Pancreatic cystic neoplasms present a complex diagnostic scenario encompassing low-and high-grade malignancies.Their prevalence varies widely,notably increasing with age,reaching 75%in individuals older than 80 years....Pancreatic cystic neoplasms present a complex diagnostic scenario encompassing low-and high-grade malignancies.Their prevalence varies widely,notably increasing with age,reaching 75%in individuals older than 80 years.Accurate diagnosis is crucial,as errors occur in approximately one-third of resected cysts discovered incidentally.Various imaging modalities such as computed tomography,magnetic resonance imaging,and endoscopic techniques are available to address this challenge.However,risk stratification remains problematic,with guideline inconsistencies and diagnostic accuracy varying according to cyst type.This review proposed a stepwisemanagement approach,considering patient factors,imaging results,and specific features.This patient-centered model offers a structured framework for optimizing the care of individuals with pancreatic cystic neoplasms.展开更多
Solitary pancreatic involvement of tuberculosis is rare, especially in an immunocompetent individual, and it may be misdiagnosed as pancreatic cystic neoplasms. Pancreatic cystic neoplasms are being identified in incr...Solitary pancreatic involvement of tuberculosis is rare, especially in an immunocompetent individual, and it may be misdiagnosed as pancreatic cystic neoplasms. Pancreatic cystic neoplasms are being identified in increasing numbers, probably because of the frequent use of radiology and advances in endoscopic techniques. However, they are composed of a variety of neoplasms with a wide range of malignant potential, and it is often difficult to differentiate pancreatic tuberculosis mimicking cystic neoplasms from benign or malignant pancreatic cystic neoplasms. Non-surgical diagnosis of pancreatic tuberculosis is inconclusive and continues to be a challenge in many cases. If so, then laparotomy should be employed to establish the diagnosis. Therefore, pancreatic tuberculosis should be kept in mind during the differential diagnosis of solitary cystic masses in the pancreas. We report a patient who had solitary pancreatic tuberculosis masquerading as pancreatic serous cystadenoma.展开更多
Pancreatic cystic neoplasms(PCNs) are a diverse group of neoplasms in the pancreas,and are more increasingly encountered with widespread abdominal screening and improved imaging techniques.The most common types of PCN...Pancreatic cystic neoplasms(PCNs) are a diverse group of neoplasms in the pancreas,and are more increasingly encountered with widespread abdominal screening and improved imaging techniques.The most common types of PCNs are serous cystic neoplasms(SCNs),mucinous cystic neoplasms(MCNs),and intraductal papillary mucinous neoplasms(IPMNs).Clinicians frequently feel bewildered in the differential diagnosis and subsequent management among the various types of lesions in the pancreas,which may lead to overtreatment or delayed treatment.The current review provides recent developments in the understanding of the three most common types of PCNs,the latest modalities used in preoperative diagnosis and differential diagnosis,as well as the most up to date management.Suggestions for diagnosis and differential diagnosis of SCNs,MCNs,and IPMNs are also provided for young surgeons.Better understanding of these neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.展开更多
The natural history and clinical manifestation of resected intraductal papillary mucinous neoplasm(IPMN)of the pancreas were elucidated,and based on this,a retrospective pancreatic database was reviewed to identify pa...The natural history and clinical manifestation of resected intraductal papillary mucinous neoplasm(IPMN)of the pancreas were elucidated,and based on this,a retrospective pancreatic database was reviewed to identify patients with IPMN who were surgically managed in our department from 1999 to June 2006.Pathologic rereview of each case was performed,and the clinico-pathologic features were examined.Student’s T test and x2 analysis were used to identify factors associated with malignancy.Fifty-one patients were identified.There were 33 males and 18 females.One patient’s pancreas was unresectable,two patients underwent a total pancreatectomy,42 patients had a pancreatecoduodenectomy and five patients had distal pancreatectomy.Main-duct type carcinoma was identified in 24 patients;branch-duct type in 15 patients,and mixed type in 12 patients.Invasive carcinoma was present in 35 patients.Weight loss and jaundice occurred more commonly in the invasive group.The average serum CA19-9 level was significantly higher in the invasive group(1542μ vs 94.5μ).The average diameter of the pancreatic duct was also wider in the invasive group(8.7 mm vs 4.3 mm).Significant predictors of malignant IPMNs included weight loss,jaundice,a high level of serum CA19-9,a large pancreatic duct and main-duct type carcinoma.展开更多
文摘Pancreatic cystic neoplasms present a complex diagnostic scenario encompassing low-and high-grade malignancies.Their prevalence varies widely,notably increasing with age,reaching 75%in individuals older than 80 years.Accurate diagnosis is crucial,as errors occur in approximately one-third of resected cysts discovered incidentally.Various imaging modalities such as computed tomography,magnetic resonance imaging,and endoscopic techniques are available to address this challenge.However,risk stratification remains problematic,with guideline inconsistencies and diagnostic accuracy varying according to cyst type.This review proposed a stepwisemanagement approach,considering patient factors,imaging results,and specific features.This patient-centered model offers a structured framework for optimizing the care of individuals with pancreatic cystic neoplasms.
文摘Solitary pancreatic involvement of tuberculosis is rare, especially in an immunocompetent individual, and it may be misdiagnosed as pancreatic cystic neoplasms. Pancreatic cystic neoplasms are being identified in increasing numbers, probably because of the frequent use of radiology and advances in endoscopic techniques. However, they are composed of a variety of neoplasms with a wide range of malignant potential, and it is often difficult to differentiate pancreatic tuberculosis mimicking cystic neoplasms from benign or malignant pancreatic cystic neoplasms. Non-surgical diagnosis of pancreatic tuberculosis is inconclusive and continues to be a challenge in many cases. If so, then laparotomy should be employed to establish the diagnosis. Therefore, pancreatic tuberculosis should be kept in mind during the differential diagnosis of solitary cystic masses in the pancreas. We report a patient who had solitary pancreatic tuberculosis masquerading as pancreatic serous cystadenoma.
基金supported by the National Natural Science Foundation of China (Nos.30925033,30801101,and 81171884)the Innovation and High-Level Talent Training Program of Department of Health of Zhejiang Province,China
文摘Pancreatic cystic neoplasms(PCNs) are a diverse group of neoplasms in the pancreas,and are more increasingly encountered with widespread abdominal screening and improved imaging techniques.The most common types of PCNs are serous cystic neoplasms(SCNs),mucinous cystic neoplasms(MCNs),and intraductal papillary mucinous neoplasms(IPMNs).Clinicians frequently feel bewildered in the differential diagnosis and subsequent management among the various types of lesions in the pancreas,which may lead to overtreatment or delayed treatment.The current review provides recent developments in the understanding of the three most common types of PCNs,the latest modalities used in preoperative diagnosis and differential diagnosis,as well as the most up to date management.Suggestions for diagnosis and differential diagnosis of SCNs,MCNs,and IPMNs are also provided for young surgeons.Better understanding of these neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.
文摘The natural history and clinical manifestation of resected intraductal papillary mucinous neoplasm(IPMN)of the pancreas were elucidated,and based on this,a retrospective pancreatic database was reviewed to identify patients with IPMN who were surgically managed in our department from 1999 to June 2006.Pathologic rereview of each case was performed,and the clinico-pathologic features were examined.Student’s T test and x2 analysis were used to identify factors associated with malignancy.Fifty-one patients were identified.There were 33 males and 18 females.One patient’s pancreas was unresectable,two patients underwent a total pancreatectomy,42 patients had a pancreatecoduodenectomy and five patients had distal pancreatectomy.Main-duct type carcinoma was identified in 24 patients;branch-duct type in 15 patients,and mixed type in 12 patients.Invasive carcinoma was present in 35 patients.Weight loss and jaundice occurred more commonly in the invasive group.The average serum CA19-9 level was significantly higher in the invasive group(1542μ vs 94.5μ).The average diameter of the pancreatic duct was also wider in the invasive group(8.7 mm vs 4.3 mm).Significant predictors of malignant IPMNs included weight loss,jaundice,a high level of serum CA19-9,a large pancreatic duct and main-duct type carcinoma.
