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Cystic tumors of the pancreas.Cancer
Imaging. 2006 Jul 13;6:60-71.
Cystic tumors
of the pancreas are less frequent than solid lesions and are often
detected incidentally, as many of these lesions are small and
asymptomatic. However, they may be associated with pancreatitis or
have malignant potential. With advancements in diagnostic imaging,
cystic lesions of the pancreas are being detected with increasing
frequency. Many lesions can cause a pancreatic cyst, most being non-neoplastic
while approximately 10% are cystic tumors, ranging from benign to
highly malignant tumors. With increasing experience it is becoming
clear that the prevalence of pseudocyst among cystic lesions of the
pancreas is lower than usually presumed. A presumptive diagnosis of
pseudocyst based on imaging appearance alone can cause a diagnostic
error, and neoplastic cysts of the pancreas are particularly
susceptible to this misdiagnosis, which can result in inappropriate
treatment. Cystic tumors of the pancreas are formed by serous or
mucinous structures showing all stages of cellular differentiation.
According to the WHO classification, they can be subdivided on the
basis of their histological type and biological behavior into benign
tumors, borderline tumors, and malignant tumors. Cystic pancreatic
tumors can be subdivided into peripheral (serous cystadenomas,
mucinous cystic tumors, solid and papillary epithelial neoplasms,
cystic islet cell tumors), which do not communicate with the main
pancreatic duct, and ductal tumors (mucinous tumor), according to
their site of origin. On the basis of imaging criteria alone, it can
be very difficult to differentiate non-tumoral cystic lesions from
neoplastic ones. The management of these patients is complex, and it
is important to correlate imaging findings with knowledge of the
patient's symptoms and of the natural history and predictors of
malignancy in pancreatic cysts.
Cystic
neoplasms of the pancreas; what a clinician should know.Cancer
Treat Rev. 2005 Nov;31(7):507-35.
Primary
cystic neoplasms of the pancreas (serous cystic neoplasms, mucinous
serous neoplasms, and intraductal papillary mucinous neoplasms) are
lesions of emerging importance. With the wide availability of modern
imaging methods, these neoplasms are being recognized with
increasing frequency. Due to the improvement of these sophisticated
imaging techniques, it is often possible to differentiate
preoperatively these primary pancreatic cystic neoplasms not only
from other cystic pancreatic disorders (such as pancreatic
pseudocysts) but also from one another. This differentiation is very
important for the clinician, since these neoplasms have radically
different biologic behavior. Serous cystic neoplasms are uniformly
benign and usually do not mandate resection unless the lesion is
symptomatic. In contrast, mucinous cystic neoplasms and intraductal
papillary mucinous neoplasms have a premalignant or overtly
malignant tendency, and therefore should be managed aggressively by
pancreatic resection. In these mucinous cystic neoplasms,
recognition of an underlying malignancy is often not possible
without a detailed histopathologic examination of the entire
resected specimen. In the absence of invasive disease, prognosis is
excellent after appropriate surgery. The presence of invasive
malignancy signifies a poor prognosis.
Cyst fluid
analysis in the differential diagnosis of pancreatic cystic lesions:
a pooled analysis.
Gastrointest Endosc. 2005
Sep;62(3):383-9.
BACKGROUND:
Pancreatic cystic tumors commonly include serous cystadenoma (SCA),
mucinous cystadenoma (MCA), and mucinous cystadenocarcinoma (MCAC).
A differential diagnosis with pseudocysts (PC) can be difficult.
Radiologic criteria are not reliable. The objective of the study is
to investigate the value of cyst fluid analysis in the differential
diagnosis of benign (SCA, PC) vs. premalignant or malignant (MCA,
MCAC) lesions. METHODS: A search in PubMed was performed with the
search terms cyst, pancrea, and fluid. Articles about cyst fluid
analysis of pancreatic lesions that contained the individual data of
at least 7 patients were included in the study. Data of all
individual patients were combined and were plotted in scatter grams.
Cutoff levels were determined. RESULTS: Twelve studies were
included, which comprised data of 450 patients. Cysts with an
amylase concentration <250 U/L were SCA, MCA, or MCAC (sensitivity
44%, specificity 98%) and, thus, virtually excluded PC. A
carcinoembryonic antigen (CEA) <5 ng/mL suggested a SCA or PC
(sensitivity 50%, specificity 95%). A CEA >800 ng/mL strongly
suggested MCA or MCAC (sensitivity 48%, specificity 98%). A
carbohydrate-associated antigen (CA) 19-9 <37 U/mL strongly
suggested PC or SCA (sensitivity 19%, specificity 98%). Cytologic
examination revealed malignant cells in 48% of MCAC (n = 111).
DISCUSSION: Most pancreatic cystic tumors should be resected without
the need for cyst fluid analysis. However, in asymptomatic patients,
in patients with an increased surgical risk, and, in patients in
whom there is a diagnostic uncertainty about the presence of a PC,
cyst fluid analysis helps to determine the optimal therapeutic
strategy.
Cystic lesions in
the pancreas: when to watch, when to resect.Curr
Gastroenterol Rep. 2000 Apr;2(2):152-8.
The diagnosis of
cystic lesions in the pancreas is becoming more common, largely due to
the increases in diagnostic imaging done for other reasons. This
review considers pseudocysts, mucinous cystic neoplasms, intraductal
papillary mucinous tumors, and serous cystadenomas in some detail. The
emphasis is on the fact that, through a careful history, physical
examination, radiologic studies, and, often, cyst fluid analysis, a
diagnosis can be reached expeditiously. This pursuit is important
because two thirds of pancreatic cystic neoplasms are malignant or
premalignant and should be resected, whereas pseudocysts and serous
cystadenomas are benign, and, depending on the case, may be treated
through observation, resection, or, for pseudocysts, by internal
drainage.
Cystic tumours of the pancreas: diagnostic
accuracy, pathologic observations and surgical consequences.Langenbecks
Arch Surg. 1998 Mar;383(1):56-61.
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