Pancreatic intraductal papillary mucinous neoplasms:Current diagnosis and management

Intraductal papillary mucinous neoplasms(IPMNs)represent approximately 1%of all pancreatic neoplasms and 25%of cystic neoplasms.They are divided into three types:main duct-IPMN(MD-IPPMN),branch duct-IPMN(BD-IPMN),and mixed type-IPMN.In this review,diagnostics,including clinical presentation and radiological investigations,were described.Magnetic resonance imaging is the most useful for most IPMNs.Management depends on the type and radiological features of IPMNs.Surgery is recommended for MD-IPMN.For BD-IPMN,management involves surgery or surveillance depending on the tumor size,cyst growth rate,solid components,main duct dilatation,high-grade dysplasia in cytology,the presence of symptoms(jaundice,new-onset diabetes,pancreatitis),and CA 19.9 serum level.The patient’s age and comorbidities should also be taken into consideration.Currently,there are different guidelines regarding the diagnosis and management of IPMNs.In this review,the following guidelines were presented:Sendai International Association of Pancreatology guidelines(2006),American Gastroenterological Association guidelines,revised international consensus Fukuoka guidelines(2012),revised international consensus Fukuoka guidelines(2017),and European evidence-based guidelines according to the European Study Group on Cystic Tumours of the Pancreas(2018).The Verona Evidence-Based Meeting 2020 was also presented and discussed.

Association between acute pancreatitis and COVID-19 infection:What do we know?

The disease caused by severe acute respiratory syndrome coronavirus 2(SARSCoV-2),also called coronavirus disease 2019(COVID-19),first originated in Wuhan,China,displaying atypical pneumonia-like respiratory symptoms in affected patients.SARS-CoV-2 primarily attacks the respiratory system,and the most common symptoms include cough,shortness of breath,and fever.However,its impact on the digestive system has been shown,and various clinical gastrointestinal manifestations of this disease have been recognized.Some reports have shown acute pancreatitis(AP)as the initial symptom in patients with COVID-19.AP may be a consequence of direct pancreatic damage by the virus because pancreatic acinar cells contain angiotensin-converting enzyme 2 receptor proteins,and SARS-CoV-2 can bind to these receptors,causing pancreatic injury.Moreover,AP may be a secondary indicator of cytokine storms and altered inflammatory responses.Our review of the literature shows that SARS-CoV-2 appears to be a new etiological infectious factor related to AP.In this manuscript,a comprehensive review of case reports and case series of patients with AP and COVID-19 is presented.All reports on COVID-19-associated AP are summarized.All cases are thoroughly analyzed and discussed in-depth.