pancreas

摘要： The impressive technological advances in recent years have rapidly translated into the shift of endoscopic ultrasound(EUS)from diagnostic modality into an interventional and therapeutic tool.Despite the great advance in its diagnosis,the majority of pancreatic adenocarcinoma cases are inoperable when diagnosed,thus demanding alternative optional therapies.EUS has emerged as an easy,minimally invasive modality targeting this carcinoma with different interventions that have been reported recently.In this review we summarize the evolving role of interventional therapeutic EUS in pancreatic adenocarcinoma management.

摘要： Mixed neuroendocrine-nonneuroendocrine neoplasms(Mi NENs)of the digestive tract are a rare heterogeneous group of tumors that present many challenges in terms of diagnosis and treatment.Over the years,the diagnostic criteria,classification,and clinical behavior of these tumors have been the subjects of ongoing debate,and the various changes in their nomenclature have strengthened the challenges associated with Mi NENs.This review is performed to provide an understanding of the key factors involved in the evolution of the designation of these tumors as Mi NEN,highlight the current diagnostic criteria,summarize the latest data on pathogenesis and provide information on available treatments.Moreover,this work seeks to increase the awareness about these rare neoplasms by presenting the clinicopathological features and prognostic factors that play important roles in their behavior and discussing their different regions of origin in the gastrointestinal system(GIS).Currently,the Mi NEN category also includes tumors in the GIS with a nonneuroendocrine component and epithelial tumors other than adenocarcinoma,depending on the organ of origin.Diagnosis is based on the presence of both morphological components in more than 30%of the tumor.However,this value needs to be reconfirmed with further studies and may be a limiting factor in the diagnosis of Mi NEN by biopsy.Furthermore,available clinicopathological data suggest that the inclusion of amphicrine tumors in the definition of Mi NEN is not supportive and warrants further investigation.The diagnosis of these tumors is not solely based on immunohistochemical findings.They are not hybrid tumors and both components can act independently;thus,careful grading of each component separately is required.In addition to parameters such as the metastatic state of the tumor at the time of diagnosis and the feasibility of surgical resection,the aggressive potential of both components has paramount importance in the choice of treatment.Regardless of the organ of origin within the GIS,almost Mi NENs are tumors with poor prognosis and are frequently encountered in the elderly and men.They are most frequently reported in the colorectum,where data from molecular studies indicate a monoclonal origin;however,further studies are required to provide additional support for this origin.

摘要： Solid pseudopapillary neoplasm of the pancreas is a low-grade malignant tumor that predominantly affects young women in their third and fourth decade.Etiology and risk factors are unknown.Clinical symptoms are aspecific and most commonly due to mass effect.Diagnosis is made by computed tomography scan or magnetic resonance imaging and histological characterization is obtained by endoscopic ultrasound-guided fine needle biopsy.Microscopically,these lesions are composed by both solid and pseudopapillary structures with necrotic and hemorrhagic areas.Occasionally,the biological behavior is aggressive with tumor recurrence and distant metastasis.Usually,curative R0 surgical resection is the best option able to provide long term survival even in advanced disease.Unresectable disease is the main predictor of poor prognosis.Chemotherapy and radiotherapy regimens are not well standardized.However,they could be effective in reducing tumor size as neoadjuvant treatment or disease control in palliative setting.Although complete surgical resection provides a cure rate of>95%,considering young age of the patients and morbidity associated to pancreatic surgery,further studies are needed to better investigate risk factors and responsiveness to hormones in order to allow early diagnosis and follow up strategies that could avoid unnecessary surgery in less aggressive disease.

摘要： BACKGROUND The differential diagnosis of abdominal masses is somewhat troublesome,especially when there is a malignancy to be evaluated.We report herein a unique case of gastric adenocarcinoma concurrent with a pancreatic schwannoma.Correct assessment of intraoperative findings is essential for adequate tumor staging and to decide the proper management of a concurrent pancreatic lesion.CASE SUMMARY Computed tomography scan performed for gastric cancer staging revealed a solid and cystic pancreatic mass that had no signs of local invasiveness.Surgical resection of the pancreas was decided preoperatively since a radical approach of the gastric tumor could be performed.There were no signs of distant metastases,and the large pancreatic mass was in contact with the posterior gastric wall.Histopathological study revealed a pancreatic schwannoma,which is an uncommon neoplasm that arises from Schwann cells around peripheral nerves.CONCLUSION Therefore,pancreatic masses deserve special attention regarding the differential diagnosis in patients with gastric cancer.The presence of a large pancreatic mass should not preclude the potentially curative intent of the gastric cancer treatment.

摘要： Gastroenteropancreatic neuroendocrine neoplasms are a heterogenous group of rare neoplasms that are increasingly being discovered,often incidentally,throughout the gastrointestinal tract with varying degrees of activity and malignant potential.Confusing nomenclature has added to the complexity of managing these lesions.The term carcinoid tumor and embryonic classification have been replaced with gastroenteropancreatic neuroendocrine neoplasm,which includes gastrointestinal neuroendocrine and pancreatic neuroendocrine neoplasms.A comprehensive multidisciplinary approach is important for clinicians to diagnose,stage and manage these lesions.While histological diagnosis is the gold standard,recent advancements in endoscopy,conventional imaging,functional imaging,and serum biomarkers complement histology for tailoring specific treatment options.In light of developing technology,our review sets out to characterize diagnostic and therapeutic advancements for managing gastroenteropancreatic neuroendocrine tumors,including innovations in radiolabeled peptide imaging,circulating biomarkers,and endoscopic treatment approaches adapted to different locations throughout the gastrointestinal system.

摘要： BACKGROUND Intrapancreatic accessory spleen(IPAS)is an uncommon condition,with the majority of cases presenting as solid lesions.Thus,this condition is frequently misdiagnosed as pancreatic solid neoplasm.Moreover,splenic cavernous hemangioma is a rare disorder,whereas lesions with a cystic appearance arising from IPAS have not been reported.CASE SUMMARY Herein,we present a case involving a 32-year-old male who had a complex cystic lesion in the tail of the pancreas revealed by conventional ultrasound.The lesion was misdiagnosed as a pancreatic cystadenoma because of its confusing anatomic location,as well as due to its peripheral nodular and internal septal enhancement patterns on contrast-enhanced ultrasound.After multidisciplinary discussion,the patient finally underwent laparoscopic pancreatic body and tail resections.Postoperative pathology demonstrated the lesion to be a cavernous hemangioma arising from the IPAS.CONCLUSION Cavernous hemangioma in the intrapancreatic accessory spleen may mimic pancreatic cystadenoma,which is a condition with the potential to be malignant.Imaging follow-ups or surgical interventions may be helpful for the exclusion of malignant risks in complicated cystic lesions,especially those with parietal and septal enhancements.

摘要： To the Editor:Cystic tumors of the pancreas are rare,accounting for 1%-5%of exocrine pancreatic tumors.Serous cystadenoma(SCA)was firstly described by Compagno and Oertel in 1978 as a benign glycogenrich neoplasm[1].In 1996 Perez-Ordonez et al.[2]reported the first case of a solid variant of SCA;since then,23 cases of this extremely uncommon tumor variant were reported.

摘要： Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases,together with other imaging tests and clinical data.Elastography can be informative,especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions.However,further studies are necessary to standardize the method,increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses.Moreover,even if promising,elastography still provides little information in the evaluation of benign conditions.

摘要： Malignant biliary obstruction generally results from primary malignancies of the pancreatic head,bile duct,gallbladder,liver,and ampulla of Vater.Metastatic lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary obstruction.The most common primaries include renal cancer,lung cancer,gastric cancer,colorectal cancer,breast cancer,lymphoma,and melanoma.They may be difficult to differentiate from primary hepato-pancreatobiliary cancer based on imaging studies,or even on biopsy.There is also no consensus on the optimal method of treatment,including the feasibility and effectiveness of endoscopic intervention or surgery.A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is presented.The diagnostic modality and clinical characteristics may differ significantly depending on the type of primary cancer.Different primaries also cause malignant biliary obstruction in different ways,including direct invasion,pancreatic or biliary metastasis,hilar lymph node metastasis,liver metastasis,and peritoneal carcinomatosis.Metastasectomy may hold promise for some types of pancreato-biliary metastases.This review aims to elucidate the current knowledge in this area,which has received sparse attention in the past.The aging population,advances in diagnostic imaging,and improved treatment options may lead to an increase in these rare occurrences going forward.

摘要： BACKGROUND Endoscopic ultrasound-guided radiofrequency ablation(EUS-RFA)is emerging as a complementary therapeutic approach for pancreatic solid masses.However,results of published data are difficult to interpret because of a retrospective design and small sample size.AIM To systematically review data on EUS-RFA for solid lesions and to pool the results of the different experiences in order to provide more consistent evidence in terms of safety and efficacy.METHODS A comprehensive systematic literature search on the main databases was performed to identify articles in which patients with pancreatic solid lesions underwent EUS-RFA.The primary outcomes were procedure-related adverse events(AEs)and mortality.Secondary outcomes were the technical success rate and the effects on primary tumor growth.Statistical analyses were performed using Stata version 14.0.RESULTS In total,14 studies were included,with 120 patients undergoing 153 ablations of 129 solid pancreatic lesions.The STARmed technology was used in seven studies,the Habib system in six studies,and the HybridTherm probe in one study.The pooled technical success rate was 99.0%(I2:25.82%).The pooled overall AE rate was 8.0%(I2:11.46%).Excluding mild AEs,the pooled rates of serious AEs was 1.0%(I2:0%).No mortality related to the procedure was reported.CONCLUSION The present pooled analysis confirms the safety and feasibility of EUS-RFA.