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PubMed1995

[The surgical treatment of pancreatic cysts and pseudocysts].

Pancreatic cysts and pseudocysts are now being detected more often as a result of wide use of abdominal echography and CT scan. Surgical strategy advocates resection whenever possible for true cysts and internal drainage for pseudocysts. The present study retrospectively analyses 8 cases of true cysts and 23 cases of pseudocysts submitted to surgery in a twenty years period. Conservative treatment and ultrasonography-guided percutaneous drainage were not discussed. Four true cysts with positive benign structure were treated by internal drainage and only two adenocarcinomas were resected. In two more malignancies internal drainage was done as a palliative procedure followed by lethal outcome. Pseudocysts were secondary to acute pancreatitis in 7 cases, chronic pancreatitis in 6 cases, abdominal trauma in 4 cases and were idiopathic in 6 cases. Caudal pancreatectomy was performed whenever distal localisation was diagnosed. External drainage imposed in 5 emergency situations but internal drainage was elective in 13 cases. In conclusion according to our experience internal drainage should be preferred as the main surgical treatment in all mature pseudocysts and also when benign true cysts are certified. Posterior transgastric cystogastroanastomosis is the procedure of choice.

Cystadenocarcinoma↗
PubMed1995

Cyst fluid analysis in the differential diagnosis of pancreatic cysts: a new approach to the preoperative assessment of pancreatic cystic lesions.

Pancreatic cysts include pseudocysts, serous tumors, and mucinous tumors, some of which are malignant. The clinical and radiologic features of these lesions may not permit a preoperative diagnosis. Analysis of percutaneous cyst fluid aspirates for cytologic findings, tumor markers, enzymes, and viscosity has been proposed as an aid to differential diagnosis. The combination of cytologic findings, carcinoembryonic antigen level, and viscosity will usually differentiate mucinous from nonmucinous cysts, whereas cytologic findings and levels of tumor markers CA 15-3 and CA 72-4 are useful to predict malignancy. Pseudocysts can be identified by a combination of cytologic features; levels of tumor markers, including NB/70K; and levels of enzymes, including amylase isoenzymes and leukocyte esterase. Serous tumors are a diagnosis of exclusion, although in 50% of cases the cytologic findings will indicate a serous tumor. When compared with conventional methods of differentiating pancreatic cysts, cyst fluid analysis is a promising new approach to the evaluation of these diagnostically difficult lesions.

Amylases↗
PubMed2006

Congenital true pancreatic cyst: a rare case.

Congenital true pancreatic cysts are very rarely seen in children. We report magnetic resonance imaging features of a case of congenital true pancreatic cyst with a high level of enzymatic activity which, to the best of our knowledge, have not previously been reported. A 4-month-old boy was admitted to our clinic with a history of abdominal swelling for one month. A mobile, smooth, non-tender mass was palpated on the left side of the abdomen during physical examination. Ultrasonography and MR imaging revealed a bilocular cystic mass sized 9.5 x 8 x 6 cm. The spleen was displaced superiorly, whereas the left kidney was displaced posteriorly. Obliteration of the peripancreatic fat planes between the cystic mass and tail of the pancreas was observed. During abdominal surgical exploration, the pancreatic tail was larger than normal, and a pancreatic cyst arising from the tail of the pancreas was observed. Total cystectomy was performed with distal pancreatectomy. Although it is extremely rare in children, congenital true pancreatic cysts should be diagnostically considered in cases involving a cystic mass neighboring the pancreas. MR imaging is not helpful in differential diagnosis of other cysts originating from neighboring organs. Total excision with distal pancreatectomy and splenic preservation are advised for distal pancreatic cysts.

Cystectomy↗
PubMed1997

Ultrasonographic study of pancreatic cysts in autosomal dominant polycystic kidney disease.

Pancreatic cysts are an uncommon extrarenal clinical feature of autosomal dominant polycystic kidney disease (ADPKD). The prevalence of pancreatic cysts, sonographically assessed in ADPKD and in the different typs of ADPKD (PKD1 and PKD2) has not been reported. We have studied 173 ADPKD patients and 160 non-affected family members and found a prevalence of pancreatic cysts, of 9% in ADPKD patients over 30 years of age. The presence of pancreatic cysts was related to the increasing age, to the female sex and to the type of ADPKD, found exclusively in PKD1 patients. No complications related to pancreatic cysts were recorded. Pancreatic cysts are an unusual feature of ADPKD and do not appear to contribute to morbidity or mortality.

Adolescent↗
PubMed1983

[Pathogenetic basis of the surgical treatment of pancreatic cysts].

A model of the pancreatic cyst was elaborated in experiments in dogs. The conditions for its appearance were maximally approximated to real conditions of the formation of a cyst in the patient. On its grounds a pathogenetically based method of the surgical treatment of pancreatic cysts in clinic is proposed.

Animals↗
PubMed1997

Expression of mucin-like carcinoma-associated antigen in the cyst fluid differentiates mucinous from nonmucinous pancreatic cysts.

OBJECTIVES: Differential diagnosis of pancreatic cystic lesions may be difficult: the main problem is to distinguish mucinous neoplasms from nonmucinous cysts. We evaluated the usefulness of the mucin-like carcinoma-associated antigen (MCA) in the fluid of pancreatic cysts for detecting mucinous neoplasms. Results were compared with those of CA 15-3, carcinoembryonic antigen (CEA), and CA 72-4 fluid content, and cytology. METHODS: Twenty-four pancreatic cyst fluids were collected from 10 pseudocysts, eight mucinous cystic tumors, and six serous cystadenomas. RESULTS: MCA was elevated in seven of eight mucinous tumors (sensitivity 87.5%, specificity 100%). A significant difference was found between MCA levels in mucinous neoplasms versus pseudocysts (p = 0.0003) and serous cystadenomas (p = 0.001). Mean MCA levels were higher (133.7 U/ml) in mucinous cystadenocarcinomas than in cystadenomas (37.5 U/ml). The sensitivity of CA 15-3, CEA, and CA 72-4 in detecting mucinous neoplasms was 50, 87.5, and 87.5%, respectively, with a specificity of 94%, 44%, and 94%, respectively. Cytology showed mucinous epithelial cells in only four of eight mucinous neoplasms, with a specificity of 100%. CONCLUSIONS: These data suggest that MCA determination in the cyst fluid is a promising new tumor marker for the preoperative diagnosis of mucinous cystic neoplasms of the pancreas.

Antigens, Neoplasm↗
PubMedDate not supplied

Congenital true pancreatic cyst: presentation and management.

Congenital true pancreatic cyst is a very rare cause of a cystic lesion of the pancreas comprising less than 1% of all pancreatic cysts. Most of these are reported in children less than 2 years of age. Described here is a case of congenital true pancreatic cyst in a 6 years old girl with the clinical, radiological and pathological details and the surgical treatment.

Child↗
PubMed2005

[Laparoscopic resection of true pancreatic cyst: report of 5 cases].

OBJECTIVE: To summarize the experience in laparoscopic resection of true pancreatic cyst. METHODS: Five patients with true pancreatic cyst, including 1 case of pancreatic head cyst and 4 cases of distal pancreatic cyst, underwent laparoscopic resection. Among them one case with pancreatic head cyst and 4 cases of distal pancreatic cyst underwent simple laparoscopic cyst resection and one case of distal pancreatic cyst underwent laparoscopic distal pancreatectomy with resection of the spleen. The curative effects were evaluated. A follow-up lasting 2 approximately 33 months was conducted. RESULTS: All operations were successful with intraoperative blood loss of 50 to 150 ml. The patients could get up and move about 6 hours after the operation and were recovered and discharged 4 to 6 days later. Follow-up showed that all symptoms disappeared and no recurrence of cyst occurred. CONCLUSION: Laparoscopic resection of true pancreatic cyst is feasible with the advantages of reduced injury and earlier recovery.

Adult↗
PubMed2002

Pancreatic cysts: depiction on single-shot fast spin-echo MR images.

PURPOSE: To evaluate single-shot fast spin-echo (SE) magnetic resonance (MR) imaging for depiction of pancreatic cysts in a large number of patients and to analyze cyst prevalence with respect to patient age and sex and other clinical information. MATERIALS AND METHODS: Single-shot fast SE images of the pancreas were obtained in 1,444 patients. The images were reviewed for presence of pancreatic cysts, which were classified as simple and nonsimple types, and cyst diameters were measured. kappa statistic, Fisher exact, McNemar Q, and Pearson product moment correlation tests were performed. RESULTS: Two hundred eighty-three (19.6%) patients had at least one pancreatic cyst. The prevalence of pancreatic cysts increased with age (r = 0.96). The percentages of male and female patients with pancreatic cysts (20.4% vs 18.8%) were not significantly different. Two hundred seventy-one (18.8%) patients had simple cysts, and 147 (10.2%) had nonsimple cysts. Of 283 patients with pancreatic cysts, 158 (55.8%) had only one pancreatic cyst. The number of patients with multiple cysts increased with age after 70 years. Four hundred fifteen (83.8%) cysts were 10 mm in diameter or smaller; 56 (11.3%), 11-20 mm in diameter; and 24 (4.9%), 21 mm in diameter or larger. Sixteen (5.7%) patients with pancreatic cysts had malignant pancreatic tumors, and 75 (26.5%) patients had pancreatitis. CONCLUSION: The prevalence of pancreatic cysts at single-shot fast SE MR imaging-especially cysts with a diameter smaller than 10 mm-is similar to that of pancreatic cysts at autopsy and higher than that of pancreatic cysts at transabdominal ultrasonography. Prevalence is especially high in patients with pancreatitis.

Adolescent↗
PubMed1997

Pancreatic cyst as a sentinel of in situ carcinoma of the pancreas. Report of two cases.

CONCLUSION: We would like to recommend detailed examination of the pancreas including cytology of the pancreatic juice in patients with pancreatic cyst to find possible concomitant early pancreatic carcinoma. Further study is necessary to determine whether there is a rational relationship between mucinous cystadenoma of the pancreas and pancreatic adenocarcinoma. BACKGROUND: Two cases of in situ carcinoma of the pancreas first detected with pancreatic cyst as a diagnostic clue are reported. Cytologic examination of the pancreatic juice was positive for malignancy in both cases, and pancreatic cyst and in situ carcinoma were located independently. METHODS AND RESULTS: Case 1: Ultrasonography (US) and computed tomography (CT) in a 54-yr-old Japanese man with a known gastric cancer revealed a pancreatic cyst. Endoscopic retrograde cholangiopancreatography (ERCP) showed a cyst in the tail of the pancreas, and cytology of the pure pancreatic juice revealed adenocarcinoma. Intraoperatively, the pancreas was cut along the portal vein, and cytology of the pancreatic juice from the pancreas distal to the cutting line showed adenocarcinoma. Resection of the body and tail of the pancreas was performed together with total gastrectomy. Histopathologically, the cyst was mucinous cystadenoma, and the surrounding pancreatic ducts and ductules showed epithelial dysplasia of moderate-to-severe degree having foci of unequivocal in situ carcinoma. No stromal invasion was seen. Case 2: A 55-yr-old Japanese man with known hepatocellular carcinoma was diagnosed as having pancreatic cyst in the tail of the pancreas on US and CT. ERCP showed a pancreatic cyst, and cytology of the pancreatic juice highly suggested adenocarcinoma. Distal pancreatectomy and splenectomy were performed. Histopathologic diagnosis of pancreatic cyst was mucinous cystadenoma. The pancreatic ductule 2 cm proximal to the pancreatic cyst showed carcinoma in situ. The diagnostic clue of in situ carcinoma of the pancreas in these two cases was a cystic lesion of the pancreas detected by check-up US and CT of known carcinoma of the stomach and liver. Cytology of the pancreatic juice was also positive for malignancy. In situ carcinoma of the pancreas was found to be independent of the cysts because of the different locations and divergent histopathologic natures of the two lesions.

Biomarkers↗
PubMed1980

[Errors in diagnosis and treatment of pancreatic cysts].

The authors observed 136 patients with pancreatic cysts. Complicated forms of the disease were found in 26 patients. It was established that despite apparent signs of disturbed functioning of the pancreas for a long time there was not a single case of correct diagnosis in local hospitals. The greatest amount of errors were made in surgical interventions in patients with pancreatic cysts.

Adolescent↗
PubMed1980

[Modern diagnostic principles in pancreatic cysts].

The authors observed 146 patients with pancreatic cysts. Operations were performed on 119 patients. Pancreatic cysts were diagnozed by a complex method of examination including retrograde endoscopic pancreatography, ultrasonic echography and selective angiography. The use of the complex method gave high diagnostic results--97.2%.

Adolescent↗
PubMed1982

Pancreatic cysts caused by carcinoma of the pancreas: a pitfall in the diagnosis of pancreatic carcinoma.

Pancreatic cysts were diagnosed on computed tomography (CT) in 6 (8%) of 73 histologically proven pancreatic carcinomas. In three of a total of seven cases studied, the initial CT diagnosis was pancreatitis. The CT features of cysts secondary to pancreatic carcinoma were identical to those of pseudocysts in pancreatitis. All cases had masses of varying sizes suggestive of carcinoma or pancreatitis. Even in retrospect, two cases were difficult to differentiate from pancreatitis with pseudocysts. Our results indicate that whenever pancreatic cysts are encountered in patients of cancer age without a history of pancreatitis, further examinations including percutaneous aspiration biopsies should be performed to exclude malignancy.

Adenocarcinoma↗
PubMed2003

[Endoscopic drainage of postnecrotic pancreatic cysts].

Results of endoscopic drainage of postnecrotic pancreatic cysts in 12 patients were analyzed. Possibilities of the method are limited by location of the cysts in pancreatic head and corpus. Clear visualization of the cysts on the gastric or duodenal wall is the main condition for this procedures feasibility. Surgery must be started with point burning in the wall that is safe and permits the surgeon to stop procedure when cyst is not found. When the cyst is drained through the duodenal lumen, it is necessary to visualize Veter's papilla and perform the procedure below it to prevent lesion of a distal part of the common bile duct. Section of the cyst with wall thickness to 3-4 mm from the duodenal lumen and the ikness to 6-7 mm from the stomach is safe enough. Endoscopic procedures are not indicated in hypertension in the bile ducts.

Adolescent↗