Calcifying Obstructive Pancreatitis: A Study of Intraductal Papillary Mucinous Neoplasm Associated With Pancreatic Calcification
|
|
- Sandra Jennifer Griffin
- 6 years ago
- Views:
Transcription
1 CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2004;2:57 63 Calcifying Obstructive Pancreatitis: A Study of Intraductal Papillary Mucinous Neoplasm Associated With Pancreatic Calcification MAURICIO ZAPIACH,* DHIRAJ YADAV,* THOMAS C. SMYRK, JOEL G. FLETCHER, RANDALL K. PEARSON,* JONATHAN E. CLAIN,* MICHAEL B. FARNELL, and SURESH T. CHARI* Divisions of *Gastroenterology and Hepatology, Anatomic Pathology, and Gastroenterologic and General Surgery; and Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota Background & Aims: We have observed intraductal papillary mucinous neoplasm (IPMN) associated with pancreatic calcification. The aim of this study is to describe the profile of IPMN associated with calcification and gain insights into the pathogenesis of calcification in IPMN. Methods: We identified 10 patients with IPMN with pancreatic calcification, of whom 7 underwent pancreatic resection. We reviewed demographic data, history of previous pancreatitis, and radiological and histological features of these patients. Results: In patients with IPMN with calcification (mean age, yr; 50% men), a diagnosis of chronic calcifying pancreatitis was entertained in 5 of 10 patients; 2 patients had undergone previous endoscopic therapy for stone removal. There was no previous history of pancreatitis in 9 of 10 patients. Radiologically, calcifications were seen diffusely throughout the gland in 8 of 10 patients and interpreted as chronic calcific pancreatitis. Although 1 of the 7 patients who underwent resection had diffuse IPMN throughout the gland, 6 patients had IPMN confined to the head or uncinate process (mean size, 2.75 cm; range, cm). Histologically, 6 of 7 IPMNs were adenomas, and 1 patient had invasive cancer. No patient had intratumoral calcification. All 7 patients had calcification within the main pancreatic duct and/or side branches, often within inspissated mucus. Conclusions: IPMN associated with pancreatic calcification can lead to misdiagnosis and inappropriate treatment for chronic calcifying pancreatitis. In the absence of intratumoral calcification or a previous history of long-standing chronic pancreatitis, calcification in IPMN likely represents a unique and hitherto unrecognized form of calcifying obstructive pancreatitis caused by prolonged partial obstruction of the pancreatic duct. Intraductal papillary mucinous neoplasm (IPMN) is being diagnosed with increasing frequency since it was first described in 1982 by Ohhashi. 1 However, IPMN is still often misdiagnosed as chronic pancreatitis because of symptoms of relapsing abdominal pain, pancreatitis, and steatorrhea and imaging findings of a dilated pancreatic duct. Pancreatic calcification generally is considered to be pathognomonic of chronic calcifying pancreatitis. Until 1998, only 6 cases of calcification associated with IPMN had been cited in the literature. 2 At the Mayo Clinic (Rochester, MN), we have seen more than 40 patients with IPMN in the past 3 years, 10 of whom have had calcification. The association of pancreatic calcification with IPMN further adds to the difficulty in distinguishing IPMN from chronic pancreatitis. There are several possible explanations for the occurrence of pancreatic calcification in IPMN. Calcification may be occurring in dysplastic tumoral tissue, IPMN may be a complication of long-standing chronic calcifying pancreatitis, or IPMN may predispose to a form of calcifying obstructive pancreatitis. Understanding the pathogenesis of calcification in IPMN has important implications for the management and treatment of these patients. For example, if calcification in IPMN were intratumoral, the presence of calcification throughout the gland would imply diffuse involvement of the gland by IPMN and require a total pancreatectomy for cure. However, if calcification were the result of chronic ductal obstruction, limited resection to remove the tumor and, consequently, the obstruction should suffice. The aim of this study is to describe clinical, radiological, and histological findings in patients with IPMN with calcification to gain insights into the pathogenesis of calcification in IPMN. Methods The study was approved by the Mayo Foundation Institutional Review Board. In the past 3 years, more than 40 Abbreviations used in this paper: CT, computed tomography; ERCP, endoscopic retrograde cholangiopancreatography; IPMN, intraductal papillary mucinous neoplasm by the American Gastroenterological Association /04/$30.00 PII: /S (04)
2 58 ZAPIACH ET AL. CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Vol. 2, No. 1 Table 1. Demographic Features, Alcohol Use, Smoking History, and Clinical Features at Presentation and Follow-up of the 10 Patients With IPMN With Calcification Patient no. Age (yr) Sex Alcohol consumption Smoking history History of pancreatitis Clinical features at presentation Weight loss Pancreatic insufficiency Jaundice 1 51 F None M 1 drink/wk M None F 2 drinks/d F None F None F None M 2 drinks/d a 9 62 M None M 2 drinks/wk 5 NOTE. Patients 1, 2, 6, 8, and 10 initially were diagnosed as having chronic calcifying pancreatitis. a Lost to follow-up., Ever used;, never used. Follow-up (mo) patients with IPMN have been diagnosed and treated at Mayo Clinic Rochester. Of these, 10 patients were noted to have pancreatic calcification on either computed tomography (CT) or endoscopic retrograde cholangiopancreatography (ERCP). We reviewed medical records of these 10 patients with attention to demographic data, including age, sex, race, presenting symptoms, and clinical history. All imaging studies (CT and ERCP) were reviewed by a single radiologist (J.G.F.), who was blinded to endoscopic and histological results. The location and distribution of the calcification were noted and classified as main pancreatic duct (i.e., intraluminal within the main pancreatic duct on axial images), peripheral (outside the main pancreatic duct), or combined main pancreatic duct and peripheral. When possible, patterns of calcification on CT and ERCP were correlated with pathological findings. A single pathologist (T.C.S.) reviewed all original sections of the 7 resected tumors. When necessary, additional sections were cut, stained, and reviewed. We noted tumor size in all patients and classified them according to World Health Organization criteria 3 (adenoma, n 6; invasive cancer, n 1). The location and distribution of the calcification seen histologically were classified as being in the main duct, side branches, or stroma. Figure 1. Non-contrast CT scan showing extensive pancreatic calcification in a patient (no. 2) with a small IPMN in the head of the pancreas. ERCP showed dilated pancreatic duct with mucin pouring out of the ampulla. Figure 2. ERCP showing a dilated pancreatic duct with multiple intraductal stones. Prior to referral to Mayo, patient (no. 1) was diagnosed with chronic pancreatitis and treated with stenting of pancreatic duct stricture and extracorporeal shockwave lithotripsy for dissolution of stones.
3 January 2004 CALCIFYING OBSTRUCTIVE PANCREATITIS 59 Table 2. Radiological Features of the 10 Patients With IPMN With Calcification Patient no. Number Focal/ diffuse Calcification MPD Location CT Peripheral Largest calculus (mm) Other radiological findings 1 5 Diffuse 10 Solid/cystic mass head of pancreas ERCP Pancreas divisum with pancreatic duct stricture, distally dilated duct with intraductal stones treated with extracorporeal shock-wave lithotripsy 2 10 Diffuse 10 Pancreatic atrophy Mucin extruding from ampulla, dilated and tortuous pancreatic duct 3 10 Diffuse 5 Pancreatic atrophy Normal-appearing ampulla, diffusely dilated pancreatic duct with ectatic side branches, mucin plug in pancreatic duct 4 10 Diffuse cm solid/cystic mass pancreatic head 5 5 Focal (tail) 6 10 Diffuse 5 Cystic lesion at the pancreatic head (before referral to Mayo Clinic) 7 5 Focal (head) Mucin extruding from ampulla, markedly dilated pancreatic duct, unable to fill duct beyond the neck of pancreas, likely due to obstructing stone 5 1-cm cyst in the head ERCP after pancreaticoduodenectomy: pancreatic duct not opacified ERCP after pancreaticoduodenectomy: irregular pancreatic duct with cystic side branches in the tail cm cystic lesion in the uncinate process 8 10 Diffuse 5 Dilated pancreatic duct, atrophy of distal gland 9 10 Diffuse 5 Diffuse ductal dilation with multiple cysts Diffuse 3 5 Cystic lesion at the head with nodal involvement CT, computed tomography; MPD, main pancreatic duct; ERCP, endoscopic retrograde cholangiopancreatography. Prominent ampulla, dilated biliary tree, dilated pancreatic duct with intraductal stones, pancreatic sphincterotomy done and stones extracted Mucin extruding from ampulla, dilated pancreatic duct with cystic dilations giving chain-of-lakes appearance Mucin extruding from ampulla, obstructing ampullary stone, cystic pancreatic duct dilation Mucin extruding from ampulla, 3-cm long pancreatic duct stricture, multiple filling defects Results Demographic and Clinical Features Mean age of patients with IPMN with calcification was years, and 50% were men (Table 1). Nine of 10 patients with IPMN with calcification had no history of pancreatitis before presentation with IPMN. Eight patients had evidence of pancreatic insufficiency before the diagnosis of IPMN (diabetes, n 4; steatorrhea, n 4). Radiological Features at CT and ERCP The radiological appearance of calcification on CT was indistinguishable from that seen in alcoholic chronic calcifying pancreatitis (Figures 1 and 2). Calcification was located only within the main pancreatic duct in 1 patient, peripherally in 3 patients, and both within the main pancreatic duct and peripherally in 6 patients. Eight patients had numerous calcifications spread diffusely throughout the gland, whereas the remaining 2 patients had focal calcification. ERCP showed intraductal stones or debris in 4 patients, all of whom also had calcifications within the main duct on CT. On duodenoscopy, mucin was seen pouring from the ampulla in 5 of 10 patients, whereas 1 patient had a mucin plug in the pancreatic duct (Table 2). In the 7 patients who underwent surgical resection, a cystic lesion was seen on CT in 6 patients (5 lesions, in the head; 1 lesion, in the uncinate process; Table 2). Histological Features Of 7 patients who underwent surgical resection, 5 patients had IPMN confined to the pancreatic head; 1 patient, in the uncinate process; and 1 patient, involving the entire gland (Table 3). Mean tumor size in patients with focal disease was 2.75 cm (n 6; range, 1.1 5cm). The pancreas was firm in consistency, with a beanbag feel because of its multiple intraductal stones. On histological examination of the resected specimen, 6 of 7
4 60 ZAPIACH ET AL. CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Vol. 2, No. 1 Table 3. Surgical Procedure, Pathological Features of IPMN, and Distribution of Calcification on Histological Examination in the 7 Patients Who Underwent Surgical Resection IPMN Calcification Patient no. Surgical procedure Indication for surgery 1 Pancreaticoduodenectomy Obstructive jaundice with cystic lesion in the head of the pancreas 2 Total pancreatectomy IPMN suspected because of mucin pouring out of ampulla on ERCP 3 Pancreaticoduodenectomy IPMN suspected because of diffusely dilated pancreatic duct with ectatic side branches and mucin plug in pancreatic duct 4 Total pancreatectomy IPMN suspected due to mucin pouring out of ampulla on ERCP 5 Pancreaticoduodenectomy IPMN suspected due to cystic lesion head of pancreas 6 Pancreaticoduodenectomy followed by completion total pancreatectomy Persistent pain following resection of IPMN in the head of pancreas 24 months prior at an outside institution 7 Pancreaticoduodenectomy Multiple cystic lesions head of pancreas with jaundice Location Dimensions (cm) Histology Main duct Side branches Intratumoral Head Invasive cancer Head Adenoma Head Adenoma Head Adenoma Uncinate Adenoma Diffuse Adenoma Head Adenoma ERCP, endoscopic retrograde cholangiopancreatography; IPMN, intraductal papillary-mucinous neoplasm. patients had adenoma, and 1 patient had invasive cancer. One patient (no. 10) had an unresectable cancer diagnosed by fine-needle aspiration of the pancreatic head lesion. All patients who underwent resection (n 7) had intraluminal calcification in the main duct (Figure 3A and B) and side branches, often within inspissated mucus (Figure 4A), indistinguishable from that seen in chronic calcifying pancreatitis. Calcification also was seen in the pancreatic duct wall (Figure 4B), and there was no intratumoral calcification. Diagnosis of IPMN and Indication for Surgery The initial diagnosis of IPMN was made by a variety of methods. Seven of 10 patients were diagnosed endoscopically, whereas in the remaining 3 patients (no. 1, 6, and 7), the diagnosis was preoperatively suspected, but only confirmed after resection. Five of the 7 patients diagnosed endoscopically had a prominent ampulla with mucin pouring out of it, 1 patient had a mucin plug, and 1 patient was noted to have mucinous intraductal debris. In addition, 5 of these patients also underwent imaging studies notable for cystic lesions in either the pancreatic head or uncinate process. In 2 patients (no. 1 and 7), surgery was performed to remove a cystic lesion in the pancreatic head that was causing obstructive jaundice. One patient (no. 6) underwent a completion pancreatectomy for persistent pain after a resection for IPMN of the pancreatic head 24 months previously at an outside institution. Discussion We report 10 patients with IPMN and pancreatic calcification. In most patients, the calcification was extensive, indistinguishable from chronic calcifying pancreatitis on imaging studies. This led to a delay in the diagnosis of IPMN and inappropriate endoscopic therapy. Chronic pancreatitis has been classified broadly into chronic calcifying pancreatitis and chronic obstructive pancreatitis. 4 The majority of patients with chronic calcifying pancreatitis, usually referred to in the literature simply as chronic pancreatitis, develop pancreatic calcification. Conversely, chronic obstructive pancreatitis in-
5 January 2004 CALCIFYING OBSTRUCTIVE PANCREATITIS 61 Figure 3. (A and B) Calcification in peripherally located small ducts. (B) There is also duct wall calcification. Note that there is no IPMN associated with the calcification. variably is caused by ductal obstruction and is not associated with pancreatic calcification. 4 We propose that IPMN causes a unique form of calcifying obstructive pancreatitis. IPMN is not uncommonly misdiagnosed as chronic pancreatitis because of its similar clinical presentation, with recurrent pancreatitis, steatorrhea, and jaundice, as well as its radiological findings of cystic lesions that are frequently confused with pseudocysts. In a patient with pancreatic calcification, the diagnosis of IPMN becomes considerably more challenging. Additionally, misdiagnosis of IPMN as chronic pancreatitis can lead to serious errors in management, illustrated by 2 of our patients. One of our patients was treated with sphincterotomy and stone removal, whereas another patient was being treated with pancreatic duct stenting and extracorporeal shockwave lithotripsy for months before being referred to our institution. Our study shows that IPMN should be considered in the differential diagnosis of chronic calcific pancreatitis. In patients with calcification, the presence of a markedly dilated pancreatic duct and 1 or more persistent cystic lesions should raise the suspicion of IPMN. The presence of mucin in the pancreatic duct, identified by mucin Figure 4. (A) Intraluminal and (B) duct wall calcification. (A) Squamous metaplasia is seen in adjacent duct. Pancreatic ducts shown were located remotely from the region of pancreas involved by IPMN.
6 62 ZAPIACH ET AL. CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Vol. 2, No. 1 pouring out of a gaping ampulla on duodenoscopy or by cyst puncture, confirms the diagnosis of IPMN. Ultimately, when other modalities have been nondiagnostic, as in 3 of our patients, only surgical resection can confirm the diagnosis. What is the pathogenesis of calcification in IPMN? Apart from the highly unlikely possibility of coincidentally occurring IPMN and chronic calcifying pancreatitis, there are 3 possible explanations for the calcification seen in IPMN. First, it may be the result of tumoral calcification, as seen in an array of other slow-growing pancreatic neoplasms, such as in serous or mucinous cystadenomas. 5 9 The central sunburst calcifications seen in serous cystadenomas are considered a pathognomonic finding for this entity, whereas rim calcifications indicate malignant transformation in mucinous cystic neoplasm. 5,6 Tumoral calcification also has been reported in solid-pseudopapillary neoplasms and rarely in ductal adenocarcinomas. 7,8 Although they are not neoplasms, pancreatic pseudocysts also have been known to calcify. 9 In our patients, careful histological examination did not show tumoral calcification in any patient. The calcification tended to be diffuse and remote from the tumor, which was often fairly small, and located in the head of the pancreas. A second explanation for calcification in IPMN could be that the tumor developed as a complication of longstanding chronic calcifying pancreatitis. Epidemiological studies have shown that irrespective of cause, chronic calcifying pancreatitis predisposes to ductal adenocarcinoma, and the risk increases with duration of pancreatitis. 10 Although the exact pathogenesis of ductal adenocarcinoma in chronic pancreatitis is not known, it is believed that increased cell turnover caused by chronic inflammation and smoking has a significant role. 3,10 Pancreatic intraepithelial neoplasms are preneoplastic lesions that also have been reported in chronic pancreatitis and resemble the histological stages of IPMN. 11,12 Consequently, it is possible that chronic pancreatitis could predispose some patients to develop IPMN, rather than ductal adenocarcinoma. In our series, only 1 patient gave a history suggestive of recurrent pancreatitis. In all other patients, IPMN was prospectively or retrospectively identified at the onset of symptoms. In our clinical practice, we have seen patients with established chronic calcific pancreatitis develop ductal adenocarcinoma, but we have yet to see 1 patient develop IPMN. It is highly unlikely that the 10 patients in our series developed IPMN as a complication of long-standing chronic calcifying pancreatitis. A third explanation for calcification is that in IPMN, chronic partial ductal obstruction predisposes to intraductal calcification. All patients with IPMN with ductal obstruction develop an obstructive form of chronic pancreatitis in the gland upstream from the obstruction. This is similar to findings in patients with ductal adenocarcinoma or other forms of ductal obstruction. However, calcification rarely, if ever, develops in obstructive pancreatitis secondary to neoplastic, traumatic, or postpancreatitis stricture. 13,14 The novelty of our observations is that we describe an obstructive form of pancreatitis in which extensive calcifications develop and delay or obscure the diagnosis of an underlying IPMN. Experimental studies in dogs have shown that pancreatolithiasis occurs with partial, rather than complete, obstruction of the duct Moreover, in these canine studies, the incidence of calcification increased with the duration of obstruction, such that 50% of these dogs developed calcifying lesions by 4 months. 17,18 In humans with obstructive pancreatitis who present with recurrent pancreatitis and pain, the obstruction is dealt with expeditiously, and the pain is relieved promptly. Therefore, the duration of obstruction is not long enough to precipitate calcifications in the majority of patients with obstructive pancreatitis. However, IPMN is a slow-growing neoplasm that may take several years to be diagnosed. 19,20 We believe that intermittent obstruction of the pancreatic duct by mucin and/or intraductal tumor in IPMN leads to intraductal calcification. Thus, IPMN represents a novel and unusual form of calcifying obstructive pancreatitis. References 1. Ohhashi K. Four cases of mucin producing cancer of the pancreas on specific findings of the papilla of vater. Prog Dig Endosc 1982;20: Origuchi N, Kimura W, Muto T, Esaki Y. Pancreatic mucin-producing adenocarcinoma associated with a pancreatic stone: report of a case. Surg Today 1998;28: Longnecker DS, Adler G, Hruban RH, Kloppel G. Intraductal papillary-mucinous neoplasms of the pancreas. In: Hamilton SR, Aaltonen LA, eds. World Health Organization classification of tumours. Pathology and genetics of tumours of the digestive system. Lyon: IARC Press, 2000: Singer MV, Gyr K, Sarles H. Revised classification of pancreatitis. Report of the Second International Symposium on the Classification of Pancreatitis in Marseille, France, March 28 30, Gastroenterology 1985;89: Warshaw AL, Compton CC, Lewandrowski K, et al. Cystic tumors of the pancreas. New clinical, radiologic, and pathologic observations in 67 patients. Ann Surg 1990;212: ; discussion, Furukawa H, Takayasu K, Mukai K, et al. Ductal adenocarcinoma of the pancreas associated with intratumoral calcification. Int J Pancreatol 1995;17: Kim T, Murakami T, Takahashi S, et al. Ductal adenocarcinoma of
7 January 2004 CALCIFYING OBSTRUCTIVE PANCREATITIS 63 the pancreas with intratumoral calcification. Abdom Imaging 1999;24: Machiki Y, Nimura Y, Kamiya J, et al. Clinicopathologic study on pancreatic cancer associated with pancreatic stones. Int J Pancreatol 1997;22: Demos TC, Posniak HV, Harmath C, et al. Cystic lesions of the pancreas. AJR Am J Roentgenol 2002;179: Lowenfels AB, Maisonneuve P, Cavallini G, et al. Pancreatitis and the risk of pancreatic cancer. International Pancreatitis Study Group. N Engl J Med 1993;328: Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann Surg 2001;234: ; discussion, Biankin AV, Biankin SA, Kench JG, et al. Aberrant p16(ink4a) and DPC4/Smad4 expression in intraductal papillary mucinous tumours of the pancreas is associated with invasive ductal adenocarcinoma. Gut 2002;50: Suda K, Mogaki M, Oyama T, et al. Histopathologic and immunohistochemical studies on alcoholic pancreatitis and chronic obstructive pancreatitis: special emphasis on ductal obstruction and genesis of pancreatitis. Am J Gastroenterol 1990;85: Sahel J, Cros RC, Durbec JP, et al. Multicenter pathological study of chronic pancreatitis. Morphological regional variations and differences between chronic calcifying pancreatitis and obstructive pancreatitis. Pancreas 1986;1: Layer P, Yamamoto H, Kalthoff L, et al. The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis. Gastroenterology 1994;107: Ammann RW, Akovbiantz A, Largiader F, et al. Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients. Gastroenterology 1984;86: Konishi K, Izumi R, Kato O, et al. Experimental pancreatolithiasis in the dog. Surgery 1981;89: Sakakibara A, Okumura N, Hayakawa T, et al. Ultrastructural changes in the exocrine pancreas of experimental pancreatolithiasis in dogs. Am J Gastroenterol 1982;77: Kloppel G. Clinicopathologic view of intraductal papillary-mucinous tumor of the pancreas. Hepatogastroenterology 1998;45: Loftus EV Jr, Olivares-Pakzad BA, Batts KP, et al. Intraductal papillary-mucinous tumors of the pancreas: clinicopathologic features, outcome, and nomenclature. Members of the Pancreas Clinic, and Pancreatic Surgeons of Mayo Clinic. Gastroenterology 1996;110: Address requests for reprints to: Suresh T. Chari, M.D., 200 First Street SW, Mayo Clinic, Rochester, Minnesota chari.suresh@mayo.edu; fax: (507)
Chronic pancreatitis mimicking intraductal papillary mucinous neoplasm of the pancreas; Report of tow cases
Jichi Medical University Journal Chronic pancreatitis mimicking intraductal papillary mucinous neoplasm of the pancreas; Report of tow cases Noritoshi Mizuta, Hiroshi Noda, Nao Kakizawa, Nobuyuki Toyama,
More informationManagement of the Mucin Filled Bile Duct. A Complication of Intraductal Papillary Mucinous Tumor of the Pancreas
CASE REPORT Management of the Mucin Filled Bile Duct. A Complication of Intraductal Papillary Mucinous Tumor of the Pancreas Anand Patel, Louis Lambiase, Antonio Decarli, Ali Fazel Division of Gastroenterology
More informationORIGINAL ARTICLE. Fate of the Pancreatic Remnant After Resection for an Intraductal Papillary Mucinous Neoplasm
ONLINE FIRST ORIGINAL ARTICLE Fate of the Pancreatic Remnant After Resection for an Intraductal Papillary Mucinous Neoplasm A Longitudinal Level II Cohort Study Toshiyuki Moriya, MD, PhD; L. William Traverso,
More informationACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts
ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts Grace H. Elta, MD, FACG 1, Brintha K. Enestvedt, MD, MBA 2, Bryan G. Sauer, MD, MSc, FACG (GRADE Methodologist) 3 and Anne Marie Lennon,
More informationMatthew McCollough, M.D. April 9, 2009 University of Louisville
Matthew McCollough, M.D. April 9, 2009 University of Louisville List the differential diagnosis for pancreatic cysts Review the epidemiology Illustrate the types of cysts through case discussions Discuss
More informationIntraductal Papillary Mucinous Neoplasms: We Still Have a Way to Go! Francesco M. Serafini, MD, FACS
Intraductal Papillary Mucinous Neoplasms: We Still Have a Way to Go! Francesco M. Serafini, MD, FACS Brooklyn VAMC September 21 st GI Grand Rounds - What is it? - Clinical entity that has emerged from
More informationPAPER. Experience With 208 Resections for Intraductal Papillary Mucinous Neoplasm of the Pancreas
PAPER Experience With 0 Resections for Intraductal Papillary Mucinous Neoplasm of the Pancreas Thomas Schnelldorfer, MD; Michael G. Sarr, MD; David M. Nagorney, MD; Lizhi Zhang, MD; Thomas C. Smyrk, MD;
More informationThe Use of Pancreatoscopy in the Diagnosis of Intraductal Papillary Mucinous Tumor Lesions of the Pancreas
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:S53 S57 The Use of Pancreatoscopy in the Diagnosis of Intraductal Papillary Mucinous Tumor Lesions of the Pancreas KENJIRO YASUDA, MUNEHIRO SAKATA, MOOSE
More informationp53 expression in invasive pancreatic adenocarcinoma and precursor lesions
Malaysian J Pathol 2011; 33(2) : 89 94 ORIGINAL ARTICLE p53 expression in invasive pancreatic adenocarcinoma and precursor lesions NORFADZILAH MY MBBCH,* Jayalakshmi PAILOOR MPath, FRCPath,* RETNESWARI
More informationAn Approach to Pancreatic Cysts. Introduction
An Approach to Pancreatic Cysts Nalini M. Guda, MD Aurora St. Luke s Medical Center, Milwaukee Clinical Adjunct Professor of Medicine, University of Wisconsin School of Medicine and Public Health Introduction
More informationCitation American Journal of Surgery, 196(5)
NAOSITE: Nagasaki University's Ac Title Author(s) Multifocal branch-duct pancreatic i neoplasms Tajima, Yoshitsugu; Kuroki, Tamotsu Amane; Adachi, Tomohiko; Mishima, T Kanematsu, Takashi Citation American
More informationDr Claire Smith, Consultant Radiologist St James University Hospital Leeds
Dr Claire Smith, Consultant Radiologist St James University Hospital Leeds Imaging in jaundice and 2ww pathway Image protocol Staging Limitations Pancreatic cancer 1.2.4 Refer people using a suspected
More informationIntraductal papillary mucinous neoplasm (IPMN) is a distinct
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2008;6:815 819 Evaluation of the Guidelines for Management of Pancreatic Branch-Duct Intraductal Papillary Mucinous Neoplasm RAYMOND S. TANG,* BENJAMIN WEINBERG,
More informationX-ray Corner. Imaging of The Pancreas. Pantongrag-Brown L
X-ray Corner 125 Imaging of The Pancreas Modern imaging modalities commonly used in pancreas include ultrasound (US), CT, and MRI. Pancreas is a retroperitoneal organ which makes it difficult to visualize
More informationCharacterization of Malignant Pancreatic Cystic Lesions in the Background of Chronic Pancreatitis
ORIGINAL ARTICLE Characterization of Malignant Pancreatic Cystic Lesions in the Background of Chronic Pancreatitis Dhanwant Gomez 1, Sakhawat H Rahman 1, Li Fong Wong 1, Caroline S Verbeke 2, Michael J
More informationSelect problems in cystic pancreatic lesions
Disclosure Select problems in cystic pancreatic lesions Five Prime Therapeutics shareholder Adicet Bio shareholder Bristol-Meyer Squibb advisory board grace.kim@ucsf.edu Pancreatic cystic lesions Intraductal
More informationManagement A Guideline Based Approach to the Incidental Pancreatic Cysts. Common Cystic Pancreatic Neoplasms.
Management 2016 A Guideline Based Approach to the Incidental Pancreatic Cysts ISMRM 2016 Masoom Haider, MD, FRCP(C) Professor of Radiology, University of Toronto Clinician Scientist, Ontario Institute
More informationCASE REPORT. Abstract. Introduction. Case Report
CASE REPORT Branch Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas Involving Type 1 Localized Autoimmune Pancreatitis with Normal Serum IgG4 Levels Successfully Diagnosed by Endoscopic Ultrasound-guided
More informationORIGINAL ARTICLE. The Impact of Laparoscopy and Laparoscopic Ultrasound on the Management of Pancreatic
ORIGINAL ARTICLE The Impact of Laparoscopy and Laparoscopic Ultrasound on the Management of Pancreatic Cystic Lesions Pinhas P. Schachter, MD; Yona Avni, MD; Gabriela Gvirtz, MD; Ada Rosen, MD; Abraham
More informationOutline. Intraductal Papillary Mucinous Neoplasm (IPMN) Guideline Review 4/6/2017. Case Example Background Classification Histology Guidelines
Intraductal Papillary Mucinous Neoplasm (IPMN) Guideline Review The Nurse Practitioner Association New York State Capital Region Teaching Day Matthew Warndorf MD Case Example Background Classification
More informationCASE 01 LA Path Slide Seminar 13 March, 08. Deepti Dhall, MD Department of Pathology and Laboratory Medicine Cedars-Sinai Medical Center
CASE 01 LA Path Slide Seminar 13 March, 08 Deepti Dhall, MD Department of Pathology and Laboratory Medicine Cedars-Sinai Medical Center Clinical History 60 year old male presented with obstructive jaundice
More informationAn Intraductal Papillary Neoplasm of the Bile Duct at the Duodenal Papilla
Published online: July 2, 2014 1662 6575/14/0072 0417$39.50/0 This is an Open Access article licensed under the terms of the Creative Commons Attribution- NonCommercial 3.0 Unported license (CC BY-NC)
More informationIntraductal papillary mucinous neoplasm of the bile ducts: a rare form of premalignant lesion of invasive cholangiocarcinoma
Intraductal papillary mucinous neoplasm of the bile ducts: a rare form of premalignant lesion of invasive cholangiocarcinoma Authors: R. Revert Espí, Y. Fernandez Nuñez, I. Carbonell, D. P. Gómez valencia,
More informationPredictive factors for invasive intraductal papillary mucinous neoplasm of the pancreas
Korean J Hepatobiliary Pancreat Surg 2011;15:27-22 Original Article Predictive factors for invasive intraductal papillary mucinous neoplasm of the pancreas Dae Young Jun 1, Hyung Jun Kwon 2, Sang Geol
More informationPancreatic Cysts. Darius C. Desai, MD FACS St. Luke s University Health Network
Pancreatic Cysts Darius C. Desai, MD FACS St. Luke s University Health Network None Disclosures Incidence Widespread use of cross sectional imaging Seen in over 2% of patients having abdominal imaging
More informationMagnetic resonance cholangiopancreatography (MRCP) is an imaging. technique that is able to non-invasively assess bile and pancreatic ducts,
SECRETIN AUGMENTED MRCP Riccardo MANFREDI, MD, MBA, FESGAR Magnetic resonance cholangiopancreatography (MRCP) is an imaging technique that is able to non-invasively assess bile and pancreatic ducts, in
More informationA pancreatic intraductal papillary mucinous neoplasm: A case report and literature review
Case report A pancreatic intraductal papillary mucinous neoplasm: A case report and literature review Martín A. Gómez Z., MD, 1 Cristian Melgar, MD, 2 Germán Junca, MD. 3 1 Gastroenterology Professor,
More informationThe most common presentation of autoimmune pancreatitis. A Diagnostic Strategy to Distinguish Autoimmune Pancreatitis From Pancreatic Cancer
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:1097 1103 A Diagnostic Strategy to Distinguish Autoimmune Pancreatitis From Pancreatic Cancer SURESH T. CHARI,* NAOKI TAKAHASHI, MICHAEL J. LEVY,* THOMAS
More informationEndoscopic Ultrasound Guided Trucut Biopsy of the Cyst Wall for Diagnosing Cystic Pancreatic Tumors
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:974 979 Endoscopic Ultrasound Guided Trucut Biopsy of the Cyst Wall for Diagnosing Cystic Pancreatic Tumors MICHAEL J. LEVY,* THOMAS C. SMYRK, RAGHURAM P.
More informationAccording to the international consensus guidelines for
ORIGINAL ARTICLE Natural History of Branch Duct Intraductal Papillary Mucinous Neoplasm With Mural Nodules A Japan Pancreas Society Multicenter Study Go Kobayashi, MD, PhD,* Naotaka Fujita, MD, PhD,* Hiroyuki
More informationMucin-Producing Neoplasms of the Pancreas: An Analysis of Distinguishing Clinical and Epidemiologic Characteristics
Mucin-Producing Neoplasms of the Pancreas: An Analysis of Distinguishing Clinical and Epidemiologic Characteristics The Harvard community has made this article openly available. Please share how this access
More informationVirtual MR Pancreatoscopy in the Evaluation of the Pancreatic Duct in Chronic Pancreatitis
MULTIMEDIA ARTICLE - Videoclips Virtual MR Pancreatoscopy in the Evaluation of the Pancreatic Duct in Chronic Pancreatitis Rakesh Kalapala 1, Lingareddy Sunitha 2, Reddy D Nageshwar 1, Guduru V Rao 1,
More informationA Multicentric Development Of Intraductal Papillary Mucinous Neoplasm Treated By Repeated Pancreatectomy
ISPUB.COM The Internet Journal of Surgery Volume 7 Number 2 A Multicentric Development Of Intraductal Papillary Mucinous Neoplasm Treated By Repeated T Matsumoto, K Iwaki, H Uchida, K Yada, K Shibata,
More informationThe role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms
The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms CYSTIC LESIONS AND FLUID COLLECTIONS OF THE PANCREAS Their pathology ranges from pseudocysts and pancreatic necrosis
More informationChronic Pancreatitis: When to Scope? Gregory A. Cote, MD, MS Assistant Professor of Medicine Indiana University School of Medicine
Chronic Pancreatitis: When to Scope? Gregory A. Cote, MD, MS Assistant Professor of Medicine Indiana University School of Medicine Endoscopy & Chronic Pancreatitis Diagnosis EUS ERCP Exocrine Function
More informationEvaluation and Management of Cystic Lesions of the Pancreas: When to Resect, When to Follow and When to Forget
Evaluation and Management of Cystic Lesions of the Pancreas: When to Resect, When to Follow and When to Forget Randall Brand, MD Professor of Medicine Division of Gastroenterology, Hepatology and Nutrition
More informationA LEADER IN ADVANCED ENDOSCOPY AND HEPATOBILIARY SURGERY
A LEADER IN ADVANCED ENDOSCOPY AND HEPATOBILIARY SURGERY St. Peter s Hospital Advanced Endoscopy & Hepatobiliary Center Welcome The St. Peter s Hospital Advanced Endoscopy & Hepatobiliary Center is a leader
More informationThe Pancreas. Basic Anatomy. Endocrine pancreas. Exocrine pancreas. Pancreas vasculature. Islets of Langerhans. Acinar cells Ductal System
SGNA: Back to Basics Rogelio G. Silva, MD Assistant Clinical Professor of Medicine University of Illinois at Chicago Department of Medicine Division of Gastroenterology Advocate Christ Medical Center GI
More informationMorphologic features in cystic lesions of pancreas-a retrospective analysis
International Journal of Advances in Medicine Cicy PJ et al. Int J Adv Med. 2018 Feb;5(1):192-196 http://www.ijmedicine.com pissn 2349-3925 eissn 2349-3933 Original Research Article DOI: http://dx.doi.org/10.18203/2349-3933.ijam20180083
More informationAn investigation of pancreatic volume by disease using pancreatic volumetry
Yamagata Med J (ISSN 0288-030X)2015;33(2):71-76 DOI 10.15022/00003469 An investigation of pancreatic volume by disease using pancreatic volumetry Tsuyoshi Fukumoto, Toshihiro Watanabe, Koji Tezuka, Akiko
More informationCommon and unusual CT and MRI manifestations of pancreatic adenocarcinoma: a pictorial review
Review Article Common and unusual CT and MRI manifestations of pancreatic adenocarcinoma: a pictorial review Min-Jie Yang, Su Li, Yong-Guang Liu, Na Jiao, Jing-Shan Gong Department of Radiology, Shenzhen
More informationEvaluation of AGA and Fukuoka Guidelines for EUS and surgical resection of incidental pancreatic cysts
Evaluation of AGA and Fukuoka Guidelines for EUS and surgical resection of incidental pancreatic cysts Authors Alexander Lee 1, Vivek Kadiyala 2,LindaS.Lee 3 Institutions 1 Texas Digestive Disease Consultants,
More informationAnatomical and Functional MRI of the Pancreas
Anatomical and Functional MRI of the Pancreas MA Bali, MD, T Metens, PhD Erasme Hospital Free University of Brussels Belgium mbali@ulb.ac.be Introduction The use of MRI to investigate the pancreas has
More informationCase Reports. Intraductal Papillary Cholangiocarcinoma: Case Report and Review of the Literature INTRODUCTION CASE REPORT
Case Reports Kongkam K, Rerknimitr R 45 Case Report and Review of the Literature Pradermchai Kongkam, M.D. Rungsun Rerknimitr, M.D. ABSTRACT A case of papillary cholangiocarcinoma is presented. A 64-year-old
More information5/17/2013. Pancreatic Cancer. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Case presentation. Differential diagnosis
Overview Case presentation Postgraduate Course in General Surgery Differential diagnosis Diagnosis and therapy Eric K. Nakakura Koloa, HI March 26, 2013 Outcomes CASE 1: CASE 1: A 78-year-old man developed
More informationGiant pancreatic mucinous cystadenoma with malignant transformation
Case Report Brunei Int Med J. 2014; 10 (3): 177-182 Giant pancreatic mucinous cystadenoma with malignant transformation Jerica CHAI 1, Vui Heng CHONG 2, Ian BICKLE 1 1 Department of Radiology and 2 Department
More informationCystic Pancreatic Lesions: Approach to Diagnosis
Cystic Pancreatic Lesions: Approach to Diagnosis Poster No.: R-0130 Congress: RANZCR-AOCR 2012 Type: Educational Exhibit Authors: A. AGARWAL, R. M. Mendelson; Perth/AU Keywords: Cysts, Biopsy, Endoscopy,
More information3/28/2012. Periampullary Tumors. Postgraduate Course in General Surgery CASE 1: CASE 1: Overview. Eric K. Nakakura Ko Olina, HI
Overview Postgraduate Course in General Surgery Case presentation Differential diagnosis Diagnosis and therapy Outcomes Principles of palliative care Eric K. Nakakura Ko Olina, HI March 27, 2012 CASE 1:
More informationCystic pancreatic lesions A proposal for a network approach. Chris Briggs Consultant HPB Surgeon Peninsula HPB Unit Derriford Hospital, Plymouth
Cystic pancreatic lesions A proposal for a network approach Chris Briggs Consultant HPB Surgeon Peninsula HPB Unit Derriford Hospital, Plymouth Aims Brief overview of cystic pancreatic lesions International
More informationFDG-PET Findings of Intraductal Oncocytic Papillary Neoplasms of the Pancreas: Two Case Reports
This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/oa-license), applicable to the online version of the article
More informationClinical Profile of Idiopathic Chronic Pancreatitis in North India
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2009;7:594 599 Clinical Profile of Idiopathic Chronic Pancreatitis in North India DEEPAK K. BHASIN,* GURSEWAK SINGH,* SURINDER S. RANA,* SHOKET M. CHOWDRY,* NUSRAT
More informationEvaluation of Suspected Pancreatic Cancer
Evaluation of Suspected Pancreatic Cancer October 15, 2015 If you experience technical difficulty during the presentation: Contact WebEx Technical Support directly at: US Toll Free: 1-866-779-3239 Toll
More informationSpectrum of Causes of Pancreatic Calcifications
Pictorial Essay Downloaded from www.ajronline.org by 46.3.200.2 on 12/21/17 from IP address 46.3.200.2. Copyright RRS. For personal use only; all rights reserved Spectrum of Causes of Pancreatic Calcifications
More informationPersPeCTIves. Controversies in the management of pancreatic ipmn. Masao Tanaka
PersPeCTIves OpiniOn Controversies in the management of pancreatic ipmn Masao Tanaka Abstract Although considerable progress has been made in our understanding of intraductal papillary mucinous neoplasm
More informationObjectives. Intraoperative Consultation of the Whipple Resection Specimen. Pancreas Anatomy. Pancreatic ductal carcinoma 11/10/2014
Intraoperative Consultation of the Whipple Resection Specimen Pathology Update Faculty of Medicine, University of Toronto November 15, 2014 John W. Wong, MD, FRCPC Department of Anatomical Pathology Sunnybrook
More informationSurgical outcomes of multifocal branch duct intraductal papillary mucinous neoplasms of pancreas
Korean J Hepatobiliary Pancreat Surg 2014;18:152-158 http://dx.doi.org/10.14701/kjhbps.2014.18.4.152 Original Article Surgical outcomes of multifocal branch duct intraductal papillary mucinous neoplasms
More informationNeoplasias Quisticas del Páncreas
SEAP -Aproximación Práctica a la Patología Gastrointestinal- Madrid, 26 de mayo, 2006 Neoplasias Quisticas del Páncreas Gregory Y. Lauwers, M.D. Director, Service Massachusetts General Hospital Harvard
More informationIntraductal Papillary Mucinous Neoplasm (IPMN) and Chronic Pancreatitis: Overlapping Pathological Entities? Two Case Reports
CASE REPORT Intraductal Papillary Mucinous Neoplasm (IPMN) and Chronic Pancreatitis: Overlapping Pathological Entities? Two Case Reports Athanasios Petrou 1, Alexandros Papalambros 2, Nicholas Brennan
More informationCase Report A Case Report of Intraductal Papillary-Mucinous Neoplasm of the Pancreas Showing Morphologic Transformation during Followup Periods
Oncology Volume 2009, Article ID 373465, 6 pages doi:10.1155/2009/373465 Case Report A Case Report of Intraductal Papillary-Mucinous Neoplasm of the Pancreas Showing Morphologic Transformation during Followup
More informationEndoscopic Ultrasonography Assessment for Ampullary and Bile Duct Malignancy
Diagnostic and Therapeutic Endoscopy, Vol. 3, pp. 35-40 Reprints available directly from the publisher Photocopying permitted by license only (C) 1996 OPA (Overseas Publishers Association) Amsterdam B.V.
More informationThe role of ERCP in chronic pancreatitis
The role of ERCP in chronic pancreatitis Marianna Arvanitakis Erasme University Hospital, ULB, Brussels, Belgium 10 th Nottingham Endoscopy Masterclass SPEAKER DECLARATIONS This presenter has the following
More informationSurgical Management of Chronic Pancreatitis VERENA LIU, MD KINGS COUNTY HOSPITAL CENTER SURGERY GRAND ROUNDS 4/1/2013
Surgical Management of Chronic Pancreatitis VERENA LIU, MD KINGS COUNTY HOSPITAL CENTER SURGERY GRAND ROUNDS 4/1/2013 Case Report 42F with h/o chronic pancreatitis due to alcohol use with chronic upper
More informationBranch duct intraductal papillary mucinous neoplasm of the pancreas: single-center experience with 324 patients who underwent surgical resection
Korean J Hepatobiliary Pancreat Surg 2015;19:113-120 http://dx.doi.org/10.14701/kjhbps.2015.19.3.113 Original Article Branch duct intraductal papillary mucinous neoplasm of the pancreas: single-center
More informationHistopathologic Findings of Multifocal Pancreatic Intraductal Papillary Mucinous Neoplasms on CT
Gastrointestinal Imaging Original Research Raman et al. CT of Multifocal Pancreatic IPMNs Gastrointestinal Imaging Original Research Siva P. Raman 1 Satomi Kawamoto 1 Amanda Blackford 2 Ralph H. Hruban
More informationChronic Pancreatitis
Falk Symposium 161 October 12, 2007 Chronic Pancreatitis David C Whitcomb MD PhD Giant Eagle Foundation Professor of Cancer Genetics. Professor of Medicine, Cell biology & Physiology, and Human Genetics
More informationAutoimmune Pancreatitis: A Great Imitator
Massachusetts General Hospital Harvard Medical School Autoimmune Pancreatitis: A Great Imitator Dushyant V Sahani MD dsahani@partners.org Autoimmune Pancreatitis: Learning Objectives Clinical manifestations
More informationSurgical management and results for cystic neoplasms of pancreas
Korean J Hepatobiliary Pancreat Surg 2013;17:118-125 Original Article Surgical management and results for cystic neoplasms of pancreas Kyung Won Han 1, Ryun Ha 1, Kun Kuk Kim 1, Jung Nam Lee 1, Yeon Suk
More informationEndoscopic Ultrasonography Clinical Impact. Giancarlo Caletti. Gastroenterologia Università di Bologna. Caletti
Clinical Impact Giancarlo Gastroenterologia Università di Bologna AUSL di Imola,, Castel S. Pietro Terme (BO) 1982 Indications Diagnosis of Submucosal Tumors (SMT) Staging of Neoplasms Evaluation of Pancreato-Biliary
More informationMorphologic Criteria of Invasive Colonic Adenocarcinoma on Biopsy Specimens
ISPUB.COM The Internet Journal of Pathology Volume 12 Number 1 Morphologic Criteria of Invasive Colonic Adenocarcinoma on Biopsy Specimens C Rose, H Wu Citation C Rose, H Wu.. The Internet Journal of Pathology.
More information40th European Congress of Cytology Liverpool, UK, 2-5 th October 2016
40th European Congress of Cytology Liverpool, UK, 2-5 th October 2016 EUS FNA of abdominal organs: An approach to reporting and triage for ancillary testing Date and time: Sunday 2 nd October 2016 15.00-16.30
More informationBiliary cytolgy and pancreatic endoscopic ultrasound-guided FNA. Leena Krogerus Helsinki, FINLAND
Biliary cytolgy and pancreatic endoscopic ultrasound-guided FNA Leena Krogerus Helsinki, FINLAND Reasons for biliary cytology PSC- is a pre-neoplastc condition in youg individulas, the cure of which is
More informationIntraductal Papillary Mucinous Neoplasm of Pancreas
Review Article Intraductal Papillary Mucinous Neoplasm of Pancreas Norman Oneil Machado, Hani al Qadhi, Khalifa al Wahibi Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman Abstract
More informationIntraductal Papillary-Mucinous Neoplasm of the Pancreas Penetrating to the Stomach and the Common Bile Duct
CASE REPORT Intraductal Papillary-Mucinous Neoplasm of the Pancreas Penetrating to the Stomach and the Common Bile Duct Norihiro Goto 1, Masahiro Yoshioka 1, Motohito Hayashi 1, Toshinao Itani 1, Jun Mimura
More informationNonsurgical Management of Asymptomatic Incidental Pancreatic Cysts
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2007;5:813 817 Nonsurgical Management of Asymptomatic Incidental Pancreatic Cysts MAOR LAHAV, YAKOV MAOR, BENJAMIN AVIDAN, BEN NOVIS, and SIMON BAR MEIR Department
More informationCLASSIFICATION OF CHRONIC PANCREATITIS
CLASSIFICATION OF CHRONIC PANCREATITIS EAGE, Podstgraduate Course, Prague, April 2010. Tomica Milosavljević School of Medicine, University of Belgrade Clinical Center of Serbia,Belgrade The phrase chronic
More informationReview. Mucin hypersecreting neoplasms
Annals of Oncology 10 SuppL 4: S99-S103, 1999. 1999 Kluwer Academic Publishers. Printed in the Netherlands. Review. Mucin hypersecreting neoplasms David L. Carr-Locke Director ofendoscopy, Brigham and
More informationCase Report. Cytological Diagnosis of Undifferentiated Carcinoma of The Pancreas with Osteoclast-like Giant Cells: Report of Three Cases
Case Report Cytological Diagnosis of Undifferentiated Carcinoma of The Pancreas with Osteoclast-like Giant Cells: Report of Three Cases Swapan Samanta* 1, S. K. Sharma 2 1 Department of Pathology, EKO
More informationSuspicious Cytologic Diagnostic Category in Endoscopic Ultrasound-Guided FNA of the Pancreas: Follow-Up and Outcomes
Suspicious Cytologic Diagnostic Category in Endoscopic Ultrasound-Guided FNA of the Pancreas: Follow-Up and Outcomes Evan A. Alston, MD 1 ; Sejong Bae, PhD 2 ; and Isam A. Eltoum, MD, MBA 1 BACKGROUND:
More informationUnusual Pancreatic Neoplasms RTC 2/11/2011
Unusual Pancreatic Neoplasms RTC 2/11/2011 Objectives Intraductal Papillary Mucinous Neoplasm (IPMN) Mucinous Cystic Neoplasm (MCN) Islet Cell Tumors Insulinoma Glucagonoma VIPoma Somatostatinoma Gastrinoma
More informationDiagnostic performance of endoscopic ultrasound-guided fine-needle aspiration in pancreatic lesions
European Review for Medical and Pharmacological Sciences 2018; 22: 1397-1401 Diagnostic performance of endoscopic in pancreatic lesions Q.-M. WU 1, Y.-N. GUO 1, Y.-Q. XU 1 Digestive Department of Beijing
More informationPancreatic Cystic Neoplasms: Predictors of Malignant Behavior and Management
Original Article Pancreatic Cystic Neoplasms: Predictors of Malignant Behavior and Management Ehab Atef, Ayman El Nakeeb, Ehab El Hanafy, Mohamed El Hemaly, Emad Hamdy, Ahmed El Geidie Surgical Center,
More informationChronic Pancreatitis
Supportive module 2: Basics of diagnosis, treatment and prevention of major gastroenterological diseases Chronic Pancreatitis LECTURE IN INTERNAL MEDICINE FOR IV COURSE STUDENTS M. Yabluchansky, L. Bogun,
More informationAccuracy of CT in predicting malignant potential of cystic pancreatic neoplasms
HPB, 2008; 10: 483490 ORIGINAL ARTICLE Accuracy of CT in predicting malignant potential of cystic pancreatic neoplasms WILLIAM E. FISHER a, SALLY E. HODGES a, VIVEK YAGNIK b, FANNIE E. MORÓN b, MENG-FEN
More informationCase Report Heterotopic Pancreas within the Proximal Hepatic Duct, Containing Intraductal Papillary Mucinous Neoplasm
Case Reports in Surgery Volume 2015, Article ID 816960, 4 pages http://dx.doi.org/10.1155/2015/816960 Case Report Heterotopic Pancreas within the Proximal Hepatic Duct, Containing Intraductal Papillary
More informationMRI features of serous oligocystic adenoma of the pancreas: differentiation from mucinous cystic neoplasm of the pancreas
The British Journal of Radiology, 85 (2012), 571 576 MRI features of serous oligocystic adenoma of the pancreas: differentiation from mucinous cystic neoplasm of the pancreas 1,2 J H LEE, MD, 1 J K KIM,
More informationPancreatic Cystic Neoplasms: Guidelines and beyond
Pancreatic Cystic Neoplasms: Guidelines and beyond Kenneth J. Chang, MD, FACG, FASGE Executive Director, Comprehensive Digestive Disease Center Professor and Chief, Gastroenterology Vincent & Anna Kong
More informationRadiological Analysis of Cystic lesions of the Pancreas
September 2002 Radiological Analysis of Cystic lesions of the Pancreas Shruthi Mahalingaiah, Harvard Medical School Year III, Agenda Background Anatomy and histology Radiological workup of a cyst in the
More informationEndoscopic ultrasonography in suspected pancreatic malignancy and indecisive CT
O r i g i n a l a r t i c l e Endoscopic ultrasonography in suspected pancreatic malignancy and indecisive CT O.L.M. Meijer 1, R.K. Weersma 1, E.J. van der Jagt 2, H.M. van Dullemen 1 * Departments of
More informationHepatobiliary and Pancreatic Malignancies
Hepatobiliary and Pancreatic Malignancies Gareth Eeson MD MSc FRCSC Surgical Oncologist and General Surgeon Kelowna General Hospital Interior Health Consultant, Surgical Oncology BC Cancer Agency Centre
More informationOriginal Policy Date 12:2013
MP 6.01.30 Magnetic Resonance Cholangiopancreatography Medical Policy Section Radiology Is12:2013sue 3:2005 Original Policy Date 12:2013 Last Review Status/Date 12:2013 Return to Medical Policy Index Disclaimer
More informationRole of Imaging Methods in Diagnosis of Acute Pancreatitis. Válek V. Radiologická klinika, FN Brno a LF MU v Brně
Role of Imaging Methods in Diagnosis of Acute Pancreatitis Válek V. Radiologická klinika, FN Brno a LF MU v Brně New Classification: Acute Pancreatitis 2007 revision of Atlanta classification and definitions
More informationCase Scenario 1. Discharge Summary
Case Scenario 1 Discharge Summary A 69-year-old woman was on vacation and noted that she was becoming jaundiced. Two months prior to leaving on that trip, she had had a workup that included an abdominal
More informationTotal pancreatectomy in six patients with intraductal papillary mucinous tumour of the pancreas: the treatment of choice
HPB 2001 Volume 3, Number 4 257 262 Total pancreatectomy in six patients with intraductal papillary mucinous tumour of the pancreas: the treatment of choice J Bendix Holme 1, NO Jacobsen 2, M Rokkjaer
More informationORIGINAL ARTICLE. Intraductal Papillary Mucinous Tumors of the Pancreas Comprise 2 Clinical Subtypes
ORIGINAL ARTICLE Intraductal Papillary Mucinous Tumors of the Pancreas Comprise 2 Clinical Subtypes Differences in Clinical Characteristics and Surgical Management Masao Kobari, MD; Shinn-ichi Egawa, MD;
More informationPancreatobiliary Frozen Section Nightmares
Pancreatobiliary Frozen Section Nightmares Aatur D. Singhi, MD PhD Assistant Professor University of Pittsburgh Medical Center Department of Pathology singhiad@upmc.edu Objectives Briefly give an overview
More informationTrans-abdominal ultrasound features of the newly named intraductal papillary neoplasm of the bile duct
Original Article on Translational Imaging in Cancer Patient Care Trans-abdominal ultrasound features of the newly named intraductal papillary neoplasm of the bile duct Xian-Shui Fu 1 *, Meng-Na He 2 *,
More informationCT 101 :Pancreas and Spleen
CT 101 :Pancreas and Spleen Shikha Khullar,, MD, MPH Division of Radiology University of South Alabama The Pancreas Normal Pancreas 3 Phase Pancreatic CT Non contrast Arterial phase : 30-35 35 second
More informationMural nodules are predictors of malignancy in mucusproducing. Histologic and Imaging Features of Mural Nodules in Mucinous Pancreatic Cysts.
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2012;10:192 198 Histologic and Imaging Features of Mural Nodules in Mucinous Pancreatic Cysts NING ZHONG,*, LIZHI ZHANG, NAOKI TAKAHASHI, VLADISLAV SHALMIYEV,*
More informationLong-term Results of Extracorporeal Shockwave Lithotripsy and Endoscopic Therapy for Pancreatic Stones
CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2005;3:1128 1135 Long-term Results of Extracorporeal Shockwave Lithotripsy and Endoscopic Therapy for Pancreatic Stones HIROSHI TADENUMA, TAKESHI ISHIHARA, TAKETO
More informationDiagnostic Algorithm for Autoimmune Pancreatitis in Korea
Review Article The Korean Journal of Pancreas and Biliary Tract 2014;19(1):7-12 pissn 1976-3573 eissn 2288-0941 한국에서자가면역췌장염의진단전략 성균관대학교의과대학삼성서울병원내과학교실 이종균 Diagnostic Algorithm for Autoimmune Pancreatitis
More information