Role of endoscopic ultrasound in the characterization of solid pseudopapillary neoplasm of the pancreas

BACKGROUND Solid pseudopapillary neoplasm(SPN)is an uncommon pathology of the pancreas with unpredictable malignant potential.Endoscopic ultrasound(EUS)assessment plays a vital role in lesion characterization and confirmation of the tissue diagnosis.However,there is a paucity of data regarding the imaging assessment of these lesions.AIM To determine the characteristic EUS features of SPN and define its role in preoperative assessment.METHODS This was an international,multicenter,retrospective,observational study of prospective cohorts from 7 large hepatopancreaticobiliary centers.All cases with postoperative histology of SPN were included in the study.Data collected included clinical,biochemical,histological and EUS characteristics.RESULTS One hundred and six patients with the diagnosis of SPN were included.The mean age was 26 years(range 9 to 70 years),with female predominance(89.6%).The most frequent clinical presentation was abdominal pain(80/106;75.5%).The mean diameter of the lesion was 53.7 mm(range 15 to 130 mm),with the slight predominant location in the head of the pancreas(44/106;41.5%).The majority of lesions presented with solid imaging features(59/106;55.7%)although 33.0%(35/106)had mixed solid/cystic characteristics and 11.3%(12/106)had cystic morphology.Calcification was observed in only 4(3.8%)cases.Main pancreatic duct dilation was uncommon,evident in only 2 cases(1.9%),whilst common bile duct dilation was observed in 5(11.3%)cases.One patient demonstrated a double duct sign at presentation.Elastography and Doppler evaluation demonstrated inconsistent appearances with no emergence of a predictable pattern.EUS guided biopsy was performed using three different types of needles:Fine needle aspiration(67/106;63.2%),fine needle biopsy(37/106;34.9%),and Sonar Trucut(2/106;1.9%).The diagnosis was conclusive in 103(97.2%)cases.Ninety-seven patients were treated surgically(91.5%)and the post-surgical SPN diagnosis was confirmed in all cases.During the 2-year follow-up period,no recurrence was observed.CONCLUSION SPN presented primarily as a solid lesion on endosonographic assessment.The lesion tended to be located in the head or body of the pancreas.There was no consistent characteristic pattern apparent on either elastography or Doppler assessment.Similarly SPN did not frequently cause stricture of the pancreatic duct or common bile duct.Importantly,we confirmed that EUS-guided biopsy was an efficient and safe diagnostic tool.The needle type used does not appear to have a significant impact on the diagnostic yield.Overall SPN remains a challenging diagnosis based on EUS imaging with no pathognomonic features.EUS guided biopsy remains the gold standard in establishing the diagnosis.

The vascular endothelial growth factor system-a new player in the pathogenesis and development of metabolic dysfunction-associated steatotic liver disease

The pathogenesis of liver disease from simple steatosis-metabolic dysfunction-associated steatotic liver disease(MASLD)-and the transition to inflammation and fibrosis-metabolic dysfunction-associated steatohepatitis(MASH)-is not well understood.However,cross-talk between subcutaneous white adipose tissue(WAT)and the liver may be of importance.

Regeneration and activation of liver progenitor cells in liver cirrhosis

Cirrhosis is characterized as the progress of regenerative nodules surrounded by fibrous bands in response to chronic hepatic injury and causes portal hypertension and end-stage hepatic disease.Following liver injury,liver progenitor cells(LPCs)can be activated and differentiate into hepatocytes in order to awaken liver regeneration and reach homeosta-sis.Recent research has uncovered some new sources of LPCs.Here,we update the mecha-nisms of LPCs-mediated liver regeneration in cirrhosis by introducing the origin of LPCs and LPCs’niche with a discussion of the influence of LPC-related cells.This article analyzes the mechanism of regeneration and activation of LPCs in cirrhosis in recent years aiming to provide help for clinical application.

The socioeconomic aspects of nonalcoholic fatty liver disease:food insecurity as a novel risk factor for steatosis and liver fibrosis

Over the last decade,the global prevalence of nonalcoholic fatty liver disease(NAFLD)in both adults and children was rapidly increasing and has become the most common cause of chronic liver disease in many parts of the world.It is predicted to become also the most frequent indication for liver transplantation by 2030 and fueling the rising incidence and prevalence of primary liver cancer in western countries(1,2).

Role of laparoscopic and robotic liver resection compared to open surgery in elderly hepatocellular carcinoma patients: a systematic review and meta-analysis

Aim:This study aimed to compare mini-invasive liver resection(MILR)(laparoscopic/robotic approach)and open liver resection(OLR)for hepatocellular carcinoma(HCC)in elderly patients with regard to clinical and oncological outcomes through a comprehensive systematic review.Methods:The MEDLINE and Cochrane Library electronic databases were systematically searched from 2009 to December 2019 to identify relevant English written studies comparing MILR and OLR.The main endpoints were Child-Pugh score,serum total bilirubin level,comorbidity,presence/absence of cirrhosis,minor/major resection,challenge segment approach,operative time,estimated intraoperative blood loss,liver failure rate,morbidity according to the Clavien-Dindo classification,length of hospital stay(LOS),postoperative mortality,number of lesions,tumor size,readmission rate,recurrence rate and survival at 1,3 and 5 years after operation.Meta-analyses provided pooled relative risks and mean differences for these outcomes.Cut-off for"elderly age"was set at 65 years old.Results:Eight studies that evaluated 3051 patients who underwent liver resection for HCC,with 950 undergoing MILR and 2101 OLR,were included after the screening process.Blood loss,morbidity,and LOS showed statistical significance in favor of MILR.In particular,with respect to OLR,MILR decreased on average blood loss by 161.43 mL(95%CI:250.24-72.61),risk of morbidity by 42%(P<0.01),LOS by 4 days(95%CI:7-2),postoperative mortality risk by 47%(although not significantly,P=0.06).Major resections were significantly more common in the OLR group(P<0.0001).Recurrence,although not significant(P=0.06),must also be emphasized.The two surgical approaches were comparable with regard to the other outcomes investigated.Conclusion:Meta-analyses confirmed the advantages of MILR in terms of short perioperative outcomes,where it may promote the extension of liver resection to HCC patients with borderline liver function.MILR may be considered an important treatment option with significant benefits in the elderly and fragile patients.However,large well-designed prospective comparative studies or randomized controlled trials would be necessary to further confirm our conclusions.

Somatic mutant clone screening: scan for novel NASH target genes in mouse liver

In a landmark study recently published in Cell,Wang et al.demonstrated a novel method of somatic adeno-associated virus(AAV)-transposon in vivo clonal screening(termed MOSAICS),which is capable to generate multiple mutant hepatocyte clones within the same tissue and thereby to scan for non-alcoholic steatohepatitis(NASH)target genes(Fig.1).1 Non-alcoholic fatty liver disease(NAFLD)is the most common liver disease affecting about 20–30%of the global population and associated with metabolic dysfunction.NAFLD can progress to NASH,characterized by liver inflammation,steatosis and hepato-cyte ballooning,and NAFLD/NASH can lead to fibrosis,cirrhosis,and ultimately liver cancer.For decades,researchers have been seeking to understand its pathogenesis and to discover ther-apeutic strategies to treat NAFLD/NASH.However,up to now,there is still no specific pharmacotherapy available.