Pancreatic cystic neoplasms are being increasingly recognized, even in the absence of symptoms, in large part, due to markedly improved imaging modalities such as magnetic resonance imaging (MRI)/magnetic resonance ch...Pancreatic cystic neoplasms are being increasingly recognized, even in the absence of symptoms, in large part, due to markedly improved imaging modalities such as magnetic resonance imaging (MRI)/magnetic resonance cholangio pancreatography (MRCP) and computer tomography (CT) scanning. During the past 2 decades, better imaging of these cystic lesions has resulted in definition of different types, including pancreatic intraductal papillary mucinous neoplasms (IPMN). While IPMN represent only a distinct minority of all pancreatic cancers, they appear to be a relatively frequent neoplastic form of pancreatic cystic neoplasm. Moreover, IPMN have a much better outcome and prognosis compared to pancreatic ductal adenocarcinomas. Therefore, recognition of this entity is exceedingly important for the clinician involved in diagnosis and further evaluation of a potentially curable form of pancreatic cancer.展开更多
AIM To investigate the reproducibility of the in vivo endoscopic ultrasound(EUS)-guided needle based confocal endomicroscopy(n CLE) image patterns in an ex vivo setting and compare these to surgical histopathology for...AIM To investigate the reproducibility of the in vivo endoscopic ultrasound(EUS)-guided needle based confocal endomicroscopy(n CLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions(PCLs). METHODS In a prospective study evaluating EUS-nC LE for evaluation of PCLs, 10 subjects underwent an in vivo nC LE(AQFlex nC LE miniprobe; Cellvizio, MaunaK ea, Paris, France) during EUS and ex vivo probe based CLE(pC LE) of the PCL(Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. RESULTS A total of 10 subjects(mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms(IPMNs), 3 mucinous cystic neoplasms(MCNs), 2 cystic neuroendocrine tumors(cystic-NETs), 1 serous cystadenoma(SCA), and 2 squamous lined PCLs. Characteristic in vivo nC LE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pC LE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology.CONCLUSION In vivo n CLE patterns are reproducible in ex vivo p CLE for all major neoplastic PCLs. These findings add further support the application of EUS-nC LE as an imaging biomarker in the diagnosis of PCLs.展开更多
Pancreatic cystic tumors(PCTs)comprise a heterogeneous group of entities,accounting for 2%to 10%of pancreatic lesions.The most common types are intraductal papillary mucinous neoplasms(IPMNs),mucinous cystic neoplasm(...Pancreatic cystic tumors(PCTs)comprise a heterogeneous group of entities,accounting for 2%to 10%of pancreatic lesions.The most common types are intraductal papillary mucinous neoplasms(IPMNs),mucinous cystic neoplasm(MCN),and serous cystic neoplasm(SCN),which account for approximately 90%of PCTs.This review discusses updates in pathologic features,malignant transformation,biologic behavior,and molecular evolution of PCTs.IPMN includes main duct and branch duct types.These can also be classified into 4 histologic subtypes based on cell lineages of differentiation,and may be associated with different tumorigenic pathways and clinicopathologic characteristics.The gastric type is the most common and is rarely associated with carcinomas,whereas the pancreatobiliary type is significantly more associated with invasive carcinoma.MCN is a mucinous cystic lesion with the presence of ovarian-type pericystic stroma.Prognosis of the resected non-invasive MCN is excellent,but the long-term survival of MCNs with invasive carcinoma may be poor.SCN includes microcystic adenoma,macrocystic adenoma,and solid variant serous adenoma.Serous cystadenocarcinoma is defined by the presence of distant metastases,which is rare in literature.Intraductal tubulopapillary neoplasm is characterized by uniformly high-grade dysplasia and ductal differentiation without overt production of mucin,with high risk for developing invasion.Acinar cell cystadenoma is a rare benign lesion with acinar differentiation.In addition,some pancreatic neuroendocrine tumors may assume a cystic configuration,sometimes referred to as cystic pancreatic endocrine neoplasm tumor,with a lower pathologic stage.Solid pseudopapillary tumor is composed of poorly cohesive monomorphic epithelial cells forming solid and pseudopapillary structures,with excellent prognosis.展开更多
文摘Pancreatic cystic neoplasms are being increasingly recognized, even in the absence of symptoms, in large part, due to markedly improved imaging modalities such as magnetic resonance imaging (MRI)/magnetic resonance cholangio pancreatography (MRCP) and computer tomography (CT) scanning. During the past 2 decades, better imaging of these cystic lesions has resulted in definition of different types, including pancreatic intraductal papillary mucinous neoplasms (IPMN). While IPMN represent only a distinct minority of all pancreatic cancers, they appear to be a relatively frequent neoplastic form of pancreatic cystic neoplasm. Moreover, IPMN have a much better outcome and prognosis compared to pancreatic ductal adenocarcinomas. Therefore, recognition of this entity is exceedingly important for the clinician involved in diagnosis and further evaluation of a potentially curable form of pancreatic cancer.
基金Supported by American College of Gastroenterology Pilot Research Grant.The Gastroflex UHD probe for the ex vivo evaluation was provided by Cellvizio,Mauna Kea Technologies,Paris,France
文摘AIM To investigate the reproducibility of the in vivo endoscopic ultrasound(EUS)-guided needle based confocal endomicroscopy(n CLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions(PCLs). METHODS In a prospective study evaluating EUS-nC LE for evaluation of PCLs, 10 subjects underwent an in vivo nC LE(AQFlex nC LE miniprobe; Cellvizio, MaunaK ea, Paris, France) during EUS and ex vivo probe based CLE(pC LE) of the PCL(Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. RESULTS A total of 10 subjects(mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms(IPMNs), 3 mucinous cystic neoplasms(MCNs), 2 cystic neuroendocrine tumors(cystic-NETs), 1 serous cystadenoma(SCA), and 2 squamous lined PCLs. Characteristic in vivo nC LE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pC LE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology.CONCLUSION In vivo n CLE patterns are reproducible in ex vivo p CLE for all major neoplastic PCLs. These findings add further support the application of EUS-nC LE as an imaging biomarker in the diagnosis of PCLs.
文摘Pancreatic cystic tumors(PCTs)comprise a heterogeneous group of entities,accounting for 2%to 10%of pancreatic lesions.The most common types are intraductal papillary mucinous neoplasms(IPMNs),mucinous cystic neoplasm(MCN),and serous cystic neoplasm(SCN),which account for approximately 90%of PCTs.This review discusses updates in pathologic features,malignant transformation,biologic behavior,and molecular evolution of PCTs.IPMN includes main duct and branch duct types.These can also be classified into 4 histologic subtypes based on cell lineages of differentiation,and may be associated with different tumorigenic pathways and clinicopathologic characteristics.The gastric type is the most common and is rarely associated with carcinomas,whereas the pancreatobiliary type is significantly more associated with invasive carcinoma.MCN is a mucinous cystic lesion with the presence of ovarian-type pericystic stroma.Prognosis of the resected non-invasive MCN is excellent,but the long-term survival of MCNs with invasive carcinoma may be poor.SCN includes microcystic adenoma,macrocystic adenoma,and solid variant serous adenoma.Serous cystadenocarcinoma is defined by the presence of distant metastases,which is rare in literature.Intraductal tubulopapillary neoplasm is characterized by uniformly high-grade dysplasia and ductal differentiation without overt production of mucin,with high risk for developing invasion.Acinar cell cystadenoma is a rare benign lesion with acinar differentiation.In addition,some pancreatic neuroendocrine tumors may assume a cystic configuration,sometimes referred to as cystic pancreatic endocrine neoplasm tumor,with a lower pathologic stage.Solid pseudopapillary tumor is composed of poorly cohesive monomorphic epithelial cells forming solid and pseudopapillary structures,with excellent prognosis.
