Rapid advances in radiologic technology and increased cross-sectional imaging have led to a sharp rise in incidental discoveries of pancreatic cystic lesions. These cystic lesions include non-neoplastic cysts with no ...Rapid advances in radiologic technology and increased cross-sectional imaging have led to a sharp rise in incidental discoveries of pancreatic cystic lesions. These cystic lesions include non-neoplastic cysts with no risk of malignancy, neoplastic non-mucinous serous cystadenomas with little or no risk of malignancy, as well as neoplastic mucinous cysts and solid pseudopapillary neoplasms both with varying riskof malignancy. Accurate diagnosis is imperative as management is guided by symptoms and risk of malignancy. Endoscopic ultrasound(EUS) allows high resolution evaluation of cyst morphology and precise guidance for fine needle aspiration(FNA) of cyst fluid for cytological, chemical and molecular analysis. Initially, clinical evaluation and radiologic imaging, preferably with magnetic resonance imaging of the pancreas and magnetic resonance cholangiopancreatography, are performed. In asymptomatic patients where diagnosis is unclear and malignant risk is indeterminate, EUSFNA should be used to confirm the presence or absence of high-risk features, differentiate mucinous from non-mucinous lesions, and diagnose malignancy. After analyzing the cyst fluid for viscosity, cyst fluid carcinoembryonic antigen, amylase, and cyst wall cytology should be obtained. DNA analysis may add useful information in diagnosing mucinous cysts when the previous studies are indeterminate. New molecular biomarkers are being investigated to improve diagnostic capabilities and management decisions in these challenging cystic lesions. Current guidelines recommend surgical pancreatic resection as the standard of care for symptomatic cysts and those with high-risk features associated with malignancy. EUSguided cyst ablation is a promising minimally invasive, relatively low-risk alternative to both surgery and surveillance.展开更多
Solid pseudopapillary neoplasm (SPN) is a rare and low-grade malignant pancreatic neoplasm composed of poorly cohesive monomorphic neoplastic cells forming solid and pseudopapillary structures with frequent hemorrhagi...Solid pseudopapillary neoplasm (SPN) is a rare and low-grade malignant pancreatic neoplasm composed of poorly cohesive monomorphic neoplastic cells forming solid and pseudopapillary structures with frequent hemorrhagic-cystic degeneration. Intraductal papillary mucinous neoplasm (IPMN) is a pancreatic exocrine tumor composed of intraductal papillary growth of mucin containing neoplastic cells in the main pancreatic duct or its major branches. In the case presented here, a 53-year-old, Japanese man was found to have multiple cystic lesions and dilatation of the main pancreatic duct in the neck of the pancreas. Histological examination revealed a main-duct and branch-duct type IPMN, of the gastric-type, involving the neck of the pancreas, associated with a 0.5 cm SPN in the caudal side of the IPMN. We diagnosed this case as synchronous SPN and IPMN. As far as we know, only one other case of synchronous SPN and IPMN has been reported. Both the present case and the previously reported case showed abnormal nuclear expression of β-catenin in SPN, whereas IPMN showed no abnormal nuclear expression. These results suggest that β-catenin abnormality is not a common pathogenetic factor of synchronous SPN and IPMN.展开更多
目的:探讨超声乳腺影像报告与数据系统(Breast imaging reporting and data system,BI-RADS)在乳腺肿块诊断中的应用价值。方法:按照BI-RADS标准对103例乳腺肿块声像图进行分析,综合评估分类,与手术或组织活检病理对照分析。结果:BI-RAD...目的:探讨超声乳腺影像报告与数据系统(Breast imaging reporting and data system,BI-RADS)在乳腺肿块诊断中的应用价值。方法:按照BI-RADS标准对103例乳腺肿块声像图进行分析,综合评估分类,与手术或组织活检病理对照分析。结果:BI-RADS描述术语中形态、方位、边缘、肿块边界、回声类型、后方声学特征、微钙化、血流分布在乳腺良、恶性肿块中有显著性差异,P<0.05;BI-RADS描述术语的阳性预测值、敏感度、特异度分别为:强回声晕(100.00%,11.94%,100.00%),肿块内部血流(92.15%,70.14%,88.88%),肿块内微钙化(91.66%,49.25%,91.66%),形态不规则(87.87%,86.56%,77.77%),边缘不清晰(87.50%,70.00%,75.00%);后方回声衰减(85.71%,35.82%,88.88)%,不平行方位(80.39%,61.19%,72.22%)。BI-RADS分类:5类51例,癌性病变49例,占96.07%;4类25例,癌性病变20例,占80%;3类27例,恶性病变为0。结论:BI-RADS描述术语规范了报告书写,并有较高的阳性预测价值,在乳腺肿瘤的诊断中有重要作用。展开更多
文摘Rapid advances in radiologic technology and increased cross-sectional imaging have led to a sharp rise in incidental discoveries of pancreatic cystic lesions. These cystic lesions include non-neoplastic cysts with no risk of malignancy, neoplastic non-mucinous serous cystadenomas with little or no risk of malignancy, as well as neoplastic mucinous cysts and solid pseudopapillary neoplasms both with varying riskof malignancy. Accurate diagnosis is imperative as management is guided by symptoms and risk of malignancy. Endoscopic ultrasound(EUS) allows high resolution evaluation of cyst morphology and precise guidance for fine needle aspiration(FNA) of cyst fluid for cytological, chemical and molecular analysis. Initially, clinical evaluation and radiologic imaging, preferably with magnetic resonance imaging of the pancreas and magnetic resonance cholangiopancreatography, are performed. In asymptomatic patients where diagnosis is unclear and malignant risk is indeterminate, EUSFNA should be used to confirm the presence or absence of high-risk features, differentiate mucinous from non-mucinous lesions, and diagnose malignancy. After analyzing the cyst fluid for viscosity, cyst fluid carcinoembryonic antigen, amylase, and cyst wall cytology should be obtained. DNA analysis may add useful information in diagnosing mucinous cysts when the previous studies are indeterminate. New molecular biomarkers are being investigated to improve diagnostic capabilities and management decisions in these challenging cystic lesions. Current guidelines recommend surgical pancreatic resection as the standard of care for symptomatic cysts and those with high-risk features associated with malignancy. EUSguided cyst ablation is a promising minimally invasive, relatively low-risk alternative to both surgery and surveillance.
文摘Solid pseudopapillary neoplasm (SPN) is a rare and low-grade malignant pancreatic neoplasm composed of poorly cohesive monomorphic neoplastic cells forming solid and pseudopapillary structures with frequent hemorrhagic-cystic degeneration. Intraductal papillary mucinous neoplasm (IPMN) is a pancreatic exocrine tumor composed of intraductal papillary growth of mucin containing neoplastic cells in the main pancreatic duct or its major branches. In the case presented here, a 53-year-old, Japanese man was found to have multiple cystic lesions and dilatation of the main pancreatic duct in the neck of the pancreas. Histological examination revealed a main-duct and branch-duct type IPMN, of the gastric-type, involving the neck of the pancreas, associated with a 0.5 cm SPN in the caudal side of the IPMN. We diagnosed this case as synchronous SPN and IPMN. As far as we know, only one other case of synchronous SPN and IPMN has been reported. Both the present case and the previously reported case showed abnormal nuclear expression of β-catenin in SPN, whereas IPMN showed no abnormal nuclear expression. These results suggest that β-catenin abnormality is not a common pathogenetic factor of synchronous SPN and IPMN.
文摘目的:探讨超声乳腺影像报告与数据系统(Breast imaging reporting and data system,BI-RADS)在乳腺肿块诊断中的应用价值。方法:按照BI-RADS标准对103例乳腺肿块声像图进行分析,综合评估分类,与手术或组织活检病理对照分析。结果:BI-RADS描述术语中形态、方位、边缘、肿块边界、回声类型、后方声学特征、微钙化、血流分布在乳腺良、恶性肿块中有显著性差异,P<0.05;BI-RADS描述术语的阳性预测值、敏感度、特异度分别为:强回声晕(100.00%,11.94%,100.00%),肿块内部血流(92.15%,70.14%,88.88%),肿块内微钙化(91.66%,49.25%,91.66%),形态不规则(87.87%,86.56%,77.77%),边缘不清晰(87.50%,70.00%,75.00%);后方回声衰减(85.71%,35.82%,88.88)%,不平行方位(80.39%,61.19%,72.22%)。BI-RADS分类:5类51例,癌性病变49例,占96.07%;4类25例,癌性病变20例,占80%;3类27例,恶性病变为0。结论:BI-RADS描述术语规范了报告书写,并有较高的阳性预测价值,在乳腺肿瘤的诊断中有重要作用。