Pankreatik Kistik Neoplaziler
Özet
Pankreatik kistik neoplaziler (PCN), abdominal görüntüleme tekniklerinin yaygınlaşmasıyla birlikte, özellikle ileri yaşlardaki bireylerde tesadüfen saptanan ve benign durumdan maligniteye kadar uzanan geniş bir spektruma sahip lezyonlardır. Bu kistler temel olarak seröz kistik tümörler (SCT), müsinöz kistik neoplazmlar (MCN), intraduktal papiller müsinöz neoplazmlar (IPMN) ve solid psödopapiller tümörler (SPN) olarak dört ana tipte sınıflandırılır. Tanı sürecinde MRI ve MRCP, kanal bağlantılarını ve mural nodülleri değerlendirmede ilk tercih edilen yöntemlerken, şüpheli vakalarda EUS-FNA ile alınan sıvı analizi; CEA düzeyleri, sitoloji ve KRAS, GNAS, TP53 gibi moleküler belirteçler aracılığıyla malignite riskini belirlemede kritik rol oynar. Malignite riski özellikle kist boyutunun 3 cm'den büyük olması, solid komponent içermesi ve ana pankreatik kanal dilatasyonu ile ilişkilidir. SCT'ler genellikle düşük malign potansiyele sahip olup sadece semptomatik vakalarda rezeksiyon gerektirirken; MCN, SPN ve yüksek riskli IPMN'lerde, özellikle genç hastalarda ve ileri neoplazi bulguları varlığında cerrahi tedavi önceliklidir. Tedavi sonrası takip süreci, patolojik bulgulara ve kistin başlangıçtaki özelliklerine göre düzenlenir.
Pancreatic cystic neoplasms (PCNs) are lesions that are frequently detected incidentally with the widespread use of abdominal imaging, especially in elderly individuals, and they encompass a broad spectrum ranging from benign conditions to malignancy. These cysts are primarily classified into four main types: serous cystic tumors (SCT), mucinous cystic neoplasms (MCN), intraductal papillary mucinous neoplasms (IPMN), and solid pseudopapillary neoplasms (SPN). During the diagnostic process, MRI and MRCP are the preferred initial methods for evaluating ductal connections and mural nodules, while in suspicious cases, fluid analysis obtained via EUS-FNA plays a critical role in determining malignancy risk through CEA levels, cytology, and molecular markers such as KRAS, GNAS, and TP53. The risk of malignancy is particularly associated with a cyst size larger than 3 cm, the presence of solid components, and main pancreatic duct dilation. While SCTs generally have low malignant potential and require resection only in symptomatic cases, surgical treatment is prioritized for MCNs, SPNs, and high-risk IPMNs, especially in young patients and in the presence of advanced neoplasia findings. The post-treatment follow-up process is organized based on pathological findings and the initial characteristics of the cyst.
Referanslar
Moris M, Bridges MD, Pooley RA, et al. Association Between Advances in High-Resolution Cross-Section Imaging Technologies and Increase in Prevalence of Pancreatic Cysts From 2005 to 2014. Clin Gastroenterol Hepatol 2016; 14:585.
Kromrey ML, Bülow R, Hübner J, et al. Prospective study on the incidence, prevalence and 5-year pancreatic-related mortality of pancreatic cysts in a population-based study. Gut 2018; 67:138.
van Huijgevoort NCM, Del Chiaro M, Wolfgang CL, van HooftJE, Besselink MG. Diagnosis and management of pancreatic cystic neoplasms: current evidence and guidelines. Nat Rev GastroenterolHepatol. Nov 2019;16(11):676–689. doi:https:// doi. org/10. 1038/ s41575- 019- 0195-x
Zaheer A, Pokharel SS, Wolfgang C, Fishman EK, Horton KM. Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions. Abdom Imaging. Apr 2013;38(2):331–41. doi:https:// doi. org/ 10. 1007/ s00261- 012- 9898-y
Tanaka M, Chari S, Adsay V, et al. International Consensus Guidelines for Management of Intraductal Papillary Mucinous Neoplasms and Mucinous Cystic Neoplasms of the Pancreas. Pancreatology 2006;6(1–2):17–32. doi:https:// doi. org/ 10. 1159/ 00009 0023
Kimura W, Nagai H, Kuroda A, Muto T, Esaki Y. Analysis of small cystic lesions of the pancreas. Int J Pancreatol. Dec 1995;18(3):197–206. doi:https:// doi. org/ 10. 1007/ bf027 84942
Ikeda M, Sato T, Morozumi A, et al. Morphologic changes in the pancreas detected by screening ultrasonography in a mass survey, with special reference to main duct dilatation, cyst formation, and calcification. Pancreas. Jul 1994;9(4):508–12. doi:https:// doi. org/ 10. 1097/ 00006 676- 19940 7000- 00014
Laffan TA, Horton KM, Klein AP, et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol. Sep 2008;191(3):802–7. doi:https:// doi. org/ 10. 2214/ ajr. 07. 3340
de Jong K, Nio CY, Hermans JJ, et al. High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol. Sep 2010;8(9):806– 11. doi:https:// doi. org/ 10. 1016/j. cgh. 2010. 05. 017
Del Chiaro M, Segersvärd R, Lohr M, et al. Early detection and prevention of pancreatic cancer: is it really possible today? World J Gastroenterol 2014;20:12118–31.
Del Chiaro M, Segersvärd R, Pozzi Mucelli R, et al. Comparison of preoperative conference-based diagnosis with histology of cystic tumors of the pancreas. Ann Surg Oncol 2014;21:1539–44.
Spinelli KS, Fromwiller TE, Daniel RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg 2004; 239:651
Fernández-del Castillo C, Targarona J, Thayer SP, et al. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 2003; 138:427.
Gill AJ, Klimstra DS, Lam AK, et al. Tumours of the pancreas. In: WHO Classification of Tumours, 5th ed, WHO Classification of Tumours Editorial Board (Ed), IARC Press, Lyon 2019. p.296.
Valsangkar NP, Morales-Oyarvide V, Thayer SP, et al. 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery 2012; 152:S4.
Scheiman JM, Hwang JH, Moayyedi P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015;148:824
Serikawa M, Sasaki T, Fujimoto et al. Management of intraductal papillary-mucinous neoplasm of the pancreas: treatment strategy based on morphologic classification. J Clin Gastroenterol 2006; 40:856.
LévyP, Jouannaud V, O’Toole D, et al. Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol 2006; 4:460.
Oyama H, Tada M, Takagi K, et al. Long-term Risk of Malignancy in Branch-Duct Intraductal Papillary Mucinous Neoplasms. Gastroenterology 2020; 158:226.
Compagno J, Oertel JE. Microcystic adenomas of the pancreas (glycogen-rich cystadenomas): a clinicopathologic study of 34 cases. Am J Clin Pathol 1978; 69:289.
Pyke CM, van Heerden JA, Colby TV, et al. The spectrum of serous cystadenoma of the pancreas. Clinical, pathologic, and surgical aspects. Ann Surg 1992; 215:132.
Lungstedt C, Dawiskiba S. Serous and mucinous cystadenoma/cystadenocarcinoma of the pancreas. Abdom Imaging 2000; 25:201.
Tseng JF, Warchaw AL, Sahani DV, et al. Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment. Ann Surg 2005; 242:413
Sharma, A. Tumors of the Pancreas. In: Current Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, Greenberger, NJ, Blumberg, RS, Burakoff, R (Eds), McGraw-Hill, New York 2009. p.318.
Romics L Jr, Oláh A, Belágyi T, et al. Solid pseudopapillary neoplasm of the pancreas--proposed algorithms for diagnosis and surgical treatment. Langenbecks Arch Surg 2010; 395:747.
Berland LL , Silverman SG , Gore RM et al. Managing incidental fi ndings on abdominal CT: white paper of the ACR incidental fi ndings committee .J Am Coll Radiol 2010 ; 7 : 754 – 73 .
Curry CA, Eng J, Horton KM, et al. CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment? AJR Am J Roentgenol 2000;175:99–103.
Demos TC, Posniak HV, Harmath C, et al. Cystic lesions of the pancreas. AJR Am J Roentgenol 2002;179:1375–88.
Jang DK, Song BJ, Ryu JK, et al. Preoperative diagnosis of pancreatic cystic lesions: the accuracy of endoscopic ultrasound and cross-sectional imaging. Pancreas 2015;44:1329–33.
Lee HJ, Kim MJ, Choi JY, et al. Relative accuracy of CT and MRI in the differentiation of benign from malignant pancreatic cystic lesions. Clin Radiol 2011;66:315–21.
Sainani NI, Saokar A, Deshpande V, et al. Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts. AJR Am J Roentgenol 2009;193:722–31.
Visser BC, Muthusamy VR, Yeh BM, et al. Diagnostic evaluation of cystic pancreatic lesions. HPB (Oxford) 2008;10:63–9.
Song SJ, Lee JM, Kim YJ, et al. Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. J Magn Reson Imaging 2007;26:86–93.
Machado NO, Al Qadhi H, Al Wahibi K. İntraductal Papillary Mucinous Neoplasm of Pancreas. N Am J Med Sci 2015; 7:160
Irie H, Honda H, Aibe Hi, et al. MR cholangiopancreatographic differentiation of benign and malignant intraductal mucin-producing tumors of the pancreas. AJR Am J Roentgenol 2000; 174:1403
Sahani DV, Kadavigere R, Blake M, et al. Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations--correlation with MRCP. Radiology 2006; 238:560.
Carbognin G, Zamboni G, Pinali L, et al. Branch duct IPMTs: value of cross-sectional imaging in the assessment of biological behavior and follow-up. Abdom Imaging 2006; 31:320.
Kim JH, Eun HW, Kim KW, et al. Intraductal papillary mucinous neoplasms with associated invasive carcinoma of the pancreas: imaging findings and diagnostic performance of MDCT for prediction of prognostic factors. AJR Am J Roentgenol 2013; 201:565.
Waters JA, Schmidt CM, Pinchot JW, et al. CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg 2008; 12:101.
Albert J, Schilling D, Breer H, et al. Mucinous cystadenomas and intraductal papillary mucinous tumors of the pancreas in magnetic resonance cholangiopancreatography. Endoscopy 2000; 32:472.
Itai Y, Ohhashi K, Nagai H, et al. "Ductectatic" mucinous cystadenoma and cystadenocarcinoma of the pancreas. Radiology 1986; 161:697.
Yu MH, Lee JY, Kim MA, et al. MR imaging features of small solid pseudopapillary tumors: retrospective differentiation from other small solid pancreatic tumors. AJR Am J Roentgenol 2010; 195:1324.
Vege SS, Ziring B, Jain R, et al. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148:819.
Singhi AD, Zeh HJ, Brand RE, et al. American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data. Gastrointest Endosc 2016; 83:1107.
ASGE Standards of Practice Committee, Muthusamy VR, Chandrasekhara V, et al. The role of endoscopy in the diagnosis and treatment of cystic pancreatic neoplasms. Gastrointest Endosc 2016; 84:1.
Elta GH, Enestvedt BK, Sauer BG, Lennon AM. ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts. Am J Gastroenterol 2018; 113:464.
Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 2004; 126:1330.
Donahue TR, Hines OJ, Farrell JJ, et al. Cystic neoplasms of the pancreas: results of 114 cases. Pancreas 2010;39:1271–6.
Kim JH, Eun HW, Park HJ, et al. Diagnostic performance of MRI and EUS in the differentiation of benign from malignant pancreatic cyst and cyst communication with the main duct. Eur J Radiol 2012;81:2927–35.
Gress F, Gottlieb K, Cummings O, et al. Endoscopic ultrasound characteristics of mucinous cystic neoplasms of the pancreas. Am J Gastroenterol 2000;95:961–5.
Yamao K, Nakamura T, Suzuki T, et al. Endoscopic diagnosis and staging of mucinous cystic neoplasms and intraductal papillary-mucinous tumors. J Hepatobiliary Pancreat Surg 2003;10:142–6.
Ahmad NA, Kochman ML, Lewis JD, et al. Can EUS alone differentiate between malignant and benign cystic lesions of the pancreas? Am J Gastroenterol 2001;96:3295–300.
Ahmad NA, Kochman ML, Brensinger C, et al. Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions. Gastrointest Endosc 2003;58:59–64.
de Jong K, van Hooft JE, Nio CY, et al. Accuracy of preoperative workup in a prospective series of surgically resected cystic pancreatic lesions. Scand J Gastroenterol 2012;47:1056–63.
Cizginer S, Turner BG, Turner B, Bilge AR, et al. Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas 2011;40:1024–8.
Sedlack R, Affi A, Vazquez-Sequeiros E, et al. Utility of EUS in the evaluation of cystic pancreatic lesions. Gastrointest Endosc 2002;56:543–7.
van der Waaij LA, van Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc. Sep 2005;62(3):383–9. doi:https:// doi. org/ 10. 1016/ s0016- 5107(05) 01581-6
Al-Rashdan A, Schmidt CM, Al-Haddad M, et al. Fluid analysis prior to surgical resection of suspected mucinous pancreatic cysts. A single centre experience. J Gastrointest Oncol 2011;2:208–14.
Park WG, Wu M, Bowen R, et al. Metabolomic-derived novel cyst fluid biomarkers for pancreatic cysts: glucose and kynurenine.Gastrointest Endosc. Aug 2013;78(2):295–302.e2. doi:https:// doi. org/ 10. 1016/j. gie. 2013. 02. 037
Gillis A, Cipollone I, Cousins G, et al. Does EUS-FNA molecular analysis carry additional value when compared to cytology in the diagnosis of pancreatic cystic neoplasm? A systematic review. HPB (Oxford) 2015;17:377–86.
Al-Haddad M, Gill KR, Raimondo M, et al. Safety and efficacy of cytology brushings versus standard fine-needle aspiration in evaluating cystic pancreatic lesions: a controlled study. Endoscopy 2010; 42:127.
Gaddam S, Ge PS, Keach JW, et al. Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study. Gastrointest Endosc 2015; 82:1060.
Khalid A, McGrath KM, Zahid M, et al. The role of pancreatic cyst fluid molecular analysis in predicting cyst pathology. Clin Gastroenterol Hepatol 2005; 3:967
Khalid A, Zahid M, Finkelstein SD, et al. Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study. Gastrointest Endosc 2009; 69:1095.
Rockacy MJ, Zahid M, McGrath KM, et al. Association between KRAS mutation, detected in pancreatic cyst fluid, and long-term outcomes of patients. Clin Gastroenterol Hepatol 2013; 11:425.
Al-Haddad M, DeWitt J, Sherman S, et al. Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts. Gastrointest Endosc 2014; 79:79.
Jabbar KS, Verbeke C, Hyltander AG, et al. Proteomic mucin profiling for the identification of cystic precursors of pancreatic cancer. J Natl Cancer Inst 2014; 106:djt439.
Zikos T, Pham K, Bowen R, et al. Cyst Fluid Glucose is Rapidly Feasible and Accurate in Diagnosing Mucinous Pancreatic Cysts. Am J Gastroenterol 2015; 110:909.
Springer S, Wang Y, Dal Molin M, et al. A combination of molecular markers and clinical features improve the classification of pancreatic cysts. Gastroenterology 2015; 149:1501.
Singhi AD, Nikiforova MN, Fasanella KE, et al. Preoperative GNAS and KRAS testing in the diagnosis of pancreatic mucinous cysts. Clin Cancer Res 2014; 20:4381.
Nikiforova MN, Khalid A, Fasanella KE, et al. Integration of KRAS testing in the diagnosis of pancreatic cystic lesions: a clinical experience of 618 pancreatic cysts. Mod Pathol 2013; 26:1478.
Wu J, Matthaei H, Maitra A, et al. Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development. Sci Transl Med 2011; 3:92ra66.
Furukawa T, Kuboki Y, Tanji E, et al. Whole-exome sequencing uncovers frequent GNAS mutations in intraductal papillary mucinous neoplasms of the pancreas. Sci Rep 2011; 1:161.
Kuboki Y, Shimizu K, Hatori T, Yamamoto M, Shibata N, Shiratori K, et al. Molecular biomarkers for progression of intraductal papillary mucinous neoplasm of the pancreas. Pancreas. 2015;44:227–35.
Kanda M, Sadakari Y, Borges M, et al. Mutant TP53 in duodenal samples of pancreatic juice from patients with pancreatic cancer or high-grade dysplasia. Clin Gastroenterol Hepatol 2013; 11:719.
Schönleben F, Qiu W, Ciau NT, et al. PIK3CA mutations in intraductal papillary mucinous neoplasm/carcinoma of the pancreas. Clin Cancer Res 2006; 12:3851.
Garcia-Carracedo D, Turk AT, Fine SA, et al. Loss of PTEN expression is associated with poor prognosis in patients with intraductal papillary mucinous neoplasms of the pancreas. Clin Cancer Res 2013; 19:6830.
Reid MD, Choi H, Balci S, Akkas G, Adsay V. Serous cystic neoplasms of the pancreas: clinicopathologic and molecular characteristics.Semin Diagn Pathol. 2014;31:475–83.
Wu J, Jiao Y, Dal Molin M, Maitra A, de Wilde RF, Wood LD, et al.Whole-exome sequencing of neoplastic cysts of the pancreas reveals recurrent mutations in components of ubiquitin-dependent pathways. Proc Natl Acad Sci U S A. 2011;108:21188–93.
Yip-Schneider MT, Wu H, Dumas RP, Hancock BA, Agaram N, RadovichM, et al. Vascular endothelial growth factor, a novel and highly accurate pancreatic fluid biomarker for serous pancreatic cysts. J Am Coll Surg. 2014;218:608–17.
Kim EK, Jang M, Park M, Kim H. LEF1, TFE3, and AR are putative diagnostic markers of solid pseudopapillary neoplasms. Oncotarget. 2017;8:93404–13.
Frossard JL, Amouyal P, Amouyal G, et al. Performance of endosonography-guided fine needle aspiration and biopsy in the diagnosis of pancreatic cystic lesions. Am J Gastroenterol 2003; 98:1516.
Jones EC, Suen KC, Grant DR, Chan NH. Fine-needle aspiration cytology of neoplastic cysts of the pancreas. Diagn Cytopathol 1987; 3:238.
Centeno BA, Lewandrowski KB, Warshaw AL, et al. Cyst fluid cytologic analysis in the differential diagnosis of pancreatic cystic lesions. Am J Clin Pathol 1994; 101:483.
Khalid A, Brugge W. ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol 2007; 102:2339.
Cellier C, Cuillerier E, Palazzo L, et al. Intraductal papillary and mucinous tumors of the pancreas: accuracy of preoperative computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasonography, and long-term outcome in a large surgical series. Gastrointest Endosc 1998; 47:42.
Sugiyama M, Atomi Y, Saito M. Intraductal papillary tumors of the pancreas: evaluation with endoscopic ultrasonography. Gastrointest Endosc 1998; 48:164.
Pais SA, Attasaranya S, Leblanc JK, et al. Role of endoscopic ultrasound in the diagnosis of intraductal papillary mucinous neoplasms: correlation with surgical histopathology. Clin Gastroenterol Hepatol 2007; 5:489.
Tanno S, Nakano Y, Nishikawa T, et al. Natural history of branch duct intraductal papillary-mucinous neoplasms of the pancreas without mural nodules: long-term follow-up results. Gut 2008; 57:339.
Kim KW, Park SH, Pyo J, et al. Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Ann Surg 2014; 259:72.
Grützmann R, Niedergethmann M, Pilarsky C, et al. Intraductal papillary mucinous tumors of the pancreas: biology, diagnosis, and treatment. Oncologist 2010; 15:1294.
Aithal GP, Chen RY, Cunningham JT, et al. Accuracy of EUS for detection of intraductal papillary mucinous tumor of the pancreas. Gastrointest Endosc 2002; 56:701.
Fasanella KE, McGrath K. Cystic lesions and intraductal neoplasms of the pancreas. Best Pract Res Clin Gastroenterol 2009; 23:35.
Bardales RH, Centeno B, Mallery JS, et al. Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of solid-pseudopapillary tumor of the pancreas: a rare neoplasm of elusive origin but characteristic cytomorphologic features. Am J Clin Pathol 2004; 121:654.
Jani N, Dewitt J, Eloubeidi M, et al. Endoscopic ultrasound-guided fine-needle aspiration for diagnosis of solid pseudopapillary tumors of the pancreas: a multicenter experience. Endoscopy 2008; 40:200.
Yang D, Trindade AJ, Yachimski P, et al. Histologic Analysis of Endoscopic Ultrasound-Guided Through the Needle Microforceps Biopsies Accurately Identifies Mucinous Pancreas Cysts. Clin Gastroenterol Hepatol 2019; 17:1587.
Yang D, Samarasena JB, Jamil LH, et al. Endoscopic ultrasound-guided through-the-needle microforceps biopsy in the evaluation of pancreatic cystic lesions: a multicenter study. Endosc Int Open 2018; 6:E1423.
Westerveld DR, Ponniah SA, Draganov PV, Yang D. Diagnostic yield of EUS-guided through-the-needle microforceps biopsy versus EUS-FNA of pancreatic cystic lesions: a systematic review and meta-analysis. Endosc Int Open 2020; 8:E656.
Crinò SF, Bernardoni L, Brozzi L, et al. Association between macroscopically visible tissue samples and diagnostic accuracy of EUS-guided through-the-needle microforceps biopsy sampling of pancreatic cystic lesions. Gastrointest Endosc 2019; 90:933.
Larghi A, Manfrin E, Fabbri C, et al. Interobserver agreement among expert pathologists on through-the-needle microforceps biopsy samples for evaluation of pancreatic cystic lesions. Gastrointest Endosc 2019; 90:784.
Nickl NJ, Lawson JM, Cotton PB. Mucinous pancreatic tumors: ERCP findings. Gastrointest Endosc 1991; 37:133.
Raijman I, Kortan P, Walden D, et al. Mucinous ductal ectasia: cholangiopancreatographic and endoscopic findings. Endoscopy 1994; 26:303.
Krishna SG, Hart PA, Malli A, et al. Endoscopic Ultrasound-Guided Confocal Laser Endomicroscopy Increases Accuracy of Differentiation of Pancreatic Cystic Lesions. Clin Gastroenterol Hepatol 2020; 18:432.
Krishna SG, Hart PA, DeWitt JM, et al. EUS-guided confocal laser endomicroscopy: prediction of dysplasia in intraductal papillary mucinous neoplasms (with video). Gastrointest Endosc 2020; 91:551.
Cheesman AR, Zhu H, Liao X, et al. Impact of EUS-guided microforceps biopsy sampling and needle-based confocal laser endomicroscopy on the diagnostic yield and clinical management of pancreatic cystic lesions. Gastrointest Endosc 2020; 91:1095.
Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012; 12:183.
Gan SI, Thompson CC, Lauwers GY, et al. Ethanol lavage of pancreatic cystic lesions: initial pilot study. Gastrointest Endosc 2005; 61:746.
Oh HC, Seo DW, Lee TY, et al. New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection. Gastrointest Endosc 2008; 67:636.
Oh HC, Seo DW, Song TJ, et al. Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts. Gastroenterology 2011; 140:172.
Canakis A, Law R, Baron T. An updated review on ablative treatment of pancreatic cystic lesions. Gastrointest Endosc 2020; 91:520.
Moyer MT, Sharzehi S, Mathew A, et al. The Safety and Efficacy of an Alcohol-Free Pancreatic Cyst Ablation Protocol. Gastroenterology 2017; 153:1295.
King JC, Ng TT, White SC, et al. Pancreatic serous cystadenocarcinoma: a case report and review of the literature. J Gastrointest Surg 2009; 13:1864.
Jais B, Rebours V, Malleo G, et al. Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). Gut 2016; 65:305.
Zamboni G, Scarpa A, Bogina G, et al. Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 1999; 23:410.
Reddy RP, Smyrk TC, Zapiach M, et al. Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin Gastroenterol Hepatol 2004; 2:1026.
Raimondo M, Tachibana I, Urrutia R, et al. Invasive cancer and survival of intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol 2002; 97:2553.
Yonezawa S, Sato E. Expression of mucin antigens in human cancers and its relationship with malignancy potential. Pathol Int 1997; 47:813.
Yonezawa S, Horinouchi M, Osako M, et al. Gene expression of gastric type mucin (MUC5AC) in pancreatic tumors: its relationship with the biological behavior of the tumor. Pathol Int 1999; 49:45.
Yonezawa S, Taira M, Osako M, et al. MUC-1 mucin expression in invasive areas of intraductal papillary mucinous tumors of the pancreas. Pathol Int 1998; 48:319.
Gold DV, Karanjawala Z, Modrak DE, et al. PAM4-reactive MUC1 is a biomarker for early pancreatic adenocarcinoma. Clin Cancer Res 2007; 13:7380.
House MG, Guo M, Iacobuzio-Donahue C, Herman JG. Molecular progression of promoter methylation in intraductal papillary mucinous neoplasms (IPMN) of the pancreas. Carcinogenesis 2003; 24:193.
Sato N, Matsubayashi H, Abe T, et al. Epigenetic down-regulation of CDKN1C/p57KIP2 in pancreatic ductal neoplasms identified by gene expression profiling. Clin Cancer Res 2005; 11:4681.
Poultsides GA, Reddy S, Cameron JL, et al. Histopathologic basis for the favorable survival after resection of intraductal papillary mucinous neoplasm-associated invasive adenocarcinoma of the pancreas. Ann Surg 2010; 251:470.
Yanagisawa A, Ohashi K, Hori M, et al. Ductectatic-type mucinous cystadenoma and cystadenocarcinoma of the human pancreas: a novel clinicopathological entity. Jpn J Cancer Res 1993; 84:474.
Tamura K, Ohtsuka T, Ideno N, et al. Treatment strategy for main duct intraductal papillary mucinous neoplasms of the pancreas based on the assessment of recurrence in the remnant pancreas after resection: a retrospective review. Ann Surg 2014;259:360–8.
Yamaguchi J, Kaneoka Y, Maeda A, et al. Positive surgical margins in surgically treated unifocal and multifocal IPMN. Int J Surg 2016;28:51–5.
Fujii T, Kato K, Kodera Y, et al. Prognostic impact of pancreatic margin status in the intraductal papillary mucinous neoplasms of the pancreas. Surgery 2010;148:285–90.
Marchegiani G, Mino-Kenudson M, Ferrone CR, et al. Patterns of recurrence after resection of IPMN. Ann Surg 2015;262:1108–14.
Pea A, Yu J, Rezaee N, et al. Targeted DNA sequencing reveals patterns of local progression in the pancreatic remnant following resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Ann Surg 2017;266:133-141.
Bhardwaj N, Dennison AR, Maddern GJ, et al. Management implications of resection margin histology in patients undergoing resection for IPMN: a meta-analysis. Pancreatology 2016;16:309–17.
Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 2004; 239:788.
D'Angelica M, Brennan MF, Suriawinata AA, et al. Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg 2004; 239:400.
Law JK , Ahmed A , Singh VK et al. A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas 2014 ; 43 : 331 – 7 .
Lee SE, Jang JY, Hwang DW, et al. Clinical features and outcome of solid pseudopapillary neoplasm: differences between adults and children. Arch Surg 2008; 143:1218.
Kim MJ, Choi DW, Choi SH, et al. Surgical treatment of solid pseudopapillary neoplasms of the pancreas and risk factors for malignancy. Br J Surg 2014; 101:1266.
Chen X, Zhou GW, Zhou HJ, et al. Diagnosis and treatment of solid-pseudopapillary tumors of the pancreas. Hepatobiliary Pancreat Dis Int 2005; 4:456.
Alexandrescu DT, O'Boyle K, Feliz A, et al. Metastatic solid-pseudopapillary tumour of the pancreas: clinico-biological correlates and management. Clin Oncol (R Coll Radiol) 2005; 17:358.
McGrath K, Slivka A. Diagnosis and management of intraductal papillary mucinous neoplasia. Nat Clin Pract Gastroenterol Hepatol 2005; 2:316.
Salvia R, Partelli S, Crippa S, et al. Intraductal papillary mucinous neoplasms of the pancreas with multifocal involvement of branch ducts. Am J Surg 2009; 198:709.
Uehara H, Nakaizumi A, Ishikawa O, et al. Development of ductal carcinoma of the pancreas during follow-up of branch duct intraductal papillary mucinous neoplasm of the pancreas. Gut 2008; 57:1561.
Sugiyama M, Atomi Y. Extrapancreatic neoplasms occur with unusual frequency in patients with intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol 1999; 94:470.
Choi MG, Kim SW, Han SS, et al. High incidence of extrapancreatic neoplasms in patients with intraductal papillary mucinous neoplasms. Arch Surg 2006; 141:51.
Yoon WJ, Ryu JK, Lee JK, et al. Extrapancreatic malignancies in patients with intraductal papillary mucinous neoplasm of the pancreas: prevalence, associated factors, and comparison with patients with other pancreatic cystic neoplasms. Ann Surg Oncol 2008; 15:3193.
Reid-Lombardo KM, Mathis KL, Wood CM, et al. Frequency of extrapancreatic neoplasms in intraductal papillary mucinous neoplasm of the pancreas: implications for management. Ann Surg 2010; 251:64.
Kamisawa T, Tu Y, Egawa N, et al. Malignancies associated with intraductal papillary mucinous neoplasm of the pancreas. World J Gastroenterol 2005; 11:5688.
Eguchi H, Ishikawa O, Ohigashi H, et al. Patients with pancreatic intraductal papillary mucinous neoplasms are at high risk of colorectal cancer development. Surgery 2006; 139:749.
