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Advanced endoscopic ultrasound management techniques for preneoplastic pancreatic cystic lesions

Hafiz Muhammad Sharjeel Arshad, Sheila Bharmal, Deniz Guney Duman, Suthat Liangpunsakul, Brian G Turner
DOI: 10.1136/jim-2016-000167 Published 23 December 2016
Hafiz Muhammad Sharjeel Arshad
1Department of Internal Medicine, University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, Illinois, USA
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Sheila Bharmal
2Department of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA
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Deniz Guney Duman
3Department of Gastroenterology, Marmara University, Istanbul, Turkey
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Suthat Liangpunsakul
4Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Brian G Turner
5Ohio Gastroenterology Group, Columbus, Ohio, USA
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  • Figure 1
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    Figure 1

    Gross appearance of a mucinous cystic lesion of the pancreas.

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    Figure 2

    Endoscopic ultrasound of a malignant mucinous lesion with a mass filling the cystic space. The outer wall of the cyst is indicated by the white arrow.

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    Figure 3

    Contrast-enhanced CT scan showing mucinous cystadenoma. A large cystic tumor with small cysts clustered at its periphery (arrow). (Adapted with permission from: Kim YH et al).68

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    Figure 4

    Contrast-enhanced CT scan showing branch duct IPMN. A cystic lesion can be seen with a markedly dilated side branch duct with wall thickening (arrow). (Adapted with permission from: Kim YH et al.)68 IPMN, intraductal papillary mucinous neoplasm.

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    Figure 5

    MR cholangiopancreatogram showing a lesion suspicious for IPMN. Image shows a cystic, grape-like pancreatic lesion. It is not clear whether there is a communication of the mass and the pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP) would be useful in this situation. (Adapted with permission from: Kim YH, et al.)68 IPMN, intraductal papillary mucinous neoplasm.

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    Figure 6

    Cytology slide of IPMN aspirate from EUS-FNA. An intact cluster of moderately atypical epithelial cells with a single residual mucin vacuole. Even small numbers of such atypical cells warrant a suspicion of carcinoma. EUS, endoscopic ultrasound; FNA, fine needle aspiration; IPMN, intraductal papillary mucinous neoplasm.

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    Figure 7

    EUS view of the EUS-RFA probe. EUS, endoscopic ultrasound; RFA, radiofrequency ablation.

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    Figure 8

    Schematic with a brief summary of management of cystic pancreatic lesions. CEA, carcinoembryonic antigen; EUS, endoscopic ultrasound; FNA, fine needle aspiration; MRCP, MR cholangiopancreatography.

Tables

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  • Table 1

    Comparison of preneoplastic pancreatic cysts (MCN and IPMN) with pseudocyst

    PseudocystMCNIPMN
    LocationAnywherePrimarily body and tailHead, body and tail
    EUS featuresPrimarily unilocular, anechoic or contains debrisUnilocular or oligolocularMultiple cysts communicating with pancreatic duct, dilated pancreatic duct
    Cystic fluid analysisCEALowHighHigh
    AmylaseHighUsually low but may be highHigh
    CytologyInflammatory cellsExtracellular mucin, mucinous epithelial cells and atypical cells may be seenExtracellular mucin, mucinous epithelial cells and atypical cells may be seen
    • CEA, carcinoembryonic antigen; EUS, endoscopic ultrasound; IPMN, intraductal papillary mucinous neoplasm; MCN, mucinous cystic neoplasm.

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Vol 65 Issue 1 Table of Contents
Journal of Investigative Medicine: 65 (1)
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Advanced endoscopic ultrasound management techniques for preneoplastic pancreatic cystic lesions
Hafiz Muhammad Sharjeel Arshad, Sheila Bharmal, Deniz Guney Duman, Suthat Liangpunsakul, Brian G Turner
Journal of Investigative Medicine Jan 2017, 65 (1) 7-14; DOI: 10.1136/jim-2016-000167

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Advanced endoscopic ultrasound management techniques for preneoplastic pancreatic cystic lesions
Hafiz Muhammad Sharjeel Arshad, Sheila Bharmal, Deniz Guney Duman, Suthat Liangpunsakul, Brian G Turner
Journal of Investigative Medicine Jan 2017, 65 (1) 7-14; DOI: 10.1136/jim-2016-000167
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Advanced endoscopic ultrasound management techniques for preneoplastic pancreatic cystic lesions
Hafiz Muhammad Sharjeel Arshad, Sheila Bharmal, Deniz Guney Duman, Suthat Liangpunsakul, Brian G Turner
Journal of Investigative Medicine Jan 2017, 65 (1) 7-14; DOI: 10.1136/jim-2016-000167
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