Confocal laser endomicroscopy (CLE) is a novel in vivo imaging technique that can provide real-time optical biopsies in the evaluation of pancreaticobiliary strictures and pancreatic cystic lesions (PCLs), both of which are plagued by low sensitivities of routine evaluation techniques. Compared to pathology alone, CLE is associated with a higher sensitivity and accuracy for the evaluation of indeterminate pancreaticobiliary strictures. CLE has the ability to determine the malignant potential of PCLs. As such, CLE can increase the diagnostic yield of endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, reducing the need for repeat procedures. It has been shown to be safe, with an adverse event rate of ≤1%. Published literature regarding its cost-effectiveness is needed.
Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Constriction, Pathologic ; Pancreatic Cyst ; Pathology ; Ultrasonography

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

BACKGROUND: Cystic neoplasms of pancreas comprise pathologically heterogeneous groups of tumors with many shared clinical features. Although relatively uncommon, they have a very important place in the surgical pathology of the pancreas because of their high cure rate and their potential confusion with far more common pancreatic pseudocysts. METHODS: We analysed clinical features of 23 patients with pancreatic cystic neoplasm that we treated within 8-years` period (13 women, 10 men, mean age; 47.2 years old) The cystic neoplasms of pancreas comprise 5 serous cystadenoma, 3 benign mucinous cystic tumor, 3 borderline malignancy of mucinous cystic tumor and 4 mucinous cystadenocarcinoma, 4 papillary cystic tumor, 1 cystic teratoma, 1 cystic mesothelioma, 1 lymphoepithelial cyst. 1 mucinous ductal ectasia. RESULTS: Mean tumor size was 6.8cm(3 to 15cm). 73.9 percent had abdominal pain and 26.1 percent had abdominal mass. Computed tomography, ultrasonography and MRI were useful in detecting cystic mass in all cases but was not reliable to distinguish serous from mucinous tumor, benign from malignant. For the treatment of the tumor, 17 distal pancreatectomy with splenectomy, 1 distal pancreatectomy with spleen preserving, 1 proximal pancreatic resection, 2 local excision of pancreas and 1 PPPD were performed. During the period of follow up (mean: 29 months) after surgical resection, 1 recurrence occurred in the patient who underwent local excision for mucinous cystic tumor showing borderline malignancy on histologic finding. All the patients are alive except 2 patients who were lost to follow-up. CONCLUSION: Pancreatic cystic neoplasms are rare and their prognosis are acceptable when they are treated early and properly. So early detection and surgical treatment is the mainstay of management of cystic neoplasm of pancreas.
Abdominal Pain ; Cystadenocarcinoma, Mucinous ; Cystadenoma, Serous ; Dilatation, Pathologic ; Female ; Follow-Up Studies ; Humans ; Lost to Follow-Up ; Magnetic Resonance Imaging ; Male ; Mesothelioma, Cystic ; Mucins ; Pancreas* ; Pancreatectomy ; Pancreatic Cyst ; Pancreatic Pseudocyst ; Pathology, Surgical ; Prognosis ; Recurrence ; Spleen ; Splenectomy ; Teratoma ; Ultrasonography