85, specificity 0.83, accuracy 0.83).Conclusions: In conclusion, our study provided preliminary evidence that textural features derived from CT images were useful in differential diagnosis of pancreatic mucinous cystadenomas and serous cystadenomas, which may provide a non-invasive approach to determine whether surgery is needed in clinical practice. However, multicentre studies with larger sample size are needed to confirm these results.

Pancreatic mucinous cystadenoma doubly complicated by acute pancreatitis and retroperitoneal rupture

Mucinous cystadenomas are the most frequent cystic benign tumors of the pancreas. They are characterized by a malignant potential. Acute pancreatitis is their most common complication. This manuscript reports a unique complication of mucinous cystadenomas of the pancreas: retroperitoneal rupture associated to acute pancreatitis. After resuscitation, the patient underwent surgery. A cystic mass of the pancreas tail with retroperitoneal rupture was found. Splenopancreatectomy was performed. Outcomes were straightforward. After 3 years of follow-up, no signs of recurrence are highlighted.

Value of Magnetic Resonance Imaging Texture Feature Analysis in the Differential Diagnosis between Pancreatic Serous Cystadenoma and Mucinous Cystadenoma

Objective To investigate the difference of tumor textures presented on T1-weighted image(T1WI) and T2-weighted image(T2WI) between pancreatic serous cystadenoma and mucinous cystadenoma. Methods Subjects including 24 patients with serous cystadenoma and 20 patients with mucinous cystadenoma who were treated in Hainan Branch of Chinese PLA General Hospital were enrolled in this study.The texture analysis was performed on T1WI and T2WI,and the texture parameters included angular second moment,contrast,correlation,inverse difference moment(IDM),and entropy.Independent sample t-test and Mann-Whitney U test were performed for the between-group comparison,the regression model was established by Binary Logistic regression analysis,and receiver operating characteristics curve(ROC) was drawn.Results The contrast and IDM of T1WI and the contrast,correlation,and IDM of T2WI showed significant differences between serous cystadenoma and mucinous cystadenoma(T1WI:Pangular second momont=0.714,Pcontrast=0.003,Pcorrelation=0.069,PIDM=0.004,Pentropy=0.818;T2WI:Pangular second momont=0.122,Pcontrast=0.000,Pcorrelation=0.000,PIDM=0.024,and Pentropy=0.081).The area under the ROC curve was 0.736-0.846 for the positive texture variables,and the area under the ROC curve was 0.879 for the variables in the model of Logistic regression.Binary Logistic regression analysis demonstrated that the contrast was a specific imaging variable for the differential diagnosis between serous cystadenoma and mucinous cystadenoma.Conclusion The texture analysis of T1WI and T2WI may be a simple and effective tool in the differential diagnosis between pancreatic serous cystadenoma and mucinous cystadenoma.

Excision of mucinous cystadenoma of pancreas is safe and effective: a case report

Background: Pancreatic cysts are frequently detected incidentally, and a definitive preoperative diagnosis remains challenging. Benign cystic lesions have a very high cure rate unless malignant change supervenes. Simple excision of benign cysts of the pancreas is safe and effective. Case presentation: We present a 31-year-old woman with a 3-year history of an enlarging symptomatic benign pancreatic mucinous cystadenoma, which was misdiagnosed radiologically as a pancreatic serous cystadenoma or a mesenteric cyst. This was managed safely by excision and resection with a distal pancreatectomy that was avoided. Conclusions: Excision of benign mucinous cystadenoma of the pancreas is safe and effective, and surveillance for recurrence is not necessary.

New guidelines for use of endoscopic ultrasound for evaluation and risk stratification of pancreatic cystic lesions may be too conservative.

The role of EUS in managing asymptomatic pancreatic cystic lesions (PCLs) remains unresolved. We retrospectively evaluated EUS in risk stratification of PCLs when adhering to the most recent AGA guidelines. Asymptomatic PCLs that were evaluated by EUS from January 2014 to December 2014 were retrospectively reviewed including associated cytology, fluid analysis, and relevant surgical pathology. Cross-sectional imaging reports were reviewed blindly by an expert radiologist using AGA risk stratification terminology. Accepted imaging high-risk features (HRF) included cyst diameter > 3cm, dilated upstream pancreatic ducts, and a solid component in the cyst. We reviewed 125 patients who underwent EUS. Expert review of cross-sectional imaging resulted in a different interpretation 25% of the time including 1 malignant cyst. Ninety-three patients (75%) had no HRFs on cross-sectional imaging; 28 patients (22%) were diagnosed with 1 HRF and 4 patients (3%) had 2 HRFs. Adhering to AGA guidelines using 2 HRF as threshold for use of EUS, the diagnosis of malignant and high-risk premalignant lesions (including pancreatic adenocarcinoma, mucinous cystadenoma, neuroendocrine tumors, and IPMN with dysplasia) had a 40% sensitivity and 100% specificity. Had EUS been utilized based on a threshold of 1 HRF on imaging, malignant and high-risk premalignant lesions would have been identified with 80% sensitivity and 95% specificity. By adding EUS to radiographic imaging, the specificity for detecting carcinomas (p = 0.0009) and detection of all premalignant lesions (p = 0.003) statistically improved. Furthermore, EUS allowed 14 patients (11%) to avoid further surveillance by lowering their risk stratification. EUS remains an essential risk stratification modality for incidental PCLs. Current guideline suggestions of its utility may be too stringent. Our study justifies expert radiology review when managing PCLs. Further studies are required to identify the optimal approach to PCL management.

Cystic lesions of pancreas: challenges in diagnosis and management

Introduction: Pancreatic cysts are common (2.5%). Cystic neoplasms represent 10% of cystic lesions and 1% of pancreatic tumors. However, it is difficult to differentiate benign cyst from malignant cystic lesions preoperatively.Objective: To study the cases of pancreatic cystic lesion who underwent various forms of pancreatic resection.Materials and Methods: Nine cases of pancreatic cystic lesion who presented to Kathmandu Medical College Teaching Hospital, Surgical Unit 3 within December 2014- November 2015 were evaluated. Four pancreatic cysts who underwent resection are discussed whereas not managed with resection are excluded.Results: There were 4 cases of pancreatic cyst who underwent pancreatic resection. First case underwent pancreaticoduodenectomy for pancreatic mucinous cystadenoma. However histopathological examination revealed a serous cystadenoma. In second case, pancreatic neck lesion suspected to be mucinous cystadenoma or pseudocyst in MRCP, with negative malignant cells in EUS guided FNAC underwent Central pancreatectomy and was found to be serous cystadenoma. The third case with suspected pseudocyst underwent Pancreaticoduodenectomy after a 3X2 cm2 cystic mass was felt at the posteroinferior side of pancreatic head and malignancy was suspected intraoperatively . HPE report was mucinous cystadenoma. The fourth case with pancreatic pseudocyst at tail with duct calculi and chronic pancreatitis underwent distal pancreatectomy with splenectomy with Frey’s procedure.Conclusion: Management of pancreatic cystic lesion is challenging. Though radiological imaging has limited role in accurate diagnosis, endoscopic ultrasound may be of some benefit.

DIAGNOSIS AND MANAGEMENT OF PANCREATIC MUCINOUS CYSTADENOMA

Pancreatic mucinous cystadenomas (MCAs) are considered to be benign tumors with a high risk of malignant progression. The pancreatic mucinous cystadenoma is considered to be a rare condition that may lead to pancreatic cancer when not surgically resected. MCAs represent 9.7% of all neoplastic pancreatic cysts. The male:female ratio of MCAs is 1:10. The condition appears mostly in women, mean age in the 5th decade. The cyst is restricted by a fibrous capsule of variable consistency and has usually no communication with the pancreatic ductal system. The MCAs are located mostly in the body or tail of the pancreas. The MCAs located in the head of the pancreas are more likely to be malignant. Complete surgical resection is the recommended therapeutic option. We present a case of a 59-year-old female patient admitted in the Departemt of Surgery and Liver Transplatation of Fundeni Clinical Institute for recurrent episodes of acute pancreatitis. After a thorough investigation was performed, the CT-examination showed a pancreatic mass, located in the tail, measuring 30/40mm. Because the CT aspect was specific for a cystic-like lesion, surgery was recommended. The patient underwent a laparoscopic caudal splenopancreatectomy with a favorable postoperative evolution. The particularity of the case comes from the patient’s clinical presentation, with recurrent acute pancreatitis and the imagistic aspect (ultrasound and CT) that initially suggested a pseudocystic-like lesion, but the elevated CA 15-3 and further elaborated examinations indicated a possible malignant lesion.

The diagnostic value of endoscopic ultrasound-guided fine-needle aspiration biopsy of cell block with immunostaining for pancreatic lesions

Objective To evaluate the diagnostic value of the cell block （CB） with immunostaining method by endoscopic ultrasound-guided fine-needle aspiration （EUS-FNA） biopsy for pancreatic lesions. Methods A total of 72 patients with pancreatic lesions underwent EUS-FNA at the First Affiliated Hospital of Guangxi Medical University from March 2012 to June 2013. The EUS-FNA samples of all patients were processed by conventional smear cytology, liquid-based cytology （LBC） and the cell block with immunos- taining. Results There were 61 pancreatic patients who were finally diagnosed as having pancreatic tumors, including 55 cases of pancreatic cancer, 2 pancreatic solid pseudopapillary tumor, 4 pancreatic endocrine tumors （PETs） , and 11 benign lesions： 4 chronic pancreatitis, 2 pancreatic tuberculosis ,4 pancreatitis and 1 pancreatic mucinous cystadenoma. The diagnostic sensitivity of conventional smear cytology, liquid-based cytology and cell block with immuno-staining method were 68. 9% （42/61）, 75.4% （46/61） and 90. 2% （ 55/61 ） , respectively. The diagnostic specificity of three methods were all 100.0%. The diagnostic accura- cy rates were 73.6% （53/72） ,79. 2% （57/72） and 91.7% （66/72）, respectively. The diagnostic accuracy rate of the cell block with immunostaining was higher than those of conventional smear cytology （ P 〈 0. 05） and the liquid-based cytology （P 〈 0. 05 ）. Conclusion Endoscopic ultrasound-guided fine-needle aspiration is a safe and effective method with high sensitivity and specificity in the diagnosis of pancreatic lesions. Cell block method combining immunohistochemistry helps to increase the diagnosis and histological diagnosis of pancreatic lesions. The cell block has a greater clinical value in the diagnosis of pancreatic lesions. Key words: Endosonography; Fine needle aspiration; Liquid-based cytology; Cell block ; Pancreatic lesions

Laparoscopic spleen-preserving distal pancreatectomy with intraoperative vascular repair

Laparoscopic vascular repair is technically challenging in pancreatic surgeries. We present a case of a 42-year-old woman who was initially admitted to our hospital because of upper abdominal pain. Preoperative abdominal enhanced CT scan revealed a cystic mass near the spleen that was 4.7 × 4.3 × 3 (cm) in dimension. Therefore, we performed laparoscopic spleen-preserving distal pancreatectomy. In this procedure, we repaired spleen-related vessels with laparoscopic suture due to the adhesion between the vessels and the tumor. Finally, the spleen was preserved with good blood supply. This procedure took 200 min and the estimated blood loss was 360 ml. The postoperative abdominal Doppler ultrasound carried out 6 days after surgery indicated blood supply to the spleen was good and there was no thrombosis. The patient was discharged without any complications on postoperative day 7. The pathological diagnosis was pancreatic mucinous cystadenoma.

Cystic and ductal tumors of the pancreas: Diagnosis and management

Incidentally discovered cystic tumors of the pancreas (CTP) are an increasingly frequent entity. It is essential to differentiate lesions whose malignant potential is either nil or negligible (pseudocyst, serous cystadenoma, simple cysts) from lesions with intermediate malignant potential (intraductal papillary mucinous tumor of the pancreas [IPMN] involving the secondary ducts, cystic endocrine tumor) or those with high malignant potential (mucinous cystadenoma, solid pseudopapillary tumors and IPMN involving the main pancreatic duct). The approach to defining malignant potential is based on diagnostic CT scan, magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS), often complemented by EUS-guided cyst puncture for biochemical and cytological analysis of cyst fluid. Surgery for diagnostic purposes should be avoided because of its significant morbidity. For pseudocysts, simple cysts and serous cystadenomas, abstention is the general rule. Resection, preserving as much pancreatic parenchyma as possible, is the rule for IPMN involving the main pancreatic duct, mucinous cystadenomas, solid and pseudopapillary tumors, and cystic endocrine tumors. Resection is rarely indicated at the outset for IPMN involving secondary pancreatic ducts; morphologic observation is the general rule and preventive excision may be indicated secondarily. Good collaboration between surgeons, radiologists and endosonographists is necessary for optimal management of CTP.

膵粘液性嚢胞腺腫の外傷性破裂の1例

膵粘液性嚢胞腺腫の外傷性破裂の1例