Journal of the Pancreas最新文献

{"title":"Autoimmune Pancreatitis: A Succinct Overview","authors":"J. Putra, Xiaoying Liu","doi":"10.6092/1590-8577/2989","DOIUrl":"https://doi.org/10.6092/1590-8577/2989","url":null,"abstract":"Autoimmune pancreatitis is a rare type of chronic pancreatitis with characteristic clinical, radiologic, and histopathologic findings. Diagnosis of autoimmune pancreatitis is often challenging due to its low incidence and nonspecific clinical and radiologic findings. Patients with autoimmune pancreatitis and pancreatic cancer share similar clinical presentations, including obstructive jaundice, abdominal pain and weight loss. Due to these overlapping features, autoimmune pancreatitis patients are often misdiagnosed with pancreatic cancer and undergo unnecessary surgery. International consensus diagnostic criteria for autoimmune pancreatitis lists 5 cardinal features to establish the diagnosis of autoimmune pancreatitis. These features include imaging, serology, other organ involvement, histopathology of the pancreas, and response to steroid therapy. Endoscopic ultrasound-guided fine needle aspiration is a routine diagnostic tool for pancreatic lesions. It is usually utilized to exclude a malignant process in autoimmune pancreatitis patients, since its role to establish a definitive diagnosis of autoimmune pancreatitis is often limited. Endoscopic ultrasound-guided-tru-cut biopsy and endoscopic ultrasound-guided fine needle using a large gauge needle (19 to 22 gauges) have been the preferred methods to obtain tissue samples for histologic evaluation. Lymphoplasmacytic infiltrates, fibrotic stroma, mildly atypical epithelial cells, periphlebitis, and obliterative periphlebitis are the common histologic findings of type 1 autoimmune pancreatitis. Meanwhile, granulocytic pancreatic ductal epithelial damage and ductal obliteration are the histologic characteristics of type 2 autoimmune pancreatitis. Immunohistochemical and molecular studies may be helpful to support the diagnosis of AIP in biopsy materials. Image: Permanent section of the fine needle aspirate showing venulitis.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 1","pages":"239-243"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71234521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acinar Cell Cystadenoma of Retroperitoneum: A Case Report and the Literature Review","authors":"Ming-Zhang Song, C. Su, C. Hsiao","doi":"10.6092/1590-8577/3002","DOIUrl":"https://doi.org/10.6092/1590-8577/3002","url":null,"abstract":"Context Acinar cell cystadenoma of pancreas is a very rare pancreatic cystic lesion. It is also a benign lesion without malignant potential. Because it is normal tissue with abnormal figuration, acinar cell transformation is also named. Case report We reported a thirty-seven-year-old female noticed to have a cystic lesion closely in contact with the pancreatic tail by abdominal CT scan. After operation, the cystic lesion was analyzed and acinar cell cystadenoma arising from retroperitoneum was confirmed. Conclusion Literature review revealed only one case of retroperitoneal acinar cell cystadenoma was reported before and the pathogenesis is still unknown. Image:  Loculated cystic lesion with watery clear fluid over retroperitoneum.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 1","pages":"307-309"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71234985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diffuse Pancreatic Mucinous Cystic Neoplasm Treated by Total Pancreatectomy","authors":"Hongyi Chen, Julie A. Teague, L. Weinberg, M. Nikfarjam","doi":"10.6092/1590-8577/2999","DOIUrl":"https://doi.org/10.6092/1590-8577/2999","url":null,"abstract":"Context  Multifocal or diffuse mucinous cystic neoplasm are uncommon and may be difficult to distinguish from multifocal intra-ducal mucinous neoplasm or diffuse serous cystadenoma.  Case report  A forty-seven-year old lady with vague abdominal pain was noted to have cystic lesions ranging from 5 to 20 mm throughout her pancreas. The cysts had enlarged over several years of observation. There was no evidence of pancreatic duct dilatation or communication with the pancreatic duct on magnetic resonance imaging. Cyst fluid analysis for carcinoembryonic antigen and amylase were non-diagnostic. A total pancreatectomy was performed, with histology confirming numerous cysts lined by mucus producing cells, without obvious ovarian-like stroma. The stroma did however demonstrate positive staining for oestrogen receptor and smooth muscle actin. These findings were most consistent with a mucinous cystic neoplasm, despite the apparent absence of typical ovarian like stroma.  Conclusion  Multifocal or diffuse pancreatic mucinous cystic neoplasm are uncommon and may be suspected when imaging demonstrates multiple pancreatic cysts without communication with the pancreatic duct or pancreatic duct dilation. Surgical resection is indicated due to the increased risk of malignancy. Image:  Sectioning of the pancreas demonstrates multiple cysts without any clear communication with the pancreatic duct and no evidence of pancreatic duct dilatation.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 1","pages":"295-298"},"PeriodicalIF":0.2,"publicationDate":"2015-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71235175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Necrotizing pancreatitis: a review of multidisciplinary management.","authors":"Anthony Sabo,&nbsp;Naeem Goussous,&nbsp;Neeraj Sardana,&nbsp;Shirali Patel,&nbsp;Steven C Cunningham","doi":"10.6092/1590-8577/2947","DOIUrl":"https://doi.org/10.6092/1590-8577/2947","url":null,"abstract":"<p><p>The objective of this review is to summarize the current state of the art of the management of necrotizing pancreatitis, and to clarify some confusing points regarding the terminology and diagnosis of necrotizing pancreatitis, as these points are essential for management decisions and communication between providers and within the literature. Acute pancreatitis varies widely in its clinical presentation. Despite the publication of the Atlanta guidelines, misuse of pancreatitis terminology continues in the literature and in clinical practice, especially regarding the local complications associated with severe acute pancreatitis. Necrotizing pancreatitis is a manifestation of severe acute pancreatitis associated with significant morbidity and mortality. Diagnosis is aided by pancreas-protocol computed tomography or magnetic resonance imaging, ideally 72 h after onset of symptoms to achieve the most accurate characterization of pancreatic necrosis. The extent of necrosis correlates well with the incidence of infected necrosis, organ failure, need for debridement, and morbidity and mortality. Having established the diagnosis of pancreatic necrosis, goals of appropriately aggressive resuscitation should be established and adhered to in a multidisciplinary approach, ideally at a high-volume pancreatic center. The role of antibiotics is determined by the presence of infected necrosis. Early enteral feeds improve outcomes compared with parenteral nutrition. Pancreatic necrosis is associated with a multitude of complications which can lead to long-term morbidity or mortality. Interventional therapy should be guided by available resources and the principle of a minimally invasive approach. When open debridement is necessary, it should be delayed at least 3-6 weeks to allow demarcation of necrotic from viable tissue. </p>","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 2","pages":"125-35"},"PeriodicalIF":0.2,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33021536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes after acute necrotizing pancreatitis: what happens to the pancreas and to the patient?","authors":"Rafaela Cristina Goebel Winter Gasparoto,&nbsp;Marcelo De Castro Jorge Racy,&nbsp;Tercio De Campos","doi":"10.6092/1590-8577/2958","DOIUrl":"https://doi.org/10.6092/1590-8577/2958","url":null,"abstract":"<p><strong>Context: </strong>Late consequences of acute pancreatitis have received little attention. It is controversial whether the pancreas fully recovers after an episode of acute pancreatitis, especially in the presence of necrosis. Therefore, the presence of late pancreatic dysfunction following acute necrotizing pancreatitis is uncertain and there are controversies about how it may affect long-term quality of life.</p><p><strong>Objectives: </strong>To evaluate pancreatic function and morphology, besides quality of life, in patients with prior acute necrotizing pancreatitis.</p><p><strong>Patients: </strong>Patients who were admitted to our hospital with acute necrotizing pancreatitis in a ten-year interval were identified and thirty-eight survivors were contacted to enroll in the study out of which sixteen patients were included.</p><p><strong>Methods: </strong>Exocrine function was studied by qualitative fecal fat excretion. Endocrine function was evaluated by oral glucose tolerance test, HOMA-beta and C-peptide. Pancreatic morphology was examined by computed tomography. Quality of life was measured by 36-item short-form health survey. Tests were performed at least twelve months after the index episode of acute necrotizing pancreatitis.</p><p><strong>Results: </strong>The prevalence of pancreatic exocrine insufficiency was 6.2%. Endocrine dysfunction was observed in half the cases, and no association with the extension of necrosis was found. Morphological changes were frequent (62.5%) and more prevalent in those who faced extensive necrosis. Quality of life was considered good, and its impairment was found exclusively in mental health domain, markedly in patients who had alcoholic pancreatitis. There was no correlation between quality of life and prognostic indicators.</p><p><strong>Conclusions: </strong>Exocrine function and quality of life were preserved in this group of patients. However, endocrine dysfunction and morphological abnormalities were frequent after acute necrotizing pancreatitis. These findings justify a long-term follow-up in order to initiate specific treatment promptly.</p>","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 2","pages":"159-66"},"PeriodicalIF":0.2,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33021540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on \"risk factors associated with recurrence in patients with solid pseudopapillary tumors of the pancreas\".","authors":"Xing Wang,&nbsp;Xubao Liu","doi":"10.6092/1590-8577/2944","DOIUrl":"https://doi.org/10.6092/1590-8577/2944","url":null,"abstract":"No abstract available. Image: West China Scool of Medicine. Sichuan University. Chengdu, China.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 2","pages":"213"},"PeriodicalIF":0.2,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33145047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Pancreatic Fistula: A Surgeon's Nightmare! An Insight with a Detailed Literature Review.","authors":"Prasad Seetharam,&nbsp;Gabriel Sunil Rodrigues","doi":"10.6092/1590-8577/2937","DOIUrl":"https://doi.org/10.6092/1590-8577/2937","url":null,"abstract":"<p><strong>Context: </strong>Postoperative fistula formation is an important complication following pancreatic resections.</p><p><strong>Objective: </strong>A large volume of literature without uniform conclusions is available regarding various controversies about postoperative pancreatic fistulae. The term postoperative pancreatic fistula includes fistula resulting from any surgery involving pancreas, most commonly pancreaticoduodenectomy and distal pancreatectomy. In this review, we have tried to present a comprehensive account of postoperative pancreatic fistula with particular emphasis on important controversies clouding the subject.</p><p><strong>Methods: </strong>We performed MEDLINE literature search for relevant articles using the key words pancreas, pancreatic cancer, pancreatectomy, pancreatoduodenectomy, Whipple's operation, postoperative, complications, fistula, management and treatment in various combinations with the Boolean operators AND, OR and NOT.</p><p><strong>Conclusions: </strong>Postoperative pancreatic fistula is a troublesome complication of pancreaticoduodenectomy. Although the risk factors for postoperative pancreatic fistula have been extensively described, none of the methods recommended for preventing postoperative pancreatic fistula have been conclusively proved to be effective. While endoscopic treatment and percutaneous treatment form important aspects of treatment of postoperative pancreatic fistula, surgery may be required for select cases.</p>","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 2","pages":"115-24"},"PeriodicalIF":0.2,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33021535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute pancreatitis induced fluid collections - the naming game.","authors":"Dana M Christopher,&nbsp;Kimberly J Chaput,&nbsp;Kimberly J Fairley,&nbsp;Andrew D Mowery,&nbsp;Christopher Valente,&nbsp;Blake A Stewart,&nbsp;Steven R Bonebrake,&nbsp;Harshit Khara,&nbsp;Amitpal S Johal","doi":"10.6092/1590-8577/2950","DOIUrl":"https://doi.org/10.6092/1590-8577/2950","url":null,"abstract":"Despite the publication of the “Revision of the Atlanta Classification and Definitions by International Consensus” [1], we have noted a continued variability in terminology used for reporting the types of pancreatic fluid collections complicating acute pancreatitis. In response to this perceived variability, we devised a survey to determine if the updated terminologies were being implemented in everyday practice. Our hypothesis was that physicians are still unclear on how to distinguish and name pancreatic fluid collections.","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 2","pages":"214-5"},"PeriodicalIF":0.2,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33145048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancements in the Management of Pancreatic Cancer: 2015 ASCO Gastrointestinal Cancers Symposium (San Francisco, CA, USA. January 15-17, 2015).","authors":"Frank C Passero,&nbsp;Muhammad Wasif Saif","doi":"10.6092/1590-8577/2955","DOIUrl":"https://doi.org/10.6092/1590-8577/2955","url":null,"abstract":"Kidney disease is a complication that is observed in 10%?30% of patients infected with human immunodeficiency virus (HIV), and is a common cause of morbidity and mortality [1],[2]. In Mexico, an estimated 175,093 HIV-infected individuals are included in national registries [3]. The increased survival of HIV-infected patients has changed the course of the disease, with renal complications related to HIV now the fourth most common cause of mortality [4].","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 2","pages":"99-103"},"PeriodicalIF":0.2,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33147302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undifferentiated (spindle cell) pancreatic carcinoma: a case report with osteochondroid differentiation.","authors":"Xing Wang,&nbsp;Yong-Hua Chen,&nbsp;Yun-Qiang Cai,&nbsp;Xu-Bao Liu","doi":"10.6092/1590-8577/2960","DOIUrl":"https://doi.org/10.6092/1590-8577/2960","url":null,"abstract":"<p><strong>Context: </strong>Undifferentiated (spindle cell) carcinomas of the pancreas are rare anaplastic variants of pancreatic ductal adenocarcinoma with a frequency of 2% of pancreatic exocrine tumors. Their clinicopathological features are limited and obtained by few previously case reports. We report a case of undifferentiated pancreatic carcinoma with a rare focal osteochondroid differentiation.</p><p><strong>Case report: </strong>A sixty-six-year-old woman was admitted to our hospital for abdominal pain and nonspecific nausea for almost 40 days. Imaging studies revealed a well-defined cystic-solid mass with heterogeneous density involving the tail of the pancreas. We performed an en bloc distal pancreatectomy with splenectomy for radical excision, as well as regional lymphadenectomy. The resected specimen revealed a 4.0×5.0 cm exophytic clear-bordered neoplasm of the tail of the pancreas containing necrotic and calcified areas, without splenic invasion. The lymph node involvement was not detected (0/5) and the surgical margins were negative. Microscopy showed pleomorphism with giant cells, spindle-shaped cells with anaplasia, and osteochondroid differentiation. A diagnosis of undifferentiated (spindle cell) carcinoma of the pancreas with focal osteochondroid differentiation was made. The patient declined chemotherapy and extended lymphadenectomy. She suffered from liver and lymph nodes metastasis 9 months after surgery, and she subsequently died 4 months later due to high tumor burden.</p><p><strong>Conclusions: </strong>Undifferentiated pancreatic carcinoma with osteochondroid differentiation is rare but associated with extremely poor prognosis. It should be included in the differential diagnosis of pancreatic mass lesions.</p>","PeriodicalId":47280,"journal":{"name":"Journal of the Pancreas","volume":"16 2","pages":"209-12"},"PeriodicalIF":0.2,"publicationDate":"2015-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33145046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}