Role of Endoscopic Ultrasonography in the Management of Benign Biliopancreatic Diseases
Pancreatic cystic disease consists of about 2.5% in individuals without history of symptoms of pancreatic disease [1, 2]. Cystic pancreatic lesions encompass a varied group of pancreatic abnormalities, including inflammatory (pseudocysts), benign (serous
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words
Benign • Cystic lesions • Chronic pancreatitis • Pseudocyst drainage • Choledochoduodenostomy • Hepaticogastrostomy • Rendezvous • Cholecystoduodenostomy • Neuroendocrine tumor • Celiac plexus neurolysis • Celiac ganglion neurolysis • Celiac plexus block • Celiac ganglion block • Cholangiopancreatography • Gastroenterostomy
Diagnostic Purposes iagnostic of Pancreatic Cystic D Lesions Pancreatic cystic disease consists of about 2.5% in individuals without history of symptoms of pancreatic disease [1, 2]. Cystic pancreatic lesions encompass a varied group of pancreatic abnormalities, including inflammatory (pseudocysts), benign (serous cystadenomas [SCAs]), precancerous (mucinous cystic neoplasms [MCNs], intraductal papillary mucinous neoplasms [IPMNs], and solid and pseudopapillary epithe-
J.-H. Chen, M.D. Department of Gastroenterology and Hepatology, G-I Endoscopic Unit, Preventive Medicine Center, Taipei Tzu Chi Hospital, Taipei, Taiwan School of Medicine, Tzu Chi University, Hualien, Taiwan e-mail: [email protected]
lium neoplasm), and other entities (cystic degeneration of ductal origin pancreatic cancer or neuroendocrine carcinomas) [3–7]. The serous cystadenomas (SCAs) often reveals multiple tiny cystic lesions or honeycomb appearance on Computed Tomogram (CT) or magnetic resonance imaging (MRI) with the pathognomonic central scar or sunburst calcification in more than 20% of these lesions (Fig. 1). SCAs consists of glycogen-stained positive cuboidal epithelial cells, and more importantly seldom carries malignant potential [8]. The pancreatic mucinous cystic neoplasms (MCNs) are relatively uncommon tumors that are composed of about one-fourth of all resected pancreatic cystic neoplasms in a large surgical series [9]. This tumor (Fig. 2) is almost seen in women (>95%) and in the distal pancreas (>95%), and is always a single lesion, unlike branch-duct-type IPMNs [10–12]. Macroscopically, MCNs look as a round large mass with a fibrous fake capsule of variable thickness and frequent calcifications. Although typically unilocular, they can be m ultilocular. The
© Springer Nature Singapore Pte Ltd. 2018 K.-H. Lai et al. (eds.), Biliopancreatic Endoscopy, https://doi.org/10.1007/978-981-10-4367-3_13
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Fig. 1 (a) EUS—multiple small cystic lesions (arrow) in a hypoechoic mass. (b) CT—a low-density mass with faint sun burst lesion (arrowhead)
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Fig. 2 (a) EUS—a single cystic lesion with septa (arrow). (b) CT—a low-density mass with septum (arrowhead)
findings of internal papillary projections or excrescence and/or mural nodules correlate significantly with malignancy [13, 14]. The presence of a dense ovarian-like stroma cells surrounding the tumor and an inner epithelial layer with tall, mucin-producing cells are pathognomonic findings. The intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are potentially malignant. These neoplasms that are grossly visible (typically >10 mm) consist of mucin-producing columnar cells. The lesions appear papillary pr
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