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

No abstract available.
Adult ; Diagnosis, Differential ; Endoscopic Ultrasound-Guided Fine Needle Aspiration ; Epithelium/pathology ; Female ; Humans ; Lymphoid Tissue/pathology ; Male ; Middle Aged ; Pancreatic Cyst/*diagnosis/pathology ; Tomography, X-Ray Computed

An epidermoid cyst arising from intrapancreatic accessory spleen (ECIPAS) is a rare disease. Most patients with an ECIPAS are detected incidentally and could be misdiagnosed as a pancreatic cystic neoplasm such as mucinous cystic neoplasm (MCN) or intraductal p ancreatic mucinous neoplasm (IPMN). We described an ECIPAS with high cystic fluid carcinoembryonic antigen (CEA), which was misdiagnosed as a MCN of pancreas. Fifty one-year-old female was presented with a 2 cm sized non-enhancing pancreas cystic mass on the outside CT scan. Endoscpic ultrasonography (EUS) guided aspiration was performed. It showed a 2.3 x 1.9 cm unilocular cyst nearby 1.6 x 1.1 cm homogenous hypoechoic mass in pancreas tail, and cystic fluid CEA was 1564.18 ng/mL. On the basis of EUS results with elevated fluid CEA level, the presumptive diagnosis is likely to MCN of pancreas, and she underwent a laparoscopic distal pancreatectomy. The final pathology was the epidermal cyst in the intrapancreatic accessory spleen.
Carcinoembryonic Antigen ; Diagnosis ; Epidermal Cyst* ; Female ; Humans ; Mucins* ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Pathology ; Rare Diseases ; Spleen* ; Tomography, X-Ray Computed ; Ultrasonography

We present a case of a fetal pancreatic cyst, a rare disease in fetal life, detected prenatally at 30 weeks' gestation by ultrasound. Routine ultrasound examination at 30 weeks' gestation by primary obstetrician showed a cyst on the fetal abdomen. Initially, the suspected diagnosis was a mesenteric cyst. Subsequent ultrasound examination at weeks 32, 36 showed a fetal retroperitoneal cyst. A 3.6 kg female neonate was born to 23 yr old woman by spontaneous vaginal delivery at 38 weeks' gestation. The fetus underwent exploratory laparotomy. Histopathologic and immunohistochemical diagnosis revealed the cyst to be a pancreatic cyst. Surgical outcome was excellent. Thus, we report this case of a pancreatic cyst detected via prenatal ultrasonography.
*Ultrasonography, Prenatal ; *Prenatal Diagnosis ; Pancreatic Cyst/pathology/*ultrasonography ; Humans ; Female ; Adult

PURPOSE: Cystic pancreatic neoplasms are rare, but interesting, because of their high cure rate. With the exception of pseudocysts and serous cystadenomas, which are always benign, these cystic neoplasms are either premalignant or malignant. However, there is no reliable clinical criteria for differential diagnosis, and the treatment plan may be confusing. METHODS: From October 1994 to November 1999, 60 cases, diagnosed as a cystic neoplasm preoperatively were reviewed retrospectively. The clinical findings of benign lesions (benign group) and those for malignant or premalignant tumors (malignant group) were compared. RESULTS: The postoperative pathology results indicate 10 serous cystadenomas, 13 mucinous cystic neoplasms, 11 solid and papillary neoplasms, 10 duct ectasias, 2 cystic islet cell tumors, 1 metastatic papillary carcinoma, 1 lymphepithelial cyst, 2 simple cysts, 6 pseudocysts, and 4 retension cysts without malignancy. The mean age of the patients was 48.6 years, and the male-to-female ratio was 5 to 7. The accuracy of CT for diagnosing the malignancy of malignant tumors was 37.8% (14/37) and that of US was 22.2% (4/18). The rate of tumors having malignant potential was 71.7% (37/60). The mean size of the tumors in the benign group was smaller than that in the malignant group (p=0.014). There was a higher proportion of females in the malignant group than in the benign group (p=0.001). Heavy alcohol consumption was found more frequently in the benign group (p=0.021). There were no differences in the other clinical findings. The mortality rate of the operations was 0%, and the morbidity rate was 18%. CONCLUSION: Since it is difficult to determine the precise tumor type of a cystic pancreatic neoplasm preoperatively, all these lesions should be treated with surgical resection in order to identify and remove the malignant or premalignant neoplasms early. However, if the operative risk is high, malignant risk factors having large sized tumor, especially more than 6 cm, female, and having no history of heavy alcohol consumption may be useful for deciding the treatment plan.
Adenoma, Islet Cell ; Alcohol Drinking ; Carcinoma, Papillary ; Cystadenoma, Serous ; Diagnosis, Differential ; Dilatation, Pathologic ; Female ; Humans ; Mortality ; Mucins ; Pancreatic Cyst* ; Pancreatic Neoplasms ; Pathology ; Retrospective Studies ; Risk Factors