As the detection rate of pancreatic cystic neoplasms (PCN) increases,recommendations or guidelines for the diagnosis and treatment of PCN have been released from professional organizations.From the perspective of radiology,we compared seven guidelines in terms of general introduction,preoperative monitoring methods and strategies,stratification of risk factors,surgical indications,and postoperative follow-ups,aiming to provide references for the evaluation of images and the formulation of individualized approach for the treatment of PCN.
Humans ; Pancreatic Cyst/therapy* ; Pancreatic Neoplasms/therapy* ; Pregnenolone Carbonitrile ; Radiography ; Radiology

Pancreatic cystic neoplasms are becoming increasingly frequent, presenting a number of challenges in clinical practice. While several guidelines have been published to address these, they are largely composed of expert opinions based on relatively low-level evidence. Their recommendations are similar in general, but there are many differences in detail. Pancreatic neoplasms have differing malignant potential, based on the histologic type and clinical and radiological features of the cysts. It is necessary to stratify the malignancy risk of each cyst, using proper evaluation methods, and to manage it appropriately, with surgical resection or surveillance. In addition, risks associated with surgical resection, costs associated with long-term follow-up, and patient discomfort and anxiety must be considered in the proper management of pancreatic cystic neoplasms. In this review, we introduce four recently published guidelines.
Anxiety ; Expert Testimony ; Follow-Up Studies ; Humans ; Pancreatic Cyst ; Pancreatic Neoplasms

The increasing discovery of pancreatic cystic neoplasm is a recent trend because of the widespread use and development of imaging techniques. Physicians have to recognize the different characteristics of the cystic neoplasms so that a determination may be selected regarding the potential for malignancy. Appropriate evaluation of pancreatic cystic lesion includes a multidisciplinary approach involving gastroenterologists with experience in endoscopic ultrasound, radiologist, and pancreatic surgeons. The selective approach is important in management of this neoplasm with minimizing incorrect diagnosis and unnecessary surgery. Considering the characteristic features of pancreatic cystic neoplasm, the clinical decision should be tailored according to needs and conditions of the individual patients.
Diagnosis ; Follow-Up Studies ; Humans ; Pancreatic Cyst ; Surgeons ; Ultrasonography ; Unnecessary Procedures

The accurate diagnosis of pancreatic cystic lesions (PCLs) is important because they determine the strategy of treatment or follow-up. Endoscopic ultrasound (EUS) has been widely used in diagnosis and treatment of PCLs. EUS can be used to obtain additional information in the case of an indeterminate cyst on computed tomography or magnetic resonance imaging, or in case of showing a worrisome feature. Contrast-enhanced EUS showed highly accurate for differential diagnosing of non-neoplastic cysts from neoplastic cyst, and it also useful for distinguishing mural nodules from mucin. EUS-guided fine needle aspiration can be used to analyze cytology, chemistry, and molecular markers in cystic fluid if there is insufficient evidence for the diagnosis by non-invasive modalities. Needle-based confocal laser endomicroscopy allows real time diagnosis of PCLs with good accuracy during EUS-guided fine needle aspiration by subcellular level imaging. Through-the-needle cystoscopy or through-the-needle forceps biopsy are also attempted in these days but the evidence for its effectiveness is insufficient. EUS-guided ablation procedures are emerging as a minimally invasive therapeutic methods for unmet needs in dichotomous treatment policy for PCLs. Large long-term follow-up observational studies have been reported on the feasibility and efficacy of EUS-guided ablation for PCLs with ethanol or in combination with chemoagent. Further study for the actual treatment effects or real clinical benefit would be needed. The use of EUS in the diagnosis and treatment of PCLs is expected to make much progress in the future.
Biopsy ; Biopsy, Fine-Needle ; Chemistry ; Cystoscopy ; Diagnosis ; Endosonography ; Ethanol ; Follow-Up Studies ; Magnetic Resonance Imaging ; Mucins ; Pancreatic Cyst ; Surgical Instruments ; Ultrasonography

Pancreatic cystic neoplasm is a clinically challenging entity. Its incidence estimated up to 45% of the general population. The biological behavior ranges from benign to malignant disease. The strategy for pancreatic cystic neoplasm could be to prevent progression to pancreatic cancer while minimizing the costs. The first step for the correct management is correct diagnosis. In this paper, the radiological differential diagnosis of them will be described.
Diagnosis ; Diagnosis, Differential ; Incidence ; Pancreatic Cyst ; Pancreatic Neoplasms ; Ultrasonography

Pancreas cystic neoplasm is a relatively common disease. However, its' pathologic diagnosis is not easy. The most frequent problem is low cellularity when compared to another organ cytology or biopsy material. Considering the procedure and anatomic difficulty, it is not uncommon to observe a low cellular smear or scanty volume of cells in the biopsy specimen. In this case, the molecular pathology test, including next-generation sequencing, may be helpful. If pathologist can identify some mutation in cells or cystic fluid, differential diagnosis of cystic neoplasm may be possible. These are KRAS and GNAS, VHL, and CTNNB1 mutation in mucinous cystic neoplasm, intraductal papillary-mucinous neoplasm, serous cystic neoplasm, and solid pseudopapillary neoplasm, respectively. The next-generation sequencing is an emerging molecular test that can detect multiple biomarkers for diagnosis, including pancreas cystic neoplasm. It has been reported that next-generation sequencing test can be applied for differential diagnosis of pancreas cystic neoplasm. However, these molecular pathology tests were not all-around; it needs to be properly managed with pathologist's quality control. It should be remembered that even if it goes through quality control, it may show a failure rate of around 30%. Despite the advances in molecular methods of high techniques, it should be remembered that the most important thing in pathologic diagnosis of pancreas cystic neoplasm is an endoscopist's skill and pathologist's expertise those provide adequate specimen and accurate diagnosis.
Biomarkers ; Biopsy ; Diagnosis ; Diagnosis, Differential ; High-Throughput Nucleotide Sequencing ; Mucins ; Pancreas ; Pancreatic Cyst ; Pathology, Molecular ; Quality Control

Pancreatic injuries due to trauma in children are rare. An early diagnosis is difficult as the signs and symptoms are insidious, but delays in diagnosis can lead to significant complications. We report a case of a child who visited the emergency department with aggravating abdominal pain. The physicians first diagnosed the abdominal pain as being caused by a disease in the emergency department, but the patient was subsequently diagnosed with pancreatic injury. Clinicians should be aware of a possible trauma in children who complain of vague abdominal pain even in the absence of corresponding history.
Abdominal Pain ; Amylases ; Child ; Diagnosis ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Humans ; Lipase ; Pancreas ; Pancreatic Pseudocyst

No abstract available.
Hemorrhage ; Pancreatic Pseudocyst

The occurrence of incidentally detected pancreatic cystic lesions (PCLs) is continuously increasing. Radiologic examinations including computed tomography and magnetic resonance imaging with magnetic resonance cholangiopancreatography have been widely used as the main diagnostic and surveillance methods for patients with incidental PCLs. Although most incidentally detected PCLs are considered benign, they have the potential to become malignant. Currently, we have several guidelines for the management of incidental PCLs. However, there is still debate over proper management, in terms of accurate diagnosis, optimal follow-up interval, and imaging tools. Because imaging studies play a crucial role in the management of incidental PCLs, the 2017 consensus recommendations of the Korean Society of Abdominal Radiology for the diagnosis and surveillance of incidental PCLs approved 11 out of 16 recommendations. Although several challenges remain in terms of optimization and standardization, these consensus recommendations might serve as useful tools to provide a more standardized approach and to optimize care of patients with incidental PCLs.
Cholangiopancreatography, Magnetic Resonance ; Consensus ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Pancreas ; Pancreatic Cyst

Cystic neoplasms of the pancreas consist of a wide range of pathological entities and are being detected more frequently due to advances in cross-sectional imaging modalities and increasing numbers of periodic health checkups. The majority of pancreatic cystic neoplasms are intraductal papillary mucinous neoplasms, serous neoplasms, and mucinous cystic neoplasms, but recently, rare cases of mucinous non-neoplastic cyst of the pancreas (MNCP) have been reported, and despite the availabilities of modern imaging systems, such as MRI and CT, the differentiation of non-neoplastic and neoplastic cysts remains challenging. Herein, we report our experience of a 65-year-old male case with an MNCP.
Aged ; Humans ; Magnetic Resonance Imaging ; Male ; Mucins ; Pancreas ; Pancreatic Cyst ; Pancreatic Neoplasms