Viszeralmedizin最新文献

{"title":"Precancerous Lesions and Carcinoma of the Pancreas.","authors":"Markus W Büchler, Irene Esposito, Lars Grenacher, Thilo Hackert, Julia Mayerle","doi":"10.1159/000375245","DOIUrl":"https://doi.org/10.1159/000375245","url":null,"abstract":"","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"53-7"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000375245","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34088775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical and Socio-Economic Relevance of Increased IPMN Detection Rates and Management Choices.","authors":"Christoph Budde,&nbsp;Georg Beyer,&nbsp;Jens-Peter Kühn,&nbsp;Markus M Lerch,&nbsp;Julia Mayerle","doi":"10.1159/000375455","DOIUrl":"https://doi.org/10.1159/000375455","url":null,"abstract":"<p><strong>Background: </strong>Increased usage of computed tomography and magnetic resonance imaging has led to a large increase in identified pancreatic cysts of up to 25% in population-based studies. The clinical and economic relevance of identifying so many cystic lesions has not been established. Compared to other organs such as liver or kidney, dysontogenetic pancreatic cysts are rare. Pancreatic cysts comprise a variety of benign, premalignant or malignant lesions; however, precise diagnosis before resection has an accuracy of only 80%. The focus of recent research was the malignant potential of intraductal papillary mucinous neoplasms (IPMN) with the aim of establishing clinical pathways addressing risk of malignancy, age and comorbidity, treatment-related morbidity and mortality as well as cost-effectiveness of treatment and surveillance. The focus of this review is to analyze the clinical and socio-economic relevance as well as the cost-benefit relation for IPMNs.</p><p><strong>Methods: </strong>For analysis, the following MESH terms were used to identify original articles, reviews, and guidelines in PubMed: ('intraductal papillary mucinous neoplasm' OR 'pancreatic cysts') and (incidence OR relevance OR socio-economic OR economic OR cost-effectiveness OR cost-benefit). The retrieved publications were reviewed with a focus on clinical and socio-economic relevance in relation to the increasing incidence of IPMN.</p><p><strong>Results: </strong>Addressing the increasing prevalence of pancreatic cystic lesions, recent consensus guidelines suggested criteria for risk stratification according to 'worrisome features' and 'high-risk stigmata'. Recent prospective cohort studies evaluated whether these can be applied in clinical practice. Evaluation of three different clinical scenarios with regard to costs and quality-adjusted life years suggested a better effectiveness of surveillance after initial risk stratification by endoscopic ultrasound-guided fine-needle aspiration with cyst fluid analysis compared with immediate resection or follow-up without further intervention. Of interest, the 'immediate surgery' strategy was lowest for cost-effectiveness.</p><p><strong>Conclusions: </strong>The increasing incidence of identified pancreatic cysts requires an improved strategy for non-invasive risk stratification based on advanced imaging strategies. In light of a malignancy risk of 2% for branch-duct IPMN, the socio-economic necessity of a balance between surveillance and resection has to be agreed on.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"47-52"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000375455","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34102637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural History and Management of Intraductal Papillary Mucinous Neoplasms: Current Evidence.","authors":"Stefan Fritz,&nbsp;Markus M Lerch","doi":"10.1159/000375186","DOIUrl":"https://doi.org/10.1159/000375186","url":null,"abstract":"<p><strong>Background: </strong>With the use of modern cross-sectional abdominal imaging modalities, an increasing number of cystic pancreatic lesions are identified incidentally. Although there is no pathological diagnosis available in most cases, it is believed that the majority of these lesions display small branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas. Even though a number of large clinical series have been published, many uncertainties remain with regard to this entity of mucinous cystic neoplasms.</p><p><strong>Methods: </strong>Systematic literature review.</p><p><strong>Results: </strong>Main-duct (MD) and mixed-type IPMNs harbor a high risk of malignant transformation. It is conceivable that most IPMNs with involvement of the main duct tend to progress to invasive carcinoma over time. Thus, formal oncologic resection is the treatment of choice in surgically fit patients. In contrast, the data regarding BD-IPMN remain equivocal, resulting in conflicting concepts. To date, it is not clear whether and which BD-IPMNs progress to carcinoma and how long this progression takes.</p><p><strong>Conclusion: </strong>While patients with MD-IPMNs should undergo surgical resection if comorbidities and life expectancy permit this, the management of small BD-IPMNs remains controversial. Population-based studies with long-term follow-up are needed to define which cohort of patients can be observed safely without immediate resection.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"25-30"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000375186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33935385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precancerous Lesions and Carcinoma of the Pancreas.","authors":"Thilo Hackert,&nbsp;Julia Mayerle","doi":"10.1159/000376554","DOIUrl":"https://doi.org/10.1159/000376554","url":null,"abstract":"The current edition of VISZERALMEDIZIN addresses the topic of pancreatic cancer with a focus on the precursors of this fatal disease. These precursors – when recognized and evaluated correctly – might offer the unique opportunity of preventing pancreatic cancer. Today, the best characterized precancerous lesions of the pancreas are the different cystic neoplasms that are addressed in the invited articles and the interdisciplinary discussion of this issue. Focusing on cystic pancreatic neoplasms, various important aspects regarding diagnosis, surveillance, treatment, clinical and basic research as well as socio-economic relevance need to be considered. Some of these aspects are the subject of an ongoing intense and controversial interdisciplinary discussion and research. Consequently, international consensus statements and guidelines on these entities are still in a constant state of flux. \u0000 \u0000With the widespread use of modern imaging modalities, asymptomatic cystic pancreatic lesions are increasingly found – some of them harmless, some of them showing incipient or already manifest malignancy. This increasing number of cystic neoplasms, which are mainly detected as asymptomatic lesions on advanced imaging, requires an adequate further management of the respective patients which implies education and integration of general practitioners, community hospitals, and tertiary referral centers specialized in pancreatic disease. Regardless of the individual management decision to act on a newly diagnosed cystic neoplasm, significant costs for the health care system may be associated – by lifelong surveillance as well as by surgery and potential additional therapies, e.g. due to consecutive exocrine or endocrine replacement therapy. \u0000 \u0000In this special issue, renowned international experts covering radiological, pathological, gastroenterological, surgical and research topics have contributed their knowledge on cystic pancreatic neoplasms as the fundamental precursors of cancer. The review articles give detailed overviews from different angles while the interdisciplinary discussion summarizes the essential and underlines the current as well as upcoming topics of interest. \u0000 \u0000With this issue, we hope to provide a comprehensive, focused, and interesting update on this fascinating and important field for our colleagues from all disciplines engaged in the clinical management as well as research of cystic pancreatic neoplasms.","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000376554","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34000286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Main- and Branch-Duct Intraductal Papillary Mucinous Neoplasms: Extent of Surgical Resection.","authors":"Thilo Hackert,&nbsp;Stefan Fritz,&nbsp;Markus W Büchler","doi":"10.1159/000375111","DOIUrl":"https://doi.org/10.1159/000375111","url":null,"abstract":"<p><strong>Background: </strong>Surgical treatment of intraductal papillary mucinous neoplasms (IPMN) requires a differentiated approach regarding indications and extent of resection.</p><p><strong>Methods: </strong>The review summarizes the current literature on indication, timing, and surgical procedures in IPMN.</p><p><strong>Results: </strong>The most important differentiation has to be made between main-duct and branch-duct IPMN as well as mixed-type lesions that biologically mimic main-duct types. In main-duct and mixed-type IPMN, the resection should be indicated by the time of the diagnosis - in accordance with the international consensus guidelines - and should follow oncological principles. Depending on IPMN localization, this implies partial pancreatoduodenectomy, distal pancreatectomy, or total pancreatectomy and includes the corresponding types of lymphadenectomy. Furthermore, branch-duct IPMN > 3 cm or bearing high-risk features (mural nodules in magnetic resonance imaging, computed tomography, or endoscopic ultrasound imaging; symptomatic lesions; elevated tumor markers) are similarly treated. As the risk for malignancy in smaller branch-duct IPMN is lower, the decision for surgical treatment is often individually made - despite the updated 2012 guidelines. In these lesions, limited surgical approaches, including enucleation and central pancreatectomy, are possible.</p><p><strong>Conclusion: </strong>Timely and radical resection of IPMN offers the unique opportunity to prevent pancreatic cancer, and even in malignant IPMN surgery can offer a curative approach with excellent long-term outcome in early stages. A structured imaging follow-up should be considered to recognize IPMN recurrence and metachronous pancreatic cancer as well as gastrointestinal neoplasias by endoscopic surveillance.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"38-42"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000375111","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34104767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Diagnosis of Cystic Pancreatic Lesions Including the Usefulness of Biomarkers.","authors":"Philippe Lévy,&nbsp;Vinciane Rebours","doi":"10.1159/000371786","DOIUrl":"https://doi.org/10.1159/000371786","url":null,"abstract":"<p><strong>Background: </strong>Cystic pancreatic lesions are more and more often found. Malignant risk ranges from nil to more than 60%. A precise diagnosis is required to adapt surveillance or therapeutic strategy.</p><p><strong>Methods: </strong>We tried to identify the most difficult differential diagnoses encountered in a tertiary center of pancreatology and to guide the reader as how to reach the correct strategy and diagnosis in these situations.</p><p><strong>Results: </strong>We identified eight clinically difficult situations: i) chronic pancreatitis versus intraductal papillary mucinous neoplasms, ii) serous versus mucinous cystic neoplasms, iii) serous cystic neoplasms versus branch-duct intraductal papillary mucinous neoplasms, iv) intraductal papillary mucinous neoplasms versus acinar cell cystadenoma, v) (pseudo-) solid serous cystic neoplasm versus neuroendocrine tumor, vi) pancreatic neuroendocrine tumors versus solid pseudopapillary tumors, vii) cystic forms of a solid tumor, and viii) rare pancreatic or peripancreatic cystic lesions. The work-up should rely on computed tomography scan, pancreatic magnetic resonance imaging, and, only if necessary, endoscopic ultrasound with or without fine needle aspiration.</p><p><strong>Conclusion: </strong>An expert analysis of imaging data allows a precise diagnosis in most of the cases. Pancreatic resection should no longer be performed in case of diagnostic doubt.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"7-13"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000371786","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33930088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cyst Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas: Imaging and Pathology.","authors":"Lars Grenacher,&nbsp;Albert Strauß,&nbsp;Frank Bergmann,&nbsp;Matthew Birdsey,&nbsp;Julia Mayerle","doi":"10.1159/000375254","DOIUrl":"https://doi.org/10.1159/000375254","url":null,"abstract":"<p><strong>Background: </strong>Intraductal papillary mucinous neoplasms (IPMNs) display diverse macroscopic, histological, and immunohistochemical characteristics with typical morphological appearance in magnetic resonance imaging. Depending on those, IPMNs may show progression into invasive carcinomas with variable frequency. Overall, IPMN-associated invasive carcinomas are found in about 30% of all IPMNs, revealing phenotpyes comparable with conventional ductal adenocarcinomas or mucinous (colloid) carcinomas of the pancreas. In Sendai-negative side-branch IPMNs, however, the annual risk of the development of invasive cancer is 2%; thus, risk stratification with regard to imaging and preoperative biomarkers and cytology is mandatory.</p><p><strong>Methods and results: </strong>The present study addresses the radiological and interventional preoperative measures including histological features to determine the risk of malignancy and the prognosis of IPMNs.</p><p><strong>Conclusion: </strong>While preoperative imaging largely relies on the detection of macroscopic features of IPMNs, which are associated with a divergent risk of malignant behavior, in resected specimens the determination of the grade of dysplasia and the detection of an invasive component are the most important features to estimate the prognosis of IPMNs.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"31-7"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000375254","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33935386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Giant Filiform Polyposis not Associated with Inflammatory Bowel Disease: A Case Report.","authors":"Rossella Ponte,&nbsp;Luca Mastracci,&nbsp;Stefano Di Domenico,&nbsp;Carlotta Ferretti,&nbsp;Franco De Cian,&nbsp;Roberto Fiocca,&nbsp;Federica Grillo","doi":"10.1159/000370342","DOIUrl":"https://doi.org/10.1159/000370342","url":null,"abstract":"<p><strong>Background: </strong>Filiform polyposis (FP) is an uncommon cause of non-neoplastic and non-syndromic polyposis. Several hypotheses concerning its pathogenesis have been published. FP is most frequently associated with a post-inflammatory reparative process; indeed, the most frequent association is with inflammatory bowel disease (IBD). FP is characterized by one to hundreds of uniform, slender, arborizing, vermiform projections of the large bowel mucosa and submucosa lined by normal or inflamed colonic mucosa. The most common sites for these polyps are the transverse and descending colon.</p><p><strong>Case report: </strong>In this report we present a case of giant FP associated with locally invasive adenocarcinoma of the right colon in a 73-year-old man with no past medical history of IBD.</p><p><strong>Conclusion: </strong>Few of these cases have been reported in the literature, and out of the approximately 20 of such case reports only one other was associated with colorectal adenocarcinoma.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"58-60"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000370342","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34104769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Incidental Pancreatic Cystic Lesions.","authors":"Christian Jenssen,&nbsp;Stefan Kahl","doi":"10.1159/000375282","DOIUrl":"https://doi.org/10.1159/000375282","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic cystic lesions (PCL) are common. They are increasingly detected as an incidental finding of transabdominal ultrasound or cross-sectional imaging. In contrast to other parenchymal organs, dysontogenetic pancreatic cysts are extremely rare. In symptomatic patients the most frequent PCL are acute and chronic pseudocysts. The majority of incidental cystic lesions, however, are neoplasias which have different risks of malignancy.</p><p><strong>Methods: </strong>PubMed was searched for studies, reviews, meta-analyses, and guidelines using the following key words: ('pancreatic cystic lesions' OR 'cystic pancreatic lesions' OR 'intraductal papillary mucinous neoplasia' OR 'mucinous cystic neoplasia' OR 'pancreatic cyst' OR 'pancreatic pseudocyst') AND (management OR treatment OR outcome OR prognosis OR diagnosis OR imaging OR 'endoscopic ultrasound' EUS-FNA OR EUS OR 'endoscopic ultrasonography' OR CT OR MRI). Retrieved papers were reviewed with regard to the diagnostic and therapeutic management of incidental PCL.</p><p><strong>Results: </strong>In addition to clinical criteria, transabdominal ultrasonography including contrast-enhanced ultrasonography, cross-sectional radiological imaging, and endoscopic ultrasound (EUS) are used for diagnostic characterization and risk assessment. EUS plays an outstanding role in differential diagnosis and prognostic characterization of incidental PCL. In a single examination it is possible to perform high-resolution morphological description, perfusion imaging, as well as fine-needle aspiration of cyst content, cyst wall, and solid components. An international consensus guideline has defined worrisome and high-risk criteria for the risk assessment of mucinous pancreatic cysts, which are mainly based on the results of EUS and cross-sectional imaging. Nevertheless, despite diagnostic progress and guideline recommendations, differential diagnosis and management decisions remain difficult. This review will discuss problems in and approaches to the diagnosis of incidental PCL.</p><p><strong>Conclusion: </strong>An evidence-based algorithm for the diagnosis of incidental PCL is proposed.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"14-24"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000375282","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33935384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraductal Papillary Mucinous Adenocarcinoma of the Pancreas: Clinical Outcomes, Prognostic Factors, and the Role of Adjuvant Therapy.","authors":"Zhi Ven Fong,&nbsp;Carlos Fernández-Del Castillo","doi":"10.1159/000373912","DOIUrl":"https://doi.org/10.1159/000373912","url":null,"abstract":"<p><strong>Background: </strong>Intraductal papillary mucinous adenocarcinoma (IPMCs) occur more frequently in main-duct intraductal papillary mucinous neoplasms.</p><p><strong>Methods: </strong>Review of the literature.</p><p><strong>Results: </strong>The prognosis of IPMCs depends on its histopathological subtype: colloid IPMCs have superior survival rates mainly secondary to more favorable pathological features, whereas tubular IPMCs have survival outcomes similar to that of conventional pancreatic adenocarcinomas. The epithelial background plays an equally important role in defining the biology of IPMCs: gastric IPMC subtypes demonstrate an overall worse survival outcome when compared to intestinal, pancreatobiliary, and oncocytic subtypes. Lymph node involvement is one of the strongest predictors of survival in IPMC, with a decreasing overall survival as the lymph node ratio increases. There is little evidence to support adjuvant chemoradiation in patients with IPMC.</p><p><strong>Conclusion: </strong>Our current understanding of IPMC biology based on histopathological and epithelial background subtypes as well as clinicopathological predictors should influence patient counseling and selection for adjuvant therapy.</p>","PeriodicalId":49114,"journal":{"name":"Viszeralmedizin","volume":"31 1","pages":"43-6"},"PeriodicalIF":0.0,"publicationDate":"2015-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000373912","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34104768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}