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Sample records for duct intraductal papillary

  1. Main-duct intraductal papillary mucinous adenoma of the pancreas

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    Takuma Kensuke

    2011-11-01

    Full Text Available Abstract Background The prevalence of carcinoma in main-duct intraductal papillary mucinous neoplasm (IPMN is high, and surgical resection is recommended for all patients with a main-duct IPMN. Results A main-duct IPMN with typical imagings including protruding lesions in the dilated main pancreatic duct was resected, but the histology was intraductal papillary mucinous adenoma of the pancreas. Discussion It has been reported that the presence of mural nodules and dilatation of MPD are significantly higher in malignant IPMNs. The presented case had protruding lesions in the dilated main pancreatic duct on endoscopic ultrasonography, but the histology was adenoma. Conclusion Preoperative distinction between benign and malignant IPMNs is difficult.

  2. Simultaneous Extensive Intraductal Papillary Neoplasm of the Bile Duct and Pancreas: A Very Rare Entity

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    Vor Luvira

    2016-01-01

    Full Text Available Intraductal papillary neoplasm of the bile duct (IPNB is a specific type of bile duct tumor. It has been proposed that it could be the biliary counterpart of the intraductal papillary neoplasm of the pancreas (IPMN-P. This hypothesis is supported by the presence of simultaneous intraductal tumors of both the bile duct and pancreas. There have been five reports of patients with simultaneous IPNB and IPMN-P. In all of these cases, biliary involvement was limited to the intrahepatic and perihilar bile duct, which had characteristics similar to IPMN-P and usually had slow progression in nature. Herein, we present the first case of extensive intraductal neoplasm involving the extrahepatic bile duct, intrahepatic bile duct, and entire length of the pancreas with a poor outcome, even after being treated aggressively with radical surgery and adjuvant chemotherapy. Additionally, we summarize previous case reports of simultaneous intraductal lesions of the bile duct and pancreas.

  3. Successful endoscopic procedures for intraductal papillary neoplasm of the bile duct:A case report

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    Kohei; Tsuchida; Michiko; Yamagata; Yasuyuki; Saifuku; Dan; Ichikawa; Kazunari; Kanke; Toshimitsu; Murohisa; Masaya; Tamano; Makoto; Iijima; Yukiko; Nemoto; Wataru; Shimoda; Toshiaki; Komori; Hirokazu; Fukui; Kazuhito; Ichikawa; Hitoshi; Sugaya; Kazuhito; Miyachi; Takahiro; Fujimori; Hideyuki; Hiraishi

    2010-01-01

    Attention has recently been focused on biliary papillary tumors as the novel disease entity intraductal papillary neoplasm of the bile duct(IPNB),which consists of papillary proliferation of dysplastic biliary epithelium.As even benign papillary tumors are considered as premalignant,some investigators recommend aggressive surgical therapy for IPNB,although no guidelines are available to manage this disease.Few reports have described long-term follow-up of patients with benign IPNB without radical resection....

  4. Heterotopic Pancreas within the Proximal Hepatic Duct, Containing Intraductal Papillary Mucinous Neoplasm

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    Alistair J. Lawrence

    2015-01-01

    Full Text Available We report a unique first case of benign heterotopic pancreas arising within the proximal hepatic bile duct, containing a focus of intraductal papillary mucinous neoplasm (IPMN. The condition was diagnosed on pathological explant after left hepatic lobectomy with total extrahepatic bile duct excision.

  5. An Intraductal Papillary Neoplasm of the Bile Duct at the Duodenal Papilla

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    Yoshiaki Kawaguchi

    2014-07-01

    Full Text Available In recent years, the disease concept of intraductal papillary neoplasm of the bile duct (IPNB has been attracting attention as a biliary lesion that is morphologically similar to intraductal papillary mucinous neoplasm (IPMN, which is considered to be a counterpart of IPMN. However, there are few reports on IPNB, and a consensus regarding the features of this disease is thus lacking. We experienced an extremely rare case of IPNB occurring in the bile duct at the duodenal papilla, which is a tumor presentation that has not previously been reported. Herein, we report this interesting case and discuss the possible association between IPMN and IPNB.

  6. Main-duct intraductal papillary mucinous neoplasm of the pancreas: a case report

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    Natalia Manetti

    2012-12-01

    Full Text Available Three distinct entities among non-inflammatory cystic lesions of the pancreas have been defined: intraductal papillary mucinous neoplasm (IPMN, serous cystic neoplasm (SCN and mucinous cystic neoplasm (MCN. IPMN is characterized by intraductal papillary growth and thick mucus secretion: its incidence has dramatically increased since its initial description. These lesions probably can progress towards invasive carcinoma. IPMNs are symptomatic in most cases: the typical presentation is a recurrent acute pancreatitis, without evident cause, of low or moderate severity. The diagnosis is usually based upon the imaging (CT/cholangio-MRI demonstrating a pancreatic cystic mass, involving a dilated main duct, eventually associated to some filling defects, or a normal Wirsung duct communicating with the cyst lesion. Surgical treatment is generally indicated for main duct IPMN and branch duct IPMN with suspected malignancy (tumour size ≥ 30 mm, mural nodules, dilated main pancreatic duct, or positive cytology or prominent symptoms. Herein we present a case of IPMN of the main duct which occurred with abdominal and back pain associated with weight loss. After the diagnosis, she successfully underwent surgery and is now in a follow-up program.

  7. Unexpected metastasis of intraductal papillary mucinous neoplasm of the bile duct into thoracic cavity with direct extension: Case report

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    Kim, Eung Tae; Heo, Jeong Nam; Park, Choong Ki [Hanyang Univ. Guri Hospital, Guri (Korea, Republic of); Choi, Yo Won; Jeon, Seok Chol [Hanyang Univ. Seoul Hospital, Seoul (Korea, Republic of)

    2012-08-15

    Intraductal papillary mucinous neoplasm (IPMN) is known to arise from intraductal proliferation of mucinous cells with findings of marked dilatation of the biliary or pancreatic duct. There are reports of the metastasis and extension of pancreatic IPMN. However, cases of biliary IPMN with direct metastasis, or metastasis to distant locations, are rare. We present a case of metastasis of biliary IPMN with unexpected direct extension into the thoracic cavity, and we attempt to account for the mechanism of this extension.

  8. Diagnostic performance of CT and MRI in distinguishing intraductal papillary neoplasm of the bile duct from cholangiocarcinoma with intraductal papillary growth

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    Liu, Yubao; Zhong, Xiaomei; Yan, Lifen; Zheng, Junhui; Liu, Zaiyi; Liang, Changhong [Guangdong Academy of Medical Sciences, Department of Radiology, Guangdong General Hospital, Guangzhou (China)

    2015-07-15

    We aimed to evaluate the diagnostic performance of CT and MRI for distinguishing intraductal papillary neoplasm of the bile duct (IPNB) from cholangiocarcinoma (CC) with intraductal papillary growth (IPG). Forty-two patients with either IPNB or CC with IPG proven by histopathology were independently reviewed in retrospect. Strict criteria for diagnosis of IPNB included presence of the designated imaging features as follows: local dilatation of the bile duct, nodule within the dilated bile duct, growing along the interior wall of bile duct. Any lesion that was not consistent with the criteria was classified as CC with IPG. Sensitivity, specificity, positive and negative predictive values for characterization of IPNB were calculated, and k test was used to assess the level of agreement. Two imaging reviewers correctly identified 21 of 26 (80.8 %) and 22 of 26 (84.6 %) IPNB cases, respectively. Alternatively, they correctly identified 14 of 16 (87.5 %) and 15 of 16 (93.8 %) CC with IPG, respectively. Agreement between the two reviewers was perfect (k = 0.81) for the diagnosis of IPNB and differentiation from CC with IPG. By using our designated diagnostic criteria of CT and MRI, IPNB can be accurately identified and possible to be distinguished from CC with IPG. (orig.)

  9. A case of undifferentiated carcinoma of the pancreas mimicking main-duct intraductal papillary mucinous neoplasm (IPMN).

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    Kawai, Yuichi; Nakamichi, Rei; Kamata, Noriko; Miyake, Hideo; Fujino, Masahiko; Itoh, Shigeki

    2015-03-01

    We report here a rare case of undifferentiated carcinoma of the pancreas mimicking main-duct intraductal papillary mucinous neoplasm. In an 80-year-old woman, an approximately 8-mm papillary mass was incidentally detected at the downstream edge of a dilatated main pancreatic duct lumen on CT and MRI. Main pancreatic duct dilatation in the pancreatic body and tail and parenchymal atrophy were observed in the upstream of the mass. Histopathologically, the tumor protruded into the downstream edge of the dilatated main pancreatic duct lumen in the pancreatic body. The tumor cells had highly atypical nuclei and abundant polymorphic structures, and showed positive staining for granulocyte colony-stimulating factor, which led to the diagnosis of undifferentiated carcinoma. A total of 13 cases of undifferentiated carcinoma with intraductal tumor growth have been reported to date. The case report by Bergmann et al. has been the smallest in histopathological specimen, and the present case is the smallest in size detected by radiological images. Since early undifferentiated carcinoma of the pancreas can resemble those of main-duct intraductal papillary mucinous neoplasm in cross-sectional images, we have to consider undifferentiated carcinoma in the differential diagnosis of the solitary and papillary mass with low contrast enhancement in early phase in the main pancreatic duct.

  10. Small invasive ductal carcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm

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    Hiroki Sakamoto; Masayuki Kitano; Takamitsu Komaki; Hajime Imai; Ken Kamata; Masatomo Kimura; Yoshifumi Takeyama; Masatoshi Kudo

    2009-01-01

    Endoscopic ultrasonography (EUS) is a highly sensitive diagnostic method for the detection of small pancreatic carcinomas.Recently, there have been some reports describing the utility of contrast-enhanced harmonic EUS (CEH-EUS) which uses sonographic contrast agent for differentiation of a pancreatic mass.This report describes a case of small adenocarcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm (IPMN) in which investigation by EUS took place every 6 mo and diagnosis was made accurately by additional CEH-EUS during the followup of the branch duct IPMN.A 68-year-old female was admitted to our hospital because of a branch duct IPMN in the pancreatic body.She had been followedup by EUS every 6 mo.However, after 2 years EUS demonstrated a low echoic area distinct from the branch duct IPMN which was vaguely discernible by EUS, and accurate sizing and differential diagnosis were considered difficult on the EUS imaging.CHEUS with Sonazoid revealed a hypovascular tumor and we suspected small pancreatic carcinoma.The histopathological diagnosis was adenocarcinoma (10 mm) in the pancreatic tail, distinct from the branch duct IPMN of the pancreatic body.EUS and CEH-EUS may play an important role in the correct diagnosis of small pancreatic tumors, including synchronous and metachronous occurrence of IPMN and ductal adenocarcinoma of the pancreas.

  11. Mucin-hypersecreting bile duct neoplasm characterized by clinicopathological resemblance to intraductal papillary mucinous neoplasm (IPMN of the pancreas

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    Harimoto Norifumi

    2007-08-01

    Full Text Available Abstract Background Although intraductal papillary mucinous neoplasm (IPMN of the pancreas is acceptable as a distinct disease entity, the concept of mucin-secreting biliary tumors has not been fully established. Case presentation We describe herein a case of mucin secreting biliary neoplasm. Imaging revealed a cystic lesion 2 cm in diameter at the left lateral segment of the liver. Duodenal endoscopy revealed mucin secretion through an enlarged papilla of Vater. On the cholangiogram, the cystic lesion communicated with bile duct, and large filling defects caused by mucin were observed in the dilated common bile duct. This lesion was diagnosed as a mucin-secreting bile duct tumor. Left and caudate lobectomy of the liver with extrahepatic bile duct resection and reconstruction was performed according to the possibility of the tumor's malignant behavior. Histological examination of the specimen revealed biliary cystic wall was covered by micropapillary neoplastic epithelium with mucin secretion lacking stromal invasion nor ovarian-like stroma. The patient has remained well with no evidence of recurrence for 38 months since her operation. Conclusion It is only recently that the term "intraductal papillary mucinous neoplasm (IPMN," which is accepted as a distinct disease entity of the pancreas, has begun to be used for mucin-secreting bile duct tumor. This case also seemed to be intraductal papillary neoplasm with prominent cystic dilatation of the bile duct.

  12. A Rare Case of Intraductal Papillary Mucinous Neoplasm of the Biliary Duct in a Patient with Prostate Adenocarcinoma

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    Ravish Parekh

    2016-12-01

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs are mucin-producing papillary neoplasms of the pancreatic or biliary ductal system that exhibit variable cellular atypia and cause ductal dilation. There are few reported cases of IPMN arising from the biliary tree in the literature. It has a higher propensity to undergo malignant transformation compared to IPMN arising from the pancreatic duct. An 80-year-old male underwent cross-sectional tomography (CT imaging of the abdomen for evaluation of prostate adenocarcinoma, which revealed an incidental 2.3 × 2.7 cm soft tissue mass centered at the porta hepatis with diffuse dilatation of the left intrahepatic biliary ductal system and mild prominence of the right intrahepatic ductal system. Endoscopic ultrasound showed 2 adjacent hilar masses involving the common hepatic duct and the left hepatic duct with protrusion of the tissue into the lumen of the duct and upstream ductal dilatation. Endoscopic retrograde cholangiopancreatography revealed a large filling defect in the common hepatic duct extending into the left hepatic duct. A large amount of clot and soft tissue with a fish-egg appearance was retrieved. The patient underwent left hepatic lobectomy, radical resection of the common hepatic duct with Roux-en-Y hepaticojejunostomy to the right hepatic duct. Histopathological examination of the resected specimen revealed intraductal papillary mucinous neoplasm with diffuse high-grade dysplasia. Follow-up CT scan of the abdomen 2 months after the surgery was negative for any masses.

  13. A Rare Case of Intraductal Papillary Mucinous Neoplasm of the Biliary Duct in a Patient with Prostate Adenocarcinoma

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    Parekh, Ravish; Krol, Gregory; Piraka, Cyrus; Batra, Surinder

    2016-01-01

    Intraductal papillary mucinous neoplasms (IPMNs) are mucin-producing papillary neoplasms of the pancreatic or biliary ductal system that exhibit variable cellular atypia and cause ductal dilation. There are few reported cases of IPMN arising from the biliary tree in the literature. It has a higher propensity to undergo malignant transformation compared to IPMN arising from the pancreatic duct. An 80-year-old male underwent cross-sectional tomography (CT) imaging of the abdomen for evaluation of prostate adenocarcinoma, which revealed an incidental 2.3 × 2.7 cm soft tissue mass centered at the porta hepatis with diffuse dilatation of the left intrahepatic biliary ductal system and mild prominence of the right intrahepatic ductal system. Endoscopic ultrasound showed 2 adjacent hilar masses involving the common hepatic duct and the left hepatic duct with protrusion of the tissue into the lumen of the duct and upstream ductal dilatation. Endoscopic retrograde cholangiopancreatography revealed a large filling defect in the common hepatic duct extending into the left hepatic duct. A large amount of clot and soft tissue with a fish-egg appearance was retrieved. The patient underwent left hepatic lobectomy, radical resection of the common hepatic duct with Roux-en-Y hepaticojejunostomy to the right hepatic duct. Histopathological examination of the resected specimen revealed intraductal papillary mucinous neoplasm with diffuse high-grade dysplasia. Follow-up CT scan of the abdomen 2 months after the surgery was negative for any masses. PMID:28100995

  14. GNAS and KRAS mutations are common in intraductal papillary neoplasms of the bile duct.

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    Motoko Sasaki

    Full Text Available Intraductal papillary neoplasms of the bile duct (IPNB shows favorable prognosis and is regarded as a biliary counterpart of intraductal papillary mucinous neoplasm (IPMN of the pancreas. Although activating point mutations of GNAS at codon 201 have been detected in approximately two thirds of IPMNs of the pancreas, there have been few studies on GNAS mutations in IPNBs. This study investigates the status of GNAS and KRAS mutations and their association with clinicopathological factors in IPNBs. We examined the status of GNAS mutation at codon 201 and KRAS mutation at codon 12&13, degree of mucin production and immunohistochemical expressions of MUC mucin core proteins in 29 patients (M/F = 15/14 with IPNB in intrahepatic and perihilar bile ducts (perihilar IPNB and 6 patients (M/F = 5/1 with IPNB in distal bile ducts (distal IPNB. GNAS mutations and KRAS mutations were detected in 50% and 46.2% of IPNBs, respectively. There was no significant correlation between the status of GNAS mutation and clinicopathological factors in IPNBs, whereas, the status of KRAS mutation was significantly inversely correlated with the degree of MUC2 expression in IPNBs (p<0.05. All IPNBs with GNAS mutation only showed high-mucin production. Degree of mucin production was significantly higher in perihilar IPNBs than distal IPNBs (p<0.05. MUC2 and MUC5AC expression was significantly higher in IPNBs with high-mucin production than those with low-mucin production (p<0.01 and p<0.05, respectively. In conclusions, this study firstly disclosed frequent GNAS mutations in IPNBs, similarly to IPMNs. This may suggest a common histopathogenesis of IPNBs and IPMNs. The status of KRAS mutations was inversely correlated to MUC2 expression and this may suggest heterogeneous properties of IPNBs. IPNBs with high-mucin production are characterized by perihilar location and high expression of MUC2 and MUC5AC, irrespective of the status of GNAS and KRAS mutations.

  15. Does preoperative cross-sectional imaging accurately predict main duct involvement in intraductal papillary mucinous neoplasm?

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    Barron, M R; Roch, A M; Waters, J A; Parikh, J A; DeWitt, J M; Al-Haddad, M A; Ceppa, E P; House, M G; Zyromski, N J; Nakeeb, A; Pitt, H A; Schmidt, C Max

    2014-03-01

    Main pancreatic duct (MPD) involvement is a well-demonstrated risk factor for malignancy in intraductal papillary mucinous neoplasm (IPMN). Preoperative radiographic determination of IPMN type is heavily relied upon in oncologic risk stratification. We hypothesized that radiographic assessment of MPD involvement in IPMN is an accurate predictor of pathological MPD involvement. Data regarding all patients undergoing resection for IPMN at a single academic institution between 1992 and 2012 were gathered prospectively. Retrospective analysis of imaging and pathologic data was undertaken. Preoperative classification of IPMN type was based on cross-sectional imaging (MRI/magnetic resonance cholangiopancreatography (MRCP) and/or CT). Three hundred sixty-two patients underwent resection for IPMN. Of these, 334 had complete data for analysis. Of 164 suspected branch duct (BD) IPMN, 34 (20.7%) demonstrated MPD involvement on final pathology. Of 170 patients with suspicion of MPD involvement, 50 (29.4%) demonstrated no MPD involvement. Of 34 patients with suspected BD-IPMN who were found to have MPD involvement on pathology, 10 (29.4%) had invasive carcinoma. Alternatively, 2/50 (4%) of the patients with suspected MPD involvement who ultimately had isolated BD-IPMN demonstrated invasive carcinoma. Preoperative radiographic IPMN type did not correlate with final pathology in 25% of the patients. In addition, risk of invasive carcinoma correlates with pathologic presence of MPD involvement.

  16. A huge intraductal papillary mucinous carcinoma of the bile duct treated by right trisectionectomy with caudate lobectomy

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    Jo Sungho

    2009-12-01

    Full Text Available Abstract Background Because intraductal papillary mucinous neoplasm of the bile duct (IPMN-B is believed to show a better clinical course than non-papillary biliary neoplasms, it is important to make a precise diagnosis and to perform complete surgical resection. Case presentation We herein report a case of malignant IPMN-B treated by right trisectionectomy with caudate lobectomy and extrahepatic bile duct resection. Radiologic images showed marked dilatation of the left medial sectional bile duct (B4 resulting in a bulky cystic mass with multiple internal papillary projections. Duodenal endoscopic examination demonstrated very patulous ampullary orifice with mucin expulsion and endoscopic retrograde cholangiogram confirmed marked cystic dilatation of B4 with luminal filling defects. These findings suggested IPMN-B with malignancy potential. The functional volume of the left lateral section was estimated to be 45%. A planned extensive surgery was successfully performed. The remnant bile ducts were also dilated but had no macroscopic intraluminal tumorous lesion. The histopathological examination yielded the diagnosis of mucin-producing oncocytic intraductal papillary carcinoma of the bile duct with poorly differentiated carcinomas showing neuroendocrine differentiation. The tumor was 14.0 × 13.0 cm-sized and revealed no stromal invasiveness. Resection margins of the proximal bile duct and hepatic parenchyma were free of tumor cell. The patient showed no postoperative complication and was discharged on 10th postoperative date. He has been regularly followed at outpatient department with no evidence of recurrence. Conclusion Considering a favorable prognosis of IPMN-B compared to non-papillary biliary neoplasms, this tumor can be a good indication for aggressive surgical resection regardless of its tumor size.

  17. A large mural nodule in branch duct intraductal papillary mucinous adenoma of the pancreas: a case report.

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    Haruki, Koichiro; Wakiyama, Shigeki; Futagawa, Yasuro; Shiba, Hiroaki; Misawa, Takeyuki; Yanaga, Katsuhiko

    2015-12-01

    Indications for resection of branch duct intraductal papillary mucinous neoplasms (IPMNs) remain controversial because of their low tendency to be malignant. Surgical resection should be recommended if any factors indicating malignancy are present. However, preoperative differentiation between benign and malignant tumors is very difficult, especially in cases of branch duct IPMNs. We herein report a case of branch duct intraductal papillary mucinous adenoma (IPMA) of the pancreas with a large mural nodule of 25 mm. A 74-year-old woman was admitted for examination and treatment for a cystic tumor in the head of the pancreas. Magnetic resonance cholangiopancreatography and computed tomography showed a cystic lesion, 50 mm in diameter, with an irregular mural nodule in the pancreatic head. Endoscopic ultrasonography demonstrated a multicystic tumor connected with the main pancreatic duct (MPD). The mural nodule had a diameter of 18 mm, and the MPD had a slight dilation of 6 mm. These findings suggested a high potential for malignancy. The patient underwent pancreaticoduodenectomy with lymph node dissection. The excised pancreas showed multiple cysts located in the branch pancreatic duct with a maximum diameter of 75 mm. The mural nodule had a maximum diameter of 25 mm. The tumor was diagnosed as an IPMA by pathological examination. After operation, the patient was discharged without any complications. Two years after resection, the patient remains in remission with no evidence of tumor recurrence.

  18. Intraductal Papillary-Mucinous Neoplasm of the Pancreas Penetrating to the Stomach and the Common Bile Duct

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    Norihiro Goto

    2012-01-01

    Full Text Available Context Intraductal papillary mucinous neoplasm (IPMN of the pancreas occasionally penetrates to others organs. We present a case of IPMN penetrating to the stomach and the common bile duct. Case report A 75-year-old man was admitted to the hospital because of epigastric pain. Computed tomography (CT showed a papillary tumor protruding into the markedly dilated main pancreatic duct and splenic vein obstruction. The tumor was diagnosed as IPMN arising in the main duct, but he rejected surgery and he was followed without treatment. One year later, gastroduodenoscopy revealed gastropancreatic fistula and we were able to pass an endoscope through the fistula and directly examine the lumen of the main pancreatic duct and the papillary tumor adjacent to the fistula. Absence of malignant cells on histopathology suggested mechanical penetration rather than invasive penetration. CT showed splenic vein reperfusion due to decreased inner pressure of the main pancreatic duct. Two and a half years later, CT revealed biliopancreatic fistula formation. Endoscope biliary drainage was performed but failed. Despite jaundice, he is still ambulatory and seen in the clinic three years after the first admission. Conclusions We have experienced a case of IPMN penetrating to the stomach and the common bile duct that has taken a slow course. It represents the importance of distinguishing mechanical penetration from invasive penetration as well as mechanical splenic vein obstruction from splenic vein invasion.

  19. Small-Sized, Flat-Type Invasive Branch Duct Intraductal Papillary Mucinous Neoplasm: A Case Report

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    Koji Shindo

    2013-10-01

    Full Text Available Recent improvements in diagnostic modalities are increasing the frequency of detection of small-sized branch duct intraductal papillary mucinous neoplasms (BD-IPMNs. International consensus guidelines for IPMN recommend surveillance without immediate resection for small-sized (<3 cm BD-IPMNs without malignant features on imaging. Our patient is the first to have undergone resection of a small-sized BD-IPMN containing invasive cancer, but without malignant features on imaging. We herein report a case involving a 70-year-old man with a small cystic lesion in the pancreas head detected by health screening ultrasonography. Detailed examination revealed that the cystic lesion was a BD-IPMN measuring about 2 cm, with no malignant features. However, cytological examination of the pancreatic juice showed atypical cells with high-grade dysplasia storing intracytoplasmic mucin, indicating malignant BD-IPMN. Pathological examination of the resected specimen showed a BD-IPMN measuring 16 mm with an associated invasive carcinoma that invaded the pancreatic parenchyma over a distance of 11 mm. In this patient, invasive cancer was present within a small BD-IPMN with no high-risk stigmata on imaging. Cytological examination of the pancreatic juice allowed for the detection of pancreatic cancer in such a small-sized IPMN. Although routine endoscopic retrograde cholangiopancreatography (ERCP with cytology is not recommended in all patients with BD-IPMNs, ERCP may contribute to the detection of small pancreatic cancers in select cases. Accumulation of cases of pancreatic cancer within small BD-IPMNs may help establish the indications for ERCP with cytological examination for the purpose of early detection of small pancreatic cancer.

  20. Experience of limited pancreatic head resection for management of branch duct intraductal papillary mucinous neoplasm in a single center

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    Kwang Yeol Paik; Seong Ho Choi

    2009-01-01

    AIM: To share our surgical experience and the outcome of limited pancreatic head resection for the management of branch duct intraductal papillary mucinous neoplasm (IPMN). METHODS: Between May 2005 and February 2008, nine limited pancreatic head resections (LPHR) were performed for IPMN of the pancreatic head. We reviewed the nine patients, retrospectively. RESULTS: Tumor was located in the uncinate process of the pancreas in all nine patients. Three patients had stents inserted in the main pancreatic duct due to injury. The mean size of tumor was 28.4 mm. Postoperative complications were found in five patients: 3 pancreatic leakages, a pancreatitis, and a duodenal stricture. Pancreatic leakages were improved by external drainage. No perioperative mortality was observed and all patients are recorded alive during the mean follow-up period of 17.2 mo. CONCLUSION: In selected patients after careful evaluation, LPHR can be used for the treatment of branch duct type IPMN. In order to avoid pancreatic ductal injury, pre- and intra-operative definite localization and careful operative techniques are required.

  1. CT and MR imaging of multilocular acinar cell cystadenoma: comparison with branch duct intraductal papillary mucinous neoplasia (IPMNs)

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    Delavaud, Christophe; Assignies, Gaspard d' ; Vilgrain, Valerie; Vullierme, Marie-Pierre [Hopital Beaujon, Service de Radiologie, Clichy (France); Cros, Jerome [Hopital Beaujon, Service d' Anatomopathologie, Clichy (France); Ruszniewski, Philippe; Hammel, Pascal; Levy, Philippe [Hopital Beaujon, Service de Pancreato-Gastro-Enterologie, Clichy (France); Couvelard, Anne [Hopital Bichat, Service d' Anatomopathologie, Paris (France); Sauvanet, Alain; Dokmak, Safi [Hopital Beaujon, Service de Chirurgie Hepato-Pancreato-Biliaire, Clichy (France)

    2014-09-15

    To describe CT and MR imaging findings of acinar cell cystadenoma (ACC) of the pancreas and to compare them with those of branch duct intraductal papillary mucinous neoplasia (BD-IPMN) to identify distinctive elements. Five patients with ACC and the 20 consecutive patients with histologically proven BD-IPMN were retrospectively included. Clinical and biological information was collected and histological data reviewed. CT and MR findings were analysed blinded to pathological diagnosis in order to identify imaging diagnostic criteria of ACC. Patients with ACC were symptomatic in all but one case and were younger than those with BD-IPMN (p = 0.006). Four radiological criteria allowed for differentiating ACC from IPMN: five or more cysts, clustered peripheral small cysts, presence of cyst calcifications and absence of communication with the main pancreatic duct (p < 0.05). Presence of at least two or three of these imaging criteria had a strong diagnostic value for ACC with a sensitivity of 100 % and 80 % and a specificity of 85 % and 100 %, respectively. Preoperative differential diagnosis between ACC and BD-IPMN can be achieved using a combination of four CT and/or MR imaging criteria. Recognition of ACC patients could change patient management and lead to more conservative treatment. (orig.)

  2. The laparoscopic enucleation for branch duct type intraductal papillary mucinous neoplasms located at the body of pancreas: A case report

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    Stevanović Dejan

    2015-01-01

    Full Text Available Introduction. Intraductal papillary mucinous neoplasms (IPMN are among the most common cystic neoplasms of the pancreas, but they represent only 1-3% of all exocrine pancreas tumors. With the development of diagnostic possibilities the number of patients with IPMN is constantly increasing and represents approximately 20% of all surgically treated pancreatic tumors. The development of laparoscopic surgery has led to advances in the treatment of cystic tumors of the pancreas with the emergence of new surgical dilemma in the choice of surgical techniques in patients with IPMN. Case Outline. A 23-year-old patient was admitted to the hospital with non-specific symptoms of upper abdomen. Performed diagnostics indicated the existence of a tumor formation at the periphery of the pancreas, in the region of the proximal corpus, 8Ч5 cm in diameter. The cystic formation, wall thickness 3 mm, was filled with dense contents and injected into the tissue of the pancreas, but did not lead to an extension of the pancreatic duct. After adequate preoperative preparation the patient was operated on, when a laparoscopic enucleation of cystic tumor with coagulation and cutting off communication between the peripheral pancreatic duct and pancreatic tumors was performed by using ultrasound scissors. Histopathological analysis of the specimen indicated an IPMN of the branch duct type (BD-IPMN with a low grade dysplasia. The line of resection was without cellular atypia. Immunohistochemical analysis showed positivity on tumor mucins (MUC-5 and MUC-2, which is typical for gastric type of BD-IPMN. Six months postoperatively the patient showed no signs of recurrence of the disease. Conclusion. Surgical treatment is the dominant choice for the treatment for IPMN. Although minimally invasive, laparoscopic enucleation of BD-IPMN is able to achieve an adequate level of radicality without the accompanying complications and with short postoperative recovery period.

  3. Evolution of incidental branch-duct intraductal papillary mucinous neoplasms of the pancreas: A study with magnetic resonance imaging cholangiopancreatography

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    Girometti, Rossano; Pravisani, Riccardo; Intini, Sergio Giuseppe; Isola, Miriam; Cereser, Lorenzo; Risaliti, Andrea; Zuiani, Chiara

    2016-01-01

    AIM To investigate the type and timing of evolution of incidentally found branch-duct intraductal papillary mucinous neoplasms (bd-IPMN) of the pancreas addressed to magnetic resonance imaging cholangiopancreatography (MRCP) follow-up. METHODS We retrospectively evaluated 72 patients who underwent, over the period 2006-2016, a total of 318 MRCPs (mean 4.4) to follow-up incidental, presumed bd-IPMN without signs of malignancy, found or confirmed at a baseline MRCP examination. Median follow-up time was 48.5 mo (range 13-95 mo). MRCPs were acquired on 1.5T and/or 3.0T systems using 2D and/or 3D technique. Image analysis assessed the rates of occurrence over the follow-up of the following outcomes: (1) imaging evolution, defined as any change in cysts number and/or size and/or appearance; and (2) alert findings, defined as worrisome features and/or high risk stigmata (e.g., thick septa, parietal thickening, mural nodules and involvement of the main pancreatic duct). Time to outcomes was described with the Kaplan-Meir approach. Cox regression model was used to investigate clinical or initial MRCP findings predicting cysts changes. RESULTS We found a total of 343 cysts (per-patient mean 5.1) with average size of 8.5 mm (range 5-25 mm). Imaging evolution was observed in 32/72 patients (44.4%; 95%CI: 32-9-56.6), involving 47/343 cysts (13.7%). There was a main trend towards small (IPMN appearance (P > 0.01). CONCLUSION Changes in MRCP appearance of incidental bd-IPNM were frequent over the follow-up (44.4%), with relatively rare (8.3%) occurrence of non-malignant alert findings that prompted further diagnostic steps. Changes occurred at a wide interval of time and were unpredictable, suggesting that imaging follow-up should be not discontinued, though MRCPs might be considerably delayed without a significant risk of missing malignancy. PMID:27920477

  4. [Intraductal papillary mucinous neoplasm of the pancreas, IPMN].

    Science.gov (United States)

    Sirén, Jukka

    2013-01-01

    With the development and increasing use of imaging techniques, intraductal papillary mucinous neoplasm (IPMN) is being detected with increasing frequency. Two forms of the disease are distinguished, the rare main duct form and the common accessory pancreatic duct form. The former often progresses to malignancy, the latter only seldom. The mixed form of IPMN exhibits features of both forms. In main duct IPMN, mucin production obstructs the pancreatic duct causing its dilatation and often symptoms typical of chronic pancreatitis. Main duct IPMN is always an indication for surgery, whereas monitoring is often sufficient for side duct IPMN.

  5. Risk Factors for Progression or Malignancy in Main-Duct and Mixed-Type Intraductal Papillary Mucinous Neoplasm of the Pancreas.

    Science.gov (United States)

    Jang, Dong Kee; Ryu, Ji Kon; Chung, Kwang Hyun; Lee, Ban Seok; Park, Joo Kyung; Lee, Sang Hyub; Kim, Yong-Tae

    2016-08-01

    The 2012 international guidelines state that surgery should be considered for all surgically fit patients with pancreatic main-duct (MD)/mixed intraductal papillary mucinous neoplasms (IPMNs). This study evaluated the follow-up results of MD/mixed IPMNs and risk factors for progression or malignancy. Patients with MD/mixed IPMNs were retrospectively enrolled and divided into surgical and nonsurgical groups. These 2 groups were compared and further categorized as progression/malignancy or not. In the nonsurgical group, disease progression was defined as radiologic tumor growth or adjacent organ invasion. Data from 101 patients (73 males; mean [SD] age, 66.3 [9.1] years), including 27 and 74 in the nonsurgical and surgical groups, respectively, were analyzed. Mural nodules were more frequently detected in the surgical group (7.4% vs 31.1%, P = 0.018), whereas more multifocal cysts were observed in the nonsurgical group (40.7% vs 20.3%, P = 0.037). Forty-one patients (40.6%) showed progression or malignancy. Multivariate analysis showed that main pancreatic duct of 10 mm or greater (odds ratio, 4.368; P = 0.024) and pre-existing diabetes (odds ratio, 3.077; P = 0.046) were independent risk factors for progression or malignancy. A watchful waiting strategy could be feasible for some patients with MD/mixed IPMNs, particularly those with a main pancreatic duct of less than 10 mm and without diabetes.

  6. Cytological analysis of small branch-duct intraductal papillary mucinous neoplasms provides a more accurate risk assessment of malignancy than symptoms

    Directory of Open Access Journals (Sweden)

    Jill Ono

    2011-01-01

    Full Text Available Objectives: The Sendai guidelines for management of patients with clinically suspected intraductal papillary mucinous neoplasms (IPMN recommend resection of cysts > 30 mm, a dilated main pancreatic duct (MPD > 6 mm, a mural nodule (MN, symptoms or positive cytology. Although sensitive, asymptomatic cysts, nonspecific symptoms, and a high threshold for positive cytology limit the specificity of the guidelines. We have assessed the value of cytology relative to symptom for predicting malignancy in IPMNs without high-risk imaging features. Materials and Methods: We retrospectively reviewed the clinical, radiological, and cytological data of 31 small branch-duct IPMNs without a MN. The cytological presence of high-grade atypical epithelial cells (HGA was considered true positive, with a corresponding histology of high-grade dysplasia or invasive carcinoma. The performance of cytology versus symptoms was evaluated by calculating the sensitivity, specificity, negative predictive value (NPV, positive predictive value (PPV, and accuracy. Results: The sensitivity (0.80, specificity (0.85, and accuracy (0.84 of HGA were higher than the corresponding performance characteristics of symptoms (0.60, 0.45, and 0.48, respectively. The NPV of no HGA on cytology was > 95%. Conclusions: Cytology is a better predictor of malignancy than symptoms, for the conservative management of small branch-duct IPMNs. Cytology contributes to a highly accurate triple negative test for malignancy in small IPMN: No dilated MPD, MN or HGA.

  7. Intraductal papillary mucinous neoplasm of pancreas

    Directory of Open Access Journals (Sweden)

    Norman Oneil Machado

    2015-01-01

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs of the pancreas are neoplasms that are characterized by ductal dilation, intraductal papillary growth, and thick mucus secretion. This relatively recently defined pathology is evolving in terms of its etiopathogenesis, clinical features, diagnosis, management, and treatment guidelines. A PubMed database search was performed. All the relevant abstracts in English language were reviewed and the articles in which cases of IPMN could be identified were further scrutinized. Information of IPMN was derived, and duplication of information in several articles and those with areas of persisting uncertainties were excluded. The recent consensus guidelines were examined. The reported incidence of malignancy varies from 57% to 92% in the main duct-IPMN (MD-IPMN and from 6% to 46% in the branch duct-IPMN (BD-IPMN. The features of high-risk malignant lesions that raise concern include obstructive jaundice in a patient with a cystic lesion in the pancreatic head, the findings on radiological imaging of a mass lesion of >30 mm, enhanced solid component, and the main pancreatic duct (MPD of size ≥10 mm; while duct size 5-9 mm and cyst size <3 mm are considered as "worrisome features." Magnetic resonance imaging (MRI and endoscopic ultrasound (EUS are primary investigations in diagnosing and following up on these patients. The role of pancreatoscopy and the analysis of aspirated cystic fluid for cytology and DNA analysis is still to be established. In general, resection is recommended for most MD-IPMN, mixed variant, and symptomatic BD-IPMN. The 5-year survival of patients after surgical resection for noninvasive IPMN is reported to be at 77-100%, while for those with invasive carcinoma, it is significantly lower at 27-60%. The follow-up of these patients could vary from 6 months to 1 year and would depend on the risk stratification for invasive malignancy and the pathology of the resected specimen. The

  8. Confocal Endomicroscopy Characteristics of Different Intraductal Papillary Mucinous Neoplasm Subtypes.

    Science.gov (United States)

    Kamboj, Amrit K; Dewitt, John M; Modi, Rohan M; Conwell, Darwin L; Krishna, Somashekar G

    2017-05-01

    Intraductal papillary mucinous neoplasms are classified into gastric, intestinal, pancreatobiliary, and oncocytic subtypes where morphology portends disease prognosis. The study aim was to demonstrate EUS-guided needle-based confocal laser endomicroscopy imaging features of intraductal papillary mucinous neoplasm subtypes. Four subjects, each with a specific intraductal papillary mucinous neoplasm subtype were enrolled. An EUS-guided needle-based confocal laser endomicroscopy miniprobe was utilized for image acquisition. The mean cyst size from the 4 subjects (2 females; mean age = 65.3±12 years) was 36.8±12 mm. All lesions demonstrated mural nodules and focal dilation of the main pancreatic duct. EUS-nCLE demonstrated characteristic finger-like papillae with inner vascular core for all subtypes. The image patterns of the papillae for the gastric, intestinal, and pancreatobiliary subtypes were similar. However, the papillae in the oncocytic subtype were thick and demonstrated a fine scale-like or honeycomb pattern with intraepithelial lumina correlating with histopathology. There was significant overlap in the needle-based confocal laser endomicroscopy findings for the different intraductal papillary mucinous neoplasm subtypes; however, the oncocytic subtype demonstrated distinct patterns. These findings need to be replicated in larger multicenter studies.

  9. Intraductal Oncocytic Papillary Neoplasms of the Pancreas.

    Science.gov (United States)

    Kallen, Michael E; Naini, Bita V

    2016-09-01

    Intraductal oncocytic papillary neoplasms (IOPNs) are cystic neoplasms with intraductal growth and complex papillae composed of oncocytic cells. IOPNs have been reported both in the pancreas and biliary tree, and are most likely closely related in these 2 locations. In the pancreas, these rare tumors are now considered 1 of the 4 histologic subtypes of intraductal papillary mucinous neoplasm (IPMN). Significant differences in histology, immunophenotype, and molecular genetics have been reported between IOPNs and other IPMN subtypes. However, there are limited data regarding the clinical behavior and prognosis of IOPNs in comparison to other subtypes of IPMN. We review features of pancreatic IOPNs and discuss the differential diagnosis of other intraductal lesions in the pancreas.

  10. [Intraductal papillary mucinous pancreas tumor].

    Science.gov (United States)

    Maev, I V; Kaziulin, A N; Kucheriavyĭ, Iu A

    2008-01-01

    Data of the literature on the epidemiology, patogenesis, diagnosis, peculiarities of the symptoms and the treatment of the intraduct papillar pancreatic tumor, are analyzed in this review. These tumors are rare, there are up to 1% of the exocrine pancreatic tumors. Intraduct proliferation of the mucin producing cells, that are disposed as papillars is typical of these tumors. There are the symptoms of the acute or chronic pancreatitis, sometimes the diagnosis of this tumor is accidental. The main diagnostic methods are ultrasound (US) and computed tomography (CT). Endoluminal ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) are the main methods to reveal the intraduct growth. The surgical treatment is necessary for these patients.

  11. Deep sequencing of cancer-related genes revealed GNAS mutations to be associated with intraductal papillary mucinous neoplasms and its main pancreatic duct dilation.

    Directory of Open Access Journals (Sweden)

    Shinichi Takano

    Full Text Available BACKGROUND: To clarify the genetic mutations associated with intraductal papillary mucinous neoplasms (IPMN and IPMN-related pancreatic tumours, we conducted cancer-related gene profiling analyses using pure pancreatic juice and resected pancreatic tissues. METHODS: Pure pancreatic juice was collected from 152 patients [nine with a normal pancreas, 22 with chronic pancreatitis (CP, 39 with pancreatic ductal adenocarcinoma (PDAC, and 82 with IPMN], and resected tissues from the pancreas were collected from 48 patients (six IPMNs and 42 PDACs. The extracted DNA was amplified by multiplexed polymerase chain reaction (PCR targeting 46 cancer-related genes containing 739 mutational hotspots. The mutations were analysed using a semiconductor-based DNA sequencer. RESULTS: Among the 46 cancer-related genes, KRAS and GNAS mutations were most frequently detected in both PDAC and IPMN cases. In pure pancreatic juice, GNAS mutations were detected in 7.7% of PDAC cases and 41.5% of IPMN cases (p<0.001 vs. others. All PDAC cases with GNAS mutations (n = 3 were accompanied by IPMN. Multivariate analysis revealed that GNAS mutations in IPMN cases were associated with dilated main pancreatic ducts (MPD, p = 0.016, while no statistically independent associations with clinical variables were observed for KRAS mutations. In the resected pancreatic tissues, GNAS mutations were detected in 50% of PDAC cases concomitant with IPMN, 33.3% of PDAC cases derived from IPMN, and 66.7% of IPMN cases, while no GNAS mutations were detected in cases of PDAC without IPMN. CONCLUSIONS: The GNAS mutation was specifically found in the cases with IPMN and it was speculated that some PDACs might be influenced by the concomitant but separately-located IPMN in their pathogenic mechanism. Furthermore, the GNAS mutation was significantly associated with MPD dilatation in IPMN cases, suggesting its role in mucus hypersecretion.

  12. [Intraductal papillary mucinous tumor: diagnostic and therapeutic approach].

    Science.gov (United States)

    Seijo Ríos, Susana; Lariño Noia, José; Iglesias García, Julio; Lozano León, Antonio; Domínguez Muñoz, Juan Enrique

    2008-02-01

    Primary cystic pancreatic neoplasms are rare tumors, with an approximate prevalence of 10% of cystic pancreatic lesions. Most of these lesions correspond to mucinous cystic neoplasm, serous cystoadenoma and intraductal papillary mucinous tumor (IPMT). IPMT is characterized by diffuse dilatation of the main pancreatic duct and/or side branches with inner defects related to mucin or tumor, or mucin extrusion from a patent ampulla. IPMT has a low potential for malignancy, with a low growth rate, a low rate of metastatic spread and postsurgical recurrence. Over the last few years, major advances have been made in the diagnostic and therapeutic management of this tumor.

  13. Intraductal Papillary Mucinous Neoplasm of the Pancreas: An Update

    Directory of Open Access Journals (Sweden)

    Shu-Yuan Xiao

    2012-01-01

    Full Text Available Intraductal papillary mucinous neoplasm (IPMN is a cystic tumor of the pancreas. The etiology is unknown, but increasing evidence suggests the involvement of several tumorigenesis pathways, including an association with hereditary syndromes. IPMN occurs more commonly in men, with the mean age at diagnosis between 64 and 67 years old. At the time of diagnosis, it may be benign, with or without dysplasia, or frankly malignant with an invasive carcinoma. Tumors arising from the main pancreatic duct are termed main-duct IPMNs, those involving the branch ducts, branch-duct IPMNs. In general, small branch-duct IPMNs are benign, particularly in asymptomatic patients, and can be safely followed. In contrast, main-duct tumors should be surgically resected and examined carefully for an invasive component. In the absence of invasion, patient’s survival is excellent, from 94 to 100%. For patients with an IPMN-associated invasive carcinoma, the prognosis overall is better than those with a de novo pancreatic ductal adenocarcinoma, with a 5-year survival of 40% to 60% in some series. However, no survival advantage can be demonstrated if the invasive component in an IPMN patient is that of the conventional tubular type (versus mucinous carcinoma. Several histomorphologic variants are recognized, although the clinical significance of this “subtyping” is not well defined.

  14. Intraductal Oncocytic Papillary Neoplasm Having Clinical Characteristics of Mucinous Cystic Neoplasm and a Benign Histology

    Directory of Open Access Journals (Sweden)

    Takatomi Oku

    2007-03-01

    Full Text Available Context An intraductal oncocytic papillary neoplasm is a rare pancreatic tumor which was first described by Adsay et al. in 1996. It has been defined as a new subgroup of IPMN. Case report We report the case of a 76-year-old woman who presented with nausea. Imaging studies revealed a cystic mass in the body of the pancreas. She underwent a successful distal pancreatectomy and splenectomy, and has subsequently remained well. Microscopically, the cyst was lined by columnar epithelium similar to pancreatic duct epithelium, and the nodular projection consisted of arborizing papillary structures, lined by plump cells with abundant eosinophilic cytoplasm. These eosinophilic cells were immunohistochemically positively stained with anti-mitochondrial antibody. The cellular atypism was mild and the proliferating index was low, compatible with adenoma of an intraductal oncocytic papillary neoplasm. Although no ovarian type stroma was identified, in our case, no communication to main pancreatic duct (located in the pancreatic body and rapid growth by intracystic hemorrhage were clinical characteristics of a mucinous cystic neoplasm, but not IPMN. Conclusion With only 17 cases reported to date, the clinical and pathological details of an intraductal oncocytic papillary neoplasm are still unclear. We herein add one case with different characteristics from those of the past reports. To our knowledge, this is the first case report of an intraductal oncocytic papillary neoplasm with the clinical characteristics of a mucinous cystic neoplasm.

  15. Multiple small "imaging" branch-duct type intraductal papillary mucinous neoplasms (IPMNs) in familial pancreatic cancer: indicator for concomitant high grade pancreatic intraepithelial neoplasia?

    Science.gov (United States)

    Bartsch, D K; Dietzel, K; Bargello, M; Matthaei, E; Kloeppel, G; Esposito, I; Heverhagen, J T; Gress, T M; Slater, E P; Langer, P

    2013-03-01

    Most screening programs for familial pancreatic cancer are currently based on endoscopic ultrasonography and/or magnetic resonance imaging (MRI). Cystic lesions, especially those suspicious for small intraductal pancreatic mucinous neoplasms (IPMNs) of the branch ducts, can be visualized in up to 40 % of individuals at risk, but their pathological importance in the setting of FPC is yet not well established. Individuals at risk from a prospective screening program for familial pancreatic cancer with small "imaging" IPMNs of the branch-duct type (BD-IPMN) who underwent pancreatic resection were analysed regarding clinico-pathological data and the locations of pancreatic lesions. Five of 125 individuals at risk who underwent screening had multiple small (size 2-10 mm) unicystic lesions and/or multicystic single lesions in the pancreatic body and tail suspicious for BD-IPMNs upon MRI imaging and decided to undergo surgical resection after interdisciplinary counselling, although none fulfilled the consensus criteria for IPMN resection. Histological examination revealed BD-IPMNs with low or moderate dysplasia of the gastric type in combination with multifocal PanIN2 and PanIN3 lesions in 4 individuals. The remaining patient had only tiny ductectasias in the pancreatic tail with multifocal PanIN 2 lesions in the entire gland and one PanIN3 lesion in the pancreatic head. Intriguingly, the location of the most dysplastic histological lesions (PanIN3) did not correspond to the preoperatively detected lesions and were not visible in preoperative imaging. In the setting of FPC, the presence of multiple small "imaging" BD-IPMNs may indicate the presence of high-grade PanIN lesions elsewhere in the pancreas.

  16. Pseudomyxoma peritonei caused by ruptured intraductal papillary mucinous neoplasm of the pancreas: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Sun; Lee, Hae Kyung; Lee, Min Hee; Yi, Boem Ha; KIm, Hee Kyung; Jung, Jun Chul; Cha, Jang Gyu [Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of)

    2014-05-15

    Pseudomyxoma peritonei (PMP) is an uncommon disease characterized by the seeding of mucin-secreting tumor cells throughout the abdomen and accumulation of mucin in the abdominal and pelvic cavities. Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are defined as pancreatic neoplasms that accumulate mucin within dilated ducts. Only a few cases of pancreatic IPMNs are associated with extra-pancreatic mucin and lead to PMP. This manuscript describes an unusual case of PMP caused by ruptured pancreatic IPMN.

  17. Intraductal Papillary Mucinous Neoplasm (IPMN) and Chronic Pancreatitis: Overlapping Pathological Entities? Two Case Reports

    OpenAIRE

    Athanasios Petrou; Alexandros Papalambros; Nicholas Brennan; Evangelos Prassas; Thoedora Margariti; Konstadinos Bramis; Theofilos Rozemberg; Efstathios Papalambros

    2011-01-01

    Context Intraductal papillary mucinous neoplasms (IPMNs) are a recently classified pancreatic neoplasm with an increasing incidence. IPMN is often misdiagnosed as chronic pancreatitis because of symptoms of relapsing abdominal pain, pancreatitis, and steatorrhea and imaging findings of a dilated pancreatic duct of cystic lesions that are frequently confused with pseudocysts. Early recognition of IPMN allows for prompt surgical resection before malignant transformation. Case reports We report ...

  18. 内镜胰管探查在精准胰腺导管内乳头状黏液瘤切除术中的应用%Application of endoscopic pancreatic duct exploration in precise pancreatectomy for intraductal papillary mucinous neoplasms

    Institute of Scientific and Technical Information of China (English)

    尚东; 张庆凯; 张桂信

    2012-01-01

    The diagnostic rate of intraductal papillary mucinous neoplasms (IPMNs) has been increased as the improvement of imaging and endoscopic techniques.All main duct type and mixed variant IPMNs should be resected as long as the patient is a good surgical candidate with reasonable life expectancy.Evaluation of resection margin ( especially circumferential margins) is very important to prevent the recurrence of IPMNs,and intraoperative pancreatoscopy plays an important role in determining the appropriate size for pancreatic resection.In this article,the experience in the treatment of 1 patient with IPMNs by precise pancreatectomy guided by endoscopy-assisted intraoperative pancreatic duct inspection was introducted.

  19. Ultrasonographic Characteristics of Intraductal Papillary Mucinous Neoplasm of the Pancreas

    Institute of Scientific and Technical Information of China (English)

    Ke Lü; Qing Dai; Zhong-hui Xu; Yi-xiu Zhang; Li Tan; Yan Yuan; Yu-xin Jiang

    2010-01-01

    Objective To analyze the clinical and ultrasonographic imaging features of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.Methods Twelve patients with IPMN underwent surgery between May 2005 and December 2008, including 4 (33.3%) with adenoma and 8 (66.7%) with adenocarcinoma. IPMN was classified preoperatively into 3 types based on sonographic findings of different sites: main duct, branch duct, and combined type. All clinical presentations and ultrasonographic findings of those patients were reviewed and the correlation be-tween ultrasonographic findings and histopathological results was analyzed.Results There were 9 men and 3 women with a mean age of 60.1±9.6 years (range, 32-73). Of all the 12 patients with IPMN, 9 (75.0%) had experienced some symptoms of epigastric discomfort and/or pain as well as backache; 7 cases were with medical history of acute pancreatitis, 5 cases with diabetes, 4 cases with elevated CAi9-9, and 2 cases with steatorrhea. All lesions of IPMN have been revealed by transabdominal ul-trasonography. The mean diameters of the lesions were 1.4±0.8 cm (range, 0. 5-2.0) and 6.3±6.0 cm (range, 2.0-20.0) in adenomas and adenocarcinomas, respectively. And the mean diameters of the main duct in ade-nomas and adenocarcinomas were 1.0±0.8 cm and 1.6±1.0 cm, respectively. Among the 4 adnomas, 3 (75.0%) cases were classified as branch type based on sonographic findings, and 2 were demonstrated as mural nodules in which no color signals was detected. Among the 8 adenocarcinomas, 5 (62.5%) cases were classi-fied as main duct type, and 3 (37.5%) as combined type. In 7 of the 8 adenocarcinomas, mural nodules were detected within the dilated ducts or cysts of the lesions in which color flow signals were detected.Conclusions Transabdominal ultrasonography can reveal the pancreatic cystic lesions of IPMN as well as dilated pancreatic ducts. Some characteristics should be noticed as suggesting the possibility of malig-nancy: clinical

  20. 胆管导管内乳头状黏液性肿瘤的影像表现和形态分型%Imaging findings and morphology classification of intraductal papillary mucinous neoplasm of the bile duct

    Institute of Scientific and Technical Information of China (English)

    应世红; 赵艺蕾; 滕晓东; 王照明; 汪启东; 陈峰; 肖文波

    2015-01-01

    Objective To investigate the CT and MRI features and morphology classification of intraductal papillary mucinous neoplasm of the bile duct (IPMN-B).Methods A total of 18 patients with IPMN-B proved by pathology were retrospectively analyzed.Out of 18 patients,16 patients underwent enhanced and non-enhanced CT,13 underwent contrast enhanced MR,and 11 out of 13 underwent both CT and MRI.IPMN-B was classified into 4 types:typical IPMN-B,cystic-forming IPMN-B,non-tumor IPMN-B and invasive IPMN-B,according to imaging findings and gross pathological findings.Results Typical IPMN-B (9 cases):tumors were distributed along the bile ducts,both upstream and downstream bile ducts were obviously dilated.Cystic-forming IPMN-B (5 cases):single or multiple tumors were found in aneurysmal dilatation of bile ducts.Non-tumor 1PMN-B (2 cases):no mass was found in the widely dilated bile ducts with smooth bile duct wall.Invasive IPMN-B (2 cases):tumors protruded into the dilated bile ducts causing jagged wall of bile duct,with accompanied abnormal density or signal intensity outside the bile ducts.Bile duct dilatations were shown in all 18 cases,and tumors were shown in 16 cases.In 2 cases no mass was displayed in widely dilated bile ducts.CT density of the tumor was lower than that of liver parenchyma,and higher than that of the bile and intraductal mucin.Signal intensity of the tumor was higher than that of stones,and lower than that of bile and intraductal mucin at MR T2WI.All tumors showed high intensity on DWI.Tumors showed mild to moderate enhancement after injection of contrast agent,CT density or signal intensity of the tumors were lower than that of the liver parenchyma during all three phases of contrast-enhanced CT or MRI.Conclusion IPMN-B has some specific CT and MR imaging features,which are helpful for the diagnosis and classification of IPMN-B.%目的 探讨胆管导管内乳头状黏液性肿瘤(IPMN-B)的CT、MRI特征及其形态分型.方法 回顾性分

  1. Intraductal papillary mucinous neoplasm (IPMN):UPDATE

    OpenAIRE

    木村, 理

    2015-01-01

    At present, IPMN is broadly divided into two main types: main duct and branch duct. However, as discussed below, the definition of mixed-type IPMN is gradually becoming accepted. In main duct IPMN, the main pancreatic duct is very dilated, while in branch duct IPMN, the branches of the pancreatic duct are dilated, resembling a bunch of grapes.IPMN is most frequently diagnosed in the elderly (around 65 years old), and the male to female ratio is 2:1, indicating that the incidence of the diseas...

  2. Malignancies associated with intraductal papillary mucinous neoplasm of the pancreas

    Institute of Scientific and Technical Information of China (English)

    Terumi Kamisawa; Yuyang Tu; Naoto Egawa; Hitoshi Nakajima; Kouji Tsuruta; Atsutake Okamoto

    2005-01-01

    AIM: As intraductal papillary mucinous neoplasm (IPMN)has a favorable prognosis, associated malignancies have potential significance in these patients. We examined the incidence and characteristics of pre-existing, coexisting and subsequent malignancies in patients with IPMN. METHODS: Seventy-nine cases of IPMN were diagnosed by detection of mucous in the pancreatic duct during endoscopic retrograde pancreatography. Histological diagnosis was confirmed in 30 cases (adenoma (n = 19)and adenocarcinoma (n = 11). Other primary malignancies associated with IPMN, occurring in the prediagnostic or postdiagnostic period, were investigated. Postdiagnostic follow-up period was 3.3±0.5 years (range, 0.2-20 years).RESULTS: Other 40 malignancies occurred in 28 patients (35%). They were found before (n = 15), at (n = 19) and after (n = 6) the diagnosis of IPMT. Major associated malignancies were gastric cancer (n = 12), colonic cancer (n = 7), esophageal cancer (n = 4), pulmonary cancer (n = 4), and independent pancreatic cancer (n = 3).Pancreatic cancer was synchronous with IPMN in two patients and metachronous in one (3 years after diagnosis of IPMN). Thirty-one lesions were treated surgically or endoscopically. Fourteen patients died of associated cancers. Development of other malignancies was related to age (71.9±8.2 vs66.8±9.3, P<0.05), but not to gender or site of the tumor.CONCLUSION: IPMN is associated with a high incidence of other malignancies, particularly gastric and colonic cancers. Common genetic mechanisms between IPMN and other associated malignancies might be present. Clinicians should pay attention to the possibility of associated malignancies in preoperative screening and follow-up of patients with IPMN.

  3. Biliary tract intraductal papillary mucinous neoplasm: A brief report and review of literature

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    Raveendran Subhash

    2014-01-01

    Full Text Available Biliary Tract Intraductal Papillary Mucinous Neoplasm (BT-IPMN is a very rare entity, gradually emerging into attention as sporadic cases are being reported worldwide. In this brief report we discuss about such an entity from our part of the world, based on a case from our institution. A 47-year-old female was referred to our department with jaundice, intermittent fever with chills and rigor of 6 weeks duration. Initial evaluation revealed obstructive jaundice with distended gall bladder. Imaging with ultrasonogram (USG and magnetic resonance imaging (MRI showed hugely dilated intra and extrahepatic biliary radicles with multiple and diffuse soft tissue lesions filling the common bile duct (CBD extending to the ductal system of left lobe of liver. A side viewing endoscopy demonstrated mucin extruding from a prominent ampulla of Vater. The patient was managed successfully by left hepatectomy with pancreaticoduodenectomy (HPD. Gross pathological examination of the specimen showed marked dilatation of intra and extra hepatic bile ducts with multiple polypoidal lesions and plenty of mucin filling the entire biliary ductal system. Histopathology revealed predominantly intraductal papillary mucinous adenocarcinoma at the hilum extending to left bile duct with diffuse dysplastic changes throughout the biliary tree. Thus the clinical, radiological and pathological features of this lesion clearly fit into the diagnosis of BT-IPMN, which is slowly being established as a definite clinical entity with features much similar to its pancreatic counterpart.

  4. Intraductal Papillary Mucinous Neoplasms of the Pancreas (IPMNs: Epidemiology, Diagnosis and Future Aspects

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    Froso Konstantinou

    2013-03-01

    Full Text Available Intraductal papillary mucinous neoplasms of the pancreas (IPMNs are potentially malignant intraductal epithelial neoplasms which consist of columnar, mucin-containing cells and arise from the epithelium of the main pancreatic duct or its branches. IPMNs as well as pancreatic intraepithelial neoplasias (PanINs and mucinous cystic neoplasms represent noninvasive precursors of invasive ductal adenocarcinoma of the pancreas. The diagnosis of IPMNs includes radiographic (CT scanning, MRI, MRCP and endoscopic evaluation (ERCP, EUS, PET, as well as serum tumor markers and molecular markers. The Sendai Consensus Guidelines help guide surgical resection for patients with IPMN. The follow-up of these patients, as well as of those who do not undergo surgical resection, is of great importance, since patients with IPMN appear to be at risk for other malignancies. Herein, the authors summarize the data presented at the 2013 ASCO Gastrointestinal Cancers Symposium regarding incidence and clinicopathological characteristics of IPMN (Abstracts #324, #187 and #179.

  5. Current roles of endoscopy in the management of intraductal papillary mucinous neoplasm of the pancreas

    OpenAIRE

    Tanaka, Masao

    2015-01-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by intraductal papillary proliferation of mucin‐producing epithelial cells that exhibit various degrees of dysplasia. IPMN is classified into four histological subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) according to its histomorphological and immunohistochemical characteristics. Endoscopic retrograde cholangiopancreatography plays a crucial role in the evaluation of these features of IPMN. End...

  6. Laparoscopic resection of synchronous intraductal papillary mucinous neoplasms: A case report

    Institute of Scientific and Technical Information of China (English)

    Xiao-Wu Xu; Rong-Hua Li; Wei Zhou; Jie Wang; Ren-Chao Zhang; Ke Chen; Yi-Ping Mou

    2012-01-01

    We describe herein a 68-year-old woman who was diagnosed with a quite rare entity of intraductal papillary mucinous neoplasms (IPMNs) occurring simultaneously in the left lateral lobe of liver and the tail of pancreas.Abdominal computed tomography and magnetic resonance cholangiopancreatography showed a cystic dilatation of the pancreatic duct in the pancreatic tail,which suggested an IPMN,and multiple intrahepatic duct stones in the left lateral lobe.The patient underwent a laparoscopic left lateral hepatolobectomy and spleenpreserving distal pancreatectomy.Intra-operative finding of massive mucin in the dilated bile duct implied an intraductal mucinous tumor in the liver.The diagnosis of synchronous IPMNs in the liver and pancreas was confirmed by pathological examination.The patient was followed up for 6 mo without signs of recurrence.Although several cases of IPMN of liver without any pancreatic association have been reported,the simultaneous occurrence of IPMNs in the liver and pancreas is very rare.To the best of our knowledge,it is the first reported case treated by laparoscopic resection.

  7. Laparoscopic resection of synchronous intraductal papillary mucinous neoplasms: a case report.

    Science.gov (United States)

    Xu, Xiao-Wu; Li, Rong-Hua; Zhou, Wei; Wang, Jie; Zhang, Ren-Chao; Chen, Ke; Mou, Yi-Ping

    2012-11-28

    We describe herein a 68-year-old woman who was diagnosed with a quite rare entity of intraductal papillary mucinous neoplasms (IPMNs) occurring simultaneously in the left lateral lobe of liver and the tail of pancreas. Abdominal computed tomography and magnetic resonance cholangiopancreatography showed a cystic dilatation of the pancreatic duct in the pancreatic tail, which suggested an IPMN, and multiple intrahepatic duct stones in the left lateral lobe. The patient underwent a laparoscopic left lateral hepatolobectomy and spleen-preserving distal pancreatectomy. Intra-operative finding of massive mucin in the dilated bile duct implied an intraductal mucinous tumor in the liver. The diagnosis of synchronous IPMNs in the liver and pancreas was confirmed by pathological examination. The patient was followed up for 6 mo without signs of recurrence. Although several cases of IPMN of liver without any pancreatic association have been reported, the simultaneous occurrence of IPMNs in the liver and pancreas is very rare. To the best of our knowledge, it is the first reported case treated by laparoscopic resection.

  8. The clinicopathologic features of intraductal papillary mucinous neoplasms of the pancreas

    Institute of Scientific and Technical Information of China (English)

    QIN Xinyu; LIU Fenglin

    2007-01-01

    Since first described in 1982.intraductal papillary mucinous neoplasm(IPMN)has been the preferred term to describe the proliferation of the pancreatic ductal epithelium.It is totally different from pancreatic carcinoma in epidemiology,histology,pathology and prognosis.According to the site of involvement.IPMNS are classified into three caregories,i.e.main duct type,branch duct type,and combined type.Most branch duct IPMNS are benign.whereas the other two types are often malignant.A large branch duct IPMN and marked dilation of the main pancreatic duct indicate the presence of adenoma at least.The additional existence of large mural nodules increases the possibility of malignancy in all types.The prognosis is more favorable after complete resection of benign and non-invasive malignant IPMNs.Malignant IPMNS that become more aggressive after parenchymal invasion necessitate adequate lymph node dissection.On the other hand.asymptomatic branch duct IPMNS without mural nodules can be observed without the need for resection for a considerable period of time.Our review addresses available data,current understanding,controversy,and future directions about IPMNS.

  9. F18-FDG-PET/CT for evaluation of intraductal papillary mucinous neoplasms (IPMN): a review of the literature.

    Science.gov (United States)

    Bertagna, Francesco; Treglia, Giorgio; Baiocchi, Gian Luca; Giubbini, Raffaele

    2013-04-01

    Intraductal papillary mucinous neoplasms (IPMN) are intraductal mucin-producing neoplasms with tall columnar, mucin-containing epithelium, with or without papillary projections, involving the main pancreatic duct and/or major side branches. They account for approximately 25 % of all cystic neoplasms and can be subdivided into benign lesions, borderline lesions, and carcinoma. In this clinical scenario accurate preoperative diagnosis can eliminate unnecessary surgery, which is risky and potentially harmful, yet enable effective selection of patients who are candidates for surgery. In this review we try to provide a complete evaluation of the use of F18-FDG-PET/CT for diagnosis of this neoplasm on the basis of published papers. F18-FDG-PET/CT seems to be an useful technique for preoperative work-up of patients with suspected IPMN and is an improvement over conventional imaging in distinguishing benign from malignant lesions, especially for selecting patients for surgical treatment or for long-term follow-up.

  10. [Intraductal papillary mucinous neoplasm and recurrent pancreatitis].

    Science.gov (United States)

    Gálvez, Eduardo; Gálvez, Gustavo; Barboza, Aurelio; Barboza, Eduardo; Combe, Juan Manuel; Combe, Mario R; Combe, Juan; Arias Stella C, Javier; Arias Stella, Javier

    2013-01-01

    Ohashi described for the first time the IPMN on 1982 as a pancreatic neoplasia with mucine cells forming papillae and producing dilatation of the main pancreatic duct or its branches. The IPMN represent the 1% of the pancreatic tumors and 5% of the cystic neoplasias. It is potentially malignant in a period of five years being more frequent in males between 60-70 and clinically these patients' presents as acute, recurrent or chronic pancreatitis, with an incidence of malignancy from 25% to 70%. CT scan and cholangio MRI allows the diagnosis, the variety, localization and possibility of determine malignancy. The treatment is the Whipple resection. We are reporting the case of an obese middle age male, being observed along the last 10 years because of recurrent pancreatitis with a cystic lesion of the head of the pancreas. The CT scan, endoscopic-ultrasound and the analysis of the liquid content suggested a mucinous lesion, reason why the patient underwent a pancreatic-duodenal resection. The histology study confirms the diagnosis of IPMN.

  11. Imaging diagnosis of branch duct intraductal papillary mucinous tumors%分支胰管型胰腺导管内乳头状黏液性肿瘤影像学诊断

    Institute of Scientific and Technical Information of China (English)

    边云; 高振坡; 王莉; 陆建平

    2015-01-01

    Objective To explore the imaging findings of branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). Methods A total of 45 BD-IPMNs were confirmed by pathology after surgery.The clinical data and imaging findings were retrospec-tively reviewed.Image analysis included characteristics and the nature of the lesions.Finally,an ROC curve was performed to evaluate the differential diagnostic efficacy between benign and malignant lesions using the imaging findings.Results There were statistically significant differences for differential diagnosis of malignant and benign BD-IPMNs in the maximum diameter of the lesions and the MPD,walls,wall nodules,shape,and the atrophy of pancreatic parenchyma (P < 0.05 ).The diagnostic sensitivity,specificity, AUC and Kappa value of benign and malignant BD-IPMNs were 94.3%,90%,92.1% and 0.81 (P =0.000 1)respectively.Conclu-sion The imaging technology is valuable in diagnosing and differentiating malignant from benign BD-IPMNs.%目的:探讨影像学方法对分支胰管型胰腺导管内乳头状黏液瘤(BD-IPMNs)良恶性的诊断价值。方法回顾性分析经手术病理证实的45例 BD-IPMNs 患者的影像学资料。患者术前均行 CT、MRCP、MR 三者中的1种或2种以上检查。分析病变的各种影像学特征,对病变的良恶性进行影像学评分,并与病理分级进行对照。绘制 ROC 曲线来评价影像学方法对 BD-IPMNs 良恶性鉴别的诊断能力。结果主胰管的直径、囊肿直径、厚囊壁、壁结节、胰腺实质的萎缩对鉴别病变的良恶性有统计学意义。影像学诊断 BD-IPMNs 的敏感性94.3%,特异性90%,曲线下面积92.1%,Kappa 值为0.81,P 值为0.0001。结论影像学对于 BD-IPMNs 的诊断以及良恶性的鉴别都具有高度的敏感性,对术前诊断和随访具有一定的价值。

  12. An analysis of clinico-pathologic features of intraductal papillary mucinous neoplasm of the pancreas

    Institute of Scientific and Technical Information of China (English)

    LOU Wenhui; JIN Dayong; WANG Dansong; XU Xuefeng; KUANG Tiantao; QIN Xinyu

    2007-01-01

    The natural history and clinical manifestation of resected intraductal papillary mucinous neoplasm(IPMN)of the pancreas were elucidated,and based on this,a retrospective pancreatic database was reviewed to identify patients with IPMN who were surgically managed in our department from 1999 to June 2006.Pathologic rereview of each case was performed,and the clinico-pathologic features were examined.Student's T test and X2 analysis were used to identify factors associated with malignancy.Fifty-one patients were identified.There were 33 males and 18 females.One patient's pancreas was unresectable,two patients underwent a total pancreatectomy,42 patients had a pancreatecoduodenectomy and five patients had distal pancreatectomy.Main-duct type carcinoma was identified in 24 patients;branch-duct type in 15 patients,and mixed type in 12 patients.Invasive carcinoma was present in 35 patients.Weight loss and iaundice occurred more commonly in the invasive group.The average serum CA19-9 level was significantly higher in the invasive group(1542μ vs 94.5μ).The average diameter of the pancreatic duct was also wider in the invasive group (8.7 mm vs 4.3 mm).Significant predictors of malignant IPMNS included weight loss,iaundice,a high level of serum CA19-9.a large pancreatic duct and main-duct type carcinoma.

  13. Intraductal papillary mucinous carcinoma of the pancreas associated with pancreas divisum: a case report and review of the literature.

    Science.gov (United States)

    Nishi, Takeshi; Kawabata, Yasunari; Ishikawa, Noriyoshi; Araki, Asuka; Yano, Seiji; Maruyama, Riruke; Tajima, Yoshitsugu

    2015-07-08

    Pancreas divisum, the most common congenital anomaly of the pancreas, is caused by failure of the fusion of the ventral and dorsal pancreatic duct systems during embryological development. Although various pancreatic tumors can occur in patients with pancreas divisum, intraductal papillary mucinous neoplasm is rare. A 77-year-old woman was referred to our hospital because she was incidentally found to have a cystic tumor in her pancreas at a regular health checkup. Contrast-enhanced abdominal computed tomography images demonstrated a cystic tumor in the head of the pancreas measuring 40 mm in diameter with slightly enhancing mural nodules within the cyst. Endoscopic retrograde pancreatography via the major duodenal papilla revealed a cystic tumor and a slightly dilated main pancreatic duct with an abrupt interruption at the head of the pancreas. The orifice of the major duodenal papilla was remarkably dilated and filled with an abundant extrusion of mucin, and the diagnosis based on pancreatic juice cytology was "highly suspicious for adenocarcinoma". Magnetic resonance cholangiopancreatography depicted a normal, non-dilated dorsal pancreatic duct throughout the pancreas. The patient underwent a pylorus-preserving pancreaticoduodenectomy under the diagnosis of intraductal papillary mucinous neoplasm with suspicion of malignancy arising in the ventral part of the pancreas divisum. A pancreatography via the major and minor duodenal papillae on the surgical specimen revealed that the ventral and dorsal pancreatic ducts were not connected, and the tumor originated in the ventral duct, i.e., the Wirsung's duct. Microscopically, the tumor was diagnosed as intraductal papillary mucinous carcinoma with microinvasion. In addition, marked fibrosis with acinar cell depletion was evident in the ventral pancreas, whereas no fibrotic change was noted in the dorsal pancreas. Invasive ductal carcinomas of the pancreas associated with pancreas divisum usually arise from the dorsal

  14. Intraductal papillary mucinous neoplasms and other pancreatic cystic lesions

    Institute of Scientific and Technical Information of China (English)

    Hugh James Freeman

    2008-01-01

    Pancreatic cystic neoplasms are being increasingly recognized, even in the absence of symptoms, in large part, due to markedly improved imaging modalities such as magnetic resonance imaging (MRI)/magnetic resonance cholangio pancreatography (MRCP) and computer tomography (CT) scanning. During the past 2 decades, better imaging of these cystic lesions has resulted in definition of different types, including pancreatic intraductal papillary mucinous neoplasms (IPMN). While IPMN represent only a distinct minority of all pancreatic cancers, they appear to be a relatively frequent neoplastic form of pancreatic cystic neoplasm. Moreover, IPMN have a much better outcome and prognosis compared to pancreatic ductal adenocarcinomas. Therefore, recognition of this entity is exceedingly important for the clinician involved in diagnosis and further evaluation of a potentially curable form of pancreatic cancer.

  15. Intraductal papillary mucinous neoplasm of the pancreas. Personal series and synthetic review

    Directory of Open Access Journals (Sweden)

    F. Gallucci

    2012-12-01

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs are rare pancreatic tumors, accounting for less than 1-2% of all neoplasms of the pancreas. The main characteristic of IPMNs is their favorable prognosis, as these pre-malignant or malignant lesions are usually slow-growing tumors and radical surgery is frequently possible. According to the localization of the lesions, three different tumor types have been identified: the main-duct IPMN, the branch-duct IPMN and the mixed-type IPMN (involving both the main pancreatic duct and the side branches. IMPNs do not present pathognomonic signs or symptoms. The obstruction of the main pancreatic duct system may cause abdominal pain and acute pancreatitis (single or recurrent episodes. The tumor may be incidentally discovered in asymptomatic patients, particularly in those with branch-duct IPMNs. In clinical practice, any non-inflammatory cystic lesion of the pancreas should be considered as possible IPMN. Computed tomography, magnetic resonance imaging with cholangiopancreatography and endoscopic ultrasonography can localize an IPMN and assess its morphology and size. The choice between non-operative and surgical management depends on the risk of malignancy and on the definitive distinction between benign and malignant IPMNs. Main-duct IPMNs have a high risk of malignant degeneration, especially in older patients. The clinical and radiological features, as well as treatment and outcome, of eight patients with IPMN (five with main-duct, two with branch-duct and one with mixed-type observed by the authors over the last ten years are presented.

  16. Intraductal papillary mucinous neoplasms of the pancreas: Correlation of helical CT features with pathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Liu Yu; Lin Xiaozhu; Upadhyaya, Manavendra; Song Qi [Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (China); Chen Kemin, E-mail: keminchen@126.com [Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine (China)

    2010-11-15

    Objective: To evaluate the CT features of intraductal papillary mucinous neoplasms of the pancreas (IPMNs), and to compare with pathological findings in order to identify CT features that can be helpful in differentiating benign IPMNs from malignant IPMNs. Materials and methods: The CT findings in 25 patients were reviewed for tumor location, tumor type, dilatation of the main pancreatic duct (MPD), MPD involvement, mural node or solid attenuating component, tumor size in branch duct or mixed duct type, dilatation of common bile duct (CBD) and invasion of surrounding structures. The data was subjected to Chi-Square Tests or Fisher's Exact Test using SPSS13.0 software with p value < 0.05 indicating significant statistical difference. Results: Presence of mural node or solid enhancing component, size of mural node or solid enhancing component {>=}7 mm, dilatation of CBD was more common in malignant IPMNs (p < 0.05). None of tumor location, tumor type, dilatation of MPD, MPD involvement, tumor size, and invasion of surrounding structures was statistically significant in differentiating benign from malignant IPMNs. Conclusions: CT features suggestive of malignant or invasive IPMNs include presence of mural node or solid enhancing component, size of mural node or solid enhancing component {>=}7 mm, and dilatation of CBD.

  17. A case of focal autoimmune pancreatitis (AIP) mimicking an intraductal papillary mucinous neoplasm (IPMN).

    Science.gov (United States)

    Nakaji, So; Hirata, Nobuto; Fujii, Hiroyuki; Iwaki, Kosuke; Shiratori, Toshiyasu; Kobayashi, Masayoshi; Wakasugi, Satoshi; Ishii, Eiji; Takeyama, Hiroyuki; Hoshi, Kazuei

    2013-08-01

    The present case involved a 76-year-old man with a cystic mass in the head of his pancreas. The cystic lesion, which measured 17.7 × 9.8 mm, was first detected by ultrasonography (US) at the age of 72 years. Follow-up endoscopic ultrasonography (EUS) performed at 4 years after the lesion had first been detected revealed a mural nodule measuring 14.0 × 8.4 mm in the cyst. Endoscopic retrograde pancreatography (ERP) imaging revealed that the main pancreatic duct was in communication with the cyst and that there was no irregular narrowing of the main pancreatic duct. On the basis of these results, the patient was diagnosed with an intraductal papillary mucinous neoplasm (IPMN), and stomach-preserving pancreaticoduodenectomy was performed. A histopathological examination revealed that the interior of the cystic part of the lesion was lined by a pancreatic ductal epithelium. A pathological examination of the nodular lesion detected storiform fibrosis, severe lymphoplasmacytic infiltration, and hyperplasia in the pancreatic duct epithelium together with a small amount of mucus. On immunohistological staining, the infiltrating lymphoplasmacytes were found to be positive for IgG4. Accordingly, the patient was diagnosed with focal autoimmune pancreatitis (AIP). In conclusion, we reported a case of focal AIP mimicking IPMN. This case showed neither enlargement of the pancreas nor irregular narrowing of the main pancreatic duct.

  18. Multifocal intraductal papillary mucinous neoplasm of the pancreas-A case report

    Institute of Scientific and Technical Information of China (English)

    Kun-Chun Chiang; Jun Te Hsu; Huang-Yang Chen; Shyh Chuan Jwo; Tsann-Long Hwang; Yi-Yin Jan; Chun-Nan Yeh

    2009-01-01

    Cystic neoplasms of the pancreas are relatively rare, comprising 10 percent of pancreatic cysts and only 1 percent of pancreatic cancers. Cystic neoplasms include mucinous cystic neoplasms, serous cystadenomas,papillary cystic tumors, cystic islet cell tumors and intraductal papillary mucinous neoplasms of the pancreas (IPMNs). IPMN was first described in 1982.It has been most commonly described in 60 to 70 years old males, and represents a relatively "new" but increasingly recognized disease. The improvement and widespread use of modern imaging equipments and heightened awareness of physicians contribute to the increasing incidence of IPMN. The majority of IPMNs are located in the pancreatic head (75%) while the rest involves the body/tail regions. Multifocal IPMNs have been hypothesized, but the true presence of multifocality is unknown. Here we present a 72-yearold male diagnosed with IPMN (carcinoma in situ) in the pancreatic head and a branch duct type IPMN (duct atypia) in the pancreatic body and tail. The patient underwent a Whipple intervention and a distal pancreatectomy. A three-year disease-free survival has been observed so far.

  19. Diagnostic and therapeutic endoscopic approaches to intraductal papillary mucinous neoplasm.

    Science.gov (United States)

    Turner, Brian G; Brugge, William R

    2010-10-27

    Pancreatic cystic lesions are increasingly identified on routine imaging. One specific lesion, known as intraductal papillary mucinous neoplasm (IPMN), is a mucinous, pancreatic lesion characterized by papillary cells projecting from the pancreatic ductal epithelium. The finding of mucin extruding from the ampulla is essentially pathognomonic for diagnosing these lesions. IPMNs are of particular interest due to their malignant potential. Lesions range from benign, adenomatous growths to high-grade dysplasia and invasive cancer. These mucinous lesions therefore require immediate attention to determine the probability of malignancy and whether observation or resection is the best management choice. Unresected lesions need long-term surveillance monitoring for malignant transformation. The accurate diagnosis of these lesions is particularly challenging due to the substantial similarities in morphology of pancreatic cystic lesions and limitations in current imaging technologies. Endoscopic evaluation of these lesions provides additional imaging, molecular, and histologic data to aid in the identification of IPMN and to determine treatment course. The aim of this article is to focus on the diagnostic and therapeutic endoscopic approaches to IPMN.

  20. Uptodate in the assessment and management of intraductal papillary mucinous neoplasms of the pancreas.

    Science.gov (United States)

    Pagliari, D; Saviano, A; Serricchio, M L; Dal Lago, A A; Brizi, M G; Lanza, F; Manfredi, R; Gasbarrini, A; Attili, F

    2017-06-01

    Intraductal Papillary Mucinous Neoplasms (IPMNs) are the most common cystic tumors of the pancreas and are considered premalignant lesions. IPMNs are characterized by the papillary growth of the ductal epithelium with rich mucin production, which is responsible for cystic segmental or diffuse dilatation of the main pancreatic duct (MPD) and/or its branches. According to the different involvement of pancreatic duct system, IPMNs are divided into main duct type (MD-IPMN), branch duct type (BD-IPMN), and mixed type (MT-IPMN). IPMNs may be incidentally discovered in asymptomatic patients, particularly in those with BD-IPMNs, when imaging studies are performed for unrelated indications. The increase in their frequency may reflect the combined effects of new diagnostic techniques, the improvement of radiologic exams and progress in the recognition of the pathology. MD-IPMNs present a higher risk of malignant progression than BD-IPMNs; as a consequence, all the guidelines strictly suggest the need of surgery for MD- and MT- IPMNs with MPD > 10 mm, while the management of BD-IPMNs is still controversial and depends on several cysts and patients features. The choice between non-operative and surgical management depends on the distinction between benign and invasive IPMN forms, assessment of malignancy risk, patient's wellness and its preferences. This manuscript revises the different guidelines for the management of IPMNs that have been published in different world countries: the international (Sendai 2006 and Fukuoka 2012), the 2013 European, the 2014 Italian, and finally the 2015 American guidelines. In summary, this review will integrate the recent insights in the combination of diagnostic techniques, such as Magnetic Resonance Imaging (MRI) and endoscopic ultrasound (EUS), pathology classification, and management of IPMNs.

  1. Surgical management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas.

    Science.gov (United States)

    Farnell, Michael B

    2008-03-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by papillary growths within the pancreatic ductal system that are at risk for undergoing malignant transformation. Main duct IPMN carries a significant risk of malignancy, and operation is recommended regardless of the presence of symptoms. The risk of malignancy is much lower for side branch IPMN, and current evidence suggests that, in the absence of symptoms, mural nodules, positive cytology, or cyst size less than 3 cm, observation is warranted. When operation is indicated, targeted pancreatic resection with frozen-section analysis of margins is recommended. Pancreatoduodenectomy or distal pacreatectomy is appropriate for the majority. Only in about 10% of patients is the disease so diffuse at presentation that total pancreatectomy is necessary. Survival following pancreatic resection for noninvasive IPMN is excellent. The risk of recurrence following pancreatic resection for invasive IPMN is significant. Surveillance is warranted both for patients subjected to pancreatic resection and for those under observation with side branch IPMN. Much is yet to be learned regarding this neoplasm, and surgical management remains in evolution.

  2. Intraductal and invasive adenocarcinoma of duct of Luschka, mimicking chronic cholecystitis and cholelithiasis

    Directory of Open Access Journals (Sweden)

    Cheema Muhammad

    2009-01-01

    Full Text Available Abstract Background Intraductal and invasive adenocarcinoma of duct of Luschka is rare. To the best of our knowledge, this is the second case report of intraductal and invasive carcinoma arising from ducts of Luschka. Case presentation Patient presented to hospital with signs and symptoms of chronic cholecystitis and cholelithiasis. Ultrasound examination revealed thickening of gallbladder wall with abnormal septation around liver bed. Patient underwent laparoscopic cholecystectomy and resection of the adjacent liver bed. Histologic examination confirmed an intraductal and invasive adenocarcinoma arising from Luschka ducts. Conclusion Adenocarcinoma of ducts of Luschka should be considered among differential diagnoses for the patients with typical clinical presentations of chronic cholecystitis and cholelithiasis.

  3. Pancreatectomy for Intraductal Papillary Mucinous Neoplasm of the Pancreas: Could Pancreaticogastrostomy Be the Anastomosis of Choice?

    Directory of Open Access Journals (Sweden)

    Stavros Gourgiotis

    2010-07-01

    Full Text Available Dear Sir, Surgical resection is the treatment of choice for intraductal papillary mucinous neoplasms (IPMNs of the pancreas. The aim of resection in the management of IPMNs is to remove all the adenomatous or malignant mucosa and to minimize the chance of recurrence in the pancreatic remnant. However, even after partial pancreatectomy with negative surgical margins for non-invasive IPMN, the tumour can recur as disseminated disease or as locally invasive or noninvasive disease in the pancreatic remnant [1]. For non-invasive IPMNs, the overall disease recurrence rate reported is 1.3 to 9.3% while, for invasive IPMNs, the overall disease recurrence rate is 12 to 68% [2]. The overall recurrence rate for IPMNs varies from 7% to 43% [2]. Our question relates to the issue of the high risk of recurrence in both non-invasive and invasive IPMNs after partial pancreatectomy. Has pancreaticogastric anastomosis been utilized in patients with IPMNs and is it something we should all think about in patients who undergo resections of the head and require surveillance with subsequent endoscopic retrograde cholangiopancreatography (ERCP? Would pancreaticogastrostomy be something we should all be doing in order to follow-up patients having a pancreatic remnant with endoscopic surveillance? Several techniques of anastomosing the pancreatic remnant to the stomach have been proposed: invagination of the stump of the pancreas, implantation of the pancreatic duct, and anastomosis between the pancreatic duct and the gastric mucosa.

  4. Intraductal papillary mucinous carcinoma with atypical manifestations: Report of two cases

    Institute of Scientific and Technical Information of China (English)

    Seung Eun Lee; Jin-Young Jang; Sung Hoon Yang; Sun-Whe Kim

    2007-01-01

    Intraductal papillary mucinous neoplasms (IPMNs) are a well-characterized group of mucin-producing cystic neoplasms of the clear malignant potential type. We report here two cases of intraductal papillary mucinous carcinoma (IPMC) with atypical manifestations. In one case, we discussed a pseudomyxoma peritonei caused by a ruptured IPMC. In the other case we discussed the fistulization of IPMC into the stomach and duodenum. These two cases suggest that IPMN can either spontaneously rupture causing mucinous materials to spill into the free abdominal cavity or directly invade adjacent organs resulting in fistula development.

  5. Intraductal Papillary Mucinous Neoplasms of the Pancreas: Clinical Surveillance and Malignant Progression, Multifocality and Implications of a Field-Defect

    Directory of Open Access Journals (Sweden)

    Helen Elaine Remotti

    2012-03-01

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs are a heterogeneous group of mucin producing cystic tumors that involve the main pancreatic duct and/or branch ducts and may be associated with invasive carcinoma. Predicting the risk of malignant transformation of an IPMN lesion can be challenging. The Sendai criteria, based in large part on radiographic imaging features, help guide surgical intervention based on the stratification of cysts into high and low risk lesions for malignancy. Invasive carcinoma may develop in the index IPMN lesion or in a separate site within the pancreas, supporting the concept of a field defect in IPMN tumorigenesis. This stresses the importance of evaluation of the entire pancreas upon diagnosis of IPMN and continued surveillance of the residual pancreas following resection. Herein, the authors summarize the data presented at the 2012 ASCO Gastrointestinal Cancers Symposium regarding prevalence and site of invasive carcinoma detected in patients undergoing surveillance for IPMN (Abstract #152.

  6. Pathological features and diagnosis of intraductal papillary mucinous neoplasm of the pancreas

    Institute of Scientific and Technical Information of China (English)

    Víctor; M; Castellano-Megías; Carolina; Ibarrola-de; Andrés; Guadalupe; López-Alonso; Francisco; Colina-Ruizdelgado

    2014-01-01

    Intraductal papillary mucinous neoplasm(IPMN) of the pancreas is a noninvasive epithelial neoplasm of mucinproducing cells arising in the main duct(MD) and/or branch ducts(BD) of the pancreas. Involved ducts are dilated and filled with neoplastic papillae and mucus in variable intensity. IPMN lacks ovarian-type stroma, unlike mucinous cystic neoplasm, and is defined as a grossly visible entity(≥ 5 mm), unlike pancreatic intraepithelial neoplasm. With the use of high-resolution imaging techniques, very small IPMNs are increasingly being identified. Most IPMNs are solitary and located in the pancreatic head, although 20%-40% are multifocal. Macroscopic classification in MD type, BD type and mixed or combined type reflects biological differences with important prognostic and preoperative clinical management implications. Based on cytoarchitectural atypia, IPMN is classified into low-grade, intermediategrade and high-grade dysplasia. Based on histological features and mucin(MUC) immunophenotype, IPMNs are classified into gastric, intestinal, pancreatobiliary and oncocytic types. These different phenotypes can be observed together, with the IPMN classified according to the predominant type. Two pathways have been suggested: gastric phenotype corresponds to less aggressive uncommitted cells(MUC1-, MUC2-, MUC5 AC +, MUC6 +) with the capacity to evolve to intestinal phenotype(intestinal pathway)(MUC1-, MUC2 +, MUC5 AC +, MUC6- or weak +) or pancreatobiliary /oncocytic phenotypes(pyloropancreatic pathway)(MUC1 +, MUC 2-, MUC5 AC +, MUC 6 +) becoming more aggressive. Prognosis of IPMN is excellent but critically worsens when invasive carcinoma arises(about 40% of IPMNs), except in some cases of minimal invasion. The clinical challenge is to establish which IPMNs should be removed because of their higher risk of developing invasive cancer. Once resected, they must be extensively sampled or, much better, submitted in its entirety for microscopic study to completely rule out

  7. Pathological features and diagnosis of intraductal papillary mucinous neoplasm of the pancreas

    Science.gov (United States)

    Castellano-Megías, Víctor M; Andrés, Carolina Ibarrola-de; López-Alonso, Guadalupe; Colina-Ruizdelgado, Francisco

    2014-01-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a noninvasive epithelial neoplasm of mucin-producing cells arising in the main duct (MD) and/or branch ducts (BD) of the pancreas. Involved ducts are dilated and filled with neoplastic papillae and mucus in variable intensity. IPMN lacks ovarian-type stroma, unlike mucinous cystic neoplasm, and is defined as a grossly visible entity (≥ 5 mm), unlike pancreatic intraepithelial neoplasm. With the use of high-resolution imaging techniques, very small IPMNs are increasingly being identified. Most IPMNs are solitary and located in the pancreatic head, although 20%-40% are multifocal. Macroscopic classification in MD type, BD type and mixed or combined type reflects biological differences with important prognostic and preoperative clinical management implications. Based on cytoarchitectural atypia, IPMN is classified into low-grade, intermediate-grade and high-grade dysplasia. Based on histological features and mucin (MUC) immunophenotype, IPMNs are classified into gastric, intestinal, pancreatobiliary and oncocytic types. These different phenotypes can be observed together, with the IPMN classified according to the predominant type. Two pathways have been suggested: gastric phenotype corresponds to less aggressive uncommitted cells (MUC1 -, MUC2 -, MUC5AC +, MUC6 +) with the capacity to evolve to intestinal phenotype (intestinal pathway) (MUC1 -, MUC2 +, MUC5AC +, MUC6 - or weak +) or pancreatobiliary /oncocytic phenotypes (pyloropancreatic pathway) (MUC1 +, MUC 2-, MUC5AC +, MUC 6 +) becoming more aggressive. Prognosis of IPMN is excellent but critically worsens when invasive carcinoma arises (about 40% of IPMNs), except in some cases of minimal invasion. The clinical challenge is to establish which IPMNs should be removed because of their higher risk of developing invasive cancer. Once resected, they must be extensively sampled or, much better, submitted in its entirety for microscopic study to

  8. Pancreatic intraductal papillary mucinous neoplasm with concomitant heterotopic pancreatic cystic neoplasia of the stomach: a case report and review of the literature

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    Schizas Dimitrios

    2010-01-01

    Full Text Available Abstract A 60-year-old Caucasian male underwent a total pancreatectomy for a mixed type pancreatic intraductal papillary mucinous neoplasm (IPMN arising in the main and secondary pancreatic ducts. During surgery, a subserosal polypoid mass was noted at the greater curvature of the gastric antrum and was enucleated. This mass was proven to be heterotopic pancreatic tissue with cystic neoplasia of the IPMN histologic subtype. Through an extensive search of the literature, we found that this is the first case ever reported with simultaneous existence of IPMN changes, in the main and secondary ducts of the orthotopic pancreas and in the heterotopic pancreatic tissue of the gastric wall.

  9. Magnetic Resonance Cholangiopancreatography with Secretin Stimulation in the Diagnosis of Intraductal Papillary Mucinous Neoplasm: A Paradigmatic Case Report

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    Elsa Iannicelli

    2014-01-01

    Full Text Available Context. One of the characteristic findings of intraductal papillary mucinous neoplasms (IPMN is the presence of a direct communication between the lesion and the ductal pancreatic system and when magnetic resonance cholangiopancreatography (MRCP shows uncertain findings, it is useful to perform a MRCP after secretin stimulation (MRCP-S which provides a better visualization of the ductal system. Case Report. We present a case of 51-year-old man in whom, during a CT follow-up for a renal tumour, was found a cystic lesion of the pancreas. To better evaluate the lesion and its suspected communication with the pancreatic system, MR with gadolinium and MRCP and MRCP-S were performed. With the MRCP and MRI it was not possible to identify a clear communication between the cystic lesion and the ductal system. MRCP-S showed an increase in signal intensity of the lesion and its communication with the ductal system, allowing us to classify the cystic lesion as a main duct in intraductal papillary mucinous neoplasm. The patient underwent a surgical duodenal pancreatectomy. The histological result of the specimen confirmed the diagnosis of adenocarcinoma IPMN. Conclusion. In this case MRCP-S has allowed a clearer identification of the cystic lesion allowing a correct diagnosis and treatment.

  10. Intraductal Papillary Mucinous Neoplasm (IPMN and Chronic Pancreatitis: Overlapping Pathological Entities? Two Case Reports

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    Athanasios Petrou

    2011-01-01

    Full Text Available Context Intraductal papillary mucinous neoplasms (IPMNs are a recently classified pancreatic neoplasm with an increasing incidence. IPMN is often misdiagnosed as chronic pancreatitis because of symptoms of relapsing abdominal pain, pancreatitis, and steatorrhea and imaging findings of a dilated pancreatic duct of cystic lesions that are frequently confused with pseudocysts. Early recognition of IPMN allows for prompt surgical resection before malignant transformation. Case reports We report two cases of patients with long histories of chronic pancreatitis (more than 15 years that went on to develop IPMN. Both patients presented with symptoms of abdominal pain, nausea, steatorrhoea and eventually weight loss. Biochemical and radiological findings were suggestive of chronic pancreatitis although no clear causes for this were identified. Both patients were followed up with multiple repeat scans with no reported sinister findings. Many years after the initial diagnosis of chronic pancreatitis, radiological investigations identified pathological changes suggestive of neoplastic development and histology confirmed IPMN. Conclusions The cases demonstrate the ongoing challenges in diagnosing and managing IPMN effectively; highlights the important aspects of epidemiology in differentiating chronic pancreatitis and IPMN; continues the discussion surrounding the relationship between IPMN and chronic pancreatitis.

  11. Intraductal papillary mucinous neoplasms of the pancreas: making a disposition using the natural history.

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    Traverso, L William; Moriya, Toshiyuki; Hashimoto, Yasushi

    2012-04-01

    The process of Intraductal papillary mucinous neoplasms (IPMN) follows the adenoma-to-carcinoma sequence. If it progresses to malignancy about 5 years is required. Even though the process is slow IPMN provides the clinician with the opportunity to avoid malignancy if the patient is at risk. The natural history as observed through Kaplan Meier event curves for occurrence of malignancy show the process to malignancy is much faster (50% within 2 years) if pancreatitis-like symptoms are present or if the main pancreatic duct (MPD) is involved. Almost all decisions to resect (95% in our experience) are based on the presence of symptoms or the MPD location. Cyst size is used infrequently. Every patient with an IPMN should always have a planned follow-up and the frequency depends on the perceived risk of malignancy-immediate imaging if becomes symptomatic to every 2 to 3 years if asymptomatic side branch lesions. The natural history provides modern guidelines for making decisions in patients with a newly discovered IPMN.

  12. Natural history of intraductal papillary mucinous neoplasms (IPMN): current evidence and implications for management.

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    Bassi, Claudio; Sarr, Michael G; Lillemoe, Keith D; Reber, Howard A

    2008-04-01

    Intraductal papillary mucinous neoplasms (IPMNs) show varying degrees of dysplasia throughout the neoplasm that can range from adenoma to invasive carcinoma, with dysplastic changes of borderline neoplasms and carcinoma in situ in between. An understanding of the natural history, and especially the required time to transform into either carcinoma in situ or an invasive adenocarcinoma, is critically important for management policy. This topic serves as the rationale for the present analysis. At the beginning of February 2007, using the key word "IPMN" in PubMed, we initially selected 119 publications using the principal criteria as defined by the WHO classification. We identified 20 appropriate original reports and one consensus paper. Neither randomized control trials (RCT) or systematic reviews of RCTs (level 1 evidence) nor cohort studies or reviews of cohort studies (level 2 evidence) have been published. Only one report fit the criteria for level 3 evidence (case control study). Nineteen papers satisfied criteria for level 4 (cases series) and two for level 5 (expert opinion publication). After additional review and analysis, we considered only six reports to be "cornerstone papers" of merit for the final review. Clues to the natural history of IPMNs can be gained by using several methods to examine the articles: (a) to verify different prognoses between main and side branch duct subtypes; (b) to compare the average age of patients with benign vs. malignant IPMNs; (c) to summarize the findings of nonoperative, observational studies based on follow up by clinical, biochemical, and imaging techniques without operative resection; (d) to determine the prognostic importance of the status of the resection margin; and (e) to follow patients clinically after surgical resection. Although important aspects of the natural history of IPMN are still unknown, the following conclusions can be drawn: (1) Branch-duct IPMNs are less aggressive than main-duct IPMNs. (2

  13. Intraductal papillary mucinous neoplasm of the pancreas (IPMN: clinico-pathological correlations and surgical indications

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    Cantù Massimiliano

    2010-04-01

    Full Text Available Abstract Background Intraductal papillary mucinous neoplasms (IPMNs are increasingly recognized entities, whose management remains sometimes controversial, due to the high rate of benign lesions and on the other side to the good survival after resection of malignant ones. Methods Retrospective analysis of a prospectively collected Western series of IPMN. Results Forty cases of IPMN were analysed (1992-2007. Most patients were symptomatic (72.5%; cholangio-MRI had the best diagnostic accuracy both for the tumour nature (83.3% and for the presence of malignancy (57.1%. ERCP was done in 8 cases (20%, and the results were poor. Thirteen patients were treated by pancreatic resection and 27 were maintained in follow-up. Total pancreatectomy was performed in 46% of the cases; in situ and invasive carcinoma were recognized in 15.4% and 38.4% of the cases, respectively. The mean follow-up was 42 months (range 12-72. One only patients with nodal metastases died 16 months after the operation for disease progression, while 91.6% of the operated patients are disease free. Out of the 27 not resected patients, 2 out of 4 presenting a lesion at high risk for malignancy died, while the remaining are in good conditions and disease free, with a mean follow-up of 31 months. Conclusion Therapeutic indication for IPMNs is mainly based upon radiological evaluation of the risk of malignancy. While the main duct tumours should be resected, preserving whenever possible a portion of the gland, the secondary ducts tumours may be maintained under observation, in absence of radiological elements of suspicion such as size larger than 3 cm, or a wall greater than 3 mm or nodules or papillae in the context of the cyst.

  14. Intraductal oncocytic papillary neoplasm of the pancreas: a case of a second neoplasm in a pancreas cancer survivor.

    Science.gov (United States)

    Garg, Mrinal S; Schuerle, Theresa; Liu, Yulin; Thakkar, Shyam J

    2015-01-31

    Cystic neoplasms, which are less common forms of exocrine pancreatic neoplasms, consist of mainly intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms. Mucinous cystic neoplasms, unlike IPMN, are not associated with ductal growth, are usually multilocular in nature, and have ovarian type stroma. Mucinous cystadenocarcinoma is a type of mucinous cystic neoplasm more commonly found in women. Intraductal oncocytic papillary neoplasms of the pancreas are the least common variant of IPMN. Despite this classification, intraductal oncocytic papillary neoplasms have been compared to mucinous cystic neoplasms in previous studies and the classification is still questioned. We report a rare case of an intraductal oncocytic papillary neoplasm of the pancreas occurring in a 52-year-old male with a prior history of surgically excised mucinous cystadenocarcinoma. This is the first known case of an intraductal oncocytic papillary neoplasm occurring after a prior pancreatic neoplasm. As the diagnosis of intraductal oncocytic papillary neoplasms are rare, having only a few case reports and small series on which to understand its disease process, it is imperative to discuss each case and detail possible correlations with other pancreatic cystic neoplasms as well as distinctions from its current association within IPMN.

  15. Intraductal Oncocytic Papillary Neoplasm of the Pancreas: A Case of a Second Neoplasm in a Pancreas Cancer Survivor

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    Mrinal S Garg

    2015-01-01

    Full Text Available Context Cystic neoplasms, which are less common forms of exocrine pancreatic neoplasms, consist of mainly intraductal papillary mucinous neoplasms (IPMN and mucinous cystic neoplasms. Mucinous cystic neoplasms, unlike IPMN, are not associated with ductal growth, are usually multilocular in nature, and have ovarian type stroma. Mucinous cystadenocarcinoma is a type of mucinous cystic neoplasm more commonly found in women. Intraductal oncocytic papillary neoplasms of the pancreas are the least common variant of IPMN. Despite this classification, intraductal oncocytic papillary neoplasms have been compared to mucinous cystic neoplasms in previous studies and the classification is still questioned. Case report We report a rare case of an intraductal oncocytic papillary neoplasm of the pancreas occurring in a 52-year-old male with a prior history of surgically excised mucinous cystadenocarcinoma. This is the first known case of an intraductal oncocytic papillary neoplasm occurring after a prior pancreatic neoplasm. Conclusion As the diagnosis of intraductal oncocytic papillary neoplasms are rare, having only a few case reports and small series on which to understand its disease process, it is imperative to discuss each case and detail possible correlations with other pancreatic cystic neoplasms as well as distinctions from its current association within IPMN.

  16. A Rare Case of an Intraductal Papillary Mucinous Neoplasm of Pancreas Fistulizing Into Duodenum With Adult Polycystic Kidney Disease

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    Pipaliya, Nirav; Rathi, Chetan; Parikh, Pathik; Patel, Ruchir; Ingle, Meghraj; Sawant, Prabha

    2015-01-01

    Intraductal papillary mucinous neoplasm (IPMN) accounts for 20-50% of all cystic neoplasms of the pancreas. Rarely, IPMN, whether benign or malignant, can fistulize into adjacent organs like duodenum, stomach or common bile duct. IPMN can be associated with other diseases like Peutz-Jeghers syndrome and familial adenomatous polyposis. Association with adult polycystic kidney disease (ADPKD) is extremely rare. We report a case of a 60-year-old male with a large IPMN in the head of the pancreas diagnosed by magnetic resonance imaging, endoscopic ultrasound and cyst fluid analysis. It was complicated by fistula formation into the second part of the duodenum. Patient was simultaneously having adult polycystic kidney disease. There is only one case report of uncomplicated IPMN with ADPKD in the literature so far. And even rarer, there is no any case report of fistulizing IPMN with ADPKD reported so far, to the best of our knowledge. PMID:27785296

  17. Oncocytic-type intraductal papillary mucinous neoplasm (IPMN-derived invasive oncocytic pancreatic carcinoma with brain metastasis - a case report

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    Chiang Kun-Chun

    2012-07-01

    Full Text Available Abstract Pancreatic cancer is a lethal disease without effective treatments at present. It ranks as s as 4th and 5th in cancer-related mortality in the western countries and worldwide. Locally advanced pancreatic duct carcinoma (PDAC and metastatic PDAC, usually found the metastases over liver, peritoneum, or lung, have been shown to be with dismal prognosis. Brain metastasis is a rare entity and most cases reported before were found post-mortem. Intraductal papillary mucinous neoplasms of the pancreas (IPMN has been deemed as a precursor of PDAC with very slow progression rate. Here we reported a case diagnosed with IPMN-derived PDAC with brain metastasis. After surgeries for PDAC and brain metastasis, subsequent chemotherapy and radiotherapy were also given. One and half year after surgery, this patient is still living with good performance status, which may warrant individualization of therapeutic strategy for PDAC with only brain metastasis.

  18. Oncocytic-type intraductal papillary mucinous neoplasm (IPMN)-derived invasive oncocytic pancreatic carcinoma with brain metastasis - a case report.

    Science.gov (United States)

    Chiang, Kun-Chun; Yu, Chi-Chang; Chen, Jim-Ray; Huang, Yu-Ting; Huang, Cheng-Cheng; Yeh, Chun-Nan; Tsai, Chien-Sheng; Chen, Li-Wei; Chen, Hsien-Cin; Hsu, Jun-Te; Wang, Cheng-Hsu; Chen, Huang-Yang

    2012-07-09

    Pancreatic cancer is a lethal disease without effective treatments at present. It ranks as s as 4th and 5th in cancer-related mortality in the western countries and worldwide. Locally advanced pancreatic duct carcinoma (PDAC) and metastatic PDAC, usually found the metastases over liver, peritoneum, or lung, have been shown to be with dismal prognosis. Brain metastasis is a rare entity and most cases reported before were found post-mortem. Intraductal papillary mucinous neoplasms of the pancreas (IPMN) has been deemed as a precursor of PDAC with very slow progression rate. Here we reported a case diagnosed with IPMN-derived PDAC with brain metastasis. After surgeries for PDAC and brain metastasis, subsequent chemotherapy and radiotherapy were also given. One and half year after surgery, this patient is still living with good performance status, which may warrant individualization of therapeutic strategy for PDAC with only brain metastasis.

  19. Pancreatic lipoma with a solid nodule mimicking invasion from adjoining intraductal papillary mucinous neoplasm

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    Yoko Namiki, MD

    2016-06-01

    Full Text Available A 74-year-old man was referred to our hospital for a mass in the pancreatic head found during screening chest computed tomography. Contrast computed tomography showed a 5-cm multicystic mass with an irregular border containing a solid component showing contrast enhancement. Caudal to this mass, a 5-cm solid mass of fat density with a nodular soft-tissue component was found. Cytology of the aspirated pancreatic fluid revealed malignant cells, and surgery was performed for suspected intraductal papillary mucinous carcinoma. Pathologic analysis of the resected specimen revealed a collision tumor of intraductal papillary mucinous neoplasm (IPMN with high-grade dysplasia and pancreatic lipoma. The soft-tissue component within the lipoma was a nodule consisting of pancreatic tissue with inflammatory infiltration and hyalinization and was not associated with IPMN invasion.

  20. Exploring the Functional Disorder and Corresponding Key Transcription Factors in Intraductal Papillary Mucinous Neoplasms Progression

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    Guiying Bai

    2015-01-01

    Full Text Available This study has analyzed the gene expression patterns of an IPMN microarray dataset including normal pancreatic ductal tissue (NT, intraductal papillary mucinous adenoma (IPMA, intraductal papillary mucinous carcinoma (IPMC, and invasive ductal carcinoma (IDC samples. And eight clusters of differentially expressed genes (DEGs with similar expression pattern were detected by k-means clustering. Then a survey map of functional disorder in IPMN progression was established by functional enrichment analysis of these clusters. In addition, transcription factors (TFs enrichment analysis was used to detect the key TFs in each cluster of DEGs, and three TFs (FLI1, ERG, and ESR1 were found to significantly regulate DEGs in cluster 1, and expression of these three TFs was validated by qRT-PCR. All these results indicated that these three TFs might play key roles in the early stages of IPMN progression.

  1. MIB-1 labeling index, Ki-67, is an indicator of invasive intraductal papillary mucinous neoplasm

    OpenAIRE

    Shimura, Tatsuo; Kofunato, Yasuhide; OKADA, Ryo; Yashima, Rei; Okada, Koji; Araki, Kenichiro; Hosouchi, Yasuo; Kuwano, Hiroyuki; Takenoshita, Seiichi

    2016-01-01

    Despite strict criteria for the observation of intraductal papillary mucinous neoplasm (IPMN), it remains difficult to distinguish invasive IPMN from non-invasive IPMN. The aim of the present study was to identify an indicator of invasive IPMN. The present study retrospectively evaluated 53 patients (28 with non-invasive and 25 with invasive IPMN) who underwent resection of IPMN, and examined the usefulness of the MIB-1 labeling index as an indicator of invasive IPMN. The MIB-1 labeling index...

  2. Predictive factors associated with malignancy of intraductal papillary mucinous pancreatic neoplasms

    Institute of Scientific and Technical Information of China (English)

    Jin; Hee; Lee; Kyu; Taek; Lee; Jongwook; Park; Sun; Youn; Bae; Kwang; Hyuck; Lee; Jong; Kyun; Lee; Kee-Taek; Jang; Jin; Seok; Heo; Seong; Ho; Choi; Dong; Wook; Choi; Jong; Chul; Rhee

    2010-01-01

    AIM:To identify preoperative predictive factors associated with malignancy of intraductal papillary mucinous neoplasms(IPMNs) of the pancreas.METHODS:Between April 1995 and April 2010,129 patients underwent surgical resection for IPMNs at our institute and had confirmed pathologic diagnoses.The medical records were retrospectively reviewed and immunohistochemical staining for mucin(MUC) in pancreatic tissues was performed.RESULTS:Univariate analysis showed that the following five variables were closely asso...

  3. Imaging features of intraductal papillary mucinous neoplasms of the pancreas in multi-detector row computed tomography

    Institute of Scientific and Technical Information of China (English)

    Ling Tan; Ya-E Zhao; Deng-Bin Wang; Qing-Bing Wang; Jing Hu; Ke-Min Chen; Xia-Xing Deng

    2009-01-01

    AIM:To retrospectively evaluate the imaging features of pancreatic intraductal papillary mucinous neoplasms (IPMNs) in multi-detector row computed tomography (MDCT).METHODS:A total of 20 patients with pathologicallyconfirmed intraductal papillary mucinous neoplasms (IPMNs) were included in this study.Axial MDCT images combined with CT angiography (CTA) and multiplanar volume reformations (MPVR) or curved reformations (CR) were preoperatively acquired.Two radiologists (Tan L and Wang DB) reviewed all the images in consensus using an interactive picture archiving and communication system.The disputes in readings were resolved through consultation with a third experienced radiologist (Chen KM).Finally,the findings and diagnoses were compared with the pathologic results.RESULTS:The pathological study revealed 12 malignant IPMNs and eight benign IPMNs.The diameters of the cystic lesions and main pancreatic ducts (MPDs) were significantly larger in malignant IPMNs compared with those of the benign IPMNs (P<0.05).The combinedtype IPMNs had a higher rate of malignancy than the other two types of IPMNs (P<0.05).Tumors with mural nodules and thick septa had a significantly higher incidence of malignancy than tumors without these features (P<0.05).Communication of side-branch IPMNs with the MPD was present in nine cases at pathologic examination.Seven of them were identified from CTA and MPVR or CR images.From comparison with the pathological diagnosis,the sensitivity,specificity,and accuracy of MDCT in characterizing the malignancy of IPMN of the pancreas were determined to be 100%,87.5% and 95%,respectively.CONCLUSION:MDCT with CTA and MPVR or CR techniques can elucidate the imaging features of IPMNs and help predict the malignancy of these tumors.

  4. Correlation between CT patterns and pathological classification of intraductal papillary mucinous neoplasm

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    Zhang Jing [Department of Imaging, Tongji Hospital of Tongji University, 389 Xincun Road, Shanghai 200065 (China)], E-mail: Zhangjingyxd@163.com; Wang Peijun [Department of Imaging, Tongji Hospital of Tongji University, 389 Xincun Road, Shanghai 200065 (China)], E-mail: Tongjipjwang@vip.sina.com; Yuan Xiaodong [Department of Radiology, Changhai Hospital of the Second Military Medical University, Shanghai 200433 (China)], E-mail: yuanxiaodongzj@163.com

    2010-01-15

    Objective: To examine CT patterns of intraductal papillary mucinous neoplasm (IPMN), analyze their correlation with pathologic classification, and discuss the value of CT in the diagnosis and differential diagnosis of IPMN. Methods: CT patterns of 39 IPMN patients, whose clinical data were complete and whose diagnosis was confirmed by surgery and pathology, were classified into three types: (1) simple main pancreatic duct (MPD) dilation type, (2) MPD dilation with pancreatic cystic lesion type, and (3) simple pancreatic cystic lesion type. Correlations between the three CT types and Takada pathologic classification (MPD type, furcation type and mixture type) were analyzed. The 39 IPMN cases were pathologically classified as the benign group and the malignant/borderline group. CT characteristics including the presence or absence of mural nodules, intrafocal partitions, focal size and the degree of MPD and common bile duct (CBD) dilation were analyzed statistically. Results: A correlation was found between the CT simple MPD dilation type and the pathological MPD type, between the MPD dilation with pancreatic cystic lesion type and the furcation and mixture types, and between the simple cystic lesion type and the furcation type (p < 0.001). The benign rate was 92% in patients without intrafocal mural nodules, and 42% in patients with intrafocal mural nodules. The difference between the two groups was statistically significant (p = 0.003). The presence or absence of intrafocal partitions was not correlated with benignancy or malignancy (p = 0.793). The maximum diameter of malignant/borderline lesions was bigger than that of benign ones (p = 0.016). There was no significant difference in MPD and CBD diameters between the benign and malignant/borderline groups. Regardless of pathological classification, the MPD diameter was larger than the CBD diameter in all cases (p = 0.02). Conclusion: The three CT types of IPMN well correlated with the pathologic classification

  5. A pancreatobiliary-type carcinoma in situ at the periphery of a mural nodule developed from a gastric adenoma in an intraductal papillary mucinous neoplasm.

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    Takasu, Naoki; Kimura, Wataru; Moriya, Toshiyuki; Takeshita, Akiko; Murayama, Saijiro; Hirai, Ichiro; Ogata, Shinya

    2010-08-01

    We report a rare case of an intraductal papillary mucinous neoplasm (IPMN) with a pancreatobiliary-type carcinoma in situ (CIS) that originated around a mural nodule formed in a gastric-type adenoma. A 64-year-old man was admitted to our hospital in December 2001 for dilation of the main pancreatic duct, detected on abdominal ultrasonography. Branch-duct-type IPMN (diameter 25 mm) was diagnosed, and because mural nodules were absent, the patient was annually followed up for 5 years. In 2006, computed tomography scans revealed thickening of the tumor wall and the development of a mural nodule (diameter approximately 6 mm); pancreatoduodenectomy with regional lymph-node dissection was performed. Histopathologic examination showed an intraductal papillary mucinous carcinoma arising from an adenoma. Hematoxylin and eosin (H&E) staining revealed that most of the tumor components, including the mural nodule, had adenomatous changes, indicating the tumor to be of the gastric type; however, immunohistochemistry showed positive MUC2 expression. Histologically, the tissues around the nodule, including those showing a cribriform pattern, were diagnosed as CIS. These tissues were classified as the pancreatobiliary-type on the basis of the results of both H&E staining and immunohistochemistry. The patient remained disease-free for 3 years after surgery.

  6. FDG-PET Findings of Intraductal Oncocytic Papillary Neoplasms of the Pancreas: Two Case Reports

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    Takashi Kato

    2012-06-01

    Full Text Available Intraductal oncocytic papillary neoplasm (IOPN of the pancreas is a rare pancreatic tumor. To date, there have been three case reports of IOPN which showed strong positivity on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET, raising the possibility of distinguishing IOPNs from other intraductal papillary mucinous neoplasms (IPMNs using FDG-PET. However, all three cases had large tumors, approximately 10 cm in diameter, and there are no case reports of FDG-PET findings of small IOPNs, i.e. tumors the average size of malignant IPMNs (3–5 cm. We report two cases with IOPN of average size with FDG-PET findings. Computed tomography (CT showed a multilocular cystic lesion 4 cm in diameter with a mural nodule 1 cm in diameter (case 1 and a cystic lesion 5 cm in diameter with a papillary mural nodule 4 cm in diameter (case 2. FDG-PET showed abnormal uptake at the same location as the pancreatic tumor revealed by CT in both cases. The maximum standardized uptake values of the lesions were 3.4 and 4.2, respectively. Surgical resection was performed and the tumor was diagnosed as IOPN with carcinoma in situ (case 1 and IOPN with minimal invasion (case 2. FDG-PET may be useful for diagnosing malignancy in IOPN, as it is in IPMN. However, in our two cases, strong accumulation was not observed in the IOPNs, which were within the average size range of malignant IPMNs.

  7. Implications of imaging criteria for the management and treatment of intraductal papillary mucinous neoplasms - benign versus malignant findings

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    Walter, Thula Cannon; Steffen, Ingo G.; Stelter, Lars H.; Hamm, Bernd; Denecke, Timm; Grieser, Christian [Charite - Universitaetsmedizin Berlin, Klinik fuer Radiologie, Campus Virchow-Klinikum, Berlin (Germany); Maurer, Martin H. [Universitaetsklinik Bern, Universitaetsinstitut fuer Radiologe, Inselspital, Bern (Switzerland); Bahra, Marcus; Faber, Wladimir; Klein, Fritz [Charite - Universitaetsmedizin Berlin, Klinik fuer Allgemein-, Viszeral- und Transplantationschirurgie Campus Virchow-Klinikum, Berlin (Germany); Blaeker, Hendrik [Charite - Universitaetsmedizin Berlin, Institut fuer Pathologie, Campus Charite Mitte, Berlin (Germany)

    2015-05-01

    Evaluation of computed tomography (CT) and magnetic resonance imaging (MRI) for differentiation of pancreatic intraductal papillary mucinous neoplasm (IPMN) subtypes based on objective imaging criteria. Fifty-eight patients with 60 histologically confirmed IPMNs were included in this retrospective study. Eighty-three imaging studies (CT,n = 42; MRI,n = 41) were analysed by three independent blinded observers (O1-O3), using established imaging criteria to assess likelihood of malignancy (-5, very likely benign; 5, very likely malignant) and histological subtype (i.e., low-grade (LGD), moderate-grade (MGD), high-grade dysplasia (HGD), early invasive carcinoma (IPMC), solid carcinoma (CA) arising from IPMN). Forty-one benign (LGD IPMN,n = 20; MGD IPMN,n = 21) and 19 malignant (HGD IPMN,n = 3; IPMC,n = 6; solid CA,n = 10) IPMNs located in the main duct (n = 6), branch duct (n = 37), or both (n = 17) were evaluated. Overall accuracy of differentiation between benign and malignant IPMNs was 86/92 % (CT/MRI). Exclusion of overtly malignant cases (solid CA) resulted in overall accuracy of 83/90 % (CT/MRI). The presence of mural nodules and ductal lesion size ≥30 mm were significant indicators of malignancy (p = 0.02 and p < 0.001, respectively). Invasive IPMN can be identified with high confidence and sensitivity using CT and MRI. The diagnostic problem that remains is the accurate radiological differentiation of premalignant and non-invasive subtypes. (orig.)

  8. Does Papillary Carcinoma of Thyroglossal Duct Cyst Develop De Novo?

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    Tekin Baglam

    2015-01-01

    Full Text Available Backround. Thyroglossal duct cyst (TDC is a developmental abnormality of the thyroid gland. Due to embryological remnants of thyroid tissue located in the TDC, the same malignant tumors that develop in the thyroid gland can also develop in the TDC. Methods. We present the unique case of a 39-year-old female with simultaneous de novo papillary carcinoma in a TDC and the thyroid gland. Results. With the suspicion of simultaneous papillary carcinoma in the TDC and the thyroid gland, Sistrunk procedure with total thyroidectomy and central neck exploration was performed. Conclusion. The clinician should have a high index of suspicion upon encountering papillary carcinoma of the TDC to differentiate de novo papillary carcinoma in the TDC from those originating from the thyroid gland, because papillary carcinoma in TDC may originate from an occult thyroid papillary carcinoma.

  9. Does Papillary Carcinoma of Thyroglossal Duct Cyst Develop De Novo?

    Science.gov (United States)

    Baglam, Tekin; Binnetoglu, Adem; Yumusakhuylu, Ali Cemal; Demir, Berat; Askan, Gokce; Sari, Murat

    2015-01-01

    Backround. Thyroglossal duct cyst (TDC) is a developmental abnormality of the thyroid gland. Due to embryological remnants of thyroid tissue located in the TDC, the same malignant tumors that develop in the thyroid gland can also develop in the TDC. Methods. We present the unique case of a 39-year-old female with simultaneous de novo papillary carcinoma in a TDC and the thyroid gland. Results. With the suspicion of simultaneous papillary carcinoma in the TDC and the thyroid gland, Sistrunk procedure with total thyroidectomy and central neck exploration was performed. Conclusion. The clinician should have a high index of suspicion upon encountering papillary carcinoma of the TDC to differentiate de novo papillary carcinoma in the TDC from those originating from the thyroid gland, because papillary carcinoma in TDC may originate from an occult thyroid papillary carcinoma.

  10. Refractory Jaundice From Intraductal Papillary Mucinous Neoplasm Treated With Cholangioscopy-Guided Radiofrequency Ablation.

    Science.gov (United States)

    Brown, Nicholas G; Camilo, Joel; McCarter, Martin; Shah, Raj J

    2016-04-01

    Intraductal papillary mucinous neoplasms (IPMNs) are epithelial neoplasms treated with surgical resection when appropriate. We present a 79-year-old man with jandice refractory to endoscopic stenting. Biliary radiofrequency ablation (RFA) with cholangioscopy was used as palliation of obstructive jaundice due to a mucin-producing pancreatic IPMN with fistulous biliary communication. Clinical improvement permitted surgery, and he returned to pre-illness status at 17 months. The use of cholangioscopy in the setting of mucinous filling defects can guide over-the-wire RFA for palliation and may be a bridge to surgery.

  11. Intraductal papillary mucinous neoplasm in chronic calcifying pancreatitis: Egg or hen?

    Institute of Scientific and Technical Information of China (English)

    Evangelos Kalaitzakis; Barbara Braden; Palak Trivedi; Yalda Sharifi; Roger Chapman

    2009-01-01

    Intraductal papillary mucinous neoplasm (IPMN) is an increasingly reported entity. Extensive pancreatic calcification is generally thought to be a sign of chronic pancreatitis, but it may occur simultaneously with IPMN leading to diagnostic difficulties. We report a case of a patient initially diagnosed with chronic calcifying pancreatitis who was later shown to have a malignant IPMN. This case illustrates potential pitfalls in the diagnosis of IPMN in the case of extensive pancreatic calcification as well as clues that may lead the clinician to suspecting the diagnosis. The possible mechanisms of the relation between pancreatic calcification and IPMN are also reviewed.

  12. Intraductal papillary mucinous tumors of the pancreas: spectrum of CT and MR findings with pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Procacci, C.; Carbognin, G.; Biasiutti, C.; Guarise, A.; Ghirardi, C.; Schenal, G. [Dept. of Radiology, University Hospital ' ' GB Rossi' ' , Verona (Italy)

    2001-10-01

    The reports of intraductal papillary mucinous tumors (IPMT) of the pancreas are increasingly more frequent in the literature. The diagnosis by means of cross-sectional imaging of these tumors is not easy, especially in the early stages, when they can mimic an inflammatory disease of the pancreas. Prompt identification of the disease is nevertheless extremely important, especially in the case of tumors originating from the collateral branches, since its recognition can modify the management of the patient, in some cases obviating recourse to surgery. (orig.)

  13. Intraductal papillary mucinous neoplasms of the pancreas: reporting clinically relevant features.

    Science.gov (United States)

    Del Chiaro, Marco; Verbeke, Caroline

    2016-11-22

    Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas can exhibit a wide spectrum of macroscopic and microscopic appearances. This not only causes occasional difficulties for the reporting pathologist in distinguishing these tumours from other lesions, but is also relevant clinically. As evidence accumulates, it becomes clear that multiple macroscopic and histological features of these neoplasms are relevant to the risk for malignant transformation and, consequently, of prime importance for clinical patient management. The need for detailed reporting is therefore increasing. This review discusses the panoply of gross and microscopic features of IPMN as well as the recommendations from recent consensus meetings regarding the pathology reporting on this tumour entity.

  14. Diagnosis of intraductal papillary mucinous neoplasm of pancreas by computed tomography%胰腺导管内乳头状黏液瘤的CT诊断

    Institute of Scientific and Technical Information of China (English)

    谢敏; 唐志强

    2012-01-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a rare tumor which has malignant potential.Differentiating IPMN from other cystic lesions of the pancreas is difficult. Its clinical symptoms are nonspecific,including nausea,vomiting,abdominal pain,fever or jaundice,possibly accompanied by hyperamy lasemia of blood and urine.Some patients have acute pancreatitis or chronic cholecystitis.According to the result of a retrospective study on clinical and imaging data of 11 patients with IPMN,we drew a conclusion that cystic dilatation of the main or branch of pancreatic ducts and mural nodules,and cystic dilatation linked with the main pancreatic ducts are the characteristics of IPMN of the pancreas.Computed tomography diagnosis is feasible to provide important information for the diagnosis of IPMN of the pancreas.

  15. [Intraductal papillary mucinous neoplasm of the pancreas (IPMN)--standards and new aspects].

    Science.gov (United States)

    Distler, M; Welsch, T; Aust, D; Weitz, J; Grützmann, R

    2014-06-01

    Intraductal papillary mucinous neoplasms (IPMN) of the pancreas belong to the heterogeneous group of cystic pancreatic lesions and have been diagnosed more frequently in recent years. Diagnosis and differentiation from other cystic lesions (pseudocysts, serous-cystic neoplasias [SCN], mucinous-cystic neoplasias [MCN], intraductal papillary-mucinous neoplasias [IPMN] and solid pseudopapillary neoplasias [SPN]) is often challenging. IPMN of the pancreas are considered as precursor lesions for the development of invasive pancreatic cancer. However, depending on the morphological (MD-IPMN, BD-IPMN) and histological subtype (intestinal, pancreatobiliary, oncocytic or gastric) the malignant potential of IPMNs varies significantly. Hence, early diagnosis and selection of the appropriate therapeutic strategy is necessary for optimal outcome and cure. There is a strong consensus for the resection of all MD-IPMN. Small BD-IPMN without signs of malignancy can be followed by observation. The increasing understanding of the histopathology and tumour biology of IPMN has led to an amendment of the 2006 International Association of Pancreatology (IAP) guidelines for the treatment of cystic pancreatic tumours. In consideration of recent data, recommendations for observation and/or follow-up of IPMN cannot be given definitely.

  16. Simultaneous Papillary Carcinoma in Thyroglossal Duct Cyst and Thyroid

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    Gustavo Cancela e Penna

    2017-01-01

    Full Text Available Thyroglossal duct cyst (TDC is a cystic expansion of a remnant of the thyroglossal duct tract. Carcinomas in the TDC are extremely rare and are usually an incidental finding after the Sistrunk procedure. In this report, an unusual case of a 36-year-old woman with concurrent papillary thyroid carcinoma arising in the TDC and on the thyroid gland is presented, followed by a discussion of the controversies surrounding the possible origins of a papillary carcinoma in the TDC, as well as the current management options.

  17. Thyroglossal Duct Papillary Thyroid Carcinoma and Synchronous Lingual Thyroid Atypia

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    Timothy Yoo

    2016-01-01

    Full Text Available Thyroglossal duct and lingual thyroid ectopic lesions are exceedingly rare synchronous findings. Papillary thyroid carcinoma of these ectopic thyroid sites is well understood but still a rare finding. This case points to some management nuances in regard to ectopic thyroid screening with imaging and also shows the effectiveness of minimally invasive transoral robotic surgery for lingual thyroid.

  18. Distinguishing benign from malignant main duct intraductal papillary mucinous tumors of the pancreas by CT and MRI%CT和MRI对主胰管型胰腺导管内乳头状黏液瘤良恶性鉴别的价值

    Institute of Scientific and Technical Information of China (English)

    边云; 李骁; 陈炜; 高振坡; 王莉; 陆建平

    2015-01-01

    Objective To evaluate the value of imaging studies in diagnosis and differentiating malignant from benign main duct intraductal papillary mucinous neoplasms (MD-IPMNs).Methods The imaging studies of a total of 31 patients with MD-IPMNs confirmed by pathology after surgery was retrospectively reviewed.All patients underwent either CT,MR or MRCP.Two radiologists observed the lesions' imaging feature,and then the lesions was scored,and the differentiation between malignant and benign was made.The Bland Altman method was used for evaluation of inter-observer agreement.The score of the lesions was compared with the pathological results.Finally,a ROC curve was used to calculate AUC,and to evaluate the role of the maximum diameter of the main pancreatic duct (MPD) obtained by imaging studies in differentiation of malignant and benign IPMNs,and to determine the best cut-off point,and sensitivity,specificity.Results Histological analysis revealed low grade dysplasia in 13 patients,middle grade dysplasia in 6 and high grade dysplasia in 5,and adenocarcinoma in 7.Imaging studies suggested benign lesions in 16,malignant lesions in 10 patients and disdiagnosis in 5.The inter-observer agreement on major imaging features was good.The maximum diameter of the MPD was clinically meaningful for distinguishing malignant from benign lesions,and the AUC was 83.8%,and the best cut-off value was 14.8 mm,the sensitivity and specificity was 66.7% and 100%.The presence of wall nodules could be an imaging feature for distinguishing malignant from benign lesions,but the size of nodules,location of nodules within pancreatic duct,the atrophy of pancreatic parenchyma,and dilated bile duct was not useful for differentiation.Conclusions The imaging studies are sensitive for diagnosis and differentiation between malignant and benign MD-IPMNs,and it is of clinical value for preoperative diagnosis and follow up.%目的 探讨影像学检查对主胰管型胰腺导管内乳头状瘤(MD-IPMN)诊

  19. Papillary carcinoma of the thyroglossal duct cyst: case report.

    Directory of Open Access Journals (Sweden)

    Nasrollah Maleki

    2015-04-01

    Full Text Available Thyroglossal duct cysts are the most common form of congenital cysts on the neck. The incidence of thyroid papillary carcinoma in thyroglossal duct cyst is less than 1%. In most cases the diagnosis is made postoperatively. We present a 22-year-old female with thyroid papillary carcinoma arising from thyroglossal duct cyst,identified in pathologic study after sistrunk operation.In our case there was neither invasion to adjacent tissue nor lymph node involvement.The patient then underwent total thyroidectomy and bilateral neck dissection. The patient was treated with radioactive iodide and thyroid suppression therapy was given as adjuvant treatment.The patient has been following for two years without any metastasis.

  20. Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract: Recommendations of verona consensus meeting

    NARCIS (Netherlands)

    V. Adsay (Volkan); M. Mino-Kenudson (Mari); T. Furukawa (Toru); O. Basturk (Olca); G. Zamboni (Giuseppe); G. Marchegiani (Giovanni); C. Bassi (Claudio); R. Salvia (Roberto); G. Malleo (Giuseppe); S. Paiella (Salvatore); C.L. Wolfgang (Christopher L.); H. Matthaei (Hanno); G.J.A. Offerhaus; I.M. Adham; M.J. Bruno (Marco); M.D. Reid (Michelle D.); A. Krasinskas (Alyssa); G. Kloppel (Günter); N. Ohike (Nobuyuki); T. Tajiri (Takuma); K.-T. Jang (Kee-Taek); J.C. Roa (Juan Carlos); P.J. Allen (Peter J.); C. Fernández-Del Castillo (Carlos); J.-Y. Jang (Jin-Young); D.S. Klimstra (David); R.H. Hruban (Ralph)

    2016-01-01

    textabstractBackground: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs). Design: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. Res

  1. Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract : Recommendations of verona consensus meeting

    NARCIS (Netherlands)

    Adsay, Volkan; Mino-Kenudson, Mari; Furukawa, Toru; Basturk, Olca; Zamboni, Giuseppe; Marchegiani, Giovanni; Bassi, Claudio; Salvia, Roberto; Malleo, Giuseppe; Paiella, Salvatore; Wolfgang, Christopher L.; Matthaei, Hanno; Offerhaus, G. Johan; Adham, Mustapha; Bruno, Marco J.; Reid, Michelle D.; Krasinskas, Alyssa; Klöppel, Günter; Ohike, Nobuyuki; Tajiri, Takuma; Jang, Kee Taek; Roa, Juan Carlos; Allen, Peter; Fernández-Del Castillo, Carlos; Jang, Jin Young; Klimstra, David S.; Hruban, Ralph H.

    2016-01-01

    Background: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs). Design: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. Results: (1) Cr

  2. Progress in research of intraductal papillary mucinous neoplasms%胰腺导管内乳头状黏液瘤的研究进展

    Institute of Scientific and Technical Information of China (English)

    郭子皓; 张杰; 郝建宇

    2011-01-01

    Intraductal papillary mucinous neoplasms (IPMNs) represent a spectrum of neoplasms arising from the main pancreatic duct or branch ducts and producing mucin and can be regarded as a type of precancerous lesions. Thanks to improvements in endoscopy and imaging techniques, IPMNs are being diagnosed with increasing frequency. However, there are currently no highly sensitive and specific preoperative criteria available to distinguish benign IPMNs from malignant ones. What's more, the necessity for EUS and ERCP in the diagnosis of IPMNs is still under debate. Here, we review recent advances in research of IPMNs and summarize potential differ-ences between benign and malignant IPMNs.%胰腺导管内乳头状黏液瘤(intraductal papillary mucinous neoplasm,IPMNs)为来源于胰腺导管上皮的分化程度多样的胰腺肿瘤,位于主胰管或其分支内,可分泌黏液,为胰腺癌的癌前病变.区分IPMNs的良恶性对制定治疗方案,预估患者预后意义重大.随影像学和内镜的发展,IPMNs发现率逐年提高,但目前仍无敏感度和特异度均高的术前IPMNs良恶性评估标准.超声内镜引导下细针穿刺活检(endoscopic ultrasonography guided fine-needle aspiration,EUS-FNA)及内镜逆行胰胆管造影(endoscopic retrograde cholangio-pancreatography,ERCP)在IPMNs诊断中的应用逐渐增多,但必要性尚存在争议.本文对IPMN研究进展进行综述,并总结文献中良恶性IPMNs可能存在的差异.

  3. Pancreatic neuroendocrine tumor with extensive intraductal invasion of the main pancreatic duct: a case report.

    Science.gov (United States)

    Kiyonaga, Maki; Matsumoto, Shunro; Mori, Hiromu; Yamada, Yasunari; Takaji, Ryo; Hijiya, Naoki; Yoshizumi, Fumitaka; Aramaki, Masanori

    2014-09-28

    Pancreatic neuroendocrine tumors account for only 1-3% of all pancreatic neoplasms and the intraductal invasion of the main pancreatic duct (MPD) is rare. We report a case of a 26-year-old woman with an endocrine tumor of the pancreas extensively invading into the MPD. She presented abdominal pain and her laboratory data showed abnormal liver function. Contrast-enhanced computed tomography demonstrated a well-enhanced mass on the arterial dominant phase in the head of the pancreas. The mass grew within the lumen of the MPD in the body of the pancreas, with dilatation of the upstream MPD. The contrast-enhancement pattern between the main tumor of the head and the intraductal lesion of the body was different. On T2-weighted magnetic resonance (MR) imaging, the pancreatic head lesion showed non homogeneously low signal intensity, while the intraductal lesion of the pancreatic body showed high signal intensity. MR cholangiopancreatography showed obstruction of the MPD in the pancreatic head to body, with dilatation of the upstream MPD. An endocrine tumor or acinar cell carcinoma of the pancreas was considered as preoperative diagnosis, and pancreaticoduodenectomy was performed. As a result, pancreatic endocrine tumor (G2) was confirmed pathologically. A rare case of pancreatic neuroendocrine tumor with extensive growth within the MPD was presented. The intraductal extension is a unique growth pattern of nonfunctioning pancreatic neuroendocrine tumor, and the desmoplastic reaction in this tumor may reflect the increased invasiveness.

  4. Endoscopic naso-pancreatic stent-guided single-branch resection of the pancreas for multiple intraductal papillary mucinous adenomas

    Institute of Scientific and Technical Information of China (English)

    Tamotsu Kuroki; Yoshitsugu Tajima; Ryuji Tsutsumi; Noritsugu Tsuneoka; Amane Kitasato; Tomohiko Adachi; Takashi Kanematsu

    2006-01-01

    In benign or low-grade malignant pancreatic tumors,complete removal of the lesion is sufficient for a cure,and thus minimal resection techniques with preservation of the pancreatic functional reserve have advantages over more extended pancreatic resections. However, a high incidence of postoperative pancreatic fistula in such procedures has been reported. Moreover, branch-type intraductal papillary mucinous neoplasms of the pancreas tend to locate in the head of the pancreas, and show less malignant potential. We describe an endoscopic nasopancreatic stent-guided single-branch resection of the pancreas for branch-type multiple intraductal papillary mucinous adenomas, along with a gastric wall-covering method for the prevention of pancreatic leakage.

  5. A case report: Cavitary infarction caused by pulmonary tumor thrombotic microangiopathy in a patient with pancreatic intraductal papillary mucinous neoplasm

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Kyoung Kyg; Kwon, Woon Jung; Choi, Seong Hoon; Lee, Jong Hwa; Cha, Hee Jeong [Ulsan University Hospital, University of Ulsan School of Medicine, Ulsan (Korea, Republic of)

    2015-08-15

    Pulmonary tumor embolism is commonly discovered at autopsy, but is rarely suspected ante-mortem. Microangiopathy is an uncommon and distinct form of simple tumor pulmonary embolism. Here, we present a 52-year-old male with tumor thrombotic microangiopathy and pulmonary infarction, which might have originated from intraductal papillary mucinous tumor of the pancreas. Multiple wedge-shaped consolidations were found initially and aggravated with cavitation. These CT features of pulmonary infarction were pathologically confirmed to result from pulmonary tumor thrombotic microangiopathy.

  6. Possible additional value of 18FDG-PET in managing pancreas intraductal papillary mucinous neoplasms: Preliminary results

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    Pizzocaro Claudio

    2008-06-01

    Full Text Available Abstract Although some clinical and radiological features may predict malignancy presence in intraductal papillary mucinous pancreas neoplasms, preoperative diagnosis remains difficult. In this study we present 7 patients with Intraductal Papillary Mucinous Neoplasm (IPMN studied both with 18FDG-PET and magnetic resonance cholangiopancreatography (MRCP. A focal hypermetabolism was documented in 2 patients (the standardized uptake value in the neoplastic foci was 6.7 and 9, while absence of FDG uptake in the neoplasm area was recorded in the remaining 5 cases. Mean follow-up was 27 months (range 21–34. The final judgement was benign IPMN in 5 cases and malignant IPMN in 2. PET scan always correctly predicted the presence or absence of malignancy, while MRCP failed to detect malignancy in 3/7 cases. In conclusion, this preliminary experience suggests that 18FDG-PET may prove useful for malignancy detection in IPMN, improving differential diagnosis with benign intraductal papillary growth by functional data.

  7. Data analysis of 36 cases with intraductal papillary mucinous neoplasm of the pancreas for their clinicopathological features, diagnosis, and treatment

    Institute of Scientific and Technical Information of China (English)

    Yuan Chunhui; Xiu Dianrong; Tao Ming; Ma Zhaolai; Jiang Bin; Li Zhifei; Li Lei

    2014-01-01

    Background Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic cystic neoplasm,accounting for 1% of all exocrine pancreatic neoplasms.This study aimed to summarize the clinicopathological and biological behaviors,as well as the experience in diagnosis and treatment of IPMN.Methods Clinicopathological data were collected from 36 cases with IPMN who were treated in Department of General Surgery,Peking University Third Hospital from May 2001 to July 2011.Results The 36 cases of IPMN patients included 27 males and 9 females (M∶F=3∶1).The age of patients ranged from 52 to 78 years,with an average of 67.3 years.Regarding tumor location,20 tumors were located in pancreatic head,3 in pancreatic neck,10 in pancreatic body and tail,and 3 in the whole pancreas.All the 36 cases underwent surgical treatment,with 13 cases of pancreaticoduodenectomy,3 cases of middle pancreatectomy,7 cases of tumor resection plus pancreaticojejunostomy,3 cases of distal pancreatectomy,7 cases of distal pancreatectomy plus spleen resection,and 3 cases of total pancreaticoduodenectomy.Of the 36 patients,9 patients underwent the operations under laparoscopy.The 36 cases included main duct type (14 cases,38.9%),branch duct type (10 cases,27.7%),and mixed duct type (12 cases,33.3%).Pathologically,of the 36 cases,there were 7 IPMN adenomas,11 borderline IPMNs,6 IPMN with carcinomas in situ,and 12 IPMNs with invasive carcinomas.All the 36 cases were followed up.During an average of 42 months follow-up period (26-129 months),no recurrence occurred.Conclusions IPMN,which primarily occurs in male,is a low-grade malignancy which may involve any part of the pancreas,with specific clinicopathological features.IPMN is a different malignancy type from pancreatic ductal carcinoma.Imaging and laboratory examination are helpful for the diagnosis and differential diagnosis.The prediction of invasive IPMN is still difficult.Surgical resection is recommended as the first choice of

  8. SLC2A1/GLUT1 expression in mural nodules of intraductal papillary mucinous neoplasm of the pancreas.

    Science.gov (United States)

    Oda, Yasunori; Aishima, Shinichi; Shindo, Koji; Fujino, Minoru; Mizuuchi, Yusuke; Hattori, Masami; Miyazaki, Tetsuyuki; Tanaka, Masao; Oda, Yoshinao

    2017-07-01

    In intraductal papillary mucinous neoplasms (IPMNs), the presence of a mural nodule showing a papillary or nodular proliferation of tumor cells in the dilated pancreatic duct is an indication for resection of IPMN. Solute carrier family 2, facilitated glucose transporter member 1, known as glucose transporter type 1 (SLC2A1/GLUT1) mediates cellular glucose uptake in many carcinomas and is correlated with increased (18)F-fluorodeoxyglucose ((18)F-FDG) uptake. We examined SLC2A1/GLUT1 expression in the mural nodules of 180 IPMN specimens to distinguish malignant/benign tumors. A mural nodule was detected in 80 (44.4%) of the IPMNs, and was detected in 18.6% (13/70) of the IPMN-low (dysplasia) specimens, 36.1% (13/36) of the IPMN-int, 93.3% (28/30) of the IPMN-high, and 59.1% (26/44) of the IPMN-inv (with an associated invasive carcinoma) specimens. The sensitivity for detecting mural nodules was 81.7% by endoscopic ultrasonography, 70% by contrast-enhanced computed tomography and 54% by endoscopic retrograde cholangiopancreatography. SLC2A1/GLUT1 expression in the mural nodules was recognized in the basal and basolateral cytomembrane of tumor cells and was expressed in 15.4% (2/13) of the IPMN-low, 15.4% (2/13) of the IPMN-int, 71.4% (20/28) of the IPMN-high and 84.6% (22/26) of the IPMN-inv groups. The SLC2A1/GLUT1 expression was significantly higher in the IPMN-high and IPMN-inv mural nodules than in those of the IPMN-low and IPMN-int groups. Our findings suggest that SLC2A1/GLUT1 is expressed late in the adenoma-carcinoma sequence during carcinogenesis in IPMN, and SLC2A1/GLUT1 act as therapeutic target for malignant IPMN. Copyright © 2017. Published by Elsevier Inc.

  9. Papillary carcinoma in a thyroglossal duct: case report

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    Antonio Santos Martins

    1999-11-01

    Full Text Available CONTEXT: Thyroglossal duct cysts are the most common congenital cervical abnormality in childhood. Malignant lesions are rare in thyroglossal duct cysts (about 1%. OBJECTIVE: To report a case of papillary carcinoma in thyroglossal duct cysts. DESIGN: Case report. CASE REPORT: The patient was a 21-year-old female with a four-month history of an anterior midline neck mass but without other symptoms. The physical examination revealed a 4.0 cm diameter, smooth, painless, cystic nodule at the level of the hyoid bone. The thyroid gland was normal by palpation and no neck lymph nodes were found. Indirect laryngoscopy, fine-needle biopsy aspiration and cervical ultrasound were normal and compatible with the physical findings of a thyroglossal duct cyst. The patient underwent surgery with this diagnosis, under general anesthesia, and the mass was resected by the usual Sistrunk procedure. There were no local signs of invasion of the tissue surrounding the cyst or duct at surgery. The patient was discharged within 24 hours. Histopathological examination of the specimen showed a 3.5 x 3.0 x 3.0 cm thyroglossal cyst, partially filled by a solid 1.0 x 0.5 cm brownish tissue. Histological sections showed a papillary carcinoma in the thyroid tissue of a thyroglossal cyst, with normal thyroid tissue at the boundary of the carcinoma. There was no capsule invasion and the margins were negative. The follow-up of the patient consisted of head and neck examinations, ultrasonography of the surgical region and thyroid, and total body scintigraphy. The patient has been followed up for two years with no further evidence of disease.

  10. Pancreatic mucinous noncystic (colloid) carcinomas and intraductal papillary mucinous carcinomas are usually microsatellite stable.

    Science.gov (United States)

    Lüttges, Jutta; Beyser, Kurt; Pust, Susanne; Paulus, Anja; Rüschoff, Josef; Klöppel, Günter

    2003-06-01

    Pancreatic mucinous noncystic (colloid) carcinomas (MNCC) differ from the usual ductal adenocarcinomas in their mucin expression profile and share with many extrapancreatic mucinous carcinomas the expression of MUC2. Because mucinous carcinomas are frequently associated with mutations of the DNA mismatch repair genes, causing them to exhibit the so-called mutator phenotype, we decided to investigate whether MNCCs of the pancreas are characterized by microsatellite instability (MSI). Twelve carcinomas with a mucinous phenotype (8 mucinous noncystic carcinomas, 3 intraductal papillary-mucinous carcinomas with an invasive muconodular component, and 1 ductal adenocarcinoma with an extensive mucinous noncystic component) and 11 ductal adenocarcinomas were immunostained with monoclonal antibodies to the mismatch repair gene products hMLH1, hMSH2, and hMSH6. For MSI analysis, DNA was isolated from microdissected tissue, and five primary microsatellites (BAT 25, BAT 26, D5S346, D17S250, and D2S123) were analyzed. MSI was diagnosed in case a novel allele was found, compared with the normal tissue. The criterion for LOH was a 75% signal reduction. All carcinomas tested exhibited nuclear expression of mismatch repair gene products, except for one MNCC that also showed MSI at the molecular level. The data suggest that pancreatic carcinomas with a mucinous phenotype (MUC2+/MUC1-) do not appear to normally exhibit mutations in the mismatch repair genes and therefore differ in their carcinogenesis from those in other organs.

  11. Novel tissue harmonic imaging clearly visualizes a case of intraductal papillary mucinous neoplasm with mural nodules.

    Science.gov (United States)

    Matsumoto, Kazuyuki; Katanuma, Akio

    2014-05-27

    Tissue Harmonic Echo (THE) imaging is a sonographic technique that potentially provides images of higher quality than can conventional B-mode images. Potential advantages of THE imaging include improved resolution, improved signal-to-noise ratio, and reduced artifacts [1, 2]. Recently, a novel THE imaging performed using an EUS system with a monitor/processing unit (EU-ME2 PREMIER PLUS; Olympus Medical Systems, Tokyo, Japan) has been developed. Using this technology, we can obtain two THE mode images, namely, THE-P (penetration) and THE-R (resolution). The THE-P mode is suitable for middle range distance observation because it receives a harmonic signal whose frequency is mainly 7.5 MHz. The THE-R mode is suitable for close distance observation from the probe because it receives a harmonic signal whose frequency mainly ranges from 10 to 12 MHz. Here, we report a case of intraductal papillary mucinous neoplasm (IPMN) with mural nodules which could be clearly detected using this novel THE imaging.

  12. Glycemic Control after Total Pancreatectomy for Intraductal Papillary Mucinous Neoplasm: An Exploratory Study

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    Laith H. Jamil

    2012-01-01

    Full Text Available Background. Glycemic control following total pancreatectomy (TP has been thought to be difficult to manage. Diffuse intraductal papillary mucinous neoplasm (IPMN is a potentially curable precursor to pancreatic adenocarcinoma, best treated by TP. Objective. Compare glycemic control in patients undergoing TP for IPMN to patients with type 1 diabetes mellitus (DM. Design/Setting. Retrospective cohort. Outcome Measure. Hemoglobin A1C(HbA1C at 6, 12, 18, and 24 months after TP. In the control group, baseline was defined as 6 months prior to the first HbA1c measure. Results. Mean HgbA1C at each point of interest was similar between TP and type I DM patients (6 months (7.5% versus 7.7%, P=0.52, 12 months (7.3% versus 8.0%, P=0.081, 18 months (7.7% and 7.6%, P=0.64, and at 24 months (7.3% versus 7.8%, P=0.10. Seven TP patients (50% experienced a hypoglycemic event compared to 65 type 1 DM patients (65%, P=0.38. Limitations. Small number of TP patients, retrospective design, lack of long-termfollowup. Conclusion. This suggests that glycemic control following TP for IPMNcan be well managed, similar to type 1 DM patients. Fear of DM following TP for IPMN should not preclude surgery when TP is indicated.

  13. Coexistence of Hashimoto's thyroiditis and papillary thyroidal carcinoma with papillary carcinoma of thyreoglossal duct

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    Čizmić Milica

    2007-01-01

    Full Text Available Background. Simultaneous presence of Hashimoto's thyroiditis and papillary thyroidal carcinoma in thyroidal gland with papillary carcinoma association in thyroglossal duct is quite rare. The questions like where the original site of primary process, is where metastasis is, what the cause of coexisting of these diseasesis present a diagnostic dilemma. Case report. We presented a case of a 53-year old female patient, with the diagnosis of Hashimoto's thyroiditis and symptoms of subclinical hypothyreosis and nodal changes in the right lobe of thyroidal gland, according to clinical investigation. Morphological examination of thyroidal gland, ultrasound examination and scintigraphy with technetium (Tc confirmed the existence of nonhomogenic tissue with parenchyma nodular changes in the right lobe of thyroidal gland that weakly bonded Tc. Fine needle biopsy in nodal changes, with cytological analyses showed no evidence of atypical thyreocites. Hashimoto's thyroiditis was confirmed on the basis of the increased values of anti-microsomal antibodies, the high levels of thyreogobulin 117 ng/ml and TSH 6.29 μIU/ml. The operation near by the nodular change in the right lobe of thyroidal gland revealed pyramidal lobe spread in the thyroglossal duct. Total thyroidectomia was done with the elimination of thyroglossal duct. Final patohystological findings showed papillary carcinoma in the nodal changes pT2, N0 and in the thyroglossal duct with the presence of Hashimoto's thyroiditis in the residual parenchyme of the thyroid gland. After the surgery the whole body scintigraphy with iodine 131 (131I did not reveal accumulation of 131I in the body, while the fixation in the neck was 1%. After that, the patient was treated with thyroxin with suppressionsubstitution doses. Conclusion. Abnormality in embrional development of thyroidal tissue might be the source of thyroidal carcinoma or the way of spreading of metastasis of primary thyroidal carcinoma from thyroid

  14. Ductal branch-oriented pancreatic resection for an intraductal papillary mucinous neoplasm in the uncinate process that caused recurrent acute pancreatitis: a case report of successful treatment.

    Science.gov (United States)

    Natsume, Toshiyuki; Maruyama, Takashi; Kobayashi, Akitoshi; Shimizu, Shinichiro; Tanaka, Hajime; Matsuzaki, Hiroshi; Miyazaki, Akinari; Ohta, Takumi; Sato, Yayoi; Yamamoto, Yuji; Aikawa, Mizuho; Otsuka, Ryota; Yanagihara, Akitoshi

    2013-12-01

    Acute pancreatitis reportedly occurs in about 15 % of cases of branch duct (BD)-intraductal papillary mucinous neoplasms (IPMNs), with two-thirds of BD-IPMNs being located in the head or uncinate process of the pancreas. However, the surgical indications and optimal treatment methods for BD-IPMNs have not been established. A 59-year-old Japanese male with epigastralgia was admitted to our hospital. A multidetector row computed tomography (MDCT) scan disclosed grade I acute pancreatitis. Magnetic resonance cholangiopancreatography disclosed a 1.5-cm BD-IPMN in the uncinate process. Two months after discharge, the epigastralgia recurred, and MDCT again revealed grade I pancreatitis. Due to the repeated episodes of pancreatitis, we performed ductal branch-oriented pancreatic resection. To detect the inferior branch of the Wirsung duct and avoid the development of a pancreatic fistula, we injected indigo carmine into the tumor which confirmed ligation of the inferior branch. Histopathologically, the tumor proved to be an adenoma. The postoperative course was uneventful in both the short- and long-term follow-up and, to date, there has been no recurrence of pancreatitis, or diabetes mellitus during the 6 years since pancreatectomy. This procedure is one of the methods that can be used for the successful resection of a BD-IPMN in the uncinate process that caused recurrent acute pancreatitis.

  15. Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers.

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    Shimizu, Yasuhiro; Yamaue, Hiroki; Maguchi, Hiroyuki; Yamao, Kenji; Hirono, Seiko; Osanai, Manabu; Hijioka, Susumu; Hosoda, Waki; Nakamura, Yasushi; Shinohara, Toshiya; Yanagisawa, Akio

    2013-07-01

    The present study was a retrospective investigation of predictors of malignancy in intraductal papillary mucinous neoplasm (IPMN) of the pancreas. The subjects were 310 patients who underwent pancreatic resection at 3 high-volume centers. Preoperative laboratory and imaging findings were analyzed in logistic regression analyses. Endoscopic ultrasonography measurements were essential for the size of mural nodules, and a central review was conducted for pathological diagnosis. Pathological diagnosis was benign IPMN in 150 cases and malignant in 160 (noninvasive carcinoma, n = 100; invasive, n = 60). In multivariate analysis, size of mural nodules, diameter of main pancreatic duct, and cyst size of branch pancreatic duct were independent predictors of malignancy, and areas under the receiver operating characteristic curve for these 3 factors were 0.798, 0.643, and 0.601, respectively. With 7 mm taken as the cutoff value for the size of mural nodules, the diagnosis of malignant IPMN had sensitivity of 74.3% and specificity of 72.7%. Carcinoma without nodules was present in 15 patients (15/160 [9.4%]). The size of mural nodules measured with endoscopic ultrasonography showed high predictive ability. However, about 10% of carcinoma patients did not have nodules, and the handling of the diagnosis in such cases is a problem for the future.

  16. 胆管内与胰腺导管内乳头状黏液性肿瘤的比较%Comparison between biliary tract intraductal papillary mucinous neoplasm and intraductal papillary mucinous neoplasm of the pancreas

    Institute of Scientific and Technical Information of China (English)

    王幸; 陈拥华; 蔡云强; 赵法之; 谭春露; 柯能文; 刘续宝

    2015-01-01

    Objective To compare biliary tract intraductal papillary mucinous neoplasm (BT-IPMN) with intraductal papillary mucinous neoplasm of the pancreas (P-IPMN).Methods From January 2008 to December 2013,eleven (6.0%) cases of BT-IPMNs were retrospectively identified from a total of 182 biliary tract tumors resected in our institution,while 50 cases underwent surgery for P-IPMN.The mean age of the 11 BT-IPMN cases was 57.3 years (range 40 to 74 years).There were 8 men (73.0%).The mean age of the 50 P-IPMN cases was 57.4 years (range 33 to 85 years).There were 34 men (68.0%).The clinical features,radiologic findings,pathology,surgical strategies,and long-term follow up outcomes between the 2 groups of patients were analyzed.Results There was no significant difference between BT-IPMN and P-IPMN in the following aspects:mean age,sex ratios and clinical presentation [including the most common presenting symptom abdominal pain (73.0% vs.68.0%),and elevated tumor markers (CEA and CA19-9)].The mean tumor size of BT-IPMN was significantly smaller than P-IPMN (1.7 vs.4.1 cm,P < 0.05).Macroscopically visible mucin was detected in all the 11 patients basing on the original surgical reports.The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilatation (100%) and intraluminal masses (55.0%).Most cases (82.0%) involved the intrahepatic bile duct and hilum.For tumor clearance,we conducted left hepatectomy in most cases (64.0%).Only one patient underwent biopsy and choledochojejunostomy for multiple tumors involving the extrahepatic,right and left bile ducts.BT-IPMN was likely to have a higher risk of malignancy (55.0% vs.44.0%) and poorer prognosis (median survival,57 vs.63 months),although there was no significant difference (P > 0.05).The patient without tumor resection died of liver failure 22 months after palliative surgery.Conclusions BT-IPMNs are very rare and they had some similarity with P-IPMN.Complete resection of BT

  17. Sub-branch and mixed-type intraductal papillary mucinous neoplasms of the pancreas: 2 case reports

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    Zafer Ozmen, MD

    2016-03-01

    Full Text Available Intraductal papillary mucinous neoplasia (IPMN is one of the cystic neoplasias of the pancreas. The imaging findings provide that these tumors are differentiated from the other cystic lesions of the pancreas, especially from the chronic pancreatitis, where the treatment protocol is completely different. Therefore, the correct diagnosis and classification of the IPMN ensures that the patient receives the correct approach and the appropriate surgery, if necessary. The purpose of this study is to emphasize the imaging findings of the different types of the IPMN and the changes in the management protocol of the patients according to these radiological findings.

  18. Imaging Diagnosis of Intraductal Papillary Mucinous Neoplasm of the Pancreas%胰腺导管内乳头状黏液性肿瘤的影像学分析

    Institute of Scientific and Technical Information of China (English)

    朱磊; 潘保见; 王成刚; 胡国祥; 沈烨; 康琳

    2012-01-01

    目的:探讨胰腺导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)的CT和磁共振成像(mag netic resonance imaging,MRI)影像学表现.方法:回顾性分析经手术病理证实的18例胰腺导管内乳头状黏液性肿瘤的影像资料与病理诊断.结果:主胰管型IPMN 3例,表现为主胰管扩张;分支胰管型IPMN 5例,表现为分叶状单发囊性病变或葡萄串样多发囊性病变伴腔内分隔;混合型IPMN 10例,表现为囊性病变伴主胰管扩张.结论:CT和MRI对胰腺IPMN的诊断具有重要价值.%Objective:To investigate the manifestations of CT and magnetic resonance imaging (MRI) in intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Methods; The CT and MRI findings of 18 patients with pathologically confirmed IPMN of the pancreas were retrospectively analyzed. Results: Three cases of main-duct type pancreatic IPMN showed dilation of pancreatic main ducts. Five cases of branch-duct type pancreatic IPMN demonstrated solitary or multiple cystic lesions with septa. Ten cases of mixed-type pancreatic IPMN displayed dilation of pancreatic main ducts with cystic lesions. Conclusions: CT and MRI are helpful to the diagnosis of IPMN of the pancreas.

  19. Does a family history of pancreatic ductal adenocarcinoma and cyst size influence the follow-up strategy for intraductal papillary mucinous neoplasms of the pancreas?

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    Mandai, Koichiro; Uno, Koji; Yasuda, Kenjiro

    2014-08-01

    This study aimed to evaluate the relationship between pancreatic ductal adenocarcinoma (PDAC) family history and PDAC development in patients followed up for intraductal papillary mucinous neoplasms (IPMNs) and to assess the cyst size relevance in determining follow-up strategies. We analyzed 300 patients with branch duct and mixed-type IPMN who were followed up at our facility. Among the patients aged 70 years or older, the frequency of PDAC did not differ significantly between those with 1 first-degree relative with PDAC and those without a family history. Although patients with IPMNs of greater than or equal to 30 mm were followed up for a significantly shorter duration than those patients with IPMNs of less than 30 mm, the frequency of IPMN progression and malignant IPMN was significantly greater in the former. The frequency of IPMN progression and pancreatic cancer did not differ significantly according to IPMN size (family history. Special attention should be paid to IPMN progression and malignant transformation in patients with IPMNs of greater than or equal to 30 mm, but cyst size need not be considered when determining follow-up strategies for patients with IPMNs of less than 30 mm without mural nodules.

  20. Digital next-generation sequencing identifies low-abundance mutations in pancreatic juice samples collected from the duodenum of patients with pancreatic cancer and intraductal papillary mucinous neoplasms.

    Science.gov (United States)

    Yu, Jun; Sadakari, Yoshihiko; Shindo, Koji; Suenaga, Masaya; Brant, Aaron; Almario, Jose Alejandro Navarro; Borges, Michael; Barkley, Thomas; Fesharakizadeh, Shahriar; Ford, Madeline; Hruban, Ralph H; Shin, Eun Ji; Lennon, Anne Marie; Canto, Marcia Irene; Goggins, Michael

    2017-09-01

    Secretin-stimulated pancreatic juice contains DNA shed from cells lining the pancreatic ducts. Genetic analysis of this fluid may form a test to detect pancreatic ductal neoplasia. We employed digital next-generation sequencing ('digital NGS') to detect low-abundance mutations in secretin-stimulated juice samples collected from the duodenum of subjects enrolled in Cancer of the Pancreas Screening studies at Johns Hopkins Hospital. For each juice sample, digital NGS necessitated 96 NGS reactions sequencing nine genes. The study population included 115 subjects (53 discovery, 62 validation) (1) with pancreatic ductal adenocarcinoma (PDAC), (2) intraductal papillary mucinous neoplasm (IPMN), (3) controls with non-suspicious pancreata. Cases with PDAC and IPMN were more likely to have mutant DNA detected in pancreatic juice than controls (both pcancer despite close surveillance had SMAD4/TP53 mutations from their cancer detected in juice samples collected over 1 year prior to their pancreatic cancer diagnosis when no suspicious pancreatic lesions were detected by imaging. The detection in pancreatic juice of mutations important for the progression of low-grade dysplasia to high-grade dysplasia and invasive pancreatic cancer may improve the management of patients undergoing pancreatic screening and surveillance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  1. Post-ERCP pancreatogastric fistula associated with an intraductal papillary-mucinous neoplasm of the pancreas – a case report and literature review

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    Yasuda Yoshikazu

    2005-10-01

    Full Text Available Abstract Background Fistula formation has been reported in intraductal papillary-mucinous neoplasms (IPMNs with or without invasion of the adjacent organs. The presence or absence of invasion is mostly determined by postoperative histological examination rather than by preoperative work-up. Case presentation A 72 year-old Japanese woman showed remarkable dilatation of the main pancreatic duct (MPD in the distal region of the pancreas. Subsequent ERCP also showed MPD dilatation, after which the patient suffered moderate pancreatitis. A subsequent gastroscopy revealed a small ulceration that had not been observed in a gastroscopy performed 3 months prior. Mucinous discharge from the ulceration suggested it might be the orifice of a fistula connected to the MPD. En bloc resection including the distal region of the pancreas, spleen, stomach and part of the transverse colon was performed under the pre- and intraoperative diagnosis of an invasive malignant IPMN. However, histopathology revealed the lesion to be of "borderline malignancy" without apparent invasion of the stomach. Light microscopy showed inflammatory cellular infiltrates (mainly neutrophils around the pancreatogastric fistula, but there was no evidence of neoplastic epithelia lining the fistulous tract. Conclusion This case highlights that a pancreatogastric fistula can develop after acute inflammation of the pancreas in the absence of cancer invasion. Further information regarding IPMN-associated fistulae is necessary to clarify the pathogenesis, diagnosis, appropriate surgical intervention and prognosis for this disorder.

  2. Magnetic resonance pancreatography: comparison of two- and three-dimensional sequences for assessment of intraductal papillary mucinous neoplasm of the pancreas

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    Choi, Jin-Young; Choi, Sun Young [Yonsei University Health System, Department of Radiology, Research Institute of Radiological Science, Seoul (Korea); Lee, Jeong Min; Kim, Soo Jin; Han, Joon Koo; Choi, Byung Ihn [Seoul National University College of Medicine, Department of Radiology and Institute of Radiation Medicine, Seoul (Korea); Lee, Min Woo [Sungkyunkwan University School of Medicine, Department of Radiology, Samsung Medical Center, Seoul (Korea); Kim, Ji Yang [Seoul National University Hospital, Healthcare System Gangnam Center, Seoul (Korea)

    2009-09-15

    The purpose was to compare two-dimensional (2D) magnetic resonance pancreatography (MRP) with 3D MRP to evaluate intraductal papillary mucinous neoplasm (IPMN). Thirty-four patients (22 men, 12 women; age range, 45-80 years) with IPMN (n = 40) were examined with MRP on 2D and 3D sequences. Two readers independently reviewed the images to assess the overall image quality, artifacts, lesion location, communication with main pancreatic duct, and potential for malignancy. The readers assigned their confidence level (1-5) for predicting ductal communication of the lesion. The results of MRP were compared with endoscopic retrograde pancreatography and surgical and histopathologic findings. Studies obtained with 3D MRP were of significantly higher technical quality than those obtained with 2D MRP. Although 3D MRP showed higher area under the ROC curve (Az) values for predicting ductal communication of the lesion, there was no statistical significance between Az values of 2D and 3D MRP (Az for 2D = 0.821, 0.864 for readers 1 and 2, respectively, and Az for 3D= 0.964, 0.921). Accuracies for discriminating benign from malignant lesions were 70 and 67.5% (reader 1 and 2, respectively, for 2D) and 62.5 and 80.1% (3D). 3D MRP showed superior image quality to that of 2D MRP but did not increase the diagnostic accuracy for predicting ductal communication of the lesion. (orig.)

  3. Does secretin stimulation add to magnetic resonance cholangiopancreatography in characterising pancreatic cystic lesions as side-branch intraductal papillary mucinous neoplasm?

    Energy Technology Data Exchange (ETDEWEB)

    Purysko, Andrei S.; Gandhi, Namita S.; Veniero, Joseph C. [Cleveland Clinic, From the Abdominal Imaging Section, Imaging Institute, Cleveland, OH (United States); Walsh, R.M. [Cleveland Clinic, Department of General Surgery, Digestive Disease Institute, Cleveland, OH (United States); Obuchowski, Nancy A. [Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, OH (United States)

    2014-12-15

    To assess the value of secretin during magnetic resonance cholangiopancreatography (MRCP) in demonstrating communication between cystic lesions and the pancreatic duct to help determine the diagnosis of side-branch intraductal papillary mucinous neoplasm (SB-IPMN). This is an IRB-approved, HIPAA-compliant retrospective study of 29 SB-IPMN patients and 13 non-IPMN subjects (control) who underwent secretin-enhanced MRCP (s-MRCP). Two readers blinded to the final diagnosis reviewed three randomised image sets: (1) pre-secretin HASTE, (2) dynamic s-MRCP and (3) post-secretin HASTE. Logistic regression, generalised linear models and ROC analyses were used to compare pre- and post-secretin results. There was no significant difference in median scores for the pre-secretin [reader 1: 1; reader 2: 2 (range -2 to 2)] and post-secretin HASTE [reader 1: 1; reader 2: 1 (range -2 to 2)] in the SB-IPMN group (P = 0.14), while the scores were lower for s-MRCP [reader 1: 0.5 (range -2 to 2); reader 2: 0 (range -1 to 2); P = 0.016]. There was no significant difference in mean maximum diameter of SB-IPMN on pre- and post-secretin HASTE, and s-MRCP (P > 0.05). Secretin stimulation did not add to MRCP in characterising pancreatic cystic lesions as SB-IPMN. (orig.)

  4. Intraductal papillary mucinous neoplasia (IPMN). Highlights from the "2010 ASCO Gastrointestinal Cancers Symposium". Orlando, FL, USA. January 22-24, 2010.

    Science.gov (United States)

    Bussom, Scott; Saif, Muhammad Wasif

    2010-03-05

    The diagnosis and treatment of intraductal papillary mucinous tumors (IPMN) of the pancreas has evolved over the last decade. IPMN is a disease of the ductal epithelium and represent a spectrum of disease, ranging from benign to malignant lesions, making the early detection and characterization of these lesions important. As with villous adenomas of the colon, not all IPMNs will develop into adenocarcinoma. Definitive management is surgical resection for appropriate candidates, as benign lesions harbor malignant potential. Growing controversy revolves around issues of natural history, management of small-branch-duct lesions, ability to predict malignancy and/or progression, and surveillance strategies. Given these controversies, novel methods are needed to help in detecting and classifying IPMNs' malignant potential so that appropriate treatment can be administered. The authors review abstracts from the 2010 ASCO Gastrointestinal Cancers Symposium held in January 2010, including biomarkers helping to classify IPMNs: IL-8 and IL-1beta from IPMN cyst aspirates (Abstract #133), and Foxp3/CD4/CD25 cells (Abstract #148) in peripheral blood. Future studies will hopefully provide insight into the many unanswered questions.

  5. Imaging patterns of intraductal papillary mucinous neoplasms of the pancreas: an illustrated discussion of the International Consensus Guidelines for the Management of IPMN.

    Science.gov (United States)

    Campbell, Naomi M; Katz, Seth S; Escalon, Joanna G; Do, Richard K

    2015-03-01

    Intraductal papillary mucinous neoplasms (IPMN) are being diagnosed with increasing frequency, necessitating an algorithm to help stratify patients into low- and high-risk groups, for follow-up versus more invasive evaluation. New evidence concerning their natural history and overall risk of malignancy has emerged since the 2006 International Association of Pancreatology consensus guidelines, prompting an update in 2012, that distinguishes radiologic 'worrisome features' from 'high-risk stigmata'. The aim of this article is to illustrate, with case examples, the variable imaging patterns of IPMN and how their radiologic features, such as cyst size and mural nodules, are interpreted in the context of the new 2012 guidelines. The 2012 and 2006 guidelines will be compared and discussed with reference to additional studies that have since been published. Despite these guidelines, lingering uncertainty remains about the natural history of IPMN, a source of unease to both radiologists and referring clinicians alike, mandating further refinement of clinical and radiologic parameters predictive of malignancy. Emerging data regarding the risk of extrapancreatic malignancy, as well as synchronous or metachronous pancreatic ductal adenocarcinoma remote in location from a branch duct IPMN are also reviewed. With the expanding research and evolving understanding of this clinicopathologic entity across the globe, radiologists will continue to play an important role in the management of patients with IPMN.

  6. Endoscopic Ultrasound-Guided Fine-Needle Aspiration Cytology in the Diagnosis of Intraductal Papillary Mucinous Neoplasms of the Pancreas. A Study of 8 Cases

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    Charitini Salla

    2007-11-01

    Full Text Available Context Intraductal papillary mucinous neoplasm (IPMN is an increasingly recognized neoplasm of the pancreas, accounting for 5% of pancreatic neoplasms, it is considered difficult to diagnose by fineneedle aspiration (FNA cytology. Objective The aim of this study was to investigate the role of EUS-guided FNA cytology in the diagnosis of IPMN of the pancreas. Patients Eight cases of surgically proven IPMN with pre-operative endoscopic ultrasound-guided (EUS-guided FNA cytology were collected for retrospective analysis. Main outcome measures EUS-FNA cytology was performed with the on-site attendance of a cytopathologist in all cases. EUS/clinical findings, macroscopic/microscopic features of cell blocks and smears, and immunocytochemical stains accompanied by histopathologic diagnosis were recorded and studied. Results EUS revealed hypoechoic masses in the head of pancreas (n=6 and in the body/tail (n=2, measuring from 16.6 to 35.8 mm. In all cases, the hypoechoic mass had a distinctive distribution, involving the main pancreatic duct and/or the associated large branch ducts while intraductal nodules or multiple cysts were detected. Cytological specimens were characterized by a background containing abundant mucin in all cases and rarely by inflammation (neutrophils and histiocytes (n=4. Neoplastic cells were entrapped in a mucinous background either single or loosely cohesive, and forming papillae in 7 cases. Mucinous epithelium was observed in all cases. Single atypical and irregular clusters were found in 3 cases (which were cytologically described as highly suggestive malignant IPMNs, and were histologically confirmed. Two cases were diagnosed as benign IPMN and, in 3 cases, the biological behavior was not easy to determine by cytology alone (histologically diagnosed as borderline. The histological diagnosis confirmed the FNA cytology diagnosis: 3 malignant IPMNs, 2 benign IPMNs and 3 borderline IPMNs. Immunostains were available in 5 out of 8

  7. Positron Emission Tomography with 2-Deoxy-2-[18F] Fluoro-DGlucose in the Detection of Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas

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    Brian KP Goh

    2007-05-01

    Full Text Available A 79-year-old Indian male was admitted with upper abdominal discomfort of 1-year duration which was associated with loss of weight and appetite. Clinical examination of the abdomen did not reveal any palpable masses. Laboratory investigations including a complete blood count, liver function tests and serum amylase were unremarkable. Standard serum tumor markers were within normal limits: carbohydrate antigen (CA 19-9, 13.4 U/mL (reference range: 3-45 U/mL; carcinoembryonic antigen (CEA, 1.4 μg/L (reference range: 0.5-3.5 μg/L and alphafetoprotein, 1.3 μg/L (reference range: 1-10 μg/L. A contrast-enhanced computed tomographic (CT scan demonstrated a cystically dilated and tortuous pancreatic duct measuring 1.9 cm, suggestive of an intraductal papillary mucinous neoplasm (IPMN. The common bile duct was dilated up to the level of the ampulla and a 3.2x2.0 cm heterogeneous soft tissue mass was observed in the head of the pancreas which extended into the duodenum, suggestive of a malignant lesion (Images 1 and 2. Fusion positron emission tomography/computed tomography (PET/CT was subsequently performed with 12.7 mCi of 2-deoxy-2-[18F] fluoro-D-glucose (18F-FDG administered intravenously. A whole body PET/CT scan was performed 60 minutes later with CT data used for attenuation correction and anatomical correlation. This confirmed a metabolically active focus within the pancreatic head mass with a standard uptake value (SUVmax of 3.5 compatible with carcinoma (Image 3.

  8. Intraductal papillary mucinous neoplasms (IPMN) of the pancreas: clinico-pathologic results Neoplasia papilar mucinosa intraductal del páncreas: resultados clínico-patológicos

    OpenAIRE

    Cienfuegos, J.A. (Javier A.); Rotellar, F. (Fernando); P. Martí-Cruchaga; V. Valentí; G. Zozaya; Bueno, A.; N. Pedano; Lozano, M. D.; J. J. Sola; F. Pardo

    2010-01-01

    Background: intraductal papillary mucinous neoplasm (IPMN) shows a series of lesions which evolve from benign lesions -adenoma- to invasive carcinoma. Aim: to analyze the clinical and pathological results of 15 patients diagnosed of IPMN, and surgically treated according to the guidelines of International Consensus Conference. Material and methods: a retrospective analysis of 15 patients surgically treated between March 1993 and September 2009, according to the International Consensus recomme...

  9. Intraductal Papillary Mucinous Neoplasm Occurring In Pancreatic Heterotopia Of The Duodenum: Two Cases And A Review Of The Literature

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    Sarah M Choi

    2008-09-01

    Full Text Available Context Heterotopic pancreas is usually an incidental finding during pathologic evaluation of gastrointestinal polyps or lesions encoun-tered during endoscopy for nonspecific symptoms or unrelated conditions. However, the same neoplastic processes that occur in normal pancreas also can occur in pancreatic heterotopias. Case report We report two cases of intraductal papillary mucinous neoplasms arising in pancreatic heterotopia within the duodenum of two patients. These cases are among the first reports of neoplasia occurring in pancre-atic heterotopia of the duodenum. Both patients are being managed expectantly, as there is currently no consensus regarding the proper follow up in these cases, particularly those that have been incompletely excised. Conclusion These cases highlight the potential for neo-plasia in pancreatic heterotopia and emphasize the importance of careful evaluation of these lesions. Close clinical follow up and possible excision may be warranted in patients with concerning pathologic or clinical findings.

  10. Pancreatic Fistula Extending into the Thigh Caused by the Rupture of an Intraductal Papillary Mucinous Adenoma of the Pancreas.

    Science.gov (United States)

    Shimizu, Yuki; Imaizumi, Hiroshi; Yamauchi, Hiroshi; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Takezawa, Miyoko; Kida, Mitsuhiro; Suzuki, Erina; Saegusa, Makoto; Koizumi, Wasaburo

    2017-01-01

    We herein report the first case of a pancreatic fistula extending into the thigh caused by the rupture of an intraductal papillary mucinous neoplasm (IPMN) of the pancreas. An 80-year-old man was suspected to have necrotizing fasciitis because of right femoral pain. Computed tomography showed fluid retention from the pancreatic head to the right iliopsoas muscle and an IPMN at the pancreatic head. The findings of endoscopic retrograde pancreatography led to the suspicion of a minor leak and a pancreatic stent was placed. The patient died due to an uncontrollable infection. A pathological autopsy showed a pancreatic fistula extending into the thigh that had been caused by the rupture of the IPMN.

  11. Pancreatic Fistula Extending into the Thigh Caused by the Rupture of an Intraductal Papillary Mucinous Adenoma of the Pancreas

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    Shimizu, Yuki; Imaizumi, Hiroshi; Yamauchi, Hiroshi; Okuwaki, Kosuke; Miyazawa, Shiro; Iwai, Tomohisa; Takezawa, Miyoko; Kida, Mitsuhiro; Suzuki, Erina; Saegusa, Makoto; Koizumi, Wasaburo

    2017-01-01

    We herein report the first case of a pancreatic fistula extending into the thigh caused by the rupture of an intraductal papillary mucinous neoplasm (IPMN) of the pancreas. An 80-year-old man was suspected to have necrotizing fasciitis because of right femoral pain. Computed tomography showed fluid retention from the pancreatic head to the right iliopsoas muscle and an IPMN at the pancreatic head. The findings of endoscopic retrograde pancreatography led to the suspicion of a minor leak and a pancreatic stent was placed. The patient died due to an uncontrollable infection. A pathological autopsy showed a pancreatic fistula extending into the thigh that had been caused by the rupture of the IPMN. PMID:28154275

  12. Obstructive Chronic Pancreatitis and/or Intraductal Papillary Mucinous Neoplasms (IPMNs: A 21-Year Long Case Report

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    Mohammed Abu-Hilal

    2006-03-01

    Full Text Available Context :Intraductal papillary mucinous neoplasms of the pancreas (IPMNs, usually present with a picture of chronic pancreatitis and must be considered within the differential diagnosis of this condition. Case report :We report a long history of a 58- year-old male who presented with recurrent attacks of pancreatitis. He was treated for chronic pancreatitis until the age of 78 when the diagnosis of IPMN was made, but radical treatment was not possible and he was managed palliatively. The patient died of sepsis and multi-organ failure 21 years following his first presentation. Conclusion :This case highlights possible pitfalls in the diagnosis and treatment of IPMNs, suggests a very long natural history, proposes possible palliative treatment in selected cases and reflects about IPMNs biological position in the chronic pancreatitisductal adenocarcinoma chain.

  13. Intraductal papillary mucinous neoplasms (IPMN of the pancreas: clinico-pathologic results Neoplasia papilar mucinosa intraductal del páncreas: resultados clínico-patológicos

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    J. A. Cienfuegos

    2010-05-01

    Full Text Available Background: intraductal papillary mucinous neoplasm (IPMN shows a series of lesions which evolve from benign lesions -adenoma- to invasive carcinoma. Aim: to analyze the clinical and pathological results of 15 patients diagnosed of IPMN, and surgically treated according to the guidelines of International Consensus Conference. Material and methods: a retrospective analysis of 15 patients surgically treated between March 1993 and September 2009, according to the International Consensus recommendation. Demographic, diagnostic tools, surgical report, pathologic database and actuarial survival were analyzed with a follow-up from one and a half month through nine years. Results: 6 patients underwent pancreaticoduodenectomies, 4 total pancreatectomies, 2 body or central pancreatectomies, 2 partial pancreatectomies (enucleation and 1 distal pancreatectomy. A morbidity of 46 and 0% hospital mortality were assessed, with a median length hospital stay of 10 days. In five cases, the IPMN was combined type (both main and branch pancreatic ducts involved in four main duct-type and branch duct-type in the another six as well. Several atypia (IPMN carcinoma in situ was observed in 2 patients and invasive carcinoma with negative lymph nodes was identified in 3 patients. A patient without invasive carcinoma died at 66 months of follow-up for pancreas adenocarcinoma. The actuarial survival up to recurrence or death was 105,133 months with a range of follow-up from 1 month and a half until 9 years. Conclusions: IPMN main duct or mixed type warrants complete resection due to its incidence of invasive carcinoma or precursor lesions of malignancy as well. Due to its multifocal pattern, patients should be followed in long-term surveillance. The management of asymptomatic IPMN type branch less than 3 cm is controversial.Introducción: la neoplasia papilar mucinosa intraductal (NPMI del páncreas comprende una serie de lesiones que evolucionan desde lesiones benignas

  14. Intraductal US-directed management of bile duct stones without radiocontrast cholangiography.

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    Park, Seon-Young; Park, Chang-Hwan; Lim, Sung-Uk; Cho, Eun-Ae; Lee, Du-Hyeon; Jun, Chung-Hwan; Kim, Hyun-Soo; Choi, Sung-Kyu; Rew, Jong-Sun

    2015-11-01

    Intraductal US (IDUS) is an examination of the bile duct by using a thin-caliber ultrasonic probe, yielding real-time, high-quality cross-sectional images. We prospectively evaluated the feasibility and safety of IDUS-directed stone removal without radiocontrast cholangiography (RC) in naïve patients with common bile duct (CBD) stones. A total of 38 naïve patients with suspected CBD stones (stones, we performed endoscopic sphincterotomy and removed the identified CBD stones without RC. The primary outcome was success rate of CBD stone removal without RC. The secondary outcomes were conversion rate to conventional ERCP with RC, fluoroscopy time, clinical responses, and adverse events. IDUS was successfully performed in all enrolled patients (38/38, 100%). No echogenic material was observed in 3 patients (1 Mirizzi syndrome, 2 spontaneous passages of CBD stones). After endoscopic sphincterotomy, IDUS-directed stone removal was successfully performed without RC in 26 patients (74.3%) in the first session. In the 9 patients, after deployment of plastic stents, IDUS-directed stone removal was successfully completed without RC in a second session. There was no conversion to conventional ERCP with RC. Median fluoroscopy time was 10 seconds. There were no immediate and delayed adverse events related to the IDUS-directed stone removal. However, asymptomatic hyperamylasemia developed in 3 patients (7.9%), who recovered without adverse events. IDUS-directed stone removal without RC is feasible and safe for patients with CBD stones. We anticipate a potentially important role of IDUS in the field of various therapeutic interventions. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  15. Intraductal papillary mucinous neoplasm (IPMN) of the gastric-type with focal nodular growth of the arborizing papillae: a case of high-grade transformation of the gastric-type IPMN.

    Science.gov (United States)

    Ban, Shinichi; Naitoh, Yoshihisa; Ogawa, Fumihiro; Shimizu, Yoshihiko; Shimizu, Michio; Yasumoto, Akihiro; Koyama, Isamu

    2006-07-01

    We present a case of intraductal papillary mucinous neoplasm (IPMN) of the pancreas, demonstrating a process of high-grade transformation of the gastric-type IPMN. An 83-year-old Japanese woman underwent pylorus-preserving pancreatoduodenectomy for removal of a multicystic mass of the pancreas head, which had been followed up for 7 years. The removed tumor was a low-grade gastric-type IPMN spreading in the branch ducts, focally forming an intraluminal nodular lesion. The nodular lesion was comprised of arborizing papillotubular proliferation of cuboidal to columnar epithelia with high-grade atypia, and was characterized by diffuse MUC1 expression and a gastric mucin phenotype (focal MUC5AC and MUC6 expressions). Therefore, the nodular lesion was consistent with the pancreatobiliary-type IPMN, and the present case suggests that the low-grade gastric-type IPMN may progress to a focal intraductal carcinoma over the years, and the pancreatobiliary-type IPMN may be one of the forms of such high-grade transformation of the gastric-type IPMN. One of the cystic lesions was an oligocystic-type serous cystic neoplasm (serous cystadenoma), which might be an incidental concomitance or have a common basis.

  16. Distinction of Invasive Carcinoma Derived From Intraductal Papillary Mucinous Neoplasms From Concomitant Ductal Adenocarcinoma of the Pancreas Using Molecular Biomarkers.

    Science.gov (United States)

    Tamura, Koji; Ohtsuka, Takao; Date, Kenjiro; Fujimoto, Takaaki; Matsunaga, Taketo; Kimura, Hideyo; Watanabe, Yusuke; Miyazaki, Tetsuyuki; Ohuchida, Kenoki; Takahata, Shunichi; Ishigami, Kousei; Oda, Yoshinao; Mizumoto, Kazuhiro; Nakamura, Masafumi; Tanaka, Masao

    2016-07-01

    To clarify the usefulness of molecular biomarkers for distinguishing invasive carcinoma derived from intraductal papillary mucinous neoplasms (IPMNs [Inv-IPMN]) from concomitant pancreatic ductal adenocarcinoma (PDAC). Data from 19 patients with resected concomitant PDAC were retrospectively reviewed. KRAS/GNAS mutations and immunohistochemical (IHC) expression of p53 and p16/CDKN2A were assessed in both IPMN and distinct PDAC. As controls, KRAS/GNAS mutations and IHC labeling were assessed between invasive and noninvasive components in 1 lesion of 22 independent patients. KRAS/GNAS mutation status of invasive and noninvasive components in Inv-IPMN was consistent in 18 (86%) of 21 patients. Conversely, mutational patterns in IPMN and distinct PDAC in the same pancreas differed from each other in 17 (89%) of 19. There were 10 (53%) and 8 (42%) of 19 patients who showed the same p53 and p16/CDKN2A staining between concomitant PDAC and distinct IPMN. In the Inv-IPMN cohort, 19 (86%) of 22 patients showed the same IHC expression pattern between the noninvasive and invasive components. It may be possible to distinguish Inv-IPMN from concomitant PDAC by assessing these molecular biomarkers. More precise distinction of Inv-IPMN and concomitant PDAC will lead to adequate recognition of the natural history of IPMNs and hence optimal management.

  17. Lessons from McCune-Albright syndrome-associated intraductal papillary mucinous neoplasms: : GNAS-activating mutations in pancreatic carcinogenesis.

    Science.gov (United States)

    Parvanescu, Alina; Cros, Jérôme; Ronot, Maxime; Hentic, Olivia; Grybek, Virginie; Couvelard, Anne; Levy, Philippe; Chanson, Philippe; Ruszniewski, Philippe; Sauvanet, Alain; Gaujoux, Sebastien

    2014-08-01

    GNAS-activating mutations are reported in intraductal papillary mucinous neoplasms (IPMNs) and in McCune-Albright syndrome, characterized by fibrous dysplasia, precocious puberty, and café au lait spots. Recently, IPMNs have been described as a McCune-Albright syndrome-associated tumor, present in about 15% of patients. The aim of the present work was to assess the prevalence of polyostotic fibrous dysplasia and McCune-Albright syndrome among patients operated on for presumptive sporadic IPMNs. All patients operated on for IPMNs between January 1, 2007, and December 31, 2012, with available imaging were retrospectively screened for polyostotic fibrous dysplasia based on their preoperative abdominal or thoracoabdominal spiral computed tomography images. Systematic screening of 272 patients operated on for IPMNs revealed 1 patient with axial and peripheral polyostotic fibrous dysplasia and café au lait spots on clinical examination suggestive of McCune-Albright syndrome. This patient had been operated on for an unusually large invasive colloid adenocarcinoma (pT3N0M0 R0) derived from an intestinal subtype GNAS-mutated IPMN. The patient underwent adjuvant chemotherapy with gemcitabine for 6 months and was alive without recurrence 6 years later. Besides providing additional evidence of a syndromic IPMN as a feature of McCune-Albright syndrome, this observation is further evidence of the functional oncogenic consequences of GNAS mutations in the pancreas.

  18. Utility of the 2006 Sendai and 2012 Fukuoka guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas

    Science.gov (United States)

    Hsiao, Chih-Yang; Yang, Ching-Yao; Wu, Jin-Ming; Kuo, Ting-Chun; Tien, Yu-Wen

    2016-01-01

    Abstract This study aimed to evaluate the utility of the 2006 Sendai and 2012 Fukuoka guidelines for differentiating malignant intraductal papillary mucinous neoplasm (IPMN) of the pancreas from benign IPMN. Between January 2000 and March 2015, a total of 138 patients underwent surgery and had a pathologically confirmed pancreatic IPMN. Clinicopathological parameters were reviewed, and all patients were classified according to both the 2006 Sendai and 2012 Fukuoka guidelines. Univariate and multivariate analyses were used for identifying significant factors associated with malignancy in IPMN. There were 9 high-grade dysplasia (HGD) and 37 invasive cancers (ICs) in the 138 patients. The positive predictive value (PPV) and negative predictive value (NPV) of the Sendai and Fukuoka guidelines for HGD/IC was 35.1%, 43.3%, 100%, and 85.4%, respectively. Of the 36 patients with worrisome features using the Fukuoka guideline, 7 patients had HGD/IC in their IPMNs. According to the multivariate analysis, jaundice, tumors of ≥3 cm, presence of mural nodule on imaging, and aged IPMN. The Sendai guideline had a better NPV, but the Fukuoka guideline had a better PPV. We suggest that patients with worrisome features based on the Fukuoka guideline be aggressively managed. PMID:27661043

  19. MR Imaging Features of Pancreas Intraductal Papillary Mucinous Neoplasm%胰腺导管内乳头状黏液性肿瘤的MRI表现

    Institute of Scientific and Technical Information of China (English)

    舒健; 赵建农; 郭大静; 谢微波; 陈维娟; 吴伟

    2009-01-01

    目的 探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的MRI特征.资料与方法 6例经病理或逆行性胆胰管造影(EBCP)证实的胰腺IPMN患者.MR扫描包括T_1WI、T_2WI、MRCP和动态增强.分析胰腺IPMN的MRI征象,并与临床及病理对照.结果 主胰管型、分支胰管型及混合型各2例,病灶主要位于胰头颈部,最大径(27.4±14.5)mm,呈分叶状,边缘清晰,T_1WI上呈低信号,T_2WI上呈高信号,增强后无强化或线状强化.2例病灶远端胰腺萎缩.2例分支胰管型主胰管最大径2.9 mm和2.2 mm,其余4例最大径(5.9 ±1.6)mm.结论 MRI对发现和正确诊断胰腺IPMN有较高价值.%Objective To assess the MR imaging features of pancreas intraductal papillary mucinous neoplasm (IPMN). Materials and Methods Six patients with IPMN proven by histopathology or ERCP underwent MR examination. The MR sequences included fast spoiled gradient echo (FSPGR) T_1 weighted (T_1W), fast recovery fast spin echo (FRFSE) T_2 weighted (T_2W),MRCP, and dynamic contrast-enhanced MR imaging. The M R imaging features of pancreatic IPMN were noted. Results IPMN in 6 patients showed as a cluster of cyst-like structures with a distinct rim in the head and neck of pancreas, The lesions were divided into main duct type in 2, branch duct type in 2, and combined type in 2.The mean and standard deviation of the maximum diameter of all IPMN was (27. 4± 14.5) nun. All IPMN were hypointensity on T_1 weighted images and hyperintensity on T_2 weighted images, with a thread like enhancement or no enhancement. The atrophy of pancreatic parenchyma was showed in 2 patients. The maximum diameter of main pancreatic duct in 2 patients of branch duct type was 2.9 mm and 2.2 mm,respectively,and the maximum diameter of main pancreatic duct in other 4 patients was (5.9 ± 1.6) mm. Conclusion MR imaging is very useful in the diagnosis of pancreas I PMN.

  20. 胰腺导管内乳头状黏液性肿瘤的MSCT和MRCP诊断%Multi-slice CT and MR cholangio-pancreatographic diagnosis of intraductal papillary mucinous neoplasm of the pancreas

    Institute of Scientific and Technical Information of China (English)

    张超; 弓静; 郭帅; 殷长均

    2011-01-01

    Objective To evaluate the multi- slice CT (MSCT) and magnetic resonance cholangio- pancreatography (MRCP) features of intraductal papillary mucinous neoplasm (IPMN) ofthe pancreas.Methods The CT and MRCP of 26 cases of IPMN including adenocarcinoma (6 cases), borderline malignancy (2), and adenoma (1) were reviewed.Results CT and MRI of IPMN in the pancreatic ductal branches (12 cases) showed solitary or multiple cystic lesions with septa or nodules in the ducts.In the 5 patients with main pancreatic duct IPMN, there was dilation of the main pancreatic duct with mural nodule.In 9 patients with mixed type pancreatic IPMN, dilation of the main pancreatic duct and cystic lesions were noted.Conclusion MSCT and MRCP are useful in the diagnosis ofpancreatic IPMN.%目的 探讨胰腺导管内乳头状黏液性肿瘤 (IPMN)的MSCT和MRCP影像学表现.方法 对26例经内镜或手术病理证实的IPMT患者的CT和MRCP表现进行回顾性分析.结果 分支胰管型IPMN12 例,表现为单发囊性病变或葡萄串样多发囊性病变伴腔内分隔或结节样突起;主胰管型 IPMN 5 例,表现为主胰管扩张伴管壁结节样突起;混合型IPMN 9例,表现为主胰管扩张和囊性病变合并存在.9例手术病理结果为腺瘤1例,交界性肿瘤2例,腺癌6例.结论 MSCT和MRCP对发现和诊断胰腺 IPMN具有较高价值.

  1. [Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas Showing High Accumulation of 18F-Fluorodeoxyglucose (FDG)--A Case Report].

    Science.gov (United States)

    Kubota, Masaru; Nishimura, Masashige; Nakatsuka, Rie; Miyazaki, Susumu; Danno, Katsuki; Motoori, Masaaki; Matsuda, Chu; Fujitani, Kazumasa; Iwase, Kazuhiro

    2015-11-01

    The diagnosis of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas includes radiographic (CT, MRI) and endoscopic evaluation (ERCP, EUS). The treatment strategy is outlined in the 2012 International Consensus Guidelines (ICG). Herein, we report a case initially not indicated for surgery. Four months after the initial diagnosis, the cystic lesion transformed into a solid mass-like lesion visible on CT. FDG-PET showed abnormal FDG uptake at the same location. Surgical resection was performed immediately, and the tumor was diagnosed as IPMN with inflammation. FDG-PET showed a false-positive diagnosis for the malignancy in this case of IPMN.

  2. Effectiveness of contrast-enhanced endoscopic ultrasound for detecting mural nodules in intraductal papillary mucinous neoplasm of the pancreas and for making therapeutic decisions

    Science.gov (United States)

    Fujita, Mitsuru; Itoi, Takao; Ikeuchi, Nobuhito; Sofuni, Atsushi; Tsuchiya, Takayoshi; Ishii, Kentaro; Kamada, Kentaro; Umeda, Junko; Tanaka, Reina; Tonozuka, Ryosuke; Honjo, Mitsuyoshi; Mukai, Shuntaro; Moriyasu, Fuminori

    2016-01-01

    Background and Objectives: There have been few studies to date evaluating the effectiveness of contrast-enhanced endoscopic ultrasound (CE-EUS) for detecting mural nodules in patients with branch duct-type intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas. We aim to evaluate the effectiveness of CE-EUS for detecting mural nodules in BD-IPMN. Patients and Methods: Of the 427 BD-IPMN patients, 21 patients (4.9%) in whom the presence of mural nodules was suggested by CE computed tomography (CT) or magnetic resonance imaging (MRI), or in whom the presence of nodule-like lesions as shown by fundamental EUS, were examined by CE-EUS. Results: The mean diameter of cystic lesions was 29.8 ± 12.8 mm. The mean diameter of mural nodules was 9.5 ± 5.7 mm. BD-IPMN was detected in the pancreatic head in 16 cases, pancreatic body in 2 cases, and pancreatic tail in 3 cases. The mean follow-up period was 17.2 ± 11.9 months. The detection rates of mural nodule-like lesions in BD-IPMN patients on CT, MRI, and fundamental EUS were 36.8%, 63.2%, and 100%, respectively. The detection rates of true mural nodules in BD-IPMN patients on CT, MRI, and fundamental EUS were 85.7%, 71.4%, and 100%, respectively. The echo levels of mural nodule-like lesions on fundamental EUS were hyperechoic in 6 patients, isoechoic in 9 patients, and hypoechoic in 6 patients. The final diagnosis was mucus lumps in 14 patients and mural nodules in 7 patients. The contrast patterns observed were avascular, isovascular, and hypervascular in 14, 3, and 4 patients, respectively. No patients showed a hypovascular pattern. Fourteen patients showing an avascular pattern were diagnosed as having mucus lumps, and they were able to avoid surgical resection. Of the 7 patients who were diagnosed as having mural nodules, 5 underwent surgical resection. The pathological findings were adenocarcinoma in 2 patients and adenoma in 3 patients. Of the 3 adenoma patients, fundamental EUS demonstrated a hypoechoic

  3. Concurrent Papillary Carcinoma Arising in Thyroglossal Duct Cyst and Thyroid Gland: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyoung Tae; Kim, Yeo Ju; Jeon, Yong Sun; Kim, Youn Jeong [Dept. of Radiology, Inha University School of Medicine, Seoul (Korea, Republic of); Kim, Sei Joong; Cho, Young Up [Dept. of General Surgery, Inha University School of Medicine, Seoul (Korea, Republic of)

    2011-05-15

    The occurrence and diagnosis of thyroglossal duct carcinoma is very rare. The synchronous occurrence of papillary carcinomas arising in a thyroglossal duct cyst (TGDC) and thyroid gland is extremely rare. Sistrunk's surgical technique must always be the initial treatment for a TGDC. However, if there is an intra-thyroidal carcinoma or local invasion, thyroidectomy has to be considered. Accurate pre-operative radiological evaluation should be performed in order to plan a surgical strategy. The aim of this report was to review our experience in the management of papillary thyroid carcinoma associated with TGDC. Our patient was a 67-year-old man who had a mural, micro- calcified nodule within a palpable, thick-walled cyst at the level of the hyoid and synchronously, a small macro-calcified mass in the isthmus of the thyroid gland.

  4. [A Case of Invasive Intraductal Papillary Mucinous Carcinoma, Penetrating the Stomach, Colon, and Jejunum].

    Science.gov (United States)

    Goto, Tadahiro; Toyama, Hirochika; Asari, Sadaki; Terai, Sachio; Kinoshita, Hisoka; Matsumoto, Taku; Kuramitsu, Kaori; Tanaka, Motofumi; Takebe, Atsushi; Kido, Masahiro; Matsumoto, Ippei; Ajiki, Tetsuo; Fukumoto, Takumi; Ku, Yonson

    2015-11-01

    A 69-year-old woman was admitted to a nearby clinic complaining of abdominal pain. Abdominal CT showed a 10 cm diameter huge cystic lesion in the body and tail of the pancreas. The patient was referred to our institution for treatment. Endoscopic ultrasonography (EUS) revealed a cystic mass with a solid lesion. Endoscopic retrograde pancreatography(ERP) demonstrated mucous at the opening of the papilla of Vater and dilatation of the pancreatic duct with a solid nodule. Contrast radiography revealed a fistula from the tumor to the jejunum. A biopsy specimen from the lesion showed adenocarcinoma. Intraoperative findings showed a tumor occupying the pancreas body and tail with suspected invasion to the stomach, jejunum, and transverse colon. We performed distal pancreatectomy with partial resection of stomach, jejunum, and colon. Pathological findings showed an invasive type of IPMC, with invasion to the subserosal layer of the stomach and colon and the mucous layer of the jejunum. While IPMC is recognized as a slow growing malignancy, some cases of invasive carcinoma with fistulation into adjacent organs have been reported. To our knowledge, a case of IPMC penetrating to 3 adjacent organs is rare.

  5. 高场强 MRCP在胰腺导管内乳头状黏液瘤的应用%The value of high-field-strength MRCP in diagnosing intraductal papillary mucinous neoplasms of pancreas

    Institute of Scientific and Technical Information of China (English)

    钱海珍; 林光武; 嵇鸣

    2014-01-01

    目的:探讨高场强 MRCP 在胰腺导管内乳头状黏液瘤(IPMNs)的应用价值。方法收集15例经手术病理证实的IPMNs 患者,回顾性分析其 MRI 表现,重点探讨 MRCP 的诊断价值。结果15例均为良性,其中主胰管型1例,分支胰管型8例,混合型6例。主胰管型表现为主胰管弥漫扩张,直径约14.5 mm,增强后未见明确强化。分支胰管型表现为分支胰管呈单发囊状或多发簇状扩张,囊灶与主胰管相通,增强后分隔、壁结节呈“轻-中”度强化。混合型表现为主胰管与分支胰管不同程度扩张,强化特点与分支胰管型相同。结论高场强 MRCP 对 IPMNs 的分型诊断、病变范围观测有重要价值,结合动态增强 MRI,有助于良恶性的鉴别。%Objective To explore the value of high-field-strength MRCP in diagnosing of intraductal papillary mucinous neoplasms (IPMNs)of pancreas.Methods Fifteen cases with IPMNs confirmed surgically and pathologically were recruited.The magnetic res-onance imaging (MRI)and MRCP findings were retrospectively analyzed.Results All cases were benign,including main pancreatic duct type (MPD)in 1,branch pancreatic duct type(BPD)in 8,and the combined type in 6.The MPD type showed diffuse dilation of main pancreatic duct which is about 14.5 mm with no enhancement.The BPD type displayed unilocular or multilocular cystic le-sions which showed communication with main pancreatic duct .The combined type demonstrated dilation of main pancreatic duct and branch pancreatic duct.The septa and mural nodule in the BPD type and the combined type were moderately enhanced.Conclusion MRCP is superior with regard to the diagnosis and classification of IPMN type and is helpful to differentiate malignant tumors from benign ones combined with routine contrast-enhanced.

  6. Intraductal papilloma of the breast in association with preoncogenic gene of breast cancer

    Institute of Scientific and Technical Information of China (English)

    Tuenchit Khammapirad; Jenjeera Prueksadee; Concepcion Diaz-Arrastia; Shaleen K Botting; Morton Leonard; Louisea Bonoan-Deomampo; Mahmoud A Eltorky

    2011-01-01

    We reported a case of an African American woman who went to the hospital with palpable right breast lump with bloody nipple discharge at University of Texas Medical Branct at Galvestion. The modalities of breast imagings included mammography and ultrasongraphy. The method used for viral identification was Linear ArrayHPV genotyping test. Intraductal papilloma revealed as high density tubular or rounded lobular masses with partially circumscribed, obscured margins and clustered punctate microcalcifications on mammograms. Ultrasound showed as intraductal masses with dilated ducts. The core biopsy demonstrated duct filled with papillary lesion and post excision revealed intraductal papilloma.HPV DNA types16, 33, 58 and71 were detected after use of Linear ArrayHPV genotyping test.

  7. Papillary Carcinoma Occurrence in a Thyroglossal Duct Cyst with Synchronous Papillary Thyroid Carcinoma without Cervical Lymph Node Metastasis: Two-Cases Report

    Directory of Open Access Journals (Sweden)

    F. B. Sobri

    2015-01-01

    Full Text Available Background. We present two rare cases of papillary carcinomas which appeared in thyroglossal duct cysts. These cases highlight that thyroglossal duct cyst can serve as malignancy of thyroid gland. Methods. A retrospective case report was carried out on 2 patients at Cipto Mangunkusumo Hospital. Results. A 57-year-old man presented with enlarged right anterior and midline neck mass, which preoperatively were diagnosed as thyroglossal duct cyst (TDC and nontoxic multinodular goiter. A total thyroidectomy and Sistrunk procedure were performed. In the second case, a 35-year-old woman presented with a lump which occurred at anterior neck region without palpable mass at the thyroid. Preoperatively, it was diagnosed as TDC. Sistrunk procedure was performed, followed by total thyroidectomy a month after the first operation. Histopathology showed papillary thyroid carcinoma in both patients. Conclusion. The occurrence of carcinoma in TDC is very rare but should always be considered as an option in making diagnosis for a neck mass.

  8. Diagnosis and management of intraductal papillary mucinous neoplasm in pancreas(IPMN)by endoscopy%内镜诊治胰腺导管内乳头状粘液性肿瘤的应用

    Institute of Scientific and Technical Information of China (English)

    杨蕾; 张斌; 李长铧; 邱云峰; 刘洋

    2012-01-01

    目的 探讨胰腺导管内乳头状粘液性肿瘤(IPMN)的诊断、内镜下治疗,以提高对该疾病的认识及内镜对其诊断及治疗的意义.方法 回顾性分析经内镜诊治的IPMN患者12例,总结并分析他们的一般情况、临床症状、影像学检查、实验室检查、内镜下治疗等方面资料.结果 12例IPMN患者以老年男性为主,无特异性临床表现,主要发生部位为胰头或钩突部,CT主要表现为囊实性低密度影,其内可有壁结节,胰管扩张伴或不伴胆管扩张,2例侵及胰腺实质.磁共振胰胆管造影(MRCP)主要表现为胰管扩张,胰腺萎缩,胰头部圆形高信号影.内镜下逆行胰胆管造影(ERCP)显示十二指肠乳头膨大,开口扩张,可见胶冻样粘液流出,胰管造影显示胰管全程扩张或胰头部囊状扩张,3例伴胆总管、肝内胆管扩张.9例行ERCP治疗,清除粘液栓并置入胰管支架,3例同时置入胆管支架.结论 IPMN是一种特殊类型的胰腺囊性疾病,影像学检查有其独特的表现,ERCP对其诊断及治疗有重要意义.%Objective To study the clinical diagnosis and treatment of intraductal papillary mucinous neoplasm in pancreas ( IPMN ) and evaluate the role of endoscopy in diagnosis and treatment. Methods The data of 12 patients with IPMN including general state of health, clinical characteristic of imaging findings, treatment by ERCP were retrospectively reviewed. Results This group is mainly of old men and no specific clinical information. CT demonstrated the cystic and solid lesion in the head or uncinate process of pancreas with mural nodules and dilatation of pancreatic duct. MRCP showed dilatation of pancreatic duct, high signal in the head of pancreas and atrophy of pancreas. ERCP was performed in all patients and found an abnormal protruding papilla of Vater with expulsion of mucous material, of whom 3 cases with dilatation of main pancreatic duct, 5 cases with cystic dilatation of head pancreatic duct, 3

  9. Combining radiomic features with a miRNA classifier may improve prediction of malignant pathology for pancreatic intraductal papillary mucinous neoplasms

    Science.gov (United States)

    Permuth, Jennifer B.; Choi, Jung; Balarunathan, Yoganand; Kim, Jongphil; Chen, Dung-Tsa; Chen, Lu; Orcutt, Sonia; Doepker, Matthew P.; Gage, Kenneth; Zhang, Geoffrey; Latifi, Kujtim; Hoffe, Sarah; Jiang, Kun; Coppola, Domenico; Centeno, Barbara A.; Magliocco, Anthony; Li, Qian; Trevino, Jose; Merchant, Nipun; Gillies, Robert; Malafa, Mokenge

    2016-01-01

    Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cancer precursors incidentally discovered by cross-sectional imaging. Consensus guidelines for IPMN management rely on standard radiologic features to predict pathology, but they lack accuracy. Using a retrospective cohort of 38 surgically-resected, pathologically-confirmed IPMNs (20 benign; 18 malignant) with preoperative computed tomography (CT) images and matched plasma-based ‘miRNA genomic classifier (MGC)’ data, we determined whether quantitative ‘radiomic’ CT features (+/- the MGC) can more accurately predict IPMN pathology than standard radiologic features ‘high-risk’ or ‘worrisome’ for malignancy. Logistic regression, principal component analyses, and cross-validation were used to examine associations. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were estimated. The MGC, ‘high-risk,’ and ‘worrisome’ radiologic features had area under the receiver operating characteristic curve (AUC) values of 0.83, 0.84, and 0.54, respectively. Fourteen radiomic features differentiated malignant from benign IPMNs (p0.80 (0.87 (95% CI:0.84-0.89)). This proof-of-concept study suggests a noninvasive radiogenomic approach may more accurately predict IPMN pathology than ‘worrisome’ radiologic features considered in consensus guidelines. PMID:27589689

  10. Combining radiomic features with a miRNA classifier may improve prediction of malignant pathology for pancreatic intraductal papillary mucinous neoplasms.

    Science.gov (United States)

    Permuth, Jennifer B; Choi, Jung; Balarunathan, Yoganand; Kim, Jongphil; Chen, Dung-Tsa; Chen, Lu; Orcutt, Sonia; Doepker, Matthew P; Gage, Kenneth; Zhang, Geoffrey; Latifi, Kujtim; Hoffe, Sarah; Jiang, Kun; Coppola, Domenico; Centeno, Barbara A; Magliocco, Anthony; Li, Qian; Trevino, Jose; Merchant, Nipun; Gillies, Robert; Malafa, Mokenge

    2016-12-27

    Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cancer precursors incidentally discovered by cross-sectional imaging. Consensus guidelines for IPMN management rely on standard radiologic features to predict pathology, but they lack accuracy. Using a retrospective cohort of 38 surgically-resected, pathologically-confirmed IPMNs (20 benign; 18 malignant) with preoperative computed tomography (CT) images and matched plasma-based 'miRNA genomic classifier (MGC)' data, we determined whether quantitative 'radiomic' CT features (+/- the MGC) can more accurately predict IPMN pathology than standard radiologic features 'high-risk' or 'worrisome' for malignancy. Logistic regression, principal component analyses, and cross-validation were used to examine associations. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were estimated. The MGC, 'high-risk,' and 'worrisome' radiologic features had area under the receiver operating characteristic curve (AUC) values of 0.83, 0.84, and 0.54, respectively. Fourteen radiomic features differentiated malignant from benign IPMNs (p0.80 (0.87 (95% CI:0.84-0.89)). This proof-of-concept study suggests a noninvasive radiogenomic approach may more accurately predict IPMN pathology than 'worrisome' radiologic features considered in consensus guidelines.

  11. Associating pancreaticostomy and biliary-irrigation for staged pancreaticoduodenectomy approach to pancreatic intraductal papillary mucinous neoplasm with recurrent cholangitis and severe jaundice

    Science.gov (United States)

    Dai, Chao; Lou, Siyuan; Zhou, Fan

    2016-01-01

    Abstract Patient concerns: A 63-year-old man was hospitalized with history of abdominal pain since more than 1 year, and that of fever with chills since 2 weeks. Diagnoses: Based on the laboratory investigations and radiologic findings, a preliminary diagnosis of pancreatic intraductal papillary mucinous neoplasm (IPMN) with recurrent cholangitis and severe jaundice was made. Interventions: An initial attempt at endoscopic and image-guided drainage proved unsuccessful. Due to cholangitis, liver dysfunction, and hypoalbuminemia, the patient was deemed to be medically unfit for radical surgery. Therefore we considered a novel strategy of associating pancreaticostomy and biliary-irrigation for staged pancreaticoduodenectomy (APBSP). In the first stage, biliary tract double irrigation (endoscopic nasobiliary drainage and T-tube) in combination with pancreaticostomy was performed, which alleviated the symptoms and helped improve the general condition of the patient. In the second stage, radical pancreaticoduodenectomy was performed. Outcomes: Over a follow-up period of 23 months, no recurrence occurred. Lessons: In this report, we present a previously unreported treatment strategy for pancreatic IPMN with recurrent cholangitis and jaundice. The innovative treatment approach may help advance the understanding and management of this condition. PMID:27902614

  12. Potential usefulness of mucin immunohistochemical staining of preoperative pancreatic biopsy or juice cytology specimens in the determination of treatment strategies for intraductal papillary mucinous neoplasm.

    Science.gov (United States)

    Hisaka, Toru; Horiuchi, Hiroyuki; Uchida, Shinji; Ishikawa, Hiroto; Kawahara, Ryuichi; Kawashima, Yusuke; Akashi, Masanori; Mikagi, Kazuhiro; Ishida, Yusuke; Okabe, Yoshinobu; Nakayama, Masamichi; Naito, Yoshiki; Yano, Hirohisa; Taira, Tomoki; Kawahara, Akihiko; Kage, Masayoshi; Kinoshita, Hisafumi; Shirozu, Kazuo

    2013-11-01

    We classified resected intraductal papillary mucinous neoplasms (IPMNs) into four subtypes (gastric, intestinal, pancreatobiliary and oncocytic) according to their morphological features and mucin expression, determined their clinicopathological characteristics and investigated the possibility of preoperatively diagnosing these subtypes. Sixty resected tumors, 4 preoperative tumor biopsies and 10 preoperative pancreatic juice cytology specimens were analyzed. The gastric and intestinal types accounted for the majority of IPMNs. Non-gastric type IPMNs were of high-grade malignancy. Many of the pancreatobiliary-type IPMNs were in an advanced stage and were associated with a poor prognosis. The results of mucin immunohistochemical staining of preoperative biopsy and surgically resected specimens were in agreement with each other, and in close agreement with those for pancreatic juice cytology specimens obtained from 10 patients during endoscopic retrograde cholangiopancreatography (ERCP). The immunostaining of preoperative biopsy specimens and ERCP-obtained pancreatic juice cytology specimens may be useful in the differential diagnosis of gastric and intestinal types of IPMN. If such techniques enable the preoperative diagnosis of IPMN subtypes, their use in combination with conventional preoperative imaging modalities may lead to surgical treatment best suited for the biological characteristics of the four subtypes.

  13. Isolated Pancreatic Uncinate Duct IPMN.

    Science.gov (United States)

    Maker, Ajay V; Maker, Vijay K

    2017-04-01

    The ventral pancreas originally forms as an evagination of the common bile duct at 32 days gestation and its duct, the uncinate duct, eventually rotates with the ventral anlage to join the dorsal pancreas and fuse with the main pancreatic duct. Thus, though often considered a "branch" duct of the pancreas, embryologically, the uncinate duct is the "main" pancreatic duct of the ventral pancreas. This concept is not fully addressed in the current definitions of intraductal papillary mucinous neoplasms of the pancreas (IPMN) where international consensus guidelines consider the main-duct IPMN as high risk for malignancy and most small branch-duct IPMN as low risk for malignancy. Thus, it is important to recognize that isolated uncinate-duct IPMN can occur and, based on its embryologic origin and increased association with high-grade dysplasia and invasive cancer, may be managed conceptually as a main duct type of disease rather than a branch duct until better biomarkers of malignancy are discovered. The images provide an example of this unique disease process.

  14. MSCT features of intraductal papillary mucinous neoplasm in the pancreas%胰腺导管内乳头状黏液性肿瘤的 MSCT 征象

    Institute of Scientific and Technical Information of China (English)

    岳奎涛; 刘剑羽; 王智勇; 李磊; 刘从容

    2012-01-01

    目的 探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的MSCT特点.方法 回顾性分析27例经病理证实的IPMN的MSCT表现.所有患者均接受16层或64层CT平扫及增强检查,其中7例接受ERCP检查.结果 27例IPMN中,主胰管型11例,包括2例交界性肿瘤,4例原位癌,5例腺癌;CT表现为胰腺不同程度萎缩,主胰管扩张,8例内部可见壁结节,1例见多发斑块状钙化.分支胰管型9例,包括腺瘤和交界性肿瘤各3例,1例原位癌,2例腺癌;其中7例位于胰头部,表现为与主胰管相通的囊性病灶,内见分隔和乳头状壁结节,呈“葡萄串”样,1例可见点状钙化;2例位于胰尾部,呈类圆形囊性病灶,增强无强化.混合型7例,包括交界性肿瘤和腺癌各3例,原位癌1例,表现为主胰管及分支胰管扩张伴腔内壁结节,3例病变内可见不同程度钙化.7例接受ERCP,其中5例明确显示囊性病灶与主胰管相通.结论 IPMN的MSCT表现具有一定特征.MSCT结合ERCP检查有助于术前准确诊断.%To analyze MSCT features of intraductal papillary mucinous neoplasms (IPMN)of the pancreas. Methods Totally 27 patients with IPMN confirmed by pathology were retrospectively analyzed. All patients underwent plain and contrast-enhance CT, 7 patients underwent ERCP. Results Among the 27 cases, 11 were interpreted as IPMN of the main pancreatic duct (MPD). Two of these 11 MPD were classified as borderline tumors, 4 were carcinomas, and 5 were adenocarcinoma. The atrophy of pancreas at different degrees and obvious dilation of MPD were demonstrated on CT, with solid mural nodules in the duct were seen in 8 cases, while 1 case had pancreatic calcification. Nine cases were interpreted as IPMN of the branch-duct type, 3 were classified as adenomas, 3 were borderline tumors, 1 was carcinomas, and 2 were adenocarcinoma. Among these 9 cases, 7 IPMN located in the pancreas head, displayed as cystic lesions linking to the main duct which shaped like grape

  15. 胰腺导管内乳头状黏液性肿瘤的CT表现与病理对照分析%CT and pathological manifestations of intraductal papillary mucinous neoplasm of pancreas: a comparative study

    Institute of Scientific and Technical Information of China (English)

    张静; 黄宗良; 张炜; 王培军; 袁小东; 邵成伟; 赵小虎; 徐卫国; 董宁欣; 王国良; 邵志宏

    2008-01-01

    目的 分析胰腺导管内乳头状黏液性肿瘤(IPMN)的CT表现特征并与病理结果进行对照,探讨CT在胰腺IPMN诊断和鉴别诊断的价值.方法 分析39例临床资料齐全、手术病理证实为IPMN病例资料,将本组病例的CT表现分为3型:(1)单纯主胰管扩张型;(2)主胰管扩张伴胰腺囊性灶型;(3)单纯胰腺囊性灶型.分析CT分型与Takada病理分型(主胰管型、分支型、混合型)的对应关系;按病理结果将IPMN分为良性组和恶性/交界组,对病变的CT特征(有无壁结节、有无分隔、病灶大小、主胰管及胆总管扩张程度)进行统计学分析.结果 单纯主胰管扩张型对应于主胰管型,主胰管扩张伴胰腺囊性灶型主要对应于分支型和混合型,单纯囊性灶型对应于分支型(P<0.001).病灶内无壁结节时病理为良性的概率为92%,病灶内有壁结节时病理为良性的概率为42%,两者差异有统计学意义(P=0.003),病灶内是否出现分隔与肿瘤的良恶性无关(P=0.793),恶性/交界性病灶的最大径大于良性病灶,P=0.016,主胰管管径、胆总管管径在良性和恶性/交界两组间差异均无统计学意义,但在不考虑病理分组的情况下,全部病例主胰管管径大于胆总管管径(P=0.02).结论 IPMN CT表现的三种分型与病理分型有较好的对应关系,有利于IPMN CT征象的分析及提高诊断的准确性.IPMN的主胰管扩张程度常超过胆总管亦具有一定的特征,结合其他典型征象能够对IPMN做出较准确的诊断.%Objective To evaluate the diagnostic value of CT in pancreas intraductal papillary mucinous neoplasm(IPMN) by analyzing its CT feature and pathological findings. Methods The clinical and CT data was analyzed among 39 patients with IPMN whose diagnosis was confirmed by pathology. The CT manifestations were classified into 3 types: simple main pancreatic duct enlargement; main pancreatic duct enlargement combined with pancreatic cystic lesion; and

  16. A Case Report of Intraductal Papillary-Mucinous Neoplasm of the Pancreas Showing Morphologic Transformation during Followup Periods

    Directory of Open Access Journals (Sweden)

    Yuichi Sanada

    2009-01-01

    Full Text Available A 64-year-old man underwent MRCP for further examination of gallbladder stones and IPMN of branch-type (IPMN-Br was pointed out. Yearly MRCP had revealed the gradual increase of the cystic components, marked dilation of the main pancreatic duct (MPD, and filling defects in the MPD. After follow-up for three years, he underwent pancreatoduodenectomy. Histologically, the dilated MPD and connecting dilated branch ducts were filled with nodular growth of tumor cells consisting of gastric-type adenoma with pyloric gland-like structures. In the MPD, a transition from gastric-type adenoma to intestinal-type carcinoma was observed. In addition, in a dilated branch duct, some components of intestinal-type carcinoma with marked arborizing structures were observed. A minimally invasion was observed around branch ducts. Immunohistochemistry revealed diffuse nuclear accumulation of PCNA and Ki67 in the tumor cells of branch dusts. Our observations suggest that the secondary infiltration to the MPD of IPMN-Br and IPMN-Br possesses malignant potential for microinvasion.

  17. Intraductal papilloma with bloody discharge from Montgomery's areolar tubercle examined by ductoscopy from the areola.

    Science.gov (United States)

    Sakai, Takehiko; Makita, Masujiro; Akiyama, Futoshi; Uehara, Kanou; Kasumi, Fujio; Horii, Rie; Sakamoto, Goi

    2006-01-01

    A patient with intraductal papilloma who had abnormal bloody discharge from Montgomery's areolar tubercle underwent mammary ductography, mammary ductoscopy from the tubercle, and microdochectomy.A 43-year-old woman who was being followed-up for left breast cancer noticed bloody discharge from Montgomery's areolar tubercle of the right breast. Because the discharge continued for 2 months, further examinations were conducted. Mammary ductoscopy of Montgomery's areolar tubercle showed a normal internal duct structure. The presence of yellowish superficial lesions suggested intraductal inflammation or superficial hyperplasia of the duct epithelium. Lavage cytology revealed benign papillary lesions. Since the discharge continued and we could not completely exclude malignancy, microdochectomy was performed. Histologically a lactiferous duct was connected to Montgomery's areolar tubercle and an intraductal papilloma was seen in part and considered to have caused the bloody discharge. Bloody discharge from Montgomery's areola tubercles is extremely rare, the present case was our first experience with ductoscopy of Montgomery's areolar tubercle out of 641 cases of mammary ductoscopy performed on patients with bloody nipple discharge from 1998 to 2004. In our case, Montgomery's areolar tubercles were connected to a lactiferous duct. Although there are a few breast carcinomas that cause bloody discharge and eruption of areola, areolar preservation should be performed with the knowledge that disease may also involve the areola through the lactiferous ducts.

  18. Single Nucleotide Polymorphisms within the 8Q24 Region are Not Associated with the Risk of Intraductal Papillary Mucinous Neoplasms of the Pancreas.

    Science.gov (United States)

    Panic, Nikola; Larghi, Alberto; Amore, Rosarita; Pastorino, Roberta; Bulajic, Milutin; Costamagna, Guido; Boccia, Stefania

    2016-09-01

    Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas have been reported to be associated with an increased risk of developing extra-pancreatic malignancies. A common genetic background has been hypothesised to be responsible for such an association. Human chromosomal region 8q24 has been associated with many types of cancer. The majority of these associations lie at approximately 128 Mb on chromosome 8. We conducted a study in order to examine the association between IPMN and single nucleotide polymorphisms (SNPs) from the 8q24 region, namely rs10505477, rs6983267, rs7014346, rs6993464, previously reported to influence general cancer susceptibility. The study was performed on 117 IPMN cases and 231 controls. Cases were enrolled at the Digestive Endoscopy Unit, Policlinico Agostino Gemelli from January, 2010 to June, 2011, with either a prevalent or incident IPMN diagnosis. Status of SNPs was determined using a StepOne Real-time PCR system (Applied Biosystems) and TaqMan SNP Genotyping Assay™ 40X. Unconditional multiple logistic regression models were used to estimate odds ratios and 95% confidence intervals for the association of selected SNPs and IPMNs. Cases were more likely to report a 1st degree family history of cancer (p<0.001), as well as heavy smoking (p=0.001) and heavy drinking habits (p<0.001). No significant association was observed between IPMN and selected SNPs. The results were confirmed also when stratified according to any 1st-degree family history of cancer. Patients with IPMN do not have a higher prevalence of SNPs in the human chromosomal region 8q24 in respect to the control population.

  19. An increased total resected lymph node count benefits survival following pancreas invasive intraductal papillary mucinous neoplasms resection: an analysis using the surveillance, epidemiology, and end result registry database.

    Directory of Open Access Journals (Sweden)

    Wenming Wu

    Full Text Available BACKGROUND: The therapeutic effect of lymph node dissection for pancreas invasive intraductal papillary mucinous neoplasms (IPMN remains unclear. The study investigated whether cancer-specific survival (CSS and overall survival (OS rates among invasive IPMN patients improve when more lymph nodes are harvested during surgery. STUDY DESIGN: The study cohort was retrieved from the Surveillance, Epidemiology, and End Results (SEER database. The lymph node count was categorized into quartiles. The relationship between lymph node count and survival was analyzed using Kaplan-Meier curves and a Cox proportional-hazards model. The stage migration was assessed by Chi-square tests. Propensity score matching (PSM was used to minimize confounding variables between groups. RESULTS: In total, 1,080 patients with resected invasive IPMNs from 1992 to 2011 were included. Univariate and multivariate Cox models indicated that an increased lymph node count independently improves survival. The Kaplan-Meier and log-rank tests identified 16 nodes as an optimal cut-off value that yielded a significant survival benefit for all invasive IPMN patients. The stage migration effect existed in this cohort. After PSM, the 5-year CSS increased from 36% to 47%, and the median survival rate increased from 30 months to 40 months by increasing the lymph node count to over 16, alone. The 5-year OS rate also provided additional support for this result. CONCLUSION: Increased lymph node counts were associated with improved survival in invasive IPMN patients. One cut-off value of lymph node count was 16 for this improvement.

  20. Endoscopic ultrasound-guided fine-needle aspiration plus KRAS and GNAS mutation in malignant intraductal papillary mucinous neoplasm of the pancreas

    Science.gov (United States)

    Bournet, Barbara; Vignolle-Vidoni, Alix; Grand, David; Roques, Céline; Breibach, Florence; Cros, Jérome; Muscari, Fabrice; Carrère, Nicolas; Selves, Janick; Cordelier, Pierre; Buscail, Louis

    2016-01-01

    Background: KRAS and GNAS mutations are common in intraductal papillary mucinous neoplasia of the pancreas (IPMN). The aims of this study were to assess the role of pre-therapeutic cytopathology combined with KRAS and GNAS mutation assays within cystic fluid sampled by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) to predict malignancy of IPMN. Patients and methods: We prospectively included 37 IPMN patients with clinical and/or imaging predictors of malignancy (men: 24; mean age: 69.5 years). Cytopathology (performed on cystic fluid and/or IPMN nodules), KRAS (Exon 2, codon 12) and GNAS (Exon 8, codon 201) mutations assays (using TaqMan® allelic discrimination) were performed on EUS-FNA material. The final diagnosis was obtained from IPMN resections (n = 18); surgical biopsies, EUS-FNA analyses, and follow-up (n = 19): 10 and 27 IPMN were benign and malignant, respectively. Results: Sensitivity, specificity, positive and negative predictive values, and accuracy of cytopathology alone to diagnose IPMN malignancy were 55 %, 100 %, 100 %, 45 %, and 66 %, respectively. When KRAS-mutation analysis was combined with cytopathology these values were 92 %, 50 %, 83 %, 71 %, and 81 %, respectively. GNAS assays did not improve the performances of cytopathology alone or those of cytopathology plus a KRAS assay. Conclusions: In patients with a likelihood of malignant IPMN at pre-therapeutic investigation, testing for KRAS mutations in cystic fluid sampling by EUS-FNA improved the results of cytopathology for the diagnosis of malignancy whereas GNAS mutation assay did not. PMID:27995180

  1. A genome-wide investigation of microRNA expression identifies biologically-meaningful microRNAs that distinguish between high-risk and low-risk intraductal papillary mucinous neoplasms of the pancreas.

    Directory of Open Access Journals (Sweden)

    Jennifer Permuth-Wey

    Full Text Available Intraductal papillary mucinous neoplasms (IPMNs are pancreatic ductal adenocarcinoma (PDAC precursors. Differentiating between high-risk IPMNs that warrant surgical resection and low-risk IPMNs that can be monitored is a significant clinical problem, and we sought to discover a panel of mi(croRNAs that accurately classify IPMN risk status.In a discovery phase, genome-wide miRNA expression profiling was performed on 28 surgically-resected, pathologically-confirmed IPMNs (19 high-risk, 9 low-risk using Taqman MicroRNA Arrays. A validation phase was performed in 21 independent IPMNs (13 high-risk, 8 low-risk. We also explored associations between miRNA expression level and various clinical and pathological factors and examined genes and pathways regulated by the identified miRNAs by integrating data from bioinformatic analyses and microarray analysis of miRNA gene targets. Six miRNAs (miR-100, miR-99b, miR-99a, miR-342-3p, miR-126, miR-130a were down-regulated in high-risk versus low-risk IPMNs and distinguished between groups (P<10-3, area underneath the curve (AUC = 87%. The same trend was observed in the validation phase (AUC = 74%. Low miR-99b expression was associated with main pancreatic duct involvement (P = 0.021, and serum albumin levels were positively correlated with miR-99a (r = 0.52, P = 0.004 and miR-100 expression (r = 0.49, P = 0.008. Literature, validated miRNA:target gene interactions, and pathway enrichment analysis supported the candidate miRNAs as tumor suppressors and regulators of PDAC development. Microarray analysis revealed that oncogenic targets of miR-130a (ATG2B, MEOX2, miR-342-3p (DNMT1, and miR-126 (IRS-1 were up-regulated in high- versus low-risk IPMNs (P<0.10.This pilot study highlights miRNAs that may aid in preoperative risk stratification of IPMNs and provides novel insights into miRNA-mediated progression to pancreatic malignancy. The miRNAs identified here and in other recent investigations warrant evaluation

  2. Imaging diagnosis progress of intraductal papillary mucinous neoplasm of pancreas%胰腺导管内乳头状黏液瘤的影像学诊断进展

    Institute of Scientific and Technical Information of China (English)

    周英文; 征锦

    2015-01-01

    With the continuous improvement of medical imaging technology , intraductal papillary mucinous neoplasm ( IPMN) of pancreas is being known by people .As IPMN of pancreas is a rare tumor which has malignant potential ,so early diagnosis and treatment are significantly important for patients .In order to improve the diagnosis and understand more about this disease ,we will talk about IPMN from different imaging methods.The sensitivity of endoscopic ultrasonography (EUS)is better,which can find the lesions safely and performe needle biopsy .CT and MRI can find the cystic lesions with separation in pancreas .Magnetic resonance cholangiopancreatography ( MRCP ) can show the communication between lesions and pancreatic duct system .Diffusion weighted imaging of MR can determine the branchedness dysplasia IPMN .PET-CT can be used to diagnose the early and systemic metastases of IPMN .%随着医学影像技术的不断提高,胰腺导管内乳头状黏液瘤( IPMN)也进一步被人们认识,由于导管内乳头状黏液瘤是少见肿瘤且具有潜在恶变的特性,所以早期诊断并早期治疗对患者有重要意义。为提高诊断水平和对该病的认识,我们回顾并分析了该病最新的影像诊断进展。超声内镜对该病的敏感度较强,能安全地够检出病变并能穿刺活检;CT及MRI能发现胰腺的具有分隔的囊性病变;磁共振胰胆管造影能无创地显示病变与胰管系统交通的情况;MR的弥散加权成像可以确定分支型发育不良的IPMN;PET-CT多用于该病发生恶变后早期及全身的转移的诊断。

  3. 乳腺导管内乳头状肿瘤187例临床病理及免疫组织化学特征%Clinicopathologic and immunohistochemical study of 187 cases of intraductal papillary neoplasm of breast

    Institute of Scientific and Technical Information of China (English)

    张虹; 熊焰; 张爽; 张莹; 王韫宏; 李挺

    2011-01-01

    目的 探讨乳腺导管内乳头状肿瘤(IDPN)的诊断方法和标准.方法 收集187例IDPN患者的临床和病理资料,结合目前认可的2003年WHO乳腺和女性生殖系统肿瘤病理学和遗传学分类标准、Page等和Tavassoli的诊断标准,对其形态学特点进行分析,并对其中53例行CD10、p63、CK14、CK5/6、CK7、乳珠蛋白-1(MGB1)及p53免疫组织化学EnVision法染色分析.结果 187例IDPN患者中导管内乳头状瘤(IDPMa) 128例,不典型导管内乳头状瘤(A-IDPMa) 16例,导管内乳头状癌(IDPCa) 43例.IDPN在形态学上表现为不同程度的上皮细胞和间质增生,以及继发病变等,这些使病灶呈现异常复杂的多样性.免疫组织化学肌上皮标记(CD10和p63)染色在IDPMa、A-IDPMa及IDPCa的表达依次减少,组间比较差异均有统计学意义(均P<0.001).基底型角蛋白(CK5/6和CK14)染色显示良性病变的表达呈镶嵌状阳性表达,在A-IDPMa的不典型区和IDPCa中表达明显减少或缺如,两者相比差异有统计学意义(P<0.001).腺腔上皮标志物CK7染色各组间比较差异无统计学意义(P=0.06).MGB1在IDPCa组染色明显减少(P值分别为0.002和0.007),p53染色各组均呈阴性.结论 IDPN是一组组织学改变复杂的疾病,应注意其诊断标准的掌握.肌上皮、基底型角蛋白和腺腔上皮标志物联合应用在该组复杂病变中有很好的诊断和鉴别诊断价值.%Objective To evaluate the diagnostic approach and criteria for intraductal papillary neoplasms of breast.Methods According to the criteria of 2003 WHO classification,187 cases of intraductal papillary neoplasm of breast were identified and enrolled into the study.The clinical and histologic features were reviewed and immunohistochemical study for CD10,p63,CK14,CK5/6,CK7,MGB1 and p53 were carried out on 53 cases.Results Amongst the 187 cases studied,there were 128 cases of intraductal papilloma,16 cases of atypical intraductal papilloma and 43 cases of

  4. 乳管镜用于乳腺导管内乳头状瘤的临床诊治研究%Application of Duct Endoscopy in Diagnosis and Therapy of Intraductal Papilloma

    Institute of Scientific and Technical Information of China (English)

    吴涛; 李怡; 何显力; 乔庆; 李金茂; 赵华栋

    2012-01-01

    目的:评价纤维乳管镜对乳管内乳头状瘤类疾病的诊断及治疗作用.方法:选取我科2009年8月-2011年8月经乳管镜诊断为导管内乳头状瘤患者144例,其中血性溢液78例,褐色溢液51例,深黄色溢液15例.回顾性分析其术前诊断及治疗过程.结果:所有病例在乳管镜下可见导管内肿物,并经镜下定位行病变腺叶切除,术后病理132例诊断为乳管内乳头状瘤,7例诊断为原位癌,3例为早期浸润性癌.结论:纤维光导乳管镜可准确诊断乳管内乳头状瘤,并进行定位切除.对此类疾病的诊治有重要应用价值.%Objective:To evaluate the application of duct endoscopy for diagnosis and therapy of intraductal papilloma. Methods; To Retrospectively analyze the data of 144 consecutive cases who had duct endoscopy for nipple discharge. Of 144 cases,the discharge was 78 bloodstained in 78 ,51 brown and 15 yellow in colour. Results: Intraductal goiter were detected by ductoscopy in all patients. Lesions were positioned by ductoscopy and excised with the Lo-bus glandularis. 132 cases were diagnosed as intraductal papilloma by pothology after operation, 7 intraductal carcinoma in situ and 3 breast cancer. Conclusion: Duct endoscopy is an only technique to diagnose intraductal papilloma accurately, and also to position and excise the lesions.

  5. A GNAS mutation found in pancreatic intraductal papillary mucinous neoplasms induces drastic alterations of gene expression profiles with upregulation of mucin genes.

    Directory of Open Access Journals (Sweden)

    Hirotake Komatsu

    Full Text Available GNAS, a gene encoding G protein stimulating α subunit, is frequently mutated in intraductal papillary mucinous neoplasms (IPMNs, which are indolent and slow-growing pancreatic tumors that secrete abundant mucin. The GNAS mutation is not observed in conventional ductal adenocarcinomas of the pancreas. To determine the functional significance of the GNAS mutation in pancreatic ductal lineage cells, we examined in vitro phenotypes of cells of pancreatic ductal lineage, HPDE, PK-8, PCI-35, and MIA PaCa-2, with exogenous expression of either wild-type or mutated (R201H GNAS. We found that exogenous GNAS upregulated intracellular cyclic adenine monophosphate (cAMP, particularly in mutated GNAS transfectants, and upregulated expression of MUC2 and MUC5AC in HPDE and PK-8 cells. By contrast, exogenous GNAS inhibited expression of mucin genes in PCI-35 and MIA PaCa-2 cells, despite upregulation of cAMP. We examined global gene expression profiles of some of the cells transfected with exogenous mutated GNAS (PK-8, PCI-35, and MIA PaCa-2, and found that PK-8 cells exhibited drastic alterations of the gene expression profile, which contrasted with modest alterations in PCI-35 and MIA PaCa-2 cells. To identify a cause of these different effects of exogenous mutated GNAS on phenotypes of the cells, we examined effects of interactions of the signaling pathways of G protein-coupled receptor (GPCR, mitogen-activated protein kinase (MAPK, and phosphatidylinositol 3-kinase (PI3K on expression of mucin genes. The MAPK and PI3K pathways significantly influenced the expression of mucin genes. Exogenous GNAS did not promote cell growth but suppressed it in some of the cells. In conclusion, mutated GNAS found in IPMNs may extensively alter gene expression profiles, including expression of mucin genes, through the interaction with MAPK and PI3K pathways in pancreatic ductal cells; these changes may determine the characteristic phenotype of IPMN. PK-8 cells expressing

  6. Endoscopic papillary large balloon dilation for the management of recurrent difficult bile duct stones after previous endoscopic sphincterotomy.

    Science.gov (United States)

    Yoon, Hyung Geun; Moon, Jong Ho; Choi, Hyun Jong; Kim, Dong Choon; Kang, Myung Soo; Lee, Tae Hoon; Cha, Sang-Woo; Cho, Young Deok; Park, Sang-Heum; Kim, Sun-Joo

    2014-03-01

    Endoscopic management of recurrent bile duct stones after endoscopic sphincterotomy (EST) is effective and safe. However, repeat EST for extension of a previous EST for recurrent bile duct stones may involve substantial risk. The aim of the present study was to evaluate the safety and efficacy of endoscopic papillary large balloon dilation (EPLBD) without repeat EST for recurrent difficult bile duct stones after previous EST. From January 2006 to October 2010, a total of 52 patients were enrolled; all had undergone EPLBD (balloon diameter: 12-20 mm) to remove recurrent difficult bile duct stones after previous EST. In all patients, stone removal had failed with conventional methods using a basket and/or balloon. The size of the balloon for EPLBD was selected to fit the diameter of the common bile duct or the largest stone. The median interval between initial EST and stone recurrence was 2.2 years (range 1-10). Median diameters of thelargest stone and balloon were 20.1 mm (range 12-40) and 14.7 mm (range 12-20), respectively. Complete stone removal was achieved in all patients (100%). The median number of endoscopic retrograde cholangiopancreatography sessions needed for complete stone removal was 1.6 (range 1-3). Additional lithotripsy was required in 16 patients (30.7%). No procedure-related complications were documented, with the exception of four cases of asymptomatic hyperamylasemia. The recurrence rate of CBD stones after bile duct clearance was 17.3% (9/52) during the follow-up period (mean 27.0 ± 14.1 months). EPLBD without repeat EST is effective and relatively safe for the extraction of recurrent difficult bile duct stones after previous EST. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

  7. Individualized surgical treatment and prognosis of intraductal papillary mucinous neoplasms of the pancreas%胰腺导管内乳头状黏液性肿瘤的外科治疗及预后分析

    Institute of Scientific and Technical Information of China (English)

    田孝东; 吴广东; 庄岩; 郭晓超; 杨尹默

    2013-01-01

    目的 探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的临床病理特征及预后.方法 回顾性研究2007年1月至2011年12月收治的56例胰腺IPMN患者的临床资料,分析不同类型IPMN的个体化治疗效果及预后.男性38例,女性18例,平均年龄(61±7)岁.其中主胰管型26例,分支胰管型18例,混合型12例.对累及主胰管或有临床症状的48例患者行手术治疗,包括胰十二指肠切除术29例,胰体尾切除术17例,全胰切除术2例.8例病灶最大径<3 cm且无任何临床表现的分支胰管型患者未行手术治疗,予定期观察.结果 术后总并发症发生率为27.1%(13/48),无围手术期死亡病例.术后病理证实非浸润性肿瘤31例;浸润性癌17例,其中淋巴结阳性7例.主胰管型、混合型和分支胰管型病例中浸润癌分别占46.2%(12/26)、3/12和2/18,组间比较差异有统计学意义(x2 =6.385,P =0.041).非浸润性肿瘤与浸润性癌患者术后5年生存率分别为100%和24.6%;淋巴结阳性患者术后生存期低于淋巴结阴性的浸润性癌患者(P =0.017).8例未行手术治疗患者随访期间病灶无明显变化.结论 IPMN恶性程度较低,进展缓慢,预后较好.累及主胰管的IPMN患者浸润性癌的比例较高,应积极手术治疗.最大径<3 cm的无症状分支胰管型患者可密切随访.%Objective To investigate the clinical manifestation,individualized surgical treatment,and prognosis of intraductal papillary mucinous neoplasms (IPMN) of pancreas.Methods The clinical data of 56 IPMN cases treated between January 2007 and December 2011 was retrospectively analyzed.Among the 56 patients (38 male and 18 female,mean age (61 ± 7) years),26 were main-duct type,18 were branch-duct type,12 were mixed type.Pancreatectomy was performed on 48 cases,including pancreaticoduodenectomy on 29 patients,distal pancreatectomy on 17 patients,and total pancreatectomy on 2 patients.Results The overall postoperative morbidity rate was 27

  8. Invasive carcinoma derived from branch duct-type IPMN may be a more aggressive neoplasm than that derived from main duct-type IPMN

    OpenAIRE

    OKABAYASHI, TAKEHIRO; Shima, Yasuo; KOSAKI, TAKUHIRO; SUMIYOSHI, TATSUAKI; KOZUKI, AKIHITO; IIYAMA, TASTUO; Takezaki, Yuka; Kobayashi, Michiya; Nishimori, Isao; Ogawa, Yasuhiro; Hanazaki, Kazuhiro

    2013-01-01

    The present study aimed to evaluate the long-term follow-up results of patients with intraductal papillary mucinous neoplasm (IPMN) and to estimate the degree of IPMN malignancy based on pathological and molecular features of resected specimens. The detection rate of IPMN has increased over the last decade; however, the management of this neoplasm remains controversial. This is particularly so for branch duct-type IPMN, which carries a high potential for malignancy and risk of recurrence. We ...

  9. Differentiating Branch Duct and Mixed IPMN in Endoscopically Collected Pancreatic Cyst Fluid via Cytokine Analysis

    OpenAIRE

    Lee, Linda S; Bellizzi, Andrew M.; Banks, Peter A.; Sainani, Nisha I.; Vivek Kadiyala; Shadeah Suleiman; Darwin L Conwell; Paulo, Joao A.

    2012-01-01

    Background. Differentiating branch duct from mixed intraductal papillary mucinous neoplasm (BD-IPMN) is problematic, but clinically important as mixed IPMNs are managed surgically, while some BD-IPMN may be followed. Inflammatory mediator proteins (IMPs) have been implicated in acute and chronic inflammatory and malignant pancreatic diseases. Aim. To compare IMP profile of pancreatic cyst fluid collected endoscopically from BD-IPMN and mixed IPMN. Methods. Pancreatic cyst fluid from ten patie...

  10. 胰管内乳头状黏液性肿瘤361例的临床特征%Intraductal papillary mucinous neoplasm of the pancreas: clinical characteristics and treatment outcomes of 361 patients

    Institute of Scientific and Technical Information of China (English)

    王雷; 邵成浩; 郑建明; 王莉; 李兆申; 夏天; 廖专; 邹多武; 金震东; 杜奕奇; 湛先保; 胡先贵; 金钢

    2012-01-01

    Objective To analyse the clinical characterization of intraductal papillary mucinous neoplasm of pancreas (IPMNs) and to improve the understanding of IPMNs.Methods Three hundred and sixty-one patients with IPMN at Shanghai Changhai Hospital between 1993 and 2012 were retrospectively analyzed.Results Among 361 cases of IPMNs,241 were men and 120 were female,with a female to male ratio of 2.6∶1.Mean age of the patients was 62 years old (16 ~ 87 years old).The duct type included the main duct in 102 patients (28.3%),a branch duct in 109 (30.2%),and mixed ducts in 150 (41.6%).The most common symptom at presentation is pancreatitis,which occur in 167 patients (46.3%).The sensitivity for the detection of IPMN was 80.2% by ERCP,76.9% by MRCP,63.9% by CT,and 50.5% by EUS.One hundred and twenty-nine patients (35.7%) were operated and diagnosed with 87 (67.2%) IPMA,21 (16.4%) IPMB,10(8.2%) IPMC(CIS) and 10 (8.2%) had invasive carcinomas.The 5-year survival rates of IPMA,IPMB,IPMC,and invasive carcinomas were 100%,100%,66.5%,and 44.7%,respectively.Conclusions IPMNs were fregrently occured is 60 years old,half of patients had acute pancreatitis history and the frequtly attack,mixed type is most anatomy type,and the outcome after surgery is good.%目的 分析胰管内乳头状黏液性肿瘤(IPMN)的临床特征,以提高对该病的认识.方法 采用单中心回顾性研究方法,分析长海医院1993年1月至2012年8月间收治的361例IPMN的临床资料,分析其临床特征.结果 361例IPMN中,男性261例,女性100例,男女比例为2.6∶1,平均年龄61岁(16 ~87岁).其中主胰管型102例(28.3%),分支胰管型109例(30.2%),混合型150例(41.6%).患者的症状主要为急性胰腺炎发作,共167例(46.3%).内镜下胰胆管造影术(ERCP)的诊断符合率最高,为80.2%(130/162),MRCP、CT、内镜超声(EUS)的检查阳性率分别为76.9%(160/208)、63.9%(159/249)、50.5%(53/105).手术治疗129

  11. Clinical significance of main pancreatic duct dilation on computed tomography: Single and double duct dilation

    Institute of Scientific and Technical Information of China (English)

    Mark D Edge; Maarouf Hoteit; Amil P Patel; Xiaoping Wang; Deborah A Baumgarten; Qiang Cai

    2007-01-01

    AIM: To study the patients with main pancreatic duct dilation on computed tomography (CT) and thereby to provide the predictive criteria to identify patients at high risk of significant diseases, such as pancreatic cancer, and to avoid unnecessary work up for patients at low risk of such diseases.METHODS: Patients with dilation of the main pancreatic duct on CT at Emory University Hospital in 2002 were identified by computer search. Clinical course and ultimate diagnosis were obtained in all the identified patients by abstraction of their computer database records.RESULTS: Seventy-seven patients were identified in this study. Chronic pancreatitis and pancreatic cancer were the most common causes of the main pancreatic duct dilation on CT. Although the majority of patients with isolated dilation of the main pancreatic duct (single duct dilation) had chronic pancreatitis, one-third of patients with single duct dilation but without chronic pancreatitis had pancreatic malignancies, whereas most of patients with concomitant biliary duct dilation (double duct dilation) had pancreatic cancer.CONCLUSION: Patients with pancreatic double duct dilation need extensive work up and careful follow up since a majority of these patients are ultimately diagnosed with pancreatic cancer. Patients with single duct dilation, especially such patients without any evidence of chronic pancreatitis, also need careful follow-up since the possibility of pancreatic malignancy, including adenocarcinoma and intraductal papillary mucinous tumors, is still high.

  12. Intraductal papillary mucinous neoplasm of pancreas:analysis of the clinicopathologic features and prognosis%胰腺导管内乳头状黏液性肿瘤的临床病理学及预后分析

    Institute of Scientific and Technical Information of China (English)

    常晓燕; 李霁; 姜英; 李媛; 卢朝辉; 陈杰

    2016-01-01

    and immunohistochemical features, and the prognosis of intraductal papillary mucinous neoplasms ( IPMN ) of the pancreas.Methods The clinical findings, morphologic features, immunophenotype and prognosis were investigated in 61 cases of IPMN.Results Of these 61 cases, 33 were in the pancreatic head and 14 were in the body and tail, and 14 in the entire pancreas.The average patients′age was 61.8 years.The initial symptom was abdominal pain in 37 cases, and the tumors were detected at routine checkup in 14 cases.The imaging examination showed dilated ducts and/or cystic and solid masses.Grossly, 32 cases were multi-loculated cystic masses containing mucin and papillary areas;13 cases were solid.Microscopically, the IPMN showed four patterns, including gastric-type ( 16 cases ) , intestinal-type ( 21 cases ) , pancreatobiliary-type ( 21 cases ) and eosinophilic-type (3 cases).The IPMN cohort included 13, 13 and 6 IPMN with low, intermediate and high-grade dysplasia respectively, and 29 IPMN associated with invasive carcinoma.The IPMN associated carcinomas were mainly ductal adenocarcinoma ( 23/29, 79.3%), followed by colloid carcinoma ( 4/29, 13.8%) and undifferentiated carcinoma (2/29,6.9%).Immunohistochemically, IPMN expressed MUC5AC (51/57, 89.4%), MUC2 (21/57,36.8%), and MUC1 (13/46,28.3%).The mean postoperative follow-up period was 32 months ( range 12-112 months).Six of 61 patients were lost to follow-up.Overall 5-year survival rate was 76%.The 5-year survival rate of IPMN with low, intermediate or high-grade dysplasia was 100%, and recurrence was local in 3 patients.The 3-year survival rate of IPMN associated with invasive carcinoma was 55%.12 of 13 patients died within 2 years after operation.Conclusions IPMN is a common cystic neoplasm of the pancreas located in the ducts.The pathologic types and classifications are clearly defined.MUC stains are helpful for the diagnosis and papillary typing.IPMN with invasive carcinoma was associated with significantly

  13. Clinical analysis of intraductal papillary mucinous neoplasm of pancreas in 27 cases%胰腺导管内乳头状黏液性肿瘤27例诊治分析

    Institute of Scientific and Technical Information of China (English)

    陆君阳; 张太平; 赵玉沛

    2011-01-01

    目的总结胰腺导管内乳头状黏液性肿瘤(IPMN)的诊治经验,寻找术前预测浸润性IPMN的指标.方法将2003年9月-2010年7月手术治疗的27例胰腺IPMN病例分为浸润性与非浸润性IPMN两组,分析比较两组间术前资料的差异.结果浸润性IPMN 15例,非浸润性IPMN12例.两组间术前梗阻性黄疸发病率、肿瘤最大直径、血清总胆红素值有显著差异.两组间性别比例、发病年龄、是否有腹痛或腰背部疼痛、腹泻、体重减轻、新发糖尿病、血清CEA、CA19-9值差异均无统计学意义.结论血清总胆红素≥22.2μmol/L及肿瘤最大直径≥3 cm可能成为预测浸润性IPMN的指标.%Objective To summarize the experience in diagnosis and treatment of intraductal papillary mucinous neoplasm(IPMN) of the pancreas and identify potential preoperative factors predicting invasiveness of intraductal papillary mucinous neoplasm of the pancreas. Methods From September 2003 to July 2010,27 patients underwent pancreatic resection for IPMN. All cases were divided into invasive and noninvasive groups. Preoperative medical records were reviewed retrospectively between the two groups. Results Pathological results revealed 15 cases of invasive IPMN and 12 noninvasive cases. The incidence of obstructive jaundice, tumor size and serum total bilirubin values were significantly different between the two groups. The other factors including sex ratio, age, incidence of abdominal pain or back pain, diarrhea, weight loss, new onset diabetes, serum CEA, CA19-9 values showed no statistical difference. Conclusion Serum total bilirubin≥22.2μmol/L and tumor size≥3 cm could be predicting factors of invasive IPMN.

  14. Prognosis of cancer with branch duct type IPMN of the pancreas

    Institute of Scientific and Technical Information of China (English)

    Nobuhito; Ikeuchi; Takao; Itoi; Atsushi; Sofuni; Fumihide; Itokawa; Takayoshi; Tsuchiya; Toshio; Kurihara; Kentaro; Ishii; Shujiro; Tsuji; Junko; Umeda; Fuminori; Moriyasu; Akihiko; Tsuchida; Kazuhiko; Kasuya

    2010-01-01

    AIM:To examine the coexistence of metachronous and synchronous cancer in branch duct intraductal papillary mucinous neoplasms of the pancreas (IPMN).METHODS: We reviewed the records of 145 patients with branch duct IPMN between January 1991 and April 2008 and assessed the relationship between IPMN and intraor extra-pancreatic carcinoma and the outcome of IPMN.RESULTS: The mean observation period was 55.9 ± 45.3 mo. Among the 145 patients, the frequency of extra-pancreatic cancer was 29.0%. The frequency of ...

  15. Intraductal biliopancreatic imaging: European Society of Gastrointestinal Endoscopy (ESGE) technology review.

    Science.gov (United States)

    Tringali, Andrea; Lemmers, Arnaud; Meves, Volker; Terheggen, Grischa; Pohl, Jürgen; Manfredi, Guido; Häfner, Michael; Costamagna, Guido; Devière, Jacques; Neuhaus, Horst; Caillol, Fabrice; Giovannini, Marc; Hassan, Cesare; Dumonceau, Jean-Marc

    2015-08-01

    This technology review expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) on the available techniques for intraductal biliopancreatic imaging. The three cholangioscopy techniques are described: the "dual-operator" and " single-operator" mother-baby approaches using dedicated instruments, and the "direct" technique using currently available ultrathin gastroscopes. The mother-baby method is standardized and reproducible, while direct cholangioscopy is technically demanding and its safety requires further evaluation. As well as direct visualization of the bile ducts, cholangioscopy has the further advantage of allowing targeted biopsy. Image quality is still suboptimal for single-operator cholangioscopy, while the other techniques have achieved adequately detailed imaging. The costs of mother-baby cholangioscopy are high and its application in clinical practice should be restricted to selected cases (i.e. indeterminate biliary strictures/intraluminal lesions, difficult biliary stones) and to the setting of tertiary care centers. Peroral pancreatoscopy may find an indication in situations where other imaging modalities (mainly EUS) are inconclusive (i.e. delineation of main duct intraductal papillary mucinous neoplasia extension, sampling of indeterminate main pancreatic duct strictures). Intraductal ultrasonography (IDUS) has a poorer performance than EUS in the staging of pancreatic malignancies and can increase the risk of pancreatitis. A promising indication for IDUS could be the evaluation of indeterminate biliary strictures and ampullary tumors. Probe-based confocal laser endomicroscopy (pCLE) of the bile ducts is a difficult and expensive technique. Appropriate training needs to be established, since interpretation of images is challenging. pCLE can be an important diagnostic tool in the setting of indeterminate biliary strictures.

  16. The value of diagnosis of intraductal papillary mucinous neoplasm of the pancreas by using MRI and MRCP%磁共振成像和磁共振胰胆管造影对胰腺导管内乳头状黏液性肿瘤的诊断价值

    Institute of Scientific and Technical Information of China (English)

    邓利猛; 廖伟华; 郑兴友; 刘慧

    2016-01-01

    Objective To investigate the diagnostic value of routine magnetic resonance imaging and MRCP for intraductal papillary mucinous tumor of pancreas (IPMNs). Methods Retrospectively analyzed the clinical data of 9 patients with IPMNs proved by surgery and pathology including routing magnetic resonance imaging and MRCP. Re-sults The study demonstrated that there were 3 cases of main duct type, MRI showed that the major performance were diffuse expansion of main pancreatic duct or segmental expansion, presented long T 1 low-signal,and long T2 high-signals,with or without intramural nodule which had mild or moderate enhancement. Four cases were branch duct type, located in uncinate process and head of pancreas. MRI showed multiple or single cystic lesion of clusters, pre-sented long T1 low-signal, and long T2 high-signals with short T2 low-signal septation. Two cases of mixed type, both the main pancreatic ducts and branch ducts have different levels of dilation. MRCP demonstrated clearly that the main pancreatic duct communicate with cystic tumor. Conclusion It may be effective to combine routine magnetic reso-nance imaging and MRCP in the diagnosis of IPMNs.%目的:探讨胰腺导管内乳头状黏液性肿瘤(IPMNs)的常规磁共振成像(MRI)和磁共振胰胆管造影(MRCP)表现。方法回顾性分析9例经手术病理证实的IPMNs患者的常规MRI和MRCP表现。结果主胰管型3例,表现为主胰管弥漫性或节段性扩张,呈长T1低信号长T2高信号,伴或不伴附壁结节,附壁结节呈轻中度强化;分支胰管型4例,病灶均位于胰头钩突处,表现为单发囊性病变或葡萄状多发囊性病变,呈长T1低信号长T2高信号,伴腔内分隔,分隔为短T2信号;混合型2例,表现主胰管和分支胰管均有不同程度扩张。 MRCP均可清晰显示扩张的管道及其交通。结论常规MRI联合MRCP对诊断胰腺IPMNs具有较高临床价值。

  17. Effects Comparison between Endoscopic Papillary Large Balloon Dilatation and Endoscopic Sphincterotomy for Common Bile Duct Stone Removal

    Directory of Open Access Journals (Sweden)

    Yandong Guo

    2015-01-01

    Full Text Available Endoscopic sphincterotomy (EST is a treatment of choice for stone extraction and is now most frequently used. The study was to compare the efficacy of endoscopic papillary large balloon dilatation (EPLBD and endoscopic sphincterotomy (EST for common bile duct stone removal. Trials comparing the effects between EPLBD and EST treatment were searched according to the study protocol. Overall stone removal rate, complete removal rate in 1st session, treatment duration, mechanical lithotripsy using rate, and overall complication rate were compared using risk ratio (RR and mean difference (MD and their 95% confidence interval (CI via RevMan 5.2 software. For overall stone removal rate, two therapies showed similar effect, but EPLBD showed better overall stone removal rate for stone >10 mm in diameter. For complete stone removal rate in 1st session, no difference was found, even for those with stone >10 mm in diameter; EPLBD showed longer treatment duration, higher mechanical lithotripsy using rate obvious overall complications rate, and more serious bleeding, whereas there were no significant differences for perforation, hyperamylasemia, pancreatitis, and cholecystitis/cholangitis. EPLBD showed better efficacy in certain conditions compared to EST, however with shortcomings, such as more duration, higher mechanical lithotripsy using rate, more serious overall complications rate, and bleeding.

  18. Immunohistochemical analysis of steroidogenic enzymes in ovarian-type stroma of pancreatic mucinous cystic neoplasms: Comparative study of subepithelial stromal cells in intraductal papillary mucinous neoplasms of the pancreas.

    Science.gov (United States)

    Ishida, Kazuyuki; Sasano, Hironobu; Moriya, Takuya; Takahashi, Yayoi; Sugimoto, Ryo; Mue, Yoshiharu; Murakami, Keigo; Fujishima, Fumiyoshi; Nakamura, Yasuhiro; Morikawa, Takanori; Motoi, Fuyuhiko; Suzuki, Takashi; Unno, Michiaki; Sugai, Tamotsu

    2016-05-01

    Mucinous cystic neoplasms (MCNs) are generally defined as cyst-forming epithelial neoplasms that arise in the pancreas and harbor characteristic ovarian-type stroma beneath the epithelium. In this study, we compared the immunoreactivity of steroid-related factors in these subepithelial stromal cells in MCNs to those in intraductal papillary mucinous neoplasms (IPMNs) to further characterize this unique MCN ovarian-type stroma through evaluation of sex steroid biosynthesis. Twenty MCNs and twenty IPMNs were examined. Immunoreactivity of steroid hormone receptors, including estrogen receptor (ERα and ERβ), progesterone receptor (PR, PR-A, and PR-B), and androgen receptor (AR), was more frequently detected in MCN ovarian-type stromal cells than in IPMN stromal cells (P enzymes cytochrome P450 cholesterol side-chain cleavage enzyme (P450scc), cytochrome P450 17 alpha-hydroxylase (P450c17) and 3β-hydroxysteroid dehydrogenase (3β-HSD) showed immunoreactivity in 9/20 (45.0 %), 15/20 (75.0 %) and 13/20 (65.0 %), respectively, of ovarian-type stroma from MCN cases. These results demonstrate that the ovarian-type stroma of MCNs can express steroidogenic enzymes. Thus, the ovarian-type stroma of MCNs can produce sex steroids that may also act on these cells.

  19. Diagnotic and treatment principle of pancreatic intraductal papillary mucinous neoplasm%胰腺导管内乳头状黏液性肿瘤的诊治策略

    Institute of Scientific and Technical Information of China (English)

    楼文晖

    2013-01-01

    胰腺导管内乳头状黏液性肿瘤(intraductal papil-lary mucinous neoplasm,IPMN)分主胰管型、混合型和分支胰管型.主胰管型、混合型和有症状的分支胰管型IPMN建议行手术切除,对恶性IPMN,需行规则性胰腺切除.对良性和交界性IPMN,可行功能保留性胰腺手术.对暂时不行手术切除的IPMN病人,应定期随访.IPMN的治疗决策需综合考虑各方面因素,包括病人的预期寿命、身体状况、治疗意愿、依从性、随访的条件等加以综合评估,最后形成个体化的治疗方案.

  20. Extrahepatic intraductal ectopic hepatocellularcarcinoma:bileductifllingdefect

    Institute of Scientific and Technical Information of China (English)

    Moritz Schmelzle; Wolfram T. Knoefel; Claus F. Eisenberger; Hanno Matthaei; Nadja Lehwald; Andreas Raffel; Roy Y. Tustas; Natalia Pomjanski; Petra Reinecke; Marcus Schmitt; Jan Schulte am Esch

    2009-01-01

    BACKGROUND: Obstructive jaundice caused by an intraductal hepatocellular carcinoma is a rare initial symptom. We report a rare case of an extrahepatic icteric type hepatocellular carcinoma. METHODS: A 75-year-old patient was admitted to our hospital because of obstructive jaundice 3 months after resection of multilocular hepatocellular carcinoma. A postoperative bile leakage was treated by placement of a decompressing stent in the common bile duct. Endoscopic retrograde choledochoscopy showed extended blood clots iflling the bile duct system and computed tomography revealed a local swelling in the common extrahepatic bile duct. The level of alpha-fetoprotein (AFP) was only slightly elevated but that of CA19-9 was dramatically increased. Cholangiography showed an intraductal iflling defect typical of a cholangiocellular carcinoma. RESULTS: Bile duct brushing cytology showed no cholangiocellular carcinoma but hepatocellular carcinoma cells in the extrahepatic bile duct. An extrahepatic bile duct resection was performed. Histological examination conifrmed the diagnosis of extrahepatic intraductal growth of hepatocellular carcinoma. CONCLUSION: Ectopic hepatocellular carcinoma is a rare but important differentially diagnosed of extrahepatic bile duct iflling defect.

  1. 非良性胰腺导管内乳头状黏液瘤计算机断层摄影特征%Imaging Features of Computed Tomography of Non-benign Intraductal Papillary Mucinous Neoplasm of Pancreas

    Institute of Scientific and Technical Information of China (English)

    朱亮; 常晓燕; 孙昊; 王萱; 陈钰; 何泳蓝; 薛华丹; 金征宇

    2011-01-01

    目的 探讨非良性胰腺导管内乳头状黏液瘤(intraductal papillary mucinous neoplasm,IPMN)计算机断层摄影(computed tomography,CT)典型影像学表现,分析IPMN影像与病理表现的一致性.方法 回顾性分析2008年5月至2011年2月本院收治的12例经手术病理证实为交界性胰腺IPMN或胰腺导管内乳头状黏液癌(intraducted papillary mucinous carcinoma,IPMC)患者的术前CT影像(腹平扫+增强+三维重建),并与其术后病理结果进行对照.结果 术后病理证实的12例非良性胰腺IPMN患者中4例为交界性IPMN,2例为非浸润性IPMC,6例为浸润性IPMC.IPMN患者临床表现腹痛无特异性,而体重减轻、黄疸和糖尿病主要见于浸润性IPMC.恶性IPMN的CT分型多为主胰管型(3例)或混合型(4例),分支胰管型较少(1例).IPMN患者常见CT表现包括胰腺内囊性病变形成、胰管扩张、胰腺钙化、实质萎缩等,其中囊内密度增高和壁结节等在交界性病变和恶性病变中均存在,胰管扩张程度与病变恶性程度呈正相关,而壁结节直径与病变恶性程度无明显相关性.恶性病变囊内容物的CT值一般高于交界性病变,且多表现为不均匀高密度.浸润性IPMC患者中50%有周围组织受累,其CT表现和病理结果完全吻合.CT显示胆总管明显增宽的病变仅见于浸润性IPMC患者.结论多排螺旋CT对非良性胰腺IPMN的术前诊断价值较高,与病理结果的相关性较好,对于IPMN病变恶性程度预测及周围组织受累判断的准确度较高,可为临床诊断和手术方式选择提供良好的支持.

  2. 胰腺导管内乳头状黏液性肿瘤的诊断与治疗%Diagnosis and treatment of intraductal papillary mucinous neoplasms in pancreas

    Institute of Scientific and Technical Information of China (English)

    陈泉宁; 彭承宏; 范跃祖; 鲁星燧; 陈春球; 程东峰

    2009-01-01

    目的 探讨胰腺导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasms,IPMN)的诊断和治疗.方法 回顾性分析了28例胰腺导管内乳头状黏液性肿瘤的临床资料.结果 28例IPMN患者主胰管型10例(35.7%),分支胰管型7例(25%),混合型11例(39.3%),7例分支胰管型IPMN均为非浸润性IPMN;术后病理示腺瘤5例,交界性肿瘤12例,原位癌1例,浸润性IPMN 10例.10例浸润性IPMN中有5例伴淋巴结转移,7例伴有神经侵犯,3例微血管侵犯,2例侵犯门静脉.行胰十二指肠切除18例,胰腺局部切除6例,胰体尾切除4例.结论 胰腺导管内乳头状黏液性肿瘤是一种具有独特临床病理特征和预后较好的病变,积极合理的手术治疗可使患者获得良好的预后.

  3. Percutaneous papillary large balloon dilation during percutaneous cholangioscopic lithotripsy for the treatment of large bile-duct stones: a feasibility study.

    Science.gov (United States)

    Han, Jee Young; Jeong, Seok; Lee, Don Haeng

    2015-03-01

    When access to a major duodenal papilla or endoscopic retrograde cholangiopancreatography has failed, percutaneous transhepatic cholangioscopic lithotripsy (PTCS-L) may be useful for removing common bile duct (CBD) stones. However, the feasibility and usefulness of percutaneous transhepatic papillary large-balloon dilation (PPLBD) during PTCS-L for the removal of large CBD stones has not been established. We aimed to determine the safety and efficacy of PPLBD for the treatment of large CBD stones. Eleven patients with large CBD stones in whom the access to the major papilla or bile duct had failed were enrolled prospectively. Papillary dilation was performed using a large (12-20 mm) dilation balloon catheter via the percutaneous transhepatic route. Post-procedure adverse events and efficacy of the stone retrieval were measured. The initial success rate of PPLBD was 100%. No patient required a basket to remove a stone after PPLBD. Electrohydraulic lithotripsy was required in 2 (18.2%) patients. The median time to complete stone removal after PPLBD was 17.8 min and no adverse events occurred after PPLBD. Asymptomatic hyperamylasemia was not encountered in any patients. This study indicates that PPLBD is safe and effective for removal of large CBD stones.

  4. 胰腺导管内乳头状黏液性肿瘤形态学特征与疾病良恶性的相关分析%Correlative characteristics of morphological features of benign/malignancy in pancreatic intraductal papillary mucinous neoplasms: a pooled analysis

    Institute of Scientific and Technical Information of China (English)

    张栋; 陈大志; 樊华; 金中奎; 李先亮; 冯艳; 郎韧

    2013-01-01

    Objective To study the clinical characteristics which are related to malignancy in pancreatic intraductal papillary mucinous neoplasm (IPMN) with an aim to provide evidence for clinical practice.Methods Using PubMed,all pancreatic IPMN related articles with positive pathologic results before July 30th,2011 were studied.A pooled analysis was carried out on the morphological features of the disease.The analysis included gender,diameter of main pancreatic duct,diameter of cystic lesion,mural nodules and histological types (benign/malignant) of the neoplasm.Results 98 articles (including 1902 cases) were collected and analyzed.1025 cases were benign (53.89%) and 877 cases (46.11 %) were malignant.Morphologically,there were a correlation between main pancreatic duct dilatation (≥5 mm),cystic lesion of large size (≥30 mm),presence of mural nodules and malignancy.The OR (95% CI) were 5.591 (3.657-8.548),3.633 (2.626-5.027) and 4.983 (3.872-6.412) respectively.Conclusions A main pancreatic duct dilatation (≥5 mm),cystic lesions of large size (≥30 mm) and presence of mural nodules prompt the tumor to be malignant.In clinical work,the management of pancreatic IPMN should be made prudently based on comprehensive analysis of clinical features and the patient's status and intent.%目的 寻找与胰腺导管内乳头状黏液性肿瘤(IPMN)良恶性相关的形态学特征以供临床实践参考.方法 研究尝试运用汇集分析的方法,通过对PubMed数据库中2011年6月30日以前所发表文献中经病理学证实的胰腺IPMN的形态学特征进行分析.主要分析数据为:性别特征、主胰管直径、囊性病变直径、壁结节情况、肿瘤的病理学类型(良、恶性).结果 共汇集文献98篇,胰腺IPMN病例1902例,其中良性1025例(53.89%),恶性877例(46.11%).胰腺IPMN形态学特征中,主胰管扩张(≥5 mm)、囊性病变尺寸较大(≥30 mm)及壁结节的存在与肿瘤的良恶

  5. A case report of intraductal papilloma in a young female patient with bloody nipple discharge

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jin Young; Youk, Ji Hyun; Ko, Kyung Hee; Heo, Jin Hyung [Bundang CHA Hospital, Pochon CHA University, Seongnam (Korea, Republic of)

    2008-09-15

    Intraductal papillomas are the most common subtype of papillomas, which are benign neoplasms of the breast. An intraductal papillomas is usually found as a solitary mass which originates in the major duct of the breast. Intraductal papilloma cases are frequently presented as nipple discharge and most commonly occur in individuals between the ages of 30 and 55 years. Few reports exist regarding cases of intraductal papillomas in children. We report a case of an intraductal papilloma, with imaging findings, which occurred in the breast of an 11-years old girl and presented as bloody nipple discharge.

  6. 58例胰腺导管内乳头状黏液性肿瘤临床分析%Clinical analysis of 58 cases of pancreatic intraductal papillary mucinous tumors

    Institute of Scientific and Technical Information of China (English)

    么国旺; 白景瑞; 李佳昕; 赵二鹏; 崔乃强

    2016-01-01

    目的 探讨胰腺导管内乳头状黏液性肿瘤(intraductal papillary mucinous neoplasm,IPMN)的诊断和治疗.方法 回顾性分析2004年12月至2014年12月10年间收治58例IPMNs病人的临床资料、病理分型、治疗方式.男性36例,女性22例,男女比例为1.6∶1,年龄39~82岁,中位年龄67岁.58例IPMNs病人均行手术治疗.其中行胰十二指肠切除术31例(53.45%),胰头部局部切除术9例(15.52%),胰体尾切除术7例(12.07%),胰体部局部切除术4例(6.90%),胰尾切除术4例(6.90%),胰尾联合脾切除1例(1.72%),全胰腺切除2例(3.44%).结果 58例IPMNs病人中主胰管型26例;分支胰管型9例;混合型23例;术后病理:腺瘤26例,交界瘤13例,非浸润癌10例,浸润性癌9例;全组的中位生存期为42.6个月;1、2和5年的生存率分别为94.5%、79.3%和65.5%.其中病理类型为浸润性癌的病人1、2、5年生存率分别为62.5%、47.5%、12.5%.结论 IPMN是一种比较罕见的肿瘤,手术治疗是目前比较好的治疗方式.

  7. Intraductal radiofrequency ablation for management of malignant biliary obstruction.

    Science.gov (United States)

    Rustagi, Tarun; Jamidar, Priya A

    2014-11-01

    Self-expandable metal stents (SEMS) are the current standard of care for the palliative management of malignant biliary strictures. Recently, endoscopic ablative techniques with direct affect to local tumor have been developed to improve SEMS patency. Several reports have demonstrated the technical feasibility and safety of intraductal radiofrequency ablation (RFA), by both endoscopic and percutaneous approaches, in palliation of malignant strictures of the bile duct. Intraductal RFA has also been used in the treatment of occlusion of both covered and uncovered SEMS occlusion from tumor ingrowth or overgrowth. This article provides a comprehensive review of intraductal RFA in the management of malignant biliary obstruction.

  8. Status of Intraductal Therapy for Ductal Carcinoma in Situ

    Science.gov (United States)

    Flanagan, Meghan; Love, Susan

    2010-01-01

    The intraductal approach is particularly appealing in the setting of ductal carcinoma in situ (DCIS), a preinvasive breast neoplasm that is thought to be entirely intraductal in its extent. Based on an emerging understanding of the anatomy of the ductal system as well as novel techniques to leverage the access accorded by the intraductal approach, researchers are actively exploring how ductal lavage, ductoscopy, and intraductal infusion of therapeutic agents may enhance breast cancer treatment. Both cytologic and molecular diagnostics continue to improve, and work is ongoing to identify the most effective diagnostic biomarkers for DCIS and cancer, although optimal targeting of the diseased duct remains an important consideration. Ductoscopy holds potential in detection of occult intraductal lesions, and ductoscopically guided lumpectomy could increase the likelihood of a more comprehensive surgical excision. Exciting pilot studies are in progress to determine the safety and feasibility of intraductal chemotherapy infusion. These studies are an important starting point for future investigations of intraductal ablative therapy for DCIS, because as our knowledge and techniques evolve, it is likely that DCIS may be the target most amenable to treatment by intraductal therapy. If such studies are successful, these approaches will allow an important and meaningful transformation in treatment options for women diagnosed with DCIS. PMID:21124756

  9. Endoscopic Papillary Large Balloon Dilatation Without Sphincterotomy for the Treatment of Large Common Bile Duct Stone: Long-Term Outcomes at a Single Center.

    Science.gov (United States)

    Park, Jin-Seok; Jeong, Seok; Bang, Byung Wook; Kang, Ae Ra; Lee, Don Haeng

    2016-10-01

    Endoscopic papillary large balloon dilatation (EPLBD) without endoscopic sphincterotomy (EST) is an accepted, simplified endoscopic technique for large common bile duct (CBD) stone removal. However, little is known about the long-term outcomes of this technique. The purpose of this study was to evaluate the long-term outcomes of EPLBD without EST for the treatment of large CBD stones. This retrospective study of EPLBD without EST for a large CBD stone was conducted between June 2005 and October 2010. A total of 128 patients with a large CBD stone were included. The primary outcome measurement was complete CBD stone removal after EPLBD. Clinical data obtained from medical records were analyzed. The overall complete stone removal rate was 94.5 %. Mechanical lithotripsy was needed in 18 (14.1 %) patients. Post-procedural pancreatitis and asymptomatic hyperamylasemia occurred in 1 (0.8 %) and 11 (8.6 %) patients, respectively. One (0.8 %) patient experienced minor bleeding. The rate of stone recurrence was 13.1 %, and median time to stone recurrence was 600 days (range 144-2284 days). Over a half (64.3 %) of stone recurrences occurred during the 2 years following stone removal. Recurrence tended to be more frequent in patients with a large CBD diameter and in patients requiring multiple endoscopic sessions for complete CBD stone retrieval. EPLBD without EST may be safe and effective in patients with a large bile duct stone.

  10. 胰腺导管内乳头状黏液性肿瘤临床特征汇集分析%A pooled analysis on the clinical characteristics of intraductal papillary mucinous neoplasms of the pancreas

    Institute of Scientific and Technical Information of China (English)

    冯艳; 张栋; 陈大志; 樊华; 潘飞; 李先亮; 李平; 郎韧

    2013-01-01

    Objective To analyze the clinical characterisaics of pancreatic intraductal papillary mucinous neoplasm (IPMN),which may provide references for its clinical diagnosis and treatment.Methods PubMed was used as a searching database to collect all the pancreatic IPMN related articles with positive pathologic results from July,2006 to June,2011.A pooled analysis was then performed.The main analysis included demographic information,main clinical manifestations,most associated concomitant diseases,morphology and pathologic types of neoplasms,and characteristics of anatomical distribution of the lesions.Results 123 articles (including 6548 patients) were collected and analyzed.There was a tendency for the older patients to suffer from pancreatic IPMNs,and males were slightly more than females.In the three types of morphoIogy,the most common was the branchduct type.Pancreatic IPMNs may appear at any part of the pancreas.The pancreatic head was the most common,followed by the pancreatic body-tail and the diffuse distribution.In all the patients,malignancy was up to half.The main clinical manifestations of pancreatic IPMNs were complete lack of specificity.Upper abdominal pain,weight loss and jaundice were common.Conclusions Particular attention should be paid to the recognition and identification of IPMNs of pancreas as the lesion has nonspecific clinical manifestations.Clinically,treatment should be based on a comprehensive analysis of the clinical features combined with the patient's general status and intent.%目的 探索胰腺导管内乳头状黏液性肿瘤(IPMN)的临床特征,为该疾病的临床诊断提供参考依据.方法 以PubMed为检索数据库,对2006年7月1日至2011年6月30日已发表的关于胰腺IPMN文献中经病理学证实的临床病例进行汇集分析,主要内容包括病例的人口统计学信息、主要临床表现、主要相关伴随疾病、肿瘤的形态学类型、解剖学分布特征、病理学类型等.结果

  11. Difference between intraductal papillary mucinous neoplasms and pancreatic ductal adenocarcinoma%胰腺导管内乳头状黏液性肿瘤与胰腺导管腺癌的差异分析

    Institute of Scientific and Technical Information of China (English)

    徐彬; 楼文晖; 王单松; 靳大勇

    2011-01-01

    Objective To identify difference between intraductal papillary mucinous neoplasms (IPMN) and pancreatic common ductal adenocarcinoma. Methods Between March 2003 and June 2006, 29 patients with pathological diagnosis of IPMN and 46 patients with pancreatic adenocarcinoma in Zhongshan Hospital were retrospectively reviewed. Clinical, biochemical, and histopathologic factors were retrospectively analyzed. Prognosis between two groups were compared by log-rank test.Results The proportion with no symptom visit in IPMN was obviously higher than in pancreatic cancer. Twenty-one of 29 specimens were malignant in IPMN. Stage of the malignant IPMN was significantly earlier than that of the pancreatic adenocarcinoma (P=0.017). Intrapancreatic neural invasion was more common in pancreatic adenocarcinoma than in malignant IPMN (P=0.005). The survival curve of the malignant IPMN was significantly better than that of the pancreatic adenocarcinoma (P=0.014). Conclusion IPMN with less aggressive bionomics can be diagnosed and treated in an earlier stage. So its prognosis is better than that of pancreatic ductal adenocarcinoma. Prognosis of malignant IPMN which is more invasive than stage Ⅱ B is simular to that of common pancreatic cancer. However, this conclusion should be further investigated.%目的 探讨胰腺导管内乳头状黏液性肿瘤(IPMN)与胰腺导管腺癌的差异.方法 回顾性收集2003年3月至2006年6月收治的资料完整的29例IPMN病例和46例胰腺导管腺癌的临床、生化、病理和随访资料,利用单因素及生存分析方法探讨两者的差异.结果 IPMN中无症状就诊比例明显高于胰腺导管腺癌(P<0.05).29例IPMN中21例为恶性,其病理分期明显早于胰腺导管腺癌(P=0.017);肿瘤对胰腺内神经的侵犯较胰腺癌少见(P=0.005).IPMN 患者术后的生存时间长于胰腺导管腺癌,而ⅡB期及以上的恶性IPMN患者术后生存时间与胰腺导管腺癌比较无明显差异.结论 IPMN与胰腺

  12. Evaluation of intraductal papillary mucinous neoplasms of the pancreas on MDCT and MRI%胰腺导管内乳头状黏液性肿瘤的影像学表现及其在术前诊断相关性浸润性癌中的应用价值

    Institute of Scientific and Technical Information of China (English)

    王大丽; 周健; 郑双丽; 夏建余; 胡红杰

    2014-01-01

    Objective The purpose of our study was to evaluate the predictive factors of the presence of invasive carcinoma associated with intraductal papillary mucinous neoplasm (IPMN) of the pancreas on MDCT and MRI.Methods Preoperative MDCT or/and MRI of 27 consecutive patients (19 men,8 women,mean age 61.3 years) who had undergone surgical resection and had a pathological diagnosis of IPMN were retrospectively assessed.The type of ductal involvement,solid appearance of the lesion,location,tumor size of branch duct type and combined type lesions,maximum diameter of the tumor,caliber of the main pancreatic duct and the extent of the common bile duct dilatation were assessed on CT and MRI and correlated with the pathological findings of the invasive carcinoma.Two abdominal radiologists reviewed all the images,and when discrepancies of the findings were found,the consensus was reached by discussion.Results Pathological analysis revealed carcinoma in situ in two patients and invasive carcinoma in 19 patients arising from the IPMN.The type of ductal involvement (P =0.038),a solid mass (P =0.003) and the common bile duct dilatation (≥ 15 mm,P =0.004) were correlated with the presence of associated invasive carcinoma.For the finding of solid and cystic mass in predicting invasive IPMN,the sensitivity was 66.7%(8/12) and specificity was 100.0% (8/8),and for bile duct diameter ≥15 mm,the sensitivity was 47.4% (9/19) and specificity was 100.0% (8/8).However,no association was found between the location of the lesion and associated invasive carcinoma.The caliber of the main pancreatic duct of patients with associated invasive carcinoma was significantly larger than that in the cases without invasive carcinoma (8.07 ± 2.23 mm vs.4.86 ± 1.86 mm,P =0.002).When using the main pancreatic duct dilatation ≥ 4 mm as the threshold,the sensitivity and specificity in predicting invasive IPMN were 94.7% (18/19) and 37.5% (3/8),respectively.For the branch duct type and

  13. Intraductal fibroadenoma under the nipple in an 11-year-old female.

    Science.gov (United States)

    Hayano, Fumiko; Yamada, Sohsuke; Nakano, Shigeo; Watanabe, Teruo; Sasaguri, Yasuyuki; Koga, Sunao

    2014-02-10

    Recently, Chung et al. have reported the detailed clinicopathological features of an extremely rare case sharing similar histopathological characteristics with fibroadenomas, phyllodes tumours, intraductal papillomas or ductal adenomas, given the name of intraductal fibroadenomatosis, as an unusual variant of intracanalicular fibroadenoma. Herein we demonstrated a very unusual case of intraductal fibroadenoma of the breast with admixture of components of intracanalicular type fibroadenoma or benign phyllodes tumour and a smaller amount of intraductal papilloma, occupying the one duct and some adjacent ductules, presenting as a well-demarcated nodule.

  14. Surgical treatment of intraductal papillary mucinous neoplasms of the pancreas%76例胰腺导管内乳头状黏液性肿瘤的外科治疗及预后分析

    Institute of Scientific and Technical Information of China (English)

    匡天涛; 靳大勇; 楼文辉; 王单松

    2011-01-01

    Objective To investigate the outcome of intraductual papillary mucious neoplasms (IPMN) of the pancreas after surgical resection. Method Clinical data of 76 patients with intraductal papillary neoplasms of the pancreas undergoing surgical resection at Zhongshan Hospital, Fudan University between January 1999 and December 2008 were retrospectively analyzed. Results Among the 76 patients,49 were male, 37 were female. 32 had noninvasive IPMNs, including adenomas( n = 16), borderline tumors (n =6 ), carcinomas in situ (n = 10 ). 44 had invasive IPMNs. Lesions were present in the head in 63 cases, in the body or tail in 10, in the whole pancreas in 3. There were significant difference in age,jaundice, weight loss, asymptomatic cases and CA199 value between noninvasive and invasive IPMNs.Three patients underwent total pancreatectomy, 59 patients underwent pancreaticoduodenectomy, 4 patients underwent pancreaticoduodenectomy with portal vein resection and reconstruction, six patients underwent distal pancreatectomy, two patients each underwent central pancreatectomy or enucleation. The overall postoperative morbidity rate were 28.9%, there was no operative mortality. Positive pancreatic margin was identified in seven patients of noninvasive neoplasms, among thoee one developed recurrence after 67 months. The five-year survival rate for patients with noninvasive and invasive neolpasms was 100% and 35% ,respectively. Size and lymph node metastasis were significant prognostic factors after surgical resection of the invasive IPMNs. Conclusions Surgical resection provides a favorable outcome for patients with noninvasive IPMNs. In contrast, invasive IPMNs was associated with a poor survival. Early resection is essential for improving survival. Long-term follow-up is necessary for all patients with IPMNs after resection.%目的 分析胰腺导管内乳头状黏液性肿瘤患者的临床特征及手术疗效.方法 收集1999年1月至2008年12月复旦大学附

  15. Papillary eccrine adenoma

    Directory of Open Access Journals (Sweden)

    Laxmisha Chandrashekar

    2004-01-01

    Full Text Available A 28-year-old man came to us with a solitary skin colored, mildly tender nodule of 6 months duration on the dorsum of the right hand. On histological examination, multiple dilated ducts without apparent continuity with the surface were found in the dermis. These dilated ducts had branching tubules with eosinophilic amorphous material filling most of the lumina. The peripheral cells of the tubules resembled myoepithelial cells, whereas the luminal border cells were cuboidal or low columnar. Papillary projections arising from the inner cells were seen extending into the lumen. These features were diagnostic of a rare tumor, papillary eccrine adenoma.

  16. Concurrent fibroadenoma and intraductal papilloma - A recurring complex lesion in a premenarcheal girl.

    Science.gov (United States)

    Alessandrini, Lara; Gobbi, Dalia; Zanon, Giovanni Franco; Dall'Igna, Patrizia; Cecchetto, Giovanni; Alaggio, Rita

    2013-02-15

    Breast diseases are rare in childhood and adolescence, most lesions being fibroadenomas and papillomas. We report the case of an 11-year old girl with a complex breast lesion with hybrid features of fibroadenoma and intraductal papilloma with an early recurrence. Microscopically, the lesion was composed of dilated ducts showing intraluminal papillary projections with small to broad fibrovascular stalks. The typical leaf-like appearance of fibroadenoma was determined by the presence at the periphery of ducts compressed and distorted by the prominent stromal component. Despite its florid epithelial hyperplasia and mild cytological atypia (more evident in the relapse), immunohistochemical staining for p63 and smooth muscle actin highlighted a continuum outer myoepithelial layer, confirming the non-invasive appearance of the lesion. Two pathogenetic links have been hypothesized: one is based on the morphological continuum between these two entities, which may represent different evolutive stages in the same lesion; the other is based on epithelial/mesenchymal interactions. The possible malignant transformation of such complex lesion is also discussed, along with its differential diagnoses. The relevance of this case lies in its rarity, as well as in the therapeutic strategies related to its biological potential and to the necessity of a conservative treatment, due to the young age of the patient.

  17. [A case of main-duct IPMN with multicentric invasive carcinoma].

    Science.gov (United States)

    Nakadai, Eri; Yoshitomi, Hideyuki; Shimizu, Hiroaki; Otsuka, Masayuki; Kato, Atsushi; Furukawa, Katsunori; Takayashiki, Tsukasa; Kuboki, Satoshi; Suzuki, Daisuke; Nakajima, Masayuki; Okamura, Daiki; Sakai, Nozomu; Miyazaki, Masaru

    2014-11-01

    Intraductal papillary mucinous neoplasm (IPMN) of the pancreas often contains multifocal lesions, and total pancreatectomy is sometimes needed for curative resection. We report here our experience with a case of IPMN with multiple invasive carcinoma foci that was successfully treated with total pancreatectomy. A 66-year-old man had jaundice, and a computed tomography (CT) scan revealed a hypovascular mass in the pancreas head in conjunction with calcification and dilation of the entire main pancreatic duct. He was diagnosed with pancreas head cancer and chronic pancreatitis, and a pancreaticoduodenectomy was planned. Intraoperative pathological examination revealed papillary growth of high grade dysplasia in the main and branch duct epithelium and perineural invasion of the atypical glands. After 2 additional resections, we performed a total pancreatectomy. Pathological findings showed that the pancreas head tumor was an invasive carcinoma derived from main-duct IPMN of the pancreas. It was a mucinous carcinoma with calcification. Moreover, we found other multiple, discontinuous invasive foci in the body and tail of the pancreas which were undetectable by preoperative imaging. This case was highly suggestive for preoperative diagnosis for pancreas tumor and developmental pattern of main-duct IPMN.

  18. Fiberoptic ductoscopy-guided intraductal biopsy for the diagnosis of intraductal lesions concomitant with pathologic nipple discharge%乳管镜直视下病灶活检在伴乳头溢液乳管疾病诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    凌泓; 柳光宇; 陆劲松; 徐晓莉; 徐维萍; 沈坤炜; 沈镇宙; 邵志敏

    2008-01-01

    目的 研究乳管镜直视下乳管内病灶活检的可行性和意义.方法 2006年5月至2007年4月,共51例有乳管内病灶的患者在复旦大学肿瘤医院接受了53次乳管镜直视下乳管内病灶活检术和随后的开放手术.结果 活检发现29例管内乳头状瘤、15例导管上皮增生、2例上皮重度不典型增生和2例恶性肿瘤.另有5例活检失败.开放手术后病理为12例单发管内乳头状瘤、12例多发性管内乳头状瘤、25例乳腺上皮增生、3例导管内癌、1例浸润性导管癌.结论 乳管镜直视下乳管内病灶活检不仅是微创、安全、方便可行、成功率高的诊断方法,还可部分替代现有开放手术.活检如发现上皮不典型增生或恶性肿瘤,则需进一步手术.%Objective To investigate the clinical significance of fiberoptic ductoscopy-guided intraductal biopsy in diagnosing nipple discharge.Methods From May 2006 to April 2007,screening fiberoptic ductoscopy was performed for intraductal papillary lesions in 53 ducts among 51 patients.Fiberoptic ductoscopy-guided intraductal biopsy was carried out followed by open microdochectomy. Results Except for a failure in 5 ducts,biopsy found papilloma in 29 cases,ductal hyperplasia in 15 cases,severe ductal hyperplasia in 2 and carcinoma in 2.Microdochectomy revealed 43 benign diseases (12 solitary intraductal papillomas,12 multiple intraductal papillomas,and 25 ductal hyperplasia)and 4 malignancies (3 ductal carcinoma in situ,1 invasive ductal carcinoma).Surgeries performed for the 5 ducts failing a biopsy attempt revealed papilloma in one and adenosis in 4.Compared with conventional microdochectomy,fiberoptic ductoscopy-guided intraductal biopsy can significantly increase the detection rate of solitary papilloma(40.7% vs. 92.6%,P<0.05).It might also underestimate multiple intraductal papilloma and breast cancer. Conclusion Fiberoptic ductoscopy-guided intraductal biopsy is microinvasive,safe,convenient with a

  19. Invasive papillary carcinoma of the male breast: Report of a rare case and review of the literature

    Directory of Open Access Journals (Sweden)

    Pant Ishita

    2009-01-01

    Full Text Available Breast masses occur in men far less commonly than women. Papillary lesions of the male breast are rare and comprise a spectrum of lesions ranging from benign intraductal papilloma to intraductal papillary carcinoma and invasive papillary carcinoma. In this case report, a 78-year-old man presented with a subareolar painless mass. Fine needle aspiration cytology (FNAC was performed. Cytologic examination revealed a cellular aspirate. A diagnosis of papillary lesion favoring papillary carcinoma was rendered. The patient underwent modified radical mastectomy, which showed invasive papillary carcinoma. As far as we know, only a few cases of invasive papillary carcinoma of the male breast have been published in the literature. To the best of our knowledge, this is the first case report of invasive papillary carcinoma of male breast in Malaysia. In this purview, we discuss papillary carcinoma of male breast with review of the relevant literature.

  20. Invasive carcinoma derived from branch duct-type IPMN may be a more aggressive neoplasm than that derived from main duct-type IPMN.

    Science.gov (United States)

    Okabayashi, Takehiro; Shima, Yasuo; Kosaki, Takuhiro; Sumiyoshi, Tatsuaki; Kozuki, Akihito; Iiyama, Tastuo; Takezaki, Yuka; Kobayashi, Michiya; Nishimori, Isao; Ogawa, Yasuhiro; Hanazaki, Kazuhiro

    2013-06-01

    The present study aimed to evaluate the long-term follow-up results of patients with intraductal papillary mucinous neoplasm (IPMN) and to estimate the degree of IPMN malignancy based on pathological and molecular features of resected specimens. The detection rate of IPMN has increased over the last decade; however, the management of this neoplasm remains controversial. This is particularly so for branch duct-type IPMN, which carries a high potential for malignancy and risk of recurrence. We retrospectively reviewed a single institution's prospective pancreatic resection database to identify IPMN patients who underwent pancreatectomy with curative intent. The clinicopathological variables of 100 patients resected for IPMN were analyzed with a detailed review of histopathological results (borderline lesions, non-invasive carcinoma and invasive carcinoma) to determine the grade of IPMN malignancy based on transforming growth factor (TGF)-β/SMAD4 signaling. The incidence of malignant change was significantly higher in patients with main duct-type IPMN (69.7%) compared with branch duct-type IPMN cases (17.9%). However, patients with an invasive carcinoma had a significantly worse outcome if it was derived from branch duct-type IPMN compared with those derived from main duct-type IPMN, and TGF-β mRNA expression was significantly increased in the former patient group. Immunohistochemistry also showed higher numbers of SMAD4-positive cells in patients with carcinoma derived from branch duct-type IPMN. Our results demonstrated that invasive carcinoma derived from branch duct-type IPMN is more aggressive than that derived from main duct-type IPMN, once invasive morphological change takes place. Determining TGF-β and/or SMAD4 status at initial diagnosis may be useful for stratifying IPMN patients into treatment regimens.

  1. Phyllodes tumor showing intraductal growth.

    Science.gov (United States)

    Makidono, Akari; Tsunoda, Hiroko; Mori, Miki; Yagata, Hiroshi; Onoda, Yui; Kikuchi, Mari; Nozaki, Taiki; Saida, Yukihisa; Nakamura, Seigo; Suzuki, Koyu

    2013-07-01

    Phyllodes tumor of the breast is a rare fibroepithelial lesion and particularly uncommon in adolescent girls. It is thought to arise from the periductal rather than intralobular stroma. Usually, it is seen as a well-defined mass. Phyllodes tumor showing intraductal growth is extremely rare. Here we report a girl who has a phyllodes tumor with intraductal growth.

  2. Multiple intraductal papillomas of breast clinically masquerading as malignancy

    Directory of Open Access Journals (Sweden)

    Singh Pallavi

    2010-01-01

    Full Text Available Background: Intraductal papilloma is characterized by proliferation of epithelial and myoepithelial cells overlying fibro-vascular stalks creating an arborescent structure within the lumen of duct. Some times multiple papillomas with florid proliferation of epithelium may be confused with malignancy. A case of multiple intraductal papillomas of breast with ulceration of overlying skin and large lump leading to clinical diagnosis of malignancy is documented here. Case Report: A 45-year-old female presented with ulcerated mass of six months duration in the left breast. On examination, a firm, immobile lump of 8× 10 cm in size involving nipple with excoriation of surrounding skin and serosanguinous discharge from nipple was present. There was no axillary lymphadenopathy. No family history of carcinoma breast was present. Fine needle aspiration smears showed benign cellular changes with apocrine metaplasia. Biopsy from an area adjacent to nipple showed intraductal papilloma. Simple mastectomy showed lobulated dirty white mass with well circumscribed nodules below the nipple and areola. On histology with immunohistochemistry a diagnosis of multiple intraductal papillomas was made. Patient is on regular follow-up and doing well. Conclusion: The case highlights the problem in differentiating marked papillomatosis from a malignant lesion of breast and importance of biopsy with immunohistochemistry in such cases for proper management.

  3. [A case of metachronous invasive ductal carcinoma concomitant with intraductal papillary-mucinous neoplasm (IPMN) of the pancreas, which could not be detected in contrast-enhanced CT scan performed 3 months ago].

    Science.gov (United States)

    Hasebe, Osamu; Ochi, Yasuhide; Hara, Etsuo; Suzawa, Kenichi; Seki, Ayako; Nagaya, Tadanobu; Tatai, Toshiharu; Jimbo, Yoko; Hosaka, Noriko

    2011-09-01

    A 61-year-old man had been followed up in another hospital under diagnosis of branch duct type IPMN for 4 years. Contrast-enhanced CT scan for regular check performed 3 months ago revealed no increase of IPMN and no pancreatic tumor. However, he complained of back pain after that, MRI was performed. It revealed a solid tumor in size of 25mm diameter at the head of pancreas. The tumor was apparent from IPMN in several imaging modalities. Pancreatoduodenectomy was performed under diagnosis of invasive ductal carcinoma concomitant with IPMN. Post-operative pathological findings revealed IPMN was adenoma with mild atypia, and solid tumor was diagnosed invasive ductal carcinoma with solitary minute liver metastasis.

  4. Efficacy of intraductal cooling to prevent the bile duct injury during radiofrequency ablation associated with hepatic blood occlusion%胆管内冷盐水灌注冷却预防肝血流阻断合并射频消融术中胆管损伤的研究

    Institute of Scientific and Technical Information of China (English)

    李静怡; 苏永辉; 蔡潮农; 郭辉; 林宇静

    2014-01-01

    目的 评价活体兔肝予肝血流阻断合并射频消融(radiofrequency ablation,RFA)术中行胆管内冷盐水灌注冷却(intraductal chilled saline perfusion,ICSP)对胆管的保护作用.方法 新西兰大白兔16只,分为2组:ICSP组于RFA术前行胆总管置管,于RFA术中夹闭入肝血流,并经胆总管置管行ICSP;非ICSP组仅于RFA术中夹闭入肝血流.术中射频针针尖距肝门部主胆管距离约5 mm.RFA术后行超声造影比较两组消融灶大小;术后6周超声观察兔肝内胆管结构,并取肝大体标本,对两组消融灶旁主胆管行病理学检查以比较损伤程度.结果 RFA术后超声造影示两组间消融灶大小差异无统计学意义(P>0.05),RFA术后6周超声检查示非ICSP组胆管扩张较为明显(P<0.05),病理学检查示非ICSP组主胆管损伤程度较严重(P <0.05).结论 行入肝血流阻断合并肝脏RFA时,采用ICSP能有效预防术中胆道热损伤.%Objective To explore the efficacy of intraductal chilled saline perfusion (ICSP) to reduce the thermal bile duct injury during the treatment of radiofrequency ablation (RFA) associating with occlusion of hepatic blood supply in rabbits.Methods 16 healthy New Zealand white rabbits were divided into 2 groups.Rabbits of the ICSP group were placed tubes in the common bile duct after laparotomy,and ICSP was performed during the RFA procedure accompanied with hepatic blood occlusion.While for rabbits of the non-ICSP group,hepatic blood occlusion and RFA were performed without ICSP.RFA electrodes were placed about 5 mm away from the hilus hepatis approximately.Contrast-enhanced ultrasonography (CEUS) was administrated to evaluate the sizes of the ablative zones after the procedure.On post-procedure 6 week,ultrasonography was prerformed to evaluate the changes of the biliary structure,and liver specimens of rabbits wcrc obtained for histopathologic observation of main bile ducts.Results Post-procedure CEUS examination showed that there

  5. Intraductal membranous fat necrosis in a fibroadenoma of breast: a case report.

    Science.gov (United States)

    Coyne, John D

    2014-09-01

    Membranous fat necrosis is an unusual type of fat necrosis occurring in the breast and normally involves the parenchyma. This report describes an apparently unique intraductal focus in a fibroadenoma following prior needling. Displacement of fatty tissue in the form of membranous fat necrosis within ducts could be added to the list of histological features following core biopsy.

  6. Preoperative predictors of malignancy and invasive carcinoma in intraductal papillary mucinous neoplasms%胰管内乳头状黏液性肿瘤的术前良、恶性与浸润性预测因子

    Institute of Scientific and Technical Information of China (English)

    王雷; 金刚; 王莉; 郑建明; 金震东; 邹多武; 张华高; 蔡全才; 李兆申

    2010-01-01

    目的 分析术前预测胰管内乳头状黏液性肿瘤(IPMN)良、恶性与浸润性的因子,及不同病理类型IPMN的手术后生存率.方法 回顾性分析长海医院1993年1月至2009年9月间手术切除的78例IPMN病例资料,采用单因素与多因素分析的方法分析病史、临床表现、肝功能、CEA、CA19-9、影像学征象等在术前判断IPMN良、恶性与浸润性的价值,分析患者术后生存率.结果 单因素分析结果显示,黄疸、急性胰腺炎、血CA19-9>37 U/ml、AKP、肿块边界不清为恶性及浸润性预测因子;主胰管扩张、分支胰管直径>30 mm、出现壁节结等为恶性预测因子;CEA>6 ng/ml为浸润性预测因子.多因素分析显示,肿块边界不清为恶性及浸润性预测因子;急性胰腺炎为浸润性预测因子.良性IPMN患者的5年生存率为100%;恶性IPMN的2年生存率为78.9%、5年生存率为68.5%,其中浸润性IPMN的2年生存率为64.6%、5年生存率为43.1%.结论 肿块边界不清为IPMN恶性预测因子,急性胰腺炎、肿块边界不清是IPMN的浸润性预测因子.%Objective To investigate the predictive factors for malignancy and invasive carcinoma of IPMN, and the survival rates of different pathological type of IPMN were compared. Methods Seventy-eight patients with IPMN admitted to Changhai Hospital from January 1993 to September 2009, who underwent surgery with histological evidence were retrospectively analyzed. The univariate and multivariate analysis of potential predictive factors, including medical history, clinical presentations, liver function, CEA, CA19-9,and imaging findings was conducted to identify the predictive factors for malignancy and invasive carcinoma of IPMN. Results Univariate analysis identified jaundice, acute pancreatitis history, CA19-9 Level > 37U/ml,AKP, unclear border of tumour as independent predictive factors for malignancy and invesiveness, main pancreatic duct dilation, branch pancreatic duct diameter > 30

  7. IDUS for Biliary and Pancreatic Duct Lesions

    Institute of Scientific and Technical Information of China (English)

    Takao ltoi

    2008-01-01

    @@ In the recent decade, wire-guided intraductal US(IDUS), which can be passed through the working channel of standard duodenoscopes to provide high-frequency ultrasound images, has been developed as a newly diagnostic tool for biliary and pancreatic duct lesions.

  8. 胰腺导管内乳头状黏液性肿瘤合并胰腺外恶性肿瘤特征荟萃分析%Pancreatic intraductal papillary mucinous neoplasm coexisting with extrapancreatic malignancy: an analysis of pooled published data

    Institute of Scientific and Technical Information of China (English)

    张栋; 郎韧; 陈大志; 樊华; 金中奎; 李先亮; 冯艳

    2012-01-01

    Objective To analyse the clinical characteristics of pancreatic intraductal papillary mucinous neoplasm (IPMN) which coexists with extrapancreatic malignancy (EPM),with an aim to provide strategies for clinical diagnosis and treatment.Methods The PubMed was used to search for the pancreatic IPMN related articles with positive pathologic results.A pooled analysis was then performed.The ratio ofpancreatic IPMNs coexisting with EPMs and the locations (or the type) of EPMs were analyzed.Results After a strict process of screening,18 articles met the pre-determined standardsand were accepted.Of the 1327 patients,363 had coexisting EPMs (27.35%).There were 392 EPMs in these 363 patients.The EPMs occurred in almost all the systems of the body,especially in the digestive tract and its related organs,which accounted for 63.06% of the EPMs. Conclusions There is a tendency for patients with pancreatic IPMN to have coexisting EPM. More than half of these EPMs are malignant tumors in the digestive system. When pancreatic IPMN is diagnosed,the clinician should be aware of the possible coexistence of an EPM and should look for the possibility of a new EPM developing in a patient after treatment of pancreatic IPMN.%目的 探讨胰腺导管内乳头状黏液性肿瘤(IPMN)合并胰腺外恶性肿瘤(EPM)的部分临床特点,为临床诊治胰腺IPMN提供帮助.方法 以PubMed为检索数据库,对已发表的关于胰腺IPMN文献中经病理学证实的临床病例进行荟萃分析,尝试阐明胰腺IPMN病例并存EPM的发生率和EPM的发生部位(类型)及其比例.结果 共筛选出符合纳入排除标准的文献18篇,共汇集病例1327例,其中并存EPM病例363例,占 27.35%.该363例病例中,共统计到392处EPM.EPM几乎可发生于全身各个系统,以消化道及其相关来源恶性肿瘤最为多见,占总EPM数量的63.06%.结论 胰腺IPMN患者常合并EPM,以消化系统恶性肿瘤居多,提示在该疾病的诊治过程中不应忽视EPM

  9. Blood group type antigens in pancreatic intraductal papillary mucinous neoplasms

    Institute of Scientific and Technical Information of China (English)

    Adriana H; ra-Luca

    2014-01-01

    BACKGROUND: There are few data on blood group (BG) types and types of pancreatic cancers. The aims of this study were to study BG types and BG-antigens in pancreatic intraductal papillary mucinous neoplasms (IPMNs). METHODS: BG  type  and  tumor  BG-antigen  (glycoprotein) expression  (studied  by  immunohistochemistry  on  tissue microarrays) were analyzed with regard to characteristics of 101 surgically resected pancreatic IPMNs. RESULTS: Non-O  BG  type  predicted  invasive  carcinoma independently from high serum CA19-9 and male gender. BG type A was observed more frequently in women than in men. Chronic pancreatitis was more frequently seen in patients with BG type B or AB. Aberrant tumor expression (with regard to BG type) of loss of A antigen expression type occurred in 15.0% of IPMNs and of loss of B antigen expression type in 62.5% of IPMNs. Intraneoplasm BG-antigen expression was not related to dysplasia grade or invasion. CONCLUSION: The results of the study suggest that in pancreatic IPMN, non-O BG type predicted invasive carcinoma, whereas for intratumor BG-antigen expression no speciifc patterns were detected with regard to the progression of glandular epithelial dysplasia or invasion.

  10. Intraductal biliary and pancreatic endoscopy:An expanding scope of possibility

    Institute of Scientific and Technical Information of China (English)

    Joel R Judah; Peter V Draganov

    2008-01-01

    Intraductal endoscopy describes the use of an endoscope to directly visualize the biliary and pancreatic ducts.For many years,technological challenges have made performing these procedures difficult.The "mother-baby" system and other various miniscopes have been developed,but routine use has been hampered due to complex setup,scope fragility and the time consuming,technically demanding nature of the procedure.Recently,the SpyGlass peroral cholangiopancreatoscopy system has shown early success at providing diagnostic information and therapeutic options.The clinical utility of intraductal endoscopy is broad.It allows better differentiation between benign and malignant processes by allowing direct visualization and targeted sampling of tissue.Therapeutic interventions,such as electrohydraulic lithotripsy (EHL),laser lithotripsy,photodynamic therapy,and argon plasma coagulation (APC),may also be performed as part of intraductal endoscopy.Intraductal endoscopy significantly increases the diagnostic and therapeutic yield of standard endoscopic retrograde cholangiography (ERCP),and as technology progresses,it is likely that its utilization will only increase.In this review of intraductal endoscopy,we describe in detail the various endoscopic platforms and their diagnostic and clinical applications.

  11. The Study of Fiberoptic Duct Endoscopy (FDS) Iodine Staining for the Diagnosis of Intraductal Proliferative Lesions%纤维乳腺导管镜下碘染色对导管内增生性病变的诊断研究

    Institute of Scientific and Technical Information of China (English)

    冯鑫至; 张凤霞; 林晓燕; 梅红; 赵斌

    2012-01-01

    Objective: To investigate the diagnostic value and clinical significance of fiberoptic duct endoscopy (FDS) iodine staining for the intraductal proliferative lesions. Methods: One hundred and seventy-seven patients with nipple discharge were included in this study. Patients were randomly divided into two groups and detected hy FDS. Ninety-two patients were conducted Lugol's solution staining under FDS (iodine staining group). Eighty-five patients were carried out routine FDS check without iodine staining (control group). All of suspicious lesions were cut and inspected with wire positioning, thus evaluating the clinical significance of Lugol's iodine staining for the diagnosis of intraductal proliferative lesions. Results: PAS staining was positive in mammary gland hyperplasia while PAS positive substance was gradually eliminated until the neglectable level. Mammary gland hyperplasia specimens took on a color of tan brown after supravital staining whereas the color of breast cancer samples after staining became significantly lighter or unstained. The diagnostic agreement rates were 97.82% and 88.24% for ductal intraepithelial neoplasia (DIN) of iodine staining group and control group respectively. The sensitivity was 98.83% and 89.16% in the two groups respectively, and the specificity was 83.33% and 50% respectively. The positive likelihood ratio was 5.93 and 1.78 respectively. The negative likelihood ratio was 0.014 and 0.217 respectively. Youden index was 0.822 and 0.392 respectively. The sensitivity and diagnostic coincidence were significantly higher in iodine staining group than those of control group (P < 0.05). Conclusion:The diagnosis for DIN of iodine staining under FDS is superior to the conventional FDS. This approach deserves to be widely applied.%目的:探讨纤维乳腺导管镜(FDS)下碘染色对乳腺导管内增生性病变的诊断价值及其临床意义.方法:选择177例乳头溢液患者行FDS检查,随机分为2组,碘染色组92

  12. Collagen Type XI Alpha 1 Expression in Intraductal Papillomas Predicts Malignant Recurrence

    Science.gov (United States)

    Freire, Javier; García-Berbel, Lucia; García-Berbel, Pilar; Pereda, Saray; Azueta, Ainara; García-Arranz, Pilar; De Juan, Ana; Vega, Alfonso; Hens, Ángela; Enguita, Ana; Muñoz-Cacho, Pedro; Gómez-Román, Javier

    2015-01-01

    Despite the progress achieved in the treatment of breast cancer, there are still many unsolved clinical issues, being the diagnosis, prognosis, and treatment of papillary diseases, one of the highest challenges. Because of its unpredictable clinical behavior, treatment of intraductal papilloma has generated a great controversy. Even though considered as a benign lesion, it presents high rate of malignant recurrence. This is the reason why there are clinicians supporting a complete excision of the lesion, while others support an only expectant follow-up. Previous results of our group suggested that procollagen 11 alpha 1 (pro-COL11A1) expression correlates with infiltrating phenotype in breast lesions. We analyzed the correlation between expression of pro-COL11A1 in intraductal papilloma and their risk of malignant recurrence. Immunohistochemistry of pro-COL11A1 was performed in 62 samples of intraductal papilloma. Ten out 11 cases relapsed as carcinoma presents positive staining for COL11A1, while just 17 out of 51 cases with benign behaviour present immunostaining. There were significant differences (P < 0.0001) when comparing patients with malignant recurrence versus nonmalignant relapse patients. These data suggest that pro-COL11A1 expression is a highly sensitive biomarker to predict malignant relapse of intraductal papilloma and it can be used as indicative factor for prevention programs. PMID:26448946

  13. Collagen Type XI Alpha 1 Expression in Intraductal Papillomas Predicts Malignant Recurrence

    Directory of Open Access Journals (Sweden)

    Javier Freire

    2015-01-01

    Full Text Available Despite the progress achieved in the treatment of breast cancer, there are still many unsolved clinical issues, being the diagnosis, prognosis, and treatment of papillary diseases, one of the highest challenges. Because of its unpredictable clinical behavior, treatment of intraductal papilloma has generated a great controversy. Even though considered as a benign lesion, it presents high rate of malignant recurrence. This is the reason why there are clinicians supporting a complete excision of the lesion, while others support an only expectant follow-up. Previous results of our group suggested that procollagen 11 alpha 1 (pro-COL11A1 expression correlates with infiltrating phenotype in breast lesions. We analyzed the correlation between expression of pro-COL11A1 in intraductal papilloma and their risk of malignant recurrence. Immunohistochemistry of pro-COL11A1 was performed in 62 samples of intraductal papilloma. Ten out 11 cases relapsed as carcinoma presents positive staining for COL11A1, while just 17 out of 51 cases with benign behaviour present immunostaining. There were significant differences (P<0.0001 when comparing patients with malignant recurrence versus nonmalignant relapse patients. These data suggest that pro-COL11A1 expression is a highly sensitive biomarker to predict malignant relapse of intraductal papilloma and it can be used as indicative factor for prevention programs.

  14. MRI features of intraductal papilloma of the breast: sheep in wolf's clothing?

    Energy Technology Data Exchange (ETDEWEB)

    Kurz, Kathinka D; Roy, Sumit (Dept. of Radiology, Stavanger Univ. Hospital, Stavanger (Norway)), e-mail: kurk@sus.no; Saleh, Andreas (Inst. of Diagnostic Radiology, Duesseldorf Univ. Hospital, Duesseldorf (Germany)); Diallo-Danebrock, Raihana (Inst. of Pathology, Duesseldorf Univ. Hospital, Duesseldorf (Germany)); Skaane, Per (Dept. of Radiology, Ullevaal Univ. Hospital, Univ. of Oslo, Oslo (Norway))

    2011-04-15

    Background: Intraductal papillomas often present as small, smooth masses, dilated ducts or microcalcifications at mammography and as smooth, hypoechoic masses at sonography. At magnetic resonance imaging (MRI), intraductal papillomas often present as small smooth masses, however, often with strong enhancement with type 2 or 3 time intensity curves. The result of the MR analysis is therefore not infrequently inconclusive in order to characterize the mass as benign or malignant. Purpose: To characterize the appearance of intraductal papillomas of the breast at MRI, and determine whether the application of diagnostic rules described in literature could contribute to correctly classifying the lesions as benign. Material and Methods: Twenty patients with histologically proven intraductal papillomas were included. Two radiologists independently reviewed the MR images of the breast. The BI-RADS nomenclature was used to describe morphology and contrast-enhancement kinetics. Interobserver agreement in the interpretation of the MR images by the two investigators was performed. Kappa coefficient was calculated as index for the level of agreement. Subsequently, three sets of diagnostic rules, including the Goettinger score described by Fischer and the interpretation flowcharts according to Kinkel and to Tozaki were applied to characterize whether a biopsy should be recommended or not. Results: All papillomas presented as masses on dynamic contrast-enhanced MRI. Only five papillomas showed a round, oval, or lobulated shape combined with smooth margins and continuous rise of the time intensity curve. Using the Goettinger score, biopsy would be recommended in 16 patients. Based on the interpretation flowcharts of Kinkel and of Tozaki, an additional 13 and 10 papillomas, respectively, were correctly classified as benign. Dilated ducts were visible in 10 patients. The interobserver agreement was good or excellent for all included variables. Conclusion: Including systematic analysis

  15. Ultrasound appearance of chronic mammary duct ectasia

    Energy Technology Data Exchange (ETDEWEB)

    Duchesne, N. [Ottawa Hospital, Dept. of Radiology, Ottawa, Ontario (Canada)]. E-mail: nathalie_duchesne_22@yahoo.ca; Skolnik, S. [Univ. of Toronto, Dept. of Family Medicine, Toronto, Ontario (Canada); Bilmer, S. [Ottawa Hospital, Dept. of Radiology, Ottawa, Ontario (Canada)

    2005-12-15

    Mammary duct ectasia (MDE), also called periductal mastitis, mammary dysplasia, or plasma cell mastitis, is a benign condition of the mammary gland first described by Haagensen in 1951. The etiology of MDE is unknown and its pathogenesis still controversial; the periductal inflammation could be either the cause or the result of dilated damaged ducts. The process is usually bilateral and asymptomatic, with only a small percentage of patients presenting with symptoms that may include long course of tumour formation, usually subareolar breast lumps, nipple discharge, nipple retraction, mastalgia, and mammary abscess or fistulas. Mammographic presentation of MDE is well known; its features include periductal calcification, benign intraductal calcification, and retroareolar duct dilatation. The periductal calcification results from dystrophic calcification and forms calcified rings or very dense, oval, elongated calcifications, each with a central lucency representing the dilated duct. Intraductal calcifications of duct ectasia represent inspissated intraductal material and are typically of uniform high density, often needle-like, and occasionally branching. Occasionally, there are no mammographic findings, and the diagnosis must rely on sonographic features. Appearance of MDE on ultrasonography (US) depends on the stage of the disease and the contents of the dilated ducts. The acute presentation has been demonstrated in the literature more often than has its chronic counterpart. In the former, duct content can vary from anechoic to isoechoic with surrounding fatty tissue. In chronic MDE, episodes of inflammation are longer. This tends to result in secretions that have a more solid, cheesy texture, partly due to cholesterol crystals, foam cells, and inflammatory cells. For both types of MDE, the appearance can mimic high-grade ductal carcinoma in situ (DCIS) on US. In this essay, 2 chronic MDE cases are presented and their US appearance discussed. Our goal is to explore

  16. A case report of hepatocellular carcinoma in common hepatic duct

    Energy Technology Data Exchange (ETDEWEB)

    Song, Chi Sung; Park, In Ae; Choi, Sang Woon; Chung, Jung Kee [YongDeungPo City Hospital, Seoul (Korea, Republic of)

    1989-08-15

    We experienced a rare case of intraductal (common hepatic duct) hepatocellular carcinoma. Review of the literature disclosed 30 cases or less in which common duct involvement was a predominant clinical feature. Well demarcated, ovoid filling defect mass in CHD without parenchymal tumor mass was noted in ultrasound, PTC and CT study. The liver was cirrhotic, but {alpha}-fetoprotein level was normal. Differential diagnosis especially with Klatskin tumor is important and thought to be possible.

  17. Intraductal mucin-hypersecreting neoplasm of the pancreas : US, CT and ERP findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ki Yeol [Korea Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-08-01

    To evaluate US, CT and endoscopic retrograde pancreatography (ERP) findings of intraductal mucin-hypersecreting neoplasm(IMHN). We categorized an IMHN as belonging to a group of disease that can be clinically detected by the pooling of mucus produced by tumors inside the main duct or branch ducts of the pancreas, thus causing dilatation of these ducts. We retrospectively reviewed the US, CT and ERP findings of five patients(hyperplasia, 4;adenocarcinoma, 1). On US and/or CT, diffuse dilatation of the main pancreatic duct was demonstrated in five patients. In two cystic lesions corresponding to cystic dilatation of branch ducts were noted at the pancreatic head(n=1) and neck(n=1). In one patient, multiple cystic lesions were seen on CT along the entire pancreas, but these were not detected on US. In all patients, dilatation of the main duct and /or its branch ducts was seen on ERP. Filling defects resulting from mucin in the main duct or branch ducts were noted in all cases. Lymphadenopathy was not seen on US or CT, but carcinoma peritonei was found in the adenocarcinoma patient at the time of operation. IMHN usually shows smooth, diffuse dilatation of the main duct, and on US or CT, dilated branch ducts are occasionally noted. ERP findings are the most characteristic and conclusive;dilatation of the main duct and/or branch ducts is noted, with a filling defect corresponding to mucin. If overlooked during diagnosis, an IMHN might be interpreted simply as chronic pancreatitis, and so the recognition of this neoplasm is important.

  18. Intraductal location of the sclerosing adenosis of the breast.

    Science.gov (United States)

    Unal, Bulent; Gur, A Serhat; Bhargava, Rohit; Edington, Howard; Ahrendt, Gretchen; Soran, Atilla

    2009-01-01

    Sclerosing adenosis is a benign breast disease with non-specific images on ultrasound or mammogram. It can mimic infiltrating carcinoma when the above mentioned imaging techniques are used. Herein we present a patient with breast cancer who received neoadjuvant chemotherapy and subsequently underwent mastectomy. Ductoscopy was performed to the mastectomised breast specimen as per the ductoscopy research protocol. Ductoscopy revealed several nodular lesions in the duct with no additional demonstrable intraductal pathology. The lesions were reported as sclerosing adenosis by pathologist. As to our knowledge, this is the first case in literature that demonstrates the use of ductoscopy in diagnosing the sclerosing adenosis in the breast tissue. Ductoscopy and development of ductoscopy guided biopsy techniques may be used as an early diagnostic method for the ductal breast lesions (Fig. 2, Ref. 10). Full Text (Free, PDF) www.bmj.sk.

  19. Differentiating Branch Duct and Mixed IPMN in Endoscopically Collected Pancreatic Cyst Fluid via Cytokine Analysis.

    Science.gov (United States)

    Lee, Linda S; Bellizzi, Andrew M; Banks, Peter A; Sainani, Nisha I; Kadiyala, Vivek; Suleiman, Shadeah; Conwell, Darwin L; Paulo, Joao A

    2012-01-01

    Background. Differentiating branch duct from mixed intraductal papillary mucinous neoplasm (BD-IPMN) is problematic, but clinically important as mixed IPMNs are managed surgically, while some BD-IPMN may be followed. Inflammatory mediator proteins (IMPs) have been implicated in acute and chronic inflammatory and malignant pancreatic diseases. Aim. To compare IMP profile of pancreatic cyst fluid collected endoscopically from BD-IPMN and mixed IPMN. Methods. Pancreatic cyst fluid from ten patients (5 BD-IPMN and 5 mixed IPMN) was collected by endoscopic ultrasound-guided fine needle aspiration or endoscopic retrograde cholangiopancreatography. Concentrations of 89 IMPs in these samples were determined using a multiplexed bead-based microarray protein assay and compared between BD-IPMN and mixed IPMN. Results. Eighty-six of 89 IMPs were detected in at least one of the 10 samples. Fourteen IMPs were detected only in mixed IPMN, while none were only in BD-IPMN. Of these, TGF-β1 was most prevalent, present in 3 of 5 mixed IPMNs. Seventy-two IMPs were detected in both BD-IPMN and mixed IPMNs. Of these, only G-CSF (P IPMNs. Conclusion. TGF-β1 and G-CSF detected in endoscopically collected pancreatic cyst fluid are potential diagnostic biomarkers capable of distinguishing mixed IPMN from BD-IPMN.

  20. Differentiating Branch Duct and Mixed IPMN in Endoscopically Collected Pancreatic Cyst Fluid via Cytokine Analysis

    Directory of Open Access Journals (Sweden)

    Linda S. Lee

    2012-01-01

    Full Text Available Background. Differentiating branch duct from mixed intraductal papillary mucinous neoplasm (BD-IPMN is problematic, but clinically important as mixed IPMNs are managed surgically, while some BD-IPMN may be followed. Inflammatory mediator proteins (IMPs have been implicated in acute and chronic inflammatory and malignant pancreatic diseases. Aim. To compare IMP profile of pancreatic cyst fluid collected endoscopically from BD-IPMN and mixed IPMN. Methods. Pancreatic cyst fluid from ten patients (5 BD-IPMN and 5 mixed IPMN was collected by endoscopic ultrasound-guided fine needle aspiration or endoscopic retrograde cholangiopancreatography. Concentrations of 89 IMPs in these samples were determined using a multiplexed bead-based microarray protein assay and compared between BD-IPMN and mixed IPMN. Results. Eighty-six of 89 IMPs were detected in at least one of the 10 samples. Fourteen IMPs were detected only in mixed IPMN, while none were only in BD-IPMN. Of these, TGF-β1 was most prevalent, present in 3 of 5 mixed IPMNs. Seventy-two IMPs were detected in both BD-IPMN and mixed IPMNs. Of these, only G-CSF (P<0.05 was present in higher concentrations in mixed IPMNs. Conclusion. TGF-β1 and G-CSF detected in endoscopically collected pancreatic cyst fluid are potential diagnostic biomarkers capable of distinguishing mixed IPMN from BD-IPMN.

  1. Thyroid cancer - papillary carcinoma

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/000331.htm Thyroid cancer - papillary carcinoma To use the sharing features on ... the lower neck. Causes About 80% of all thyroid cancers diagnosed in the United States are the papillary ...

  2. Amputation neuroma mimics common hepatic duct carcinoma.

    Science.gov (United States)

    Koike, N; Todoroki, T; Kawamoto, T; Inagawa, S; Yoshida, S; Fukao, K

    2000-01-01

    Most amputation neuromas of the biliary tract occur in the cystic duct stump after cholecystectomy and are asymptomatic. However, when they arise in the main hepatic duct and are associated with obstructive jaundice, it is difficult to distinguish them from carcinoma. We describe a case in which preoperative differential diagnosis was difficult. A 60-year-old man was admitted to the Institute of Clinical Medicine, University of Tsukuba, with a chief complaint of jaundice. Cholangiography showed an irregularly elevated nodular lesion on the lateral wall of the common hepatic duct and multiple floating stones in the choledochus. Ultrasonography and computed tomography revealed one-sided regional thickening of the common hepatic duct associated with dilatation of the intrahepatic and extrahepatic bile ducts. Carbohydrate antigen 19-9 level was markedly elevated to 11,200 IU/mL in the bile juice, but was only 38 IU/mL in the serum, below the limit of abnormality. Cholangioscopy showed papillary tumor with coarse granular surface mimicking papillary carcinoma, but biopsy revealed no malignancy. The patient underwent hepaticocholedochus resection. Although the macroscopic finding from the surgical specimens was papillary carcinoma of the common hepatic duct penetrating to the hepatoduodenal ligament, histopathological examination revealed an amputation neuroma consisting of hypertrophic nerve tissues and giant cells containing foreign bodies, probably as a consequence of a previous cholecystectomy. The postoperative course was uneventful and the patient has been living well for the 5 years since the resection.

  3. Case series: imaging features of intraductal papillomas in patients presenting as nipple discharge

    Directory of Open Access Journals (Sweden)

    Vedita Dhull

    2016-07-01

    Results: 7/25 patients had intraductal papilloma as proven by surgery/ FNA. Mass lesion was identified in all 7 cases on sonography and MRI while it was detected in only 3 cases on mammography. Dilated ducts were demonstated in all 7 cases on sonography, in 6 cases on CE- MRI and 5 cases on mammography respectively. Conclusions: Mammography has limited diagnostic accuracy in patients with unexplained nipple discharge and MRI should be considered the diagnostic technique of choice in this clinical setting, with relevant corresponding area focussed on sonography. [Int J Res Med Sci 2016; 4(7.000: 2878-2882

  4. Diagnostic and therapeutic direct peroral cholangioscopy using an intraductal anchoring balloon

    Institute of Scientific and Technical Information of China (English)

    Mansour A Parsi; Tyler Stevens; John J Vargo

    2012-01-01

    AIM:To report our experience using a recently introduced anchoring balloon for diagnostic and therapeutic direct peroral cholangioscopy (DPOC).METHODS:Consecutive patients referred for diagnostic or therapeutic peroral cholangioscopy were evaluated in a prospective cohort study.The patients underwent DPOC using an intraductal anchoring balloon,which was recently introduced to allow consistent access to the biliary tree with an ultraslim upper endoscope.The device was later voluntarily withdrawn from the market by the manufacturer.RESULTS:Fourteen patients underwent DPOC using the anchoring balloon.Biliary access with an ultraslim upper endoscope was accomplished in all 14 patients.In 12 (86%) patients,ductal access required sphincteroplasty with a 10-mm dilating balloon.Intraductal placement of the ultraslim upper endoscope allowed satisfactory visualization of the biliary mucosa to the level of the confluence of the right and left hepatic ducts in 13 of 14 patients (93%).Therapeutic interventions by DPOC were successfully completed in all five attempted cases (intraductal biopsy in one and DPOC guided laser lithotripsy in four).Adverse events occurred in a patient on immunosuppressive therapy who developed an intrahepatic biloma at the site of the anchoring balloon.This required hospitalization and antibiotics.Repeat endoscopic retrograde cholangiopancreatography 8 wk after the index procedure showed resolution of the biloma.CONCLUSION:Use of this anchoring balloon allowed consistent access to the biliary tree for performance of diagnostic and therapeutic DPOC distal to the biliary bifurcation.

  5. 乳腺导管内隆起性病变的临床分析%Clinical analysis of breast intraductal eminence lesions

    Institute of Scientific and Technical Information of China (English)

    牛献勇

    2014-01-01

    目的 总结乳腺导管内隆起性病变在乳腺导管镜检查时的表现类型,指导临床对病变性质的判定.方法 对北京市大兴区妇幼保健院2009年1月至2013年1月的382例乳头溢液患者行乳腺导管镜检查,发现乳腺导管镜内隆起性病变153例(40.9%),均进行手术,分析乳腺导管镜诊断与病理组织学诊断的相互关系.结果 153例隆起性病变的镜下诊断:乳管内乳头状瘤124例,乳管内乳头状瘤病11例,乳腺导管内癌1例,浆细胞性乳腺炎伴局部增生17例.术后病理诊断:乳管内乳头状瘤122例,乳管内乳头状瘤恶变1例,乳管内乳头状瘤病11例;乳腺导管内癌1例,局部导管上皮增生3例(其中不典型增生1例),浆细胞性乳腺炎伴局部导管上皮增生15例.镜下诊断符合率:乳管内乳头状瘤98.4%;乳管内乳头状瘤病100.0%;乳管内癌100.0%;浆细胞性乳腺炎伴局部导管增生88.2%.结论 乳腺导管镜对乳管内隆起胜病变大部分能做出正确诊断,但应警惕癌前病变及恶变的误诊和漏诊.%Objective To observe the types of breast intraductal eminence lesions.Methods Three hundred and eighty-two patients with no breast milk sample of nipple discharge were examined using ductoscopy in Daxing materal and child health hospital in Beijing city from January 2009 to January 2013.Of them 153 patients were found suffering intraductal eminence lesions (40.9% of nipple discharge) and were treated with operation.Results The ductoscopy diagnosis of 153 patients with eminence lesions was as follows:124 cases of intraductal papilloma,11 cases of intraductal papillomatosis,1 case of intraductal carcinoma; 17 cases ofplasma cell mastitis with local hyperplasia.Post operation pathological diagnosis was as follows:122 cases of intraductal papilloma,1 case of intraductal papilloma with malignant transformation,11 cases of intraductal papillomatosis,1 case of intraductal carcinoma,3 cases of local duct

  6. Acute Cholangitis following Intraductal Migration of Surgical Clips 10 Years after Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Natalie E. Cookson

    2015-01-01

    Full Text Available Background. Laparoscopic cholecystectomy represents the gold standard approach for treatment of symptomatic gallstones. Surgery-associated complications include bleeding, bile duct injury, and retained stones. Migration of surgical clips after cholecystectomy is a rare complication and may result in gallstone formation “clip cholelithiasis”. Case Report. We report a case of a 55-year-old female patient who presented with right upper quadrant pain and severe sepsis having undergone an uncomplicated laparoscopic cholecystectomy 10 years earlier. Computed tomography (CT imaging revealed hyperdense material in the common bile duct (CBD compatible with retained calculus. Endoscopic retrograde cholangiopancreatography (ERCP revealed appearances in keeping with a migrated surgical clip within the CBD. Balloon trawl successfully extracted this, alleviating the patient’s jaundice and sepsis. Conclusion. Intraductal clip migration is a rarely encountered complication after laparoscopic cholecystectomy which may lead to choledocholithiasis. Appropriate management requires timely identification and ERCP.

  7. Intraductal delivery of adenoviruses targets pancreatic tumors in transgenic Ela-myc mice and orthotopic xenografts.

    Science.gov (United States)

    José, Anabel; Sobrevals, Luciano; Miguel Camacho-Sánchez, Juan; Huch, Meritxell; Andreu, Núria; Ayuso, Eduard; Navarro, Pilar; Alemany, Ramon; Fillat, Cristina

    2013-01-01

    Gene-based anticancer therapies delivered by adenoviruses are limited by the poor viral distribution into the tumor. In the current work we have explored the feasibility of targeting pancreatic tumors through a loco-regional route. We have taken advantage of the ductal network in the pancreas to retrogradelly inject adenoviruses through the common bile duct in two different mouse models of pancreatic carcinogenesis: The transgenic Ela-myc mice that develop mixed neoplasms displaying both acinar-like and duct-like neoplastic cells affecting the whole pancreas; and mice bearing PANC-1 and BxPC-3 orthotopic xenografts that constitute a model of localized human neoplastic tumors. We studied tumor targeting and the anticancer effects of newly thymidine kinase-engineered adenoviruses both in vitro and in vivo, and conducted comparative studies between intraductal or intravenous administration. Our data indicate that the intraductal delivery of adenovirus efficiently targets pancreatic tumors in the two mouse models. The in vivo application of AduPARTKT plus ganciclovir (GCV) treatment induced tumor regression in Ela-myc mice. Moreover, the intraductal injection of ICOVIR15-TKT oncolytic adenoviruses significantly improved mean survival of mice bearing PANC-1 and BxPC-3 pancreatic xenografts from 30 to 52 days and from 20 to 68 days respectively (p less than 0.0001) when combined with GCV. Of notice, both AduPARTKT and ICOVIR15-TKT antitumoral responses were stronger by ductal viral application than intravenously, in line with the 38-fold increase in pancreas transduction observed upon ductal administration. In summary our data show that cytotoxic adenoviruses retrogradelly injected to the pancreas can be a feasible approach to treat localized pancreatic tumors.

  8. Differential diagnosis of microcalcification. Micro-cyst (blunt duct) adenosis

    Energy Technology Data Exchange (ETDEWEB)

    Lanyi, M.; Citoler, P.

    1981-03-01

    One hundred and thirty-five operations were carried out because of a finding of microcalcification in the breast. In 10% of these, the calcification was shown histologically to be within foci of micro-cyst (blunt duct) adenosis. Analysis of the radiographic appearances of the microcalcification revealed a characteristic radiographic pattern. The differential diagnosis of groups of calcification in intraduct carcinomas and in benign lesions is discussed.

  9. High resolution 3D MRI of mouse mammary glands with intra-ductal injection of contrast media.

    Science.gov (United States)

    Markiewicz, Erica; Fan, Xiaobing; Mustafi, Devkumar; Zamora, Marta; Roman, Brian B; Jansen, Sanaz A; Macleod, Kay; Conzen, Suzanne D; Karczmar, Gregory S

    2015-01-01

    The purpose of this study was to use high resolution three-dimensional (3D) magnetic resonance imaging (MRI) to study mouse mammary gland ductal architecture based on intra-ductal injection of contrast agents. Female FVB/N mice age 12-20 weeks (n=12), were used in this study. A 34G, 45° tip Hamilton needle with a 25μL Hamilton syringe was inserted into the tip of the nipple. Approximately 20-25μL of a Gadodiamide/Trypan blue/saline solution was injected slowly over one minute into the nipple and duct. To prevent washout of contrast media from ducts due to perfusion, and maximize the conspicuity of ducts on MRI, mice were sacrificed one minute after injection. High resolution 3D T1-weighted images were acquired on a 9.4T Bruker scanner after sacrifice to eliminate motion artifacts and reduce contrast media leakage from ducts. Trypan blue staining was well distributed throughout the ductal tree. MRI showed the mammary gland ductal structure clearly. In spoiled gradient echo T1-weighted images, the signal-to-noise ratio of regions identified as enhancing mammary ducts following contrast injection was significantly higher than that of muscle (pcontrast media (pcontrast agents to measure metabolism or target receptors in normal ducts and ducts with in situ cancers.

  10. The Role of Breast Fiberoptic Duct Endoscopy in the Diagnosis of 105 Breast Diseases with Abnormal Nipple Discharge%乳管镜在105例伴乳头溢液性疾病中的治疗价值分析

    Institute of Scientific and Technical Information of China (English)

    周树伟; 苏蓓蓓

    2015-01-01

    目的:探讨乳管镜在乳头溢液疾病中的价值。方法乳头溢液患者105例,自溢液管插入纤维乳管镜观察溢液乳管及其分支的结构及内容物状况,发现并确定病灶位置。结果乳管镜插入成功率100%,镜下发现乳管内肿物68例(64.76%);诊断为乳头状瘤53例,乳头状瘤病5例,乳腺导管癌7例(其中似原位导管癌3例),乳管扩张、炎症27例。手术92例,经病理证实对乳腺癌诊断的灵敏度87.5%(7/8),特异度98.82%(84/85)。结论乳管镜检查为乳头溢液病因诊断的首选方法,对导管癌及癌前病变的早期发现有重要价值。%Objective To evaluate the value of ifberoptic ductoscopy in diagnosis of nipple discharge diseases.Methods 105 patients with nipple discharge liquid were examined by ifberoptic ductoscopy, to investigate concerned duct with its branch and deifne location and extent of intraductal leisions.Results Breast duct endoscope insertion success rate 100%, endoscopic ifndings of intraductal tumor in 68 cases(64.76%); diagnosis of papillary tumor in 53 cases, 5 cases of papillary hyperplasia, 7 cases of ductal carcinoma of the breast(which resembles the ductal carcinoma in situ in 3 cases), inlfammation in 27 cases, breast duct dilatation. Operation in 92 cases conifrmed by pathology, 87.5% sensitivity in the diagnosis of breast cancer(7/8), a speciifcity of 98.82%(84/85). Conclusion Fiberoptic ductoscopy overlfow the preferred method for liquid etiological diagnosis of nipple, on early ductal carcinoma and precancerous lesions was found to have an important value.

  11. Autoimmune Pancreatitis Presenting a Short Narrowing of Main Pancreatic Duct with Subsequent Progression to Diffuse Pancreatic Enlargement over 24 Months; Natural History of Autoimmune Pancreatitis

    Directory of Open Access Journals (Sweden)

    Shuichiro Umemura

    2014-05-01

    Full Text Available Context Initial pancreatogram and natural history of autoimmune pancreatitis (AIP have not been clarified, and there were few recent studies concerning the association between AIP and intraductal papillary mucinous neoplasm (IPMN. Case report We report an 81-yearold man with AIP associated with IPMN. Although the initial pancreatogram was normal, a short narrowing of the main pancreatic duct (MPD appeared during a follow-up for IPMN after 6 months, which was highly suggestive of pancreatic cancer. A narrowing of the MPD extended after 15 months, and this progressed to diffuse narrowing of the MPD with an elevation in the serum IgG4 levels after 24 months. Finally, the patient was diagnosed with diffuse-type AIP, according to the Japanese diagnostic criteria 2011 and the International Consensus Diagnostic Criteria. Considering the natural history of AIP, this marked change of the MPD is indicative of this condition. Conclusion Wereport a case of AIP presenting with a short narrowing of the MPD with subsequent progression to diffuse pancreatic enlargement during a follow-up for IPMN.

  12. Association of Chronic Pancreatitis and Malignant Main Duct IPMN: A Rare but Difficult Clinical Problem.

    Science.gov (United States)

    Berger, Zoltán; De La Fuente, Hernán; Meneses, Manuel; Matamala, Fernanda; Sepúlveda, Makarena; Rojas, Claudia

    2017-01-01

    We report the case of a 70-year-old woman who consulted for recurrent short episodes of mild-to-moderate abdominal pain. Dilated main pancreatic duct was seen on CAT scan and magnetic resonance, with multiple calcifications and intraductal stones, typical in CP. However, for a more pronounced cystic dilatation in the pancreatic head, we could not exclude the coexistence of a main duct IPMN. ERCP was performed, with pancreatic sphincterotomy and extraction of pancreatic stones, but, at the same time, mucin extrusion was seen from the dilated duct through the papilla. Pancreatoduodenectomy was performed. Surgery and histology confirmed malignant IPMN with the typical image of chronic pancreatitis and intraductal stones in the vicinity. The patient is doing well 4 years after the surgery, without recurrence of the malignant disease, with changes of chronic pancreatitis in the pancreatic remnant. This paper discusses the possible relationships between the two entities and emphasizes the need of differential diagnosis.

  13. Association of Chronic Pancreatitis and Malignant Main Duct IPMN: A Rare but Difficult Clinical Problem

    Directory of Open Access Journals (Sweden)

    Zoltán Berger

    2017-01-01

    Full Text Available We report the case of a 70-year-old woman who consulted for recurrent short episodes of mild-to-moderate abdominal pain. Dilated main pancreatic duct was seen on CAT scan and magnetic resonance, with multiple calcifications and intraductal stones, typical in CP. However, for a more pronounced cystic dilatation in the pancreatic head, we could not exclude the coexistence of a main duct IPMN. ERCP was performed, with pancreatic sphincterotomy and extraction of pancreatic stones, but, at the same time, mucin extrusion was seen from the dilated duct through the papilla. Pancreatoduodenectomy was performed. Surgery and histology confirmed malignant IPMN with the typical image of chronic pancreatitis and intraductal stones in the vicinity. The patient is doing well 4 years after the surgery, without recurrence of the malignant disease, with changes of chronic pancreatitis in the pancreatic remnant. This paper discusses the possible relationships between the two entities and emphasizes the need of differential diagnosis.

  14. Renal papillary necrosis

    Directory of Open Access Journals (Sweden)

    Stephen A. Geller

    2013-12-01

    Full Text Available In 1877, Dr. Nikolaus Friedreich (1825-1882; student of Virchow who became Professor of Pathology at Heidelberg and who also described Friedreich’s ataxia first described renal papillary necrosis (RPN in patients with prostatic hypertrophy and secondary hydronephrosis. Thereafter in 1937, Froboese and Günther emphasized the association of this entity with diabetes mellitus. These authors also observed renal papillary necrosis in cases of urinary tract obstruction even in the absence of diabetes mellitus.

  15. Papillary thyroid carcinoma

    DEFF Research Database (Denmark)

    Godballe, C; Asschenfeldt, P; Sørensen, J A;

    1994-01-01

    The age influence on the prognosis of papillary thyroid carcinoma was analyzed in a group of 67 patients. A marked decline in cause-specific survival was found for patients older than 60 years of age at the time of diagnosis. In order to find a tumor-biological explanation of the prognostic...... invasion and distant metastases. The results indicate that 60 years of age the time of diagnosis may be the "prognostic break-point" for papillary thyroid carcinoma....

  16. Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Mizandari, Malkhaz [Tbilisi State Medical University, Department of Radiology (Georgia); Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk; Xi Feng [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Ao Guokun [The 309 Hospital of Chinese PLA, Department of Radiology (China); Kyriakides, Charis [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom); Dickinson, Robert [Imperial College London, Department of Bioengineering (United Kingdom); Nicholls, Joanna; Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Imperial College, London, Hammersmith Hospital Campus, Department of Surgery (United Kingdom)

    2013-06-15

    Purpose. Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction. Methods. Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted. Results. Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14-260) days and median stent patency of 84.5 (range 14-260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14-260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38-210) days. Conclusions. In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.

  17. [Experimental microendoscopy of the milk duct system (ductoscopy)].

    Science.gov (United States)

    Rimbach, S; Wallwiener, D; Fein, A; von Fournier, D; Bastert, G

    1995-01-01

    According to recent reports, the microendoscopic lactiferous duct investigation (ductoscopy) could improve diagnosis in case of pathological nipple discharge. However, the description of a reproducible and reliable methodology, suitable for thorough evaluation of the lactiferous duct is missing so far. Therefore, the pressure study developed a procedure, that may serve now as an experimental basis for further clinical evaluation. Access to the mamillary duct is primarily gained using atraumatic flexible teflon catheters. Corresponding to the diameter of the duct, either a semirigid 0.87 mm fiberendoscope can be successfully introduced via a 1.2 mm catheter, or a flexible 0.50 mm fiberendoscope via a 1.0 mm catheter. A controlled distension using few milliliters of ringer's lactate is the prerequisite for clear visualization of the intraductal space and protection against iatrogenic wall lesions. Metal microtocars are available as prototypes. They carry a somewhat higher risk to perforate, but are advantageous when pointing at an intraductal structure and using the microtrocar as a mark for microdochectomy.

  18. Intraductal papilloma in an axillary lymph node of a patient with human immunodeficiency virus: a case report and review of the literature.

    Science.gov (United States)

    Cottom, Hannah; Rengabashyam, Bhavani; Turton, Philip E; Shaaban, Abeer M

    2014-05-23

    Inclusions of ectopic breast tissue in axillary lymph nodes are reported very infrequently and typically are only identified microscopically as an incidental finding. Furthermore the development of a benign proliferative lesion in the form of an intraductal papilloma from intranodal ectopic breast tissue is an extremely rare phenomenon with only three previous cases reported. This report describes an unusual and rare case of an intraductal papilloma arising in an axillary lymph node of a patient known to have the human immunodeficiency virus. A 40-year-old Black African woman underwent excision of an enlarged palpable axillary lymph node. In the preceding 7 years she had received at least six separate surgical excisions to her ipsilateral breast for papillomatosis. The last surgical intervention was performed 1 year prior to presentation with an enlarged axillary lymph node. Histological examination of her axillary lymph node revealed a papillomatous proliferative epithelial lesion within an apparent encompassing duct, resembling a mammary intraductal papilloma. In the surrounding lymphoid tissue small groups of duct-like structures were additionally noted. Immunostaining with a panel of myoepithelial markers in conjunction with oestrogen receptor produced a mixed heterogeneous staining pattern in both the papillomatous lesion and the peripheral duct-like structures. This confirmed the diagnosis of a benign intraductal papilloma within an axillary lymph node, considered to have arisen from ectopic breast tissue. This case demonstrates that intranodal ectopic breast tissue has the potential to undergo benign proliferative change albeit extremely rarely. Therefore this possibility must be considered to ensure the correct diagnosis is made. In addition, to the best of our knowledge, this is the first case report which has described recurrent intraductal papillomas and the subsequent development of an intraductal papilloma within an ipsilateral axillary lymph node, in

  19. A nomogram based on mammary ductoscopic indicators for evaluating the risk of breast cancer in intraductal neoplasms with nipple discharge.

    Science.gov (United States)

    Lian, Zhen-Qiang; Wang, Qi; Zhang, An-Qin; Zhang, Jiang-Yu; Han, Xiao-Rong; Yu, Hai-Yun; Xie, Si-Mei

    2015-04-01

    Mammary ductoscopy (MD) is commonly used to detect intraductal lesions associated with nipple discharge. This study investigated the relationships between ductoscopic image-based indicators and breast cancer risk, and developed a nomogram for evaluating breast cancer risk in intraductal neoplasms with nipple discharge. A total of 879 consecutive inpatients (916 breasts) with nipple discharge who underwent selective duct excision for intraductal neoplasms detected by MD from June 2008 to April 2014 were analyzed retrospectively. A nomogram was developed using a multivariate logistic regression model based on data from a training set (687 cases) and validated in an independent validation set (229 cases). A Youden-derived cut-off value was assigned to the nomogram for the diagnosis of breast cancer. Color of discharge, location, appearance, and surface of neoplasm, and morphology of ductal wall were independent predictors for breast cancer in multivariate logistic regression analysis. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.36. Area under the curve values of 0.812 (95 % confidence interval (CI) 0.763-0.860) and 0.738 (95 % CI 0.635-0.841) was obtained in the training and validation sets, respectively. The accuracies of the nomogram for breast cancer diagnosis were 71.2 % in the training set and 75.5 % in the validation set. We developed a nomogram for evaluating breast cancer risk in intraductal neoplasms with nipple discharge based on MD image findings. This model may aid individual risk assessment and guide treatment in clinical practice.

  20. Efficacy and safety of endoscopic papillary balloon dilation for the removal of bile duct stones: Data from a "real-life" multicenter study on Dilation-Assisted Stone Extraction.

    Science.gov (United States)

    Di Mitri, Roberto; Mocciaro, Filippo; Pallio, Socrate; Pecoraro, Giulia Maria; Tortora, Andrea; Zulli, Claudio; Attardo, Simona; Maurano, Attilio

    2016-10-16

    To report data on Dilation-Assisted Stone Extraction (DASE) use in clinical practice and its efficacy and safety trough three Italian referral centers for biliopancreatic diseases treatment. From January 2011 to December 2015 we collected data on 120 patients treated with DASE. Technical success was obtained when the endoscopist was able to place the balloon trough the papilla inflating the balloon until the final diameter for an adequate time (at least 30 s). Clinical success was obtained after complete stone removal (no remaining stones were visible at the cholangiogram). Forty-nine male (40.8%) and 71 female (59%) were enrolled. The mean age was 67.8 years ± 15.7. The mean common bile duct (CBD) dilation was 19.2 mm ± 3.9 and the mean size of stones 15.8 ± 2.9. DASE was applied as first approach in 38% (62% after initial failure of stones extraction). Technical and clinical success was of 91% and 87% respectively. In those in which DASE failed alternative treatment were adopted. After DASE 18% of patients experienced a complication (bleeding 9%, pancreatitis 8%, perforation 0.8%). At univariable analysis, elective endoscopic retrograde cholangiopancreatography (P = 0.031), DASE as first approach (P = 0.032), and cannulation of major papilla followed by guidewire insertion (P = 0.004) were related to low risk of complications. Pre-cut was related to an increased risk of complications (P = 0.01). DASE allowed a higher first-session success rate and can be consider a valid alternative to endoscopic sphincterotomy not only for bigger CBD stones.

  1. Efficacy and safety of endoscopic papillary balloon dilation for the removal of bile duct stones: Data from a “real-life” multicenter study on Dilation-Assisted Stone Extraction

    Science.gov (United States)

    Di Mitri, Roberto; Mocciaro, Filippo; Pallio, Socrate; Pecoraro, Giulia Maria; Tortora, Andrea; Zulli, Claudio; Attardo, Simona; Maurano, Attilio

    2016-01-01

    AIM To report data on Dilation-Assisted Stone Extraction (DASE) use in clinical practice and its efficacy and safety trough three Italian referral centers for biliopancreatic diseases treatment. METHODS From January 2011 to December 2015 we collected data on 120 patients treated with DASE. Technical success was obtained when the endoscopist was able to place the balloon trough the papilla inflating the balloon until the final diameter for an adequate time (at least 30 s). Clinical success was obtained after complete stone removal (no remaining stones were visible at the cholangiogram). RESULTS Forty-nine male (40.8%) and 71 female (59%) were enrolled. The mean age was 67.8 years ± 15.7. The mean common bile duct (CBD) dilation was 19.2 mm ± 3.9 and the mean size of stones 15.8 ± 2.9. DASE was applied as first approach in 38% (62% after initial failure of stones extraction). Technical and clinical success was of 91% and 87% respectively. In those in which DASE failed alternative treatment were adopted. After DASE 18% of patients experienced a complication (bleeding 9%, pancreatitis 8%, perforation 0.8%). At univariable analysis, elective endoscopic retrograde cholangiopancreatography (P = 0.031), DASE as first approach (P = 0.032), and cannulation of major papilla followed by guidewire insertion (P = 0.004) were related to low risk of complications. Pre-cut was related to an increased risk of complications (P = 0.01). CONCLUSION DASE allowed a higher first-session success rate and can be consider a valid alternative to endoscopic sphincterotomy not only for bigger CBD stones. PMID:27803771

  2. European experts consensus statement on cystic tumours of the pancreas.

    Science.gov (United States)

    Del Chiaro, Marco; Verbeke, Caroline; Salvia, Roberto; Klöppel, Gunter; Werner, Jens; McKay, Colin; Friess, Helmut; Manfredi, Riccardo; Van Cutsem, Eric; Löhr, Matthias; Segersvärd, Ralf

    2013-09-01

    Cystic lesions of the pancreas are increasingly recognized. While some lesions show benign behaviour (serous cystic neoplasm), others have an unequivocal malignant potential (mucinous cystic neoplasm, branch- and main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm). European expert pancreatologists provide updated recommendations: diagnostic computerized tomography and/or magnetic resonance imaging are indicated in all patients with cystic lesion of the pancreas. Endoscopic ultrasound with cyst fluid analysis may be used but there is no evidence to suggest this as a routine diagnostic method. The role of pancreatoscopy remains to be established. Resection should be considered in all symptomatic lesions, in mucinous cystic neoplasm, main duct intraductal papillary mucinous neoplasm and solid pseudo-papillary neoplasm as well as in branch duct intraductal papillary mucinous neoplasm with mural nodules, dilated main pancreatic duct >6mm and possibly if rapidly increasing in size. An oncological partial resection should be performed in main duct intraductal papillary mucinous neoplasm and in lesions with a suspicion of malignancy, otherwise organ preserving procedures may be considered. Frozen section of the transection margin in intraductal papillary mucinous neoplasm is suggested. Follow up after resection is recommended for intraductal papillary mucinous neoplasm, solid pseudo-papillary neoplasm and invasive cancer.

  3. Endoscopic pancreatic duct stent placement for inflammatory pancreatic diseases

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    The role of endoscopic therapy in the management of pancreatic diseases is continuously evolving; at present most pathological conditions of the pancreas are successfully treated by endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS),or both. Endoscopic placement of stents has played and still plays a major role in the treatment of chronic pancreatitis, pseudocysts, pancreas divisum, main pancreatic duct injuries, pancreatic fistulae, complications of acute pancreatitis, recurrent idiopathic pancreatitis,and in the prevention of post-ERCP pancreatitis. These stents are currently routinely placed to reduce intraductal hypertension, bypass obstructing stones, restore lumen patency in cases with dominant, symptomatic strictures,seal main pancreatic duct disruption, drain pseudocysts or fluid collections, treat symptomatic major or minor papilla sphincter stenosis, and prevent procedure-induced acute pancreatitis. The present review aims at updating and discussing techniques, indications, and results of endoscopic pancreatic duct stent placement in acute and chronic inflammatory diseases of the pancreas.

  4. Diagnosis and treatment value of endoscopic retrograde cholangiopancreatography for intraductal papillary mucinous neoplasms of biliary and pancreatic ducts%内镜下胰胆管逆行造影术在胆胰管导管内乳头状黏液性瘤中的应用价值

    Institute of Scientific and Technical Information of China (English)

    郑金辉; 何利平; 陈勇; 王丽珍; 高丽影; 张咩仔

    2015-01-01

    目的 探讨内镜下胰胆管逆行造影术(ERCP)对胆胰管导管内乳头状黏液瘤(IPMN)的诊治作用.方法 回顾性分析经ERCP诊治的9例IPMN,分析临床表现、实验室检查、影像学表现等方面特点,经ERCP结合超声内镜作出初步诊断,采用超细内镜进入囊腔活检,以求术后病理确诊,后根据具体病情予相应内镜处理.结果 5例胆管导管内乳头状黏液瘤(IPMNs-B),4例胰管导管内乳头状黏液瘤(IPMNs-P),均无特异性的临床表现和实验室检查;超声、CT、MRI主要表现为胆胰管扩张,仅1例IPMNs-P胰头部见囊实性团块、壁结节及主胰管明显扩张(5.5 cm);ERCP均显示乳头开口扩张,胶冻样黏液流出,胰胆管不同程度扩张.9例行ERCP抽吸黏液后,1例IPMNs-B同时置入胆管及胰管支架,3例IPMNs-P置入胰管支架,1例放置胆道金属支架;术后1例出现轻症胰腺炎(11.1%,1/9),3例出现淀粉酶升高而无症状(33.3%,3/9),无出血或穿孔等并发症发生.结论 ERCP是一种安全可靠的诊断方法选择,对IPMN的诊治具有重要作用.结合病理诊断,可为外科术前提供明确的诊断和可靠的证据.

  5. [Morphologic, morphometric and immunohistochemical studies on pancreatic intraductal hyperplasia and infiltrating carcinoma].

    Science.gov (United States)

    Tomaszewska, R

    1999-01-01

    , attempting to correlate this expression with the p53 gene mutations. The results of our study indicate that intraductal pancreatic proliferations form a group of heterogeneous lesions possessing different proliferative activity of cells, karyometric features and HER-2/neu, bcl-2 and p53 genes expression. The precancerous lesion in the pancreas may be atypical papillary hyperplasia, which is similar to intraductal carcinoma with respect to the proliferative activity of cells and HER-2/neu, bcl-2 and p53 expression. Pancreatic carcinoma is characterised by high p53, CD44s and CD44v6 expression and low bcl-2 expression. CD44 and p53 genes expression is independent and between bcl-2 and p53 expression there is an inverse correlation. The p53 and CD44v6 expression is the higher the lower is the histological grade of the pancreatic carcinoma.

  6. Effect of portal hypertension and duct ligature on pancreatic fluid pressures in cats

    DEFF Research Database (Denmark)

    Ebbehøj, N; Borly, L; Heyeraas, K J

    1990-01-01

    In two groups of cats recordings were performed, during laparotomy, of pancreatic tissue fluid pressure measured by a needle technique, interstitial fluid pressure measured by micropipette technique, pancreatic intraductal pressure, and portal vein pressure. In one group of cats the pressures were...... measured before and after acutely induced portal hypertension; in the other group of cats the pressures were measured after an overnight ligature of the pancreatic main duct. At rest the needle pressure was equal to duct pressure but significantly lower than interstitial fluid pressure and portal pressure....... Acute portal hypertension caused no significant changes in micropipette, needle, or duct pressures. Pancreatic duct ligature increased duct pressure, interstitial fluid pressure, and needle pressure. We conclude that the fluid pressure in the pancreas is probably influenced by the production...

  7. Efficacy analysis of endoscopic sphincterotomy plus endoscopic papillary balloon dilation for remove of common bile duct stons%内镜下乳头小切开联合球囊扩张治疗胆总管结石临床疗效分析

    Institute of Scientific and Technical Information of China (English)

    闫方博; 张健康

    2014-01-01

    Objective To explore the effectiveness and safety of endoscopic sphincterotomy(EST)plus endoscopic pap-illary balloon dilation (EPBD) for the removal of common bile duct stones. Methods One hundred patients who re-ceived endoscopic retrograde pancreatic angiography(ERCP)in the first hospital of shanxi medical university from June 2012 to March 2014 were randomly divided into EST group and ESBD group. ESBD group in advance nipples small in-cision after balloon expansion; EST group used normal operation. The successful rate of stone clear-ance,operation time,the rate of mechanical lithotripsy and related complications were observed.Results After one time,all stones were removed one time from 46 cases(92%) assigned EST and 48 cases(96%) assigned EPBD(P>0.05); Mechanical lithotripsy was used to fragment stones 8 cases(16%) in EST group and 2 cases(4%) in ESBD group(P0.05); Average operation time,respectively (45.3±13.0) min and (30.5±9.2) min(P0.05);使用机械碎石分别有8例(16%)和2例(4%),差异有统计学意义(P0.05);两组平均操作时间分别为(45.3±13.0)min和(30.5±9.2)min,差异有统计学意义(P<0.05)。结论内镜下乳头括<肌小切开联合球囊扩张术取石成功率及术后并发症发生率与常规括<肌切开术相当,但平均操作时间及使用机械碎石的机率与EST相比较低,是治疗胆总管结石安全、有效的方法。

  8. Biomarker validation for intraductal papillary mucinous neoplasms of the pancreas | Division of Cancer Prevention

    Science.gov (United States)

    DESCRIPTION (provided by applicant): A critical component to successful cancer screening is the identification of a lesion for which intervention will result in prolonged survival or cure.The five-year survival of patients with resected stage IA pancreas cancer (the earliest identifiable lesion and |

  9. Pancreatic Cysts

    Science.gov (United States)

    ... be cancerous when found. Intraductal papillary mucinous neoplasm (IPMN) is a growth in the main pancreatic duct or one of its side branches. IPMN may be precancerous or cancerous. It occurs most ...

  10. Mammary Duct Ectasia

    Science.gov (United States)

    ... tenderness or inflammation of the clogged duct (periductal mastitis). Mammary duct ectasia most often occurs in women ... that's turned inward (inverted) A bacterial infection called mastitis also may develop in the affected milk duct, ...

  11. [Primary carcinoma of the thyroid growing in thyroglossal duct cyst: presentation of two cases].

    Science.gov (United States)

    Godlewska, Paulina; Bruszewska, Elzbieta; Kozłowicz-Gudzińska, Izabella; Prokurat, Andrzej I; Chrupek, Małgorzata; Zegadło-Mylik, Maria A; Kluge, Przemysław

    2007-01-01

    Thyroglossal duct remnants (TGDR), most often cysts, are the most common type of developmental abnormalities of the thyroid gland. In about 1 to 2% of TGDR neoplastic transformation occurs. Papillary carcinoma of the thyroid may be encountered in over 90% of such cases. Two cases of primary papillary carcinoma of the thyroid in TGDR in young girls are presented. The diagnostic and therapeutic problems are shared, and up-to-date management guidelines in similar cases are discussed.

  12. Effect of portal hypertension and duct ligature on pancreatic fluid pressures in cats

    DEFF Research Database (Denmark)

    Ebbehøj, N; Borly, L; Heyeraas, K J

    1990-01-01

    In two groups of cats recordings were performed, during laparotomy, of pancreatic tissue fluid pressure measured by a needle technique, interstitial fluid pressure measured by micropipette technique, pancreatic intraductal pressure, and portal vein pressure. In one group of cats the pressures were...... measured before and after acutely induced portal hypertension; in the other group of cats the pressures were measured after an overnight ligature of the pancreatic main duct. At rest the needle pressure was equal to duct pressure but significantly lower than interstitial fluid pressure and portal pressure...

  13. Can Analgesic-abuse Nephropathy is a Fertile Groundfor for Rare Collecting Duct (Bellini Duct) Renal Cell Carcinoma or Merely a Coincidence?

    OpenAIRE

    Jhorawat, R.; Beniwal, P.; Malhotra, V.

    2016-01-01

    Nonsteroid antiinflammatory drugs have been implicated as nephrotoxic drugs, causing both acute and chronic adverse effects that range from reversible ischemia to chronic kidney disease and urothelial tumors to renal cell carcinoma specially papillary subtype. We report one case of collecting duct (Bellini duct) renal cell carcinoma in patient with analgesic-abuse nephropathy. This young individual was suffering from ankylosing spondylitis since the age of 16 years and was consuming diclofena...

  14. Can analgesic-abuse nephropathy is a fertile groundfor rare collecting duct (bellini duct) renal cell carcinoma or merely a coincidence?

    OpenAIRE

    Jhorawat, R.; Beniwal, P.; Malhotra, V.

    2016-01-01

    Nonsteroid antiinflammatory drugs have been implicated as nephrotoxic drugs, causing both acute and chronic adverse effects that range from reversible ischemia to chronic kidney disease and urothelial tumors to renal cell carcinoma specially papillary subtype. We report one case of collecting duct (Bellini duct) renal cell carcinoma in patient with analgesic-abuse nephropathy. This young individual was suffering from ankylosing spondylitis since the age of 16 years and was consuming diclofena...

  15. Ultrasonographic findings of thyroglossal duct papillary carcinoma: A case report

    Directory of Open Access Journals (Sweden)

    Chonticha Srivanitchapoom

    2017-01-01

    Conclusion: Ultrasound and FNAB of the TGDC, thyroid gland and cervical lymph nodes are the useful preoperative evaluations leading to the accurate diagnosis. The definitive treatment is Sistrunk’s operation with the possible addition of total thyroidectomy and neck dissection when indicated.

  16. Diagnosis and treatment of thyroglossal duct carcinoma: Report of three cases with review of literatures

    Institute of Scientific and Technical Information of China (English)

    Zhipeng SUN; Chuanbin GUO; Guangyan YU; Yi ZHAN; Yan CHEN; Yan GAO

    2008-01-01

    Thyroglossal duct carcinoma, which is usually diagnosed postoperatively, is a rare malignant tumor arising in the thyroglossal duct cyst. The definitive diag-nosis can be made only after microscopic examination. We retrospectively reviewed three cases of thyroglossal duct carcinoma diagnosed in Peking University School and Hospital of Stomatology from January 1986 to August 2006. Clinical and pathological features were investigated and the optimal treatment protocol was proposed. The constituent ratio of thyroglossal duct car-cinoma among surgically excised thyroglossal duct lesions was 2.9%. The clinical presentation of thyroglos-sal duct carcinoma was very similar to that of its benign counterpart. Two cases were diagnosed as thyroglossal duct cyst prior to the operation, the remaining one as dermoid cyst. All three cases were diagnosed as papillary carcinoma of thyroid origin after microscopic examina-tion. Primary thyroglossal duct carcinoma should con-form to the following criteria: localization of the carcinoma to a clearly demonstrable thyroglossal duct cyst or tract; clinically or histologically confirmed absence of carcinoma of the thyroid gland. Papillary carcinoma is the most common histological type, which usually develops slowly with an excellent Prognosis. The histological characteristics including: formation of pap-illary structure; nuclear morphological variations such as ground glass nuclei, pseudoinclusions, intranuclear grooves and filaments; concentrically calcified struc-tures termed psammoma bodies which is regarded as a strong indication of papillary carcinoma; and positiv-ity in immunohistological staining for thyroglobin. Sistrunk procedure of excision is the choice for treat-ment. A close follow-up is needed. In the presence of thyroid gland masses or cervical lymphadenopathy, thyroidectomy or neck dissection should be recom-mended. The effect of thyroid suppression therapy and radioactive iodine therapy is not conclusive.

  17. Primary Osteosarcoma of the Breast Arising in an Intraductal Papilloma

    Directory of Open Access Journals (Sweden)

    Khalefa Ali Alghofaily

    2017-01-01

    Full Text Available Introduction. Primary osteosarcoma of the breast is extremely rare, and an osteosarcoma arising from an intraductal papilloma is exceptional. Case Presentation. A 72-year-old Saudi Arabian woman presented with a solid, bone-containing breast mass that was diagnosed as primary osteosarcoma of the breast on biopsy. She had a history of untreated intraductal papilloma. Treatment was completed with a modified mastectomy after excluding extramammary metastases. However, she subsequently developed multiple recurrent lesions at the same site. Conclusion. Primary osteogenic sarcomas of the breast are very rare. Although the main treatment is resection the optimal management remains uncertain and prognosis is poor.

  18. Fiberoptic ductoscopy-guided intraductal biopsy improve the diagnosis of nipple discharge.

    Science.gov (United States)

    Ling, Hong; Liu, Guang-yu; Lu, Jin-song; Love, Susan; Zhang, Jia-xin; Xu, Xiao-li; Xu, Wei-ping; Shen, Kun-wei; Shen, Zhen-zhou; Shao, Zhi-min

    2009-01-01

    Fiberoptic ductoscopy (FDS)-guided intraductal biopsy is a minimally invasive technique developed to obtain pathologic diagnoses for patients with spontaneous nipple discharge. We performed biopsies of 53 intraductal lesions from March 2006 to April 2007 followed by surgical microdochectomy. FDS-guided intraductal biopsy was shown to be a minimally invasive, safe, and convenient technique with a high ability (90.6%) to get adequate samples. Twenty-seven solitary papillomas, 12 multiple intraductal papilloma, five ductal hyperplasia, three ductal carcinoma in situ, and one invasive ductal carcinoma were diagnosed. Compared with conventional microdochectomy, FDS-guided intraductal biopsy can significantly increase the detection rate of solitary papilloma (40.7% versus 92.6%, p < 0.05). It should be a routine procedure after intraductal lesion found by screening FDS. Since it would underestimate all multiple intraductal papilloma and some (50%) cancer, microdochectomy is inevitable if biopsies show atypical ductal hyperplasia.

  19. Percutaneous Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent in Malignant Biliary Obstruction: Feasibility and Early Results

    Energy Technology Data Exchange (ETDEWEB)

    Pai, Madhava, E-mail: madhava.pai@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom); Valek, Vlastimil; Tomas, Andrasina [University Hospital Brno Bohunice, Department of Radiology (Czech Republic); Doros, Attila [Semmelweis University, Radiology Unit, Department of Transplantation and Surgery (Hungary); Quaretti, Pietro [IRCCS Policlinico San Matteo, Department of Radiology (Italy); Golfieri, Rita; Mosconi, Cristina [University of Bologna, Department of Radiology, Policlinico S. Orsola-Malpighi (Italy); Habib, Nagy, E-mail: nagy.habib@imperial.ac.uk [Hammersmith Hospital, Imperial College, HPB Unit, Department of Surgery (United Kingdom)

    2013-07-11

    PurposeThe major complication occurring with biliary stents is stent occlusion, frequently seen because of tumour in-growth, epithelial hyperplasia, and sludge deposits, resulting in recurrent jaundice and cholangitis. We report a prospective study with the results of first in man percutaneous intraductal radiofrequency (RF) ablation to clear the blocked metal stents in patients with malignant biliary obstruction using a novel bipolar RF catheter.MethodsNine patients with malignant biliary obstruction and blocked metal stents were included. These patients underwent intraductal biliary RF ablation through the blocked metal stent following external biliary decompression with an internal–external biliary drainage.ResultsAll nine patients had their stent patency restored successfully without the use of secondary stents. Following this intervention, there was no 30-day mortality, haemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the nine patients, six are alive and three patients are dead with a median follow-up of 122 (range 50–488) days and a median stent patency of 102.5 (range 50–321) days. Six patients had their stent patent at the time of last follow-up or death. Three patients with stent blockage at 321, 290, and 65 days postprocedure underwent percutaneous transhepatic drain insertion and repeat ablation.ConclusionsIn this selective group of patients, it appears that this new approach is safe and feasible. Efficacy remains to be proven in future, randomized, prospective studies.

  20. Solitary eccrine syringofibroadenoma: a case report showing papillary tubular adenoma-like features

    Directory of Open Access Journals (Sweden)

    Toshiyuki Yamamoto

    2016-10-01

    Full Text Available We herein describe a case showing eccrine syringofibroadenoma occurred on the dorsum of the right foot of a 46-year-old Japanese female. Histopathologic examination revealed anastomosing cords and strands of cuboidal epithelial cells extending from the epidermis to the upper dermis, with a number of well-defined ducts suggesting eccrine ductal origin. In addition, there were papillary tubular adenoma-like ductal structures lined by a few rows of epithelial cells with papillary projections into the lumen surrounded by fibrous stroma in the mid-dermis. It is of note that various histologic features showing different differentiation were seen in a single lesion of eccrine syringofibroadenoma.

  1. Apparent mesonephric duct (rete anlage) origin for cysts and proliferative epithelial lesions in the mouse ovary.

    Science.gov (United States)

    Long, Gerald G

    2002-01-01

    Ovaries and adjacent parovarian (mesovarial) tissues of CD-1 mice of various ages were examined to characterize cystic and proliferative epithelial lesions of the ovary and parovarian tissues. Ovaries and adjacent tissues from 6 mice each at approximately 3 and 8 months of age were processed for light microscopy and step-sections (50-micron intervals) of the entire tissue were examined. Tissues were collected from 40 mice each at 16 through 24 months of age and 3 step sections per mouse were examined. Mesonephric duct remnants were found in all mice at 3 and 8 months. Ducts were usually in the mesovarial adipose tissue and near or within the ovarian hilus and were often loosely associated with smooth muscle of the mesovarial ligament. The epithelium of the ducts varied from low cuboidal to columnar, occasional individual cells were ciliated, and small papillary configurations of epithelium were occasionally present. Ducts were dilated (> 1 mm) more often in mice at 8 months compared to 3 months, and some were continuous with cystic spaces within the ovaries. As mice aged (16-24 months), dilation and cystic change in ducts and associated compression of ovarian tissue away from the ovarian hilus became common. The epithelium of dilated ducts was generally flattened, but foci of cuboidal to columnar epithelium and/or occasional ciliated cells were present. Many ducts contained foci of hyperplastic and/or hypertrophic epithelium, and papillary projections of epithelium were occasionally found. Some of the latter lesions were consistent with a diagnosis of papillary cystadenoma. Hyperplasia of associated fibromuscular stroma was limited to a few apparently extraovarian ducts. The results of this study indicate that remnant mesonephric ductular structures are common in and adjacent to the ovaries of CD-1 mice. As mice age, these ducts become dilated and, in some, the epithelium becomes hyperplastic and/or hyperptrophic. These mesonephric duct remnants appear to be a

  2. Can Analgesic-abuse Nephropathy is a Fertile Groundfor for Rare Collecting Duct (Bellini Duct) Renal Cell Carcinoma or Merely a Coincidence?

    Science.gov (United States)

    Jhorawat, R; Beniwal, P; Malhotra, V

    2016-01-01

    Nonsteroid antiinflammatory drugs have been implicated as nephrotoxic drugs, causing both acute and chronic adverse effects that range from reversible ischemia to chronic kidney disease and urothelial tumors to renal cell carcinoma specially papillary subtype. We report one case of collecting duct (Bellini duct) renal cell carcinoma in patient with analgesic-abuse nephropathy. This young individual was suffering from ankylosing spondylitis since the age of 16 years and was consuming diclofenac and paracetamol (acetaminophen) combination for >15 years. He developed hypertension, secondary glomerulopathy, chronic kidney disease and collecting duct renal cell carcinoma.

  3. Can analgesic-abuse nephropathy is a fertile groundfor rare collecting duct (bellini duct renal cell carcinoma or merely a coincidence?

    Directory of Open Access Journals (Sweden)

    R Jhorawat

    2016-01-01

    Full Text Available Nonsteroid antiinflammatory drugs have been implicated as nephrotoxic drugs, causing both acute and chronic adverse effects that range from reversible ischemia to chronic kidney disease and urothelial tumors to renal cell carcinoma specially papillary subtype. We report one case of collecting duct (Bellini duct renal cell carcinoma in patient with analgesic-abuse nephropathy. This young individual was suffering from ankylosing spondylitis since the age of 16 years and was consuming diclofenac and paracetamol (acetaminophen combination for >15 years. He developed hypertension, secondary glomerulopathy, chronic kidney disease and collecting duct renal cell carcinoma.

  4. 胰腺导管内管状乳头状肿瘤三例临床病理学特征%Clinicopathological analysis of 3 cases of intraductal tubulopapillary neoplasm of the pancreas and literature review

    Institute of Scientific and Technical Information of China (English)

    陈颖; 陈星晔; 朱明华

    2014-01-01

    Objective To analyze the clinical symptoms,pathological features and K-ras mutation alterations of intraductal tubulopapillary neoplasm (ITPN),and to better understand ITPN.Methods We collected the clinical data of 3 cases of ITPNs of Changhai Hospital and 16 cases in literature,and analyzed the morphology,K-ras mutation,immunophenotype of tumor cells by routine H&E staining,immonohistochemistry,and fluorescence PCR.Then it was compared with 81 cases of intraductal papillary mucinous tumor (IPMT).Results All the 3 patients of ITPN were male,with a median age of 43 years.Two lesions were located in pancreatic head and 1 case in pancreatic body and tail.ITPNs presented as intraductal solid masses,and consisted of cells with uniformly median-to-high grade nuclear atypia,and tumor cells were arranged as glandular and cribriform.One case was accompanied with invasive ductal adenocarcinoma and peripancreatic lymph node metastasis.All tumor cells of epithelial marker cytokeratin was positively expressed,and p53 was positively expressed in some tumor cells.However,CHR,NSE,MUC2 and MUC5AC were negatively expressed,and K-ras mutation was not detected.The tumor cells of IPMT were presented as papillary pattern and cribriform structure was observed.The majority of cells were mucous epithelium,or goblet cells (intestinal type),a few were eosinophilic epithelium (eosinophilic cells type) and cuboidal epithelium (pancreatic,biliary duct type),MUC2 and MUC5AC was positively expressed,and K-ras mutation rate was 50%.Conclusions As a new tumor entity of pancreas,ITPNs show distinctive features with IPMTs.%目的 分析胰腺导管内管状乳头状肿瘤(ITPN)的临床特征、病理形态学特征以及K-ras 基因突变状况,以提高对该病的认知度.方法 收集上海长海医院3例ITPN,并综合文献报道的16例资料,分析它们的临床表现、肿瘤的大体及病理组织学改变、免疫表型、K-ras基因突变状况,并与81例胰腺导管内黏液性乳

  5. Intraductal fibroadenoma under the nipple in an 11-year-old female

    National Research Council Canada - National Science Library

    Hayano, Fumiko; Yamada, Sohsuke; Nakano, Shigeo; Watanabe, Teruo; Sasaguri, Yasuyuki; Koga, Sunao

    2014-01-01

    Recently, Chung et al. have reported the detailed clinicopathological features of an extremely rare case sharing similar histopathological characteristics with fibroadenomas, phyllodes tumours, intraductal papillomas...

  6. Metastatic papillary gallbladder carcinoma with a unique presentation and clinical course.

    Science.gov (United States)

    Chapman, Brandon C; Jones, Teresa; McManus, Martine C; Shah, Raj; Gajdos, Csaba

    2014-09-28

    Papillary gallbladder adenocarcinoma (PGA) represents 5% of malignant gallbladder tumors. Metastatic disease frequently involves lymph nodes or other structures in the hepatoduodenal ligament. A Fifty-nine-year-old female with right upper quadrant pain and a giant gallbladder on ultrasound was found to have a segment 6 liver lesion during an attempted laparoscopic cholecystectomy. After appropriate staging, she underwent an open cholecystectomy and extended right hepatic lobectomy with portal lymph node dissection. Pathology demonstrated well-to-moderately differentiated PGA with identical morphology and immunohistochemistry in the liver resection specimen with negative margins. Despite adjuvant chemotherapy, she developed increased uptake in the head of the pancreas on PET scan. Endoscopic ultrasound with fine needle aspiration demonstrated metastatic PGA. She underwent an attempted Whipple operation but due to repeatedly positive pancreatic duct margins, she ended up with a total pancreatectomy and splenectomy. Final pathology showed metastatic PGA along the entire length of the pancreatic duct with only a single focus of tumor invasion into the pancreatic parenchyma. She developed a new liver metastases six months later that was unresponsive to FOLFOX therapy and she died of metastatic disease 33 months from her initial diagnosis. To our knowledge, this is the first report of metastatic PGA recurring along the entire pancreatic duct with disease confined to the pancreas only. We hypothesize that papillary tumor cells spread to pancreatic duct via the common bile duct and remained dormant for several years. An aggressive surgical approach may prolong survival in well-selected patients with PGA's.

  7. Selumetinib in Treating Patients With Papillary Thyroid Cancer That Did Not Respond to Radioactive Iodine

    Science.gov (United States)

    2016-12-02

    Recurrent Thyroid Gland Carcinoma; Stage I Thyroid Gland Papillary Carcinoma; Stage II Thyroid Gland Papillary Carcinoma; Stage III Thyroid Gland Papillary Carcinoma; Stage IV Thyroid Gland Papillary Carcinoma

  8. Early bile duct cancer

    Institute of Scientific and Technical Information of China (English)

    Jae Myung Cha; Myung-Hwan Kim; Se Jin Jang

    2007-01-01

    Bile duct cancers are frequently diagnosed as advanced diseases. Over half of patients with advanced bile duct cancer present with unresectable malignancies and their prognosis has been very poor even after curative resections. Although there has been a need to diagnose bile duct cancer at its early stage, it has been a difficult goal to achieve due to our lack of knowledge regarding this disease entity. Early bile duct cancer may be defined as a carcinoma whose invasion is confined within the fibromuscular layer of the extrahepatic bile duct or intrahepatic large bile duct without distant metastasis irrespective of lymph node involvement. Approximately 3%-10% of resected bile duct cancers have been reported to be early cancers in the literature. The clinicopathological features of patients with early bile duct cancer differ from those of patients with advanced bile duct cancer, with more frequent asymptomatic presentation, characteristic histopathological findings,and excellent prognosis. This manuscript is organized to emphasize the need for convening an international consensus to develop the concept of early bile duct cancer.

  9. Thyroglossal Duct Cyst Carcinomas in Pediatric Patients: Report of Two Cases with a Comprehensive Literature Review.

    Science.gov (United States)

    Thompson, Lester D R; Herrera, Hannah B; Lau, Sean K

    2017-03-14

    Thyroglossal duct cyst (TGDC) carcinomas are rarely encountered in the pediatric population. The clinical behavior of these tumors in the pediatric setting is unclear and management is not well defined. Two cases of pediatric thyroglossal duct cyst carcinoma were identified in a review of all thyroglossal duct cysts diagnosed over a ten year period. These two cases were analyzed along with 57 cases of thyroglossal duct cyst carcinoma affecting patients less than 21 years of age compiled from the English literature. Fifty-nine patients (36 females, 23 males) aged 6-20 years (mean 15.0 years) were identified. All presented with an anterior midline neck mass, which was typically mobile and non-tender. The average tumor size was 2.6 cm. Histologically, all tumors were papillary thyroid carcinomas arising in a background of a thyroglossal duct cyst. The tumors exhibited a papillary, follicular, or mixed architecture with classical papillary thyroid carcinoma nuclear features. Soft tissue extension was present in 16 cases. All patients were managed surgically with a Sistrunk procedure, with additional thyroidectomy performed in 29 patients, combined with a lymph node dissection (n = 15), or a Sistrunk and lymph node dissection (n = 5). All patients were stage I at presentation, with 11 showing lymph node metastases. Postoperative radioactive iodine was employed in 20 patients. A papillary carcinoma of the thyroid gland was reported in four of the patients who had concurrent/subsequent thyroidectomies. Recurrences were reported in four patients, with distant metastases in one patient, who died of disease (13 months). Follow up data was available for 45 patients, with an overall mean follow-up of 54.5 months. All patients were alive, with the exception of one who died with disease. TGDC carcinomas in pediatric patients is associated with a good overall prognosis, best managed by Sistrunk procedure alone, with selected lymph node dissection if clinically

  10. Gallstone disease: Symptoms, diagnosis and endoscopic management of common bile duct stones.

    Science.gov (United States)

    Caddy, Grant R; Tham, Tony C K

    2006-01-01

    Bile duct stones (BDS) are often suspected on history and clinical examination alone but symptoms may be variable ranging from asymptomatic to complications such as biliary colic, pancreatitis, jaundice or cholangitis. The majority of BDS can be diagnosed by transabdominal ultrasound, computed tomography, endoscopic ultrasound or magnetic resonance cholangiography prior to endoscopic or laparoscopic removal. Approximately 90% of BDS can be removed following endoscopic retrograde cholangiography (ERC)+sphincterotomy. Most of the remaining stones can be removed using mechanical lithotripsy. Patients with uncorrected coagulopathies may be treated with ERC+pneumatic dilatation of the sphincter of Oddi. Shockwave lithotripsy (intraductal and extracorporeal) and laser lithotripsy have also been used to fragment large bile duct stones prior to endoscopic removal. The role of medical therapy in treatment of BDS is currently uncertain. This review focuses on the clinical presentation, investigation and current management of BDS.

  11. Papillary thyroid carcinoma in children and adolescents.

    Science.gov (United States)

    Chung, Bo Mi; Park, Sung Hee; Kim, Soo Jin; Seo, Jae Seung; Kim, Yang Soo; Shim, Hyung Jin; Lee, Jong Beum

    2014-09-01

    Differentiated thyroid carcinoma is uncommon in children and constitutes 0.5% to 3% of all pediatric malignancies. Few studies have reported imaging findings of childhood papillary thyroid carcinomas. We report 3 cases of papillary thyroid carcinomas in children. Among the 3 patients, the youngest was a 7-year-old girl. In the current report, we describe 2 cases of classic papillary thyroid carcinoma and 1 case of pediatric diffuse sclerosing variant of papillary thyroid carcinoma. The ultrasonographic features and diagnostic procedures in these pediatric patients are similar to those in adults.

  12. The clinical assessment of intraductal ultrasonography in the differential diagnosis of pancreatic carcinoma and chronic pancreatitis.

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective: To assess and compare the clinical value of intraductal ultrasonography (IDUS) in the differential diagnosis of pancreatic carcinoma and chronic pancreatitis with conventional imaging methods. Methods: IDUS was carried out in eighteen patients with pancreatic carcinoma and chronic pancreatitis

  13. Study of Benign and Malignant Intraductal Lesions of the Breast by Fiberoptic Ductoscopy

    Institute of Scientific and Technical Information of China (English)

    Juan Xu; Qi Wang; Anqin Zhang; Wenping Li; Juntao Shi; Zhongyang Chen

    2005-01-01

    OBJECTIVE To observe and subtype the appearance of intraductal papilloma (lesions) and of infiltrating ductal carcinoma or early infiltrating ductal carcinoma using a fiberoptic ductoscope (FDS) examination, and to discuss the differentiation and diagnosis of benign and malignant tumors by FDS.METHODS The characteristics of FDS images and diagnostic data for 229patients with intraductal papilloma (lesions) and 50 patients with ductal carcinoma, who were confirmed by surgical pathology from October 1998 to December 2003, were analyzed retrospectively.RESULTS The appearance of the lesions observed by FDS were grouped into 4 types: a monothelia (type Ⅰ), polythelia (type Ⅱ), superficies (type Ⅲ)and a mixture (type Ⅳ). Intraductal papillomas (lesions) were more commonly seen in type Ⅰ and Ⅱ, and intraductal carcinomas or early infiltrating ductal carcinomas were more commonly seen in type Ⅲ and Ⅳ;there was a statistically significant difference in the distribution of the ductoscopic types, except in type Ⅱ, between the two types of lesions, P<0.001. The focal detection rate by FDS for intraductal papilloma and papillomatosis was 99.6% (228/229) and for breast cancer was 96.0% (48/50). The diagnostic accuracy was 97.8% (224/229) and 82.0% (41/50),respectively.CONCLUSION FDS can be a guide for the treament of benign and malignant intraductal tumors, with early discovery and accurate diagnosis.

  14. Papillary microcarcinoma of the thyroid gland

    DEFF Research Database (Denmark)

    Londero, Stefano Christian; Godballe, Christian; Krogdahl, Annelise

    2008-01-01

    INTRODUCTION: Papillary microcarcinomas (PMC) of the thyroid gland are defined according to The WHO Committee as papillary carcinomas measuring 10 mm or less in diameter. A large proportion of these tumours are found coincidentally in the treatment of symptomatic goitre and most cases follow...

  15. Coexistence of papillary carcinoma and Hashimoto's thyroiditis.

    Science.gov (United States)

    Matesa-Anić, Dubravka; Matesa, Neven; Dabelić, Nina; Kusić, Zvonko

    2009-03-01

    The aim of the study was to determine the incidence of coexistence of papillary carcinoma and Hashimoto's thyroiditis in cytologic material. Cytologic findings were collected from 10508 patients that underwent ultrasound-guided fine needle aspiration cytology (FNAC) of the thyroid. Hashimoto's thyroiditis was found in 2156 (20.5%) and papillary carcinoma in 269 (2.6%) of 10508 patients with FNAC, whereas both Hashimoto's thyroiditis and papillary carcinoma were present in 42 (0.4%) patients. Among patients with FNAC diagnosis of Hashimoto's thyroiditis, the prevalence of papillary carcinoma was 1.9%. Among patients with FNAC diagnosis of papillary carcinoma, the prevalence of Hashimoto's thyroiditis was 15.6%. There was no statistically significant association between the presence of papillary carcinoma and Hashimoto's thyroiditis in patients undergoing FNAC (p=0.0522). In conclusion, in a large series of patients, the incidence of Hashimoto's thyroiditis and papillary carcinoma coexistence in cytologic material was 0.4%. There was no statistically significant relationship between Hashimoto's thyroiditis and papillary carcinoma in cytologic material.

  16. Curved-Duct

    Directory of Open Access Journals (Sweden)

    Je Hyun Baekt

    2000-01-01

    Full Text Available A numerical study is conducted on the fully-developed laminar flow of an incompressible viscous fluid in a square duct rotating about a perpendicular axis to the axial direction of the duct. At the straight duct, the rotation produces vortices due to the Coriolis force. Generally two vortex cells are formed and the axial velocity distribution is distorted by the effect of this Coriolis force. When a convective force is weak, two counter-rotating vortices are shown with a quasi-parabolic axial velocity profile for weak rotation rates. As the rotation rate increases, the axial velocity on the vertical centreline of the duct begins to flatten and the location of vorticity center is moved near to wall by the effect of the Coriolis force. When the convective inertia force is strong, a double-vortex secondary flow appears in the transverse planes of the duct for weak rotation rates but as the speed of rotation increases the secondary flow is shown to split into an asymmetric configuration of four counter-rotating vortices. If the rotation rates are increased further, the secondary flow restabilizes to a slightly asymmetric double-vortex configuration. Also, a numerical study is conducted on the laminar flow of an incompressible viscous fluid in a 90°-bend square duct that rotates about axis parallel to the axial direction of the inlet. At a 90°-bend square duct, the feature of flow by the effect of a Coriolis force and a centrifugal force, namely a secondary flow by the centrifugal force in the curved region and the Coriolis force in the downstream region, is shown since the centrifugal force in curved region and the Coriolis force in downstream region are dominant respectively.

  17. THE EXPRESSION OF APOPTOSIS RELATED GENES IN THE PROCESS OF CANCERATION OF ATYPICAL HYPERPLASIA OF MAMMARY DUCT

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Objective: To investigate the expression of apoptosis related genes p53 and bcl-2 in atypical hyperplasia of mammary duct and the relationship between the gene expression and oncogenesis of breast. Methods: mRNA of apoptosis related gene p53 and bcl-2 were detected by in situ hybridization in 44 cases of atypical ductal hyperplasia. p53 protein expression was detected by immunohistochemistry. The data were compared with those of 6 cases of benign hyperplasia and 26 cases of breast carcinoma. Results: The expression of p53 mRNA was 66.7% in benign hyperplasia, 40% in atypical ductal hyperplasia (55.6% in mild, 41.7% in medium, 26.1% in severe) and 19.2% in carcinoma (of which 21.4% were intraductal carcinoma and 16.7% were invasive). The expression of p53 protein was negative in benign hyperplasia, 24% in atypical hyperplasia (mild 11.1%, medium 25%, severe 34.8%), 38.5% in carcinoma (intraductal carcinoma 35.7%, invasive ductal carcinoma 41.7%). The expression of bcl-2 was negative in benign hyperplasia, 78.6% in intraductal carcinoma, 83.3% in invasive ductal carcinoma. Conclusion: Loss and mutation of p53 gene and excessive expression bcl-2 mRNA were detected in severe atypical ductal hyperplasia.

  18. Particle deposition in ventilation ducts

    Energy Technology Data Exchange (ETDEWEB)

    Sippola, Mark Raymond [Univ. of California, Berkeley, CA (United States)

    2002-09-01

    Exposure to airborne particles is detrimental to human health and indoor exposures dominate total exposures for most people. The accidental or intentional release of aerosolized chemical and biological agents within or near a building can lead to exposures of building occupants to hazardous agents and costly building remediation. Particle deposition in heating, ventilation and air-conditioning (HVAC) systems may significantly influence exposures to particles indoors, diminish HVAC performance and lead to secondary pollutant release within buildings. This dissertation advances the understanding of particle behavior in HVAC systems and the fates of indoor particles by means of experiments and modeling. Laboratory experiments were conducted to quantify particle deposition rates in horizontal ventilation ducts using real HVAC materials. Particle deposition experiments were conducted in steel and internally insulated ducts at air speeds typically found in ventilation ducts, 2-9 m/s. Behaviors of monodisperse particles with diameters in the size range 1-16 μm were investigated. Deposition rates were measured in straight ducts with a fully developed turbulent flow profile, straight ducts with a developing turbulent flow profile, in duct bends and at S-connector pieces located at duct junctions. In straight ducts with fully developed turbulence, experiments showed deposition rates to be highest at duct floors, intermediate at duct walls, and lowest at duct ceilings. Deposition rates to a given surface increased with an increase in particle size or air speed. Deposition was much higher in internally insulated ducts than in uninsulated steel ducts. In most cases, deposition in straight ducts with developing turbulence, in duct bends and at S-connectors at duct junctions was higher than in straight ducts with fully developed turbulence. Measured deposition rates were generally higher than predicted by published models. A model incorporating empirical equations based on the

  19. Particle deposition in ventilation ducts

    Energy Technology Data Exchange (ETDEWEB)

    Sippola, Mark R.

    2002-09-01

    Exposure to airborne particles is detrimental to human health and indoor exposures dominate total exposures for most people. The accidental or intentional release of aerosolized chemical and biological agents within or near a building can lead to exposures of building occupants to hazardous agents and costly building remediation. Particle deposition in heating, ventilation and air-conditioning (HVAC) systems may significantly influence exposures to particles indoors, diminish HVAC performance and lead to secondary pollutant release within buildings. This dissertation advances the understanding of particle behavior in HVAC systems and the fates of indoor particles by means of experiments and modeling. Laboratory experiments were conducted to quantify particle deposition rates in horizontal ventilation ducts using real HVAC materials. Particle deposition experiments were conducted in steel and internally insulated ducts at air speeds typically found in ventilation ducts, 2-9 m/s. Behaviors of monodisperse particles with diameters in the size range 1-16 {micro}m were investigated. Deposition rates were measured in straight ducts with a fully developed turbulent flow profile, straight ducts with a developing turbulent flow profile, in duct bends and at S-connector pieces located at duct junctions. In straight ducts with fully developed turbulence, experiments showed deposition rates to be highest at duct floors, intermediate at duct walls, and lowest at duct ceilings. Deposition rates to a given surface increased with an increase in particle size or air speed. Deposition was much higher in internally insulated ducts than in uninsulated steel ducts. In most cases, deposition in straight ducts with developing turbulence, in duct bends and at S-connectors at duct junctions was higher than in straight ducts with fully developed turbulence. Measured deposition rates were generally higher than predicted by published models. A model incorporating empirical equations based on

  20. What Is Bile Duct Cancer?

    Science.gov (United States)

    ... the liver. Types of bile duct cancer by cell type Bile duct cancers can also be divided ... Our Volunteers More ACS Sites Bookstore Shop Cancer Atlas Press Room Cancer Statistics Center Volunteer Learning Center ...

  1. Gallbladder and Bile Duct Disorders

    Science.gov (United States)

    ... Disorders Overview of Gallbladder and Bile Duct Disorders Cholecystitis Gallstones Biliary Pain Without Gallstones Narrowing of the ... ducts are blocked, the gallbladder may become inflamed ( cholecystitis ). Biliary pain without gallstones (acalculous biliary pain) can ...

  2. Malignant tumors of Stensen's duct.

    Science.gov (United States)

    Steiner, M; Gould, A R; Miller, R L; Johnson, J A

    1999-01-01

    A rare case of squamous cell carcinoma arising in Stensen's duct is reported. The literature concerning malignant neoplasia originating in this site is reviewed, with attention given to the histopathologic diversity of neoplasms occurring in the duct, criteria for determination of origin in the duct, and outcomes of therapy.

  3. Cornice Duct System

    Energy Technology Data Exchange (ETDEWEB)

    Wayne Place; Chuck Ladd

    2004-10-29

    SYNERGETICS, INC., has designed, developed, and tested an air handling duct system that integrates the air duct with the cornice trim of interior spaces. The device has the advantage that the normal thermal losses from ducts into unconditioned attics and crawl spaces can be totally eliminated by bringing the ducts internal to the conditioned space. The following report details work conducted in the second budget period to develop the Cornice Duct System into a viable product for use in a variety of residential or small commercial building settings. A full-scale prototype has been fabricated and tested in a laboratory test building at the Daylighting Facility at North Carolina State University., Based on the results of that testing, the prototype design as been refined, fabricated, installed, and extensively tested in a residential laboratory house. The testing indicates that the device gives substantially superior performance to a standard air distribution system in terms of energy performance and thermal comfort. Patent Number US 6,511,373 B2 has been granted on the version of the device installed and tested in the laboratory house. (A copy of that patent is attached.) Refinements to the device have been carried through two additional design iterations, with a particular focus on reducing installation time and cost and refining the air control system. These new designs have been fabricated and tested and show substantial promise. Based on these design and testing iterations, a final design is proposed as part of this document. That final design is the basis for a continuation in part currently being filed with the U.5, Patent office.

  4. Papillary fibroelastoma of the heart

    Directory of Open Access Journals (Sweden)

    Ahuja Janhvi

    2008-10-01

    Full Text Available Primary intra-cardiac tumors are rare. Most of them are benign. Of the benign tumors, myxomas are the most common. Others are lipoma, rhabdomyoma, hemangioma, and papillary fibroelastoma (PFE. PFE is a relatively rare benign tumor of the heart. It occurs commonly on cardiac valves and is often an incidental finding. They are most commonly discovered during autopsy, but may present with thromboembolism, which is a dreaded complication. It is important to be aware of this entity because even though it is benign it may present with life-threatening complications, which are well documented in literature. Surgery is the treatment of choice for these tumors. We present the case of a 30-year-old male in whom PFE was an incidental finding

  5. SPECT/CT imaging in children with papillary thyroid carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hwa-Young; Gelfand, Michael J.; Sharp, Susan E. [Cincinnati Children' s Hospital, Department of Radiology, Cincinnati, OH (United States)

    2011-08-15

    SPECT/CT improves localization of single photon-emitting radiopharmaceuticals. To determine the utility of SPECT/CT in children with papillary thyroid carcinoma. 20 SPECT/CT and planar studies were reviewed in 13 children with papillary thyroid carcinoma after total thyroidectomy. Seven studies used I-123 and 13 used I-131, after elevating TSH by T4 deprivation or intramuscular thyrotropin alfa. Eight children had one study and five children had two to four studies. Studies were performed at initial post-total thyroidectomy evaluation, follow-up and after I-131 treatment doses. SPECT/CT was performed with a diagnostic-quality CT unit in 13 studies and a localization-only CT unit in 7. Stimulated thyroglobulin was measured (except in 2 cases with anti-thyroglobulin antibodies). In 13 studies, neck activity was present but poorly localized on planar imaging; all foci of uptake were precisely localized by SPECT/CT. Two additional foci of neck uptake were found on SPECT/CT. SPECT/CT differentiated high neck uptake from facial activity. In six studies (four children), neck uptake was identified as benign by SPECT/CT (three thyroglossal duct remnants, one skin contamination, two by precise anatomical CT localization). In two children, SPECT/CT supported a decision not to treat with I-131. When SPECT/CT was unable to identify focal uptake as benign, stimulated thyroglobulin measurements were valuable. In three of 13 studies with neck uptake, SPECT/CT provided no useful additional information. SPECT/CT precisely localizes neck iodine uptake. In small numbers of patients, treatment is affected. SPECT/CT should be used when available in thyroid carcinoma patients. (orig.)

  6. [Intraductal meibomian gland probing for the treatment of blepharitis].

    Science.gov (United States)

    Fermon, S; Zaga, I Hindi; Alvarez Melloni, D

    2015-02-01

    To describe the results of the meibomian gland probing as a treatment of severe posterior blepharitis. Prospective, longitudinal study of patients with signs and symptoms of severe posterior blepharitis, who were treated with meibomian gland probing in Centro Oftalmológico Interlomas (CENOFI). A total of 16 patients were included, 62.5% female and 32.5% male, diagnosed with severe posterior blepharitis. Treatment was performed in one eye. The time of rupture of the tear film was evaluated, using a subjective scale of 0-10 photophobia, the improvement in pain and visual acuity was measured before the procedure, and at one week and 6 months after. All the patients showed a statistically significant improvement in all 4 variables al 6 months. There were no complications. The dysfunction of the meibomian glands is a common reason for ophthalmology consulting. The study describes the results obtained by performing an intraductal survey, which was shown to be safe and effective in 100% of the sample. It can be concluded from this study that meibomian gland probing is an effective and promising treatment for blepharitis resistant to conservative treatment. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  7. 14 CFR 25.1103 - Induction system ducts and air duct systems.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Induction system ducts and air duct systems....1103 Induction system ducts and air duct systems. (a) Each induction system duct upstream of the first... auxiliary power unit bleed air duct systems, no hazard may result if a duct failure occurs at any...

  8. Warthin-like papillary thyroid carcinoma: a case report

    Directory of Open Access Journals (Sweden)

    Haeri H

    2013-02-01

    Full Text Available Background: Warthin tumor- like papillary carcinoma of thyroid is a rare variant of papillary thyroid carcinoma. It is characterized by distinct papillary structures lined by oncocytic tumor cells with nuclear features of papillary carcinoma and marked lymphoplasmocytic infiltrate in the papillary stalks. This tumor derives its name from its resemblance to Warthin tumor of major salivary glands.Case presentation: We report a 54- year- old man presented with bilateral thyroid masses. Histopathological study showed papillary structures lined by cells with eosinophilic granular cytoplasm and ground- glass nuclei with lymphoplasmacytic infiltration of the stalks.Conclusion: Warthin tumor-like papillary thyroid carcinoma could be mistaken for benign lymphoepithelial lesions such as Hashimoto thyroiditis, Hurthle cell tumors and tall cell variant of papillary carcinoma. Follow- up information on the previously reported cases has suggested that these tumors behave similarly to usual papillary carcinoma.

  9. Monitoring the progression from intraductal carcinoma to invasive ductal carcinoma based on multiphoton microscopy

    Science.gov (United States)

    Wu, Yan; Fu, Fangmeng; Lian, Yuane; Nie, Yuting; Zhuo, Shuangmu; Wang, Chuan; Chen, Jianxin

    2015-09-01

    Intraductal carcinoma is a precancerous lesion of the breast and the immediate precursor of invasive ductal carcinoma. Multiphoton microscopy (MPM) was used to monitor the progression from intraductal carcinoma to invasive ductal carcinoma, which can improve early detection of precursor lesions and halt progression to invasive neoplastic disease. It was found that MPM has the capability to reveal the qualitative changes in features of cells, structure of basement membranes, and architecture of collagens during the development from intraductal carcinoma to invasive ductal carcinoma, as well as the quantitative alterations in nuclear area, circle length of basement membrane, and collagen density. Combined with intra-fiberoptic ductoscopy or transdermal biopsy needle, MPM has the potential to provide immediate histological diagnosis of tumor progression in the field of breast carcinoma.

  10. 乳腺导管内乳头状瘤的MR表现及与乳管镜、超声检查的对比研究%A comparative study of MRI of intraductal papilloma of the breast with fiberoptic ductoscopy and ultrasound

    Institute of Scientific and Technical Information of China (English)

    董妍; 孙玲玲; 赵嫚; 岳玲

    2013-01-01

    Objective:To evaluate the MR value for diagnosis of intraductal papilloma of the breast,and discuss the superiority and deficiency of MR.Methods:To retrospectively analyze MR features of 16 cases of intraductal papilloma confirmed by pathology,and compared the results with fiberoptic ductoscopy and ultrasound.Results:The findings of MR and ultrasound revealed three patterns:mass in/beside the dilated duct;mass in breast without dilated duct;and dilated duct only.The imageing features of fiberoptic ductoscopy included mass in mammary duct and inflammation.The positive rates of MR,fiberoptic ductoscopy and ultrasound were 88.9%,80.0%,83.3%.Conclusion:All the MR,fiberoptic ductoscopy and ultrasound have high value in diagnosis of intraductal papilloma of the breast,but also have disadvantages.Combining the three methods will improve the diagnosis of intraductal papilloma.%目的:评价MR对乳腺导管内乳头状瘤的诊断价值及此种检查方法的优势与不足.方法:对16例经病理证实的乳腺导管内乳头状瘤患者的MR检查结果进行回顾性分析,并与乳管镜、超声检查结果进行对比.结果:MR与超声表现分为三种:扩张导管内或导管旁结节;乳腺内实性结节,不伴随导管扩张;单纯导管扩张,乳腺内无实性结节.而乳管镜检查主要表现为管腔内的新生物及管壁的炎性改变.MR、乳管镜、超声检查的阳性率分别为:88.9%、80.0%、83.3%.结论:MR、乳管镜及超声检查对导管内乳头状瘤的诊断均具有较高价值,但也各有弊端,将三种方法结合,有望提高导管内乳头状瘤患者的诊断水平.

  11. 3C DUCT DESIGN METHOD

    Institute of Scientific and Technical Information of China (English)

    Huan-RueiShiu; Feng-ChuOu; Sih-LiChen

    2002-01-01

    A new 3C duct design method is proposed for designing a high quality, energy-efficiency cost-effective air duct system. It not only considers the demand of volume flow rate, but also takes into consideration a number of issues including system pressure balance, noise, vibration, space limitation and total system cost. This new method comprises three major calculation procedures:initial computer-aided design (CAD), computer-aided simulation (CAS) and correction processes (CP). An example is presented in this study to understand the characteristics of 3C method. It shows that 3C duct design method provides a simple computation procedure for an optimum air duct system. It also shortens the design schedule, prevents human calculation errors, and reduces the dependence on designer experience. In addition to apply in a new duct system design, 3C duct design method is also a powerful design tool for the expansion of an existing duct system.

  12. Thyroid papillary carcinoma arising in ectopic thyroid tissue within a neck branchial cyst

    Directory of Open Access Journals (Sweden)

    Di Fiore Agnese

    2006-05-01

    Full Text Available Abstract Background Thyroid gland derives from one median anlage at the base of the tongue, and from the two fourth branchial pouches. A number of anomalies may occur during their migration. These can be in form of ectopic tissues, which are frequently found along the course of thyroglossal duct and rarely in other sites, many of these may develop same diseases as the thyroid gland. Case presentation A 36-years-old female presented with a 3 month history of left side neck mass. The mass disappeared following aspiration of brown colored fluid, which on cytological examination showed cells with nuclear irregularities that warranted the resection of the lesion. The histology demonstrated a thyroid papillary carcinoma arising within the branchial cyst. Thereafter, the patient underwent a total thyroidectomy with central lymph nodes dissection. Histology showed a multifocal papillary carcinoma with central lymph nodes metastases. Only four cases of primary thyroid carcinomas in neck branchial cyst have been described so far. Conclusion In a lateral cystic neck mass, although rare, occurrence of ectopic thyroid tissue and presence of a papillary thyroid carcinoma should be kept in mind.

  13. Salivary duct carcinoma

    DEFF Research Database (Denmark)

    Breinholt, Helle; Elhakim, Mohammad Talal; Godballe, Christian;

    2016-01-01

    1990 to 2005 were identified. Histological slides were reviewed, and data concerning demographics, tumour site, clinical stage, treatment profiles and follow-up were retrieved. Survival estimates and prognostic factors were evaluated by comparing Kaplan-Meier plots using the Mantel-Haenszel log......-rank test. RESULTS: Salivary duct carcinoma showed an incidence of 0.04/100.000 inhabitants/year. Distant recurrence was seen in 52% of patients. Five-year overall survival, disease-specific survival and recurrence-free survival were 32%, 42% and 35%, respectively. Univariate analyses suggested that overall...... stage (III/IV) and vascular invasion have a negative impact on all survival measures. Involved resection margins correlated with a poorer overall survival and disease-specific survival, whereas adjuvant radiotherapy improved overall survival and recurrence-free survival. CONCLUSIONS: Salivary duct...

  14. Clinical Pathological Study on Breast Ductal Papillary Tumor%乳腺导管内乳头状肿瘤临床病理探讨

    Institute of Scientific and Technical Information of China (English)

    季恩

    2016-01-01

    乳头状肿瘤是一种常见肿瘤,而乳腺导管内乳头状肿瘤更为常见。此类疾病的临床症状不具备较强的相似性,因此可以通过观察肿瘤在不同阶段出现的增生现象进行分析和判断。同时,在诊断过程中采取肌上皮细胞化验这一方式进行辅助诊断,对于乳腺导管内肿瘤病变具有一定的意义。%Papillary carcinoma is a common tumor,and intraductal papilloma is more common. The clinical symptoms of this disease do not have strong similarities,therefore the phenomenon can be observed through the proliferation of tumor in different stages of the analysis and judgement, and in the process of taking diagnosis of myoepithelial cells in this way to test for diagnosis. The diagnosis method has certain significance for intraductal papilloma.

  15. Papillary thyroid microcarcinoma in Denmark 1996-2008

    DEFF Research Database (Denmark)

    Londero, Stefano Christian; Krogdahl, Annelise; Bastholt, Lars;

    2013-01-01

    With an observed general rise in papillary thyroid carcinoma incidence, papillary microcarcinoma (PMC) is accordingly found more frequently and often incidentally by histological examination of surgical specimens from presumed benign thyroid disease. Only a few studies have specifically addressed...

  16. Papillary thyroid microcarcinoma in Denmark 1996-2008

    DEFF Research Database (Denmark)

    Londero, Stefano Christian; Krogdahl, Annelise; Bastholt, Lars

    2013-01-01

    With an observed general rise in papillary thyroid carcinoma incidence, papillary microcarcinoma (PMC) is accordingly found more frequently and often incidentally by histological examination of surgical specimens from presumed benign thyroid disease. Only a few studies have specifically addressed...

  17. Renal Papillary Necrosis: Role of Radiology

    Science.gov (United States)

    Pandya, Vaidehi K.

    2016-01-01

    Renal Papillary Necrosis (RPN) is idefined as Ischemic necrobiosis of the papilla in the medulla of the kidneys. Variety of etiological factors are recognized which cause papillary necrosis, such as analgesic nephropathy, diabetes mellitus, urinary obstruction and sickle cell haemoglobinopathy. The early diagnosis of RPN is important to improve prognosis and reduce morbidity. Radiological Imaging offers early diagnosis and can guide prompt treatment of papillary necrosis and can minimize a decline in renal function. Here we report three cases of RPN with typical imaging findings. One of them was diabetic and hypertensive female with recurrent Urinary tract Infections and other was a male with no known co-morbidity. Both of them were diagnosed to have renal papillary necrosis on CT scan and were managed operatively and conservatively, respectively. Third case was a healthy female being investigated to be renal donor for her son. Here RPN was an incidental finding and was treated conservatively. Thus CT scan could detect it pre-operatively and complications due to transplantation of a kidney with papillary necrosis were avoided. So, we want to emphasize the importance of Radiology, particularly CT scanning in detection of RPN and to guide early and prompt treatment. PMID:26894147

  18. MR mammography is useful in the preoperative locoregional staging of breast carcinomas with extensive intraductal component

    Energy Technology Data Exchange (ETDEWEB)

    Goethem, M. van [Department of Radiology, University Hospital Antwerp, Antwerp (Belgium)]. E-mail: Mireille_Van_Goethem@hotmail.com; Schelfout, K. [Department of Pathology, University Hospital Antwerp, Antwerp (Belgium); Kersschot, E. [Department of Radiology, OLV Hospital Aalst, Aalst (Belgium); Colpaert, C. [Department of Pathology, University Hospital Antwerp, Antwerp (Belgium); Verslegers, I. [Department of Radiology, University Hospital Antwerp, Antwerp (Belgium); Biltjes, I. [Department of Radiology, University Hospital Antwerp, Antwerp (Belgium); Tjalma, W.A. [Department of Gynaecology and Gynaecological Oncology, University Hospital Antwerp, Antwerp (Belgium); De Schepper, A. [Department of Radiology, University Hospital Antwerp, Antwerp (Belgium); Weyler, J. [Department of Epidemiology and Social Medicine University Antwerp, Antwerp (Belgium); Parizel, P.M. [Department of Radiology, University Hospital Antwerp, Antwerp (Belgium)

    2007-05-15

    Purpose: To determine the role of magnetic resonance (MR) mammography in detection and assessment of extent of tumors with extensive intraductal component (EIC+). Material and methods: In a prospective study, 233 consecutive women with a suspicious lesion underwent preoperative MR mammography and 209 invasive ductal carcinomas were detected. We studied the prediction of intraductal spread on mammography (MX), ultrasound (US) and MR. We compared the size of the total lesion on MX, US and MR and correlated it with histopathology. Enhancement patterns on MR were described. Results: Of 209 invasive ductal carcinomas, 50 were EIC+ (24%). MX predicted intraductal spread in EIC+ carcinomas in 48.5%, US in 34.2% and MR in 68%. Compared to MX and US, MR was best in assessment of total tumor size. On MR, ductal spread in EIC+ tumors presented as ductal or linear enhancement, long spicules, a regional enhancing area or nodules adjacent to a mass. Conclusion: MR had the highest sensitivity to predict intraductal spread and was superior in assessing total tumor size.

  19. Development of Intraductal Technique for Breast Cancer Prevention, Diagnosis and Treatment (97 Breast)

    Science.gov (United States)

    1999-10-01

    Surgeons 2. Presentations: (1) Istituto Europeo di Oncologia ( Milan) Grand Rounds, "Intraductal approach to the breast," July 7, 1999. (2) Yale...in nipple aspirate fluid (NAF) using manual breast pumps (Petrakis et al and Sartorius et al), nipple aspiration is a relatively inefficient technique

  20. Obstructive jaundice due to hepatocarcinoma with intraductal growth. Report of a successful resection.

    Science.gov (United States)

    Jiménez, L C; Teruel, A; Mezquita, S; Martínez, J; Colina, F

    1990-03-01

    We present a patient with hepatocellular carcinoma causing obstructive jaundice due to intraductal growth, diagnosed intraoperatively by cholangiography and histological examination, and radically treated by left lobectomy, extrahepatic biliary tract resection and Roux-en-Y hepaticojejunostomy. Survival after operation was 13 months. Other similar cases reported in the literature are reviewed.

  1. Asymptomatic common bile duct stones.

    Science.gov (United States)

    Rosseland, A R; Glomsaker, T B

    2000-11-01

    Patients with asymptomatic bile duct stones exhibit typical signs, such as elevated liver function tests, dilated bile ducts on ultrasound, a history of jaundice, or pancreatitis. The incidence of asymptomatic bile duct stones is about 10%, but up to 2% of patients show no signs of the disease. Bile duct stones can be diagnosed by using clinical judgement, scoring systems, or discriminant function tests. Which diagnostic modality is most reliable, cost-effective and safe, varies with different hospitals. Which therapy is most effective, safe and the cheapest also varies with different departments, but in the future an increasing number of departments will use the one-stage laparoscopic approach.

  2. Noise reduction of spiral ducts.

    Science.gov (United States)

    Lapka, Wojciech; Cempel, Czesław

    2007-01-01

    The paper presents noise reduction (NR) of spiral ducts as a result of computational modeling of acoustic wave propagation. Three-dimensional models were created with the finite element method in COMSOL Multiphysics version 3.3. Nine models of spiral ducts with 1-9 spiral leads were considered. Time-harmonic analysis was used to predict NR, which was shown in spectral and interval frequency bands. Spiral duct performance can be seen as a comparison of NR before and after a change from a circular to a spiral duct.

  3. Left Atrium Papillary Fibroelastomas: A Cause of Cerebral Emboli

    Directory of Open Access Journals (Sweden)

    A. G. Ciss

    2012-01-01

    Full Text Available Papillary fibroelastomas are cardiac benign tumours. Among the benign cardiac tumor, papillary fibroelastomas are reported second after myxomas. Most often diagnosed incidentally, papillary fibroelastomas may embolize to cerebral circulation. Valvular locations are predominant; location in left atrium is rare. In this paper, we present a case of papillary fibroelastoma located in left atrium with symptoms of cerebral embolization. Transoesophageal echocardiography diagnosed a mobile mass. The patient was treated with surgical resection without further embolic complication.

  4. Intravascular papillary endothelial hyperplasia of the mandibular lingual mucosa

    Institute of Scientific and Technical Information of China (English)

    Benay Tokman; (S)ebnem (S)im(s)ek; Erkan Erkmen; Tülin Oygur

    2004-01-01

    @@ In 1923, Masson1 described an unusual papillary endothelial proliferation that he named as "hemangioendotheliome vegetant intravasculaire". In 1976, Clearkin and Enzinger2 coined the term intravascular papillary endothelial hyperplasia (IPEH) that is now in use. This term refers to the presence of endothelium lined papillary projections within a vascular space. Characteristically, the papillary structures are composed of a single layer of swollen or plump endothelial cells without cellular pleomorphism, mitotic activity or necrosis.

  5. Fiberoptic ductoscopy in diagnosis and therapy of intraductal papilloma of the breast%乳管镜在乳腺导管内肿瘤诊断及治疗中的应用

    Institute of Scientific and Technical Information of China (English)

    邹裷; 朱碧荣; 李丽

    2016-01-01

    目的:评价乳管镜在乳腺导管内肿瘤临床诊治中的作用及应用价值。方法:我科2013年1月-2014年6月经门诊乳管镜诊治乳头溢液患者共1709人次,其中诊断为乳腺导管内肿瘤患者123例,在我科行手术治疗患者105人,回顾性分析其术前诊断、术后病检及治疗过程。结果:123例患者在乳管镜下见乳腺导管内肿瘤样病变,105人行病变导管及所属腺叶部分切除术,术后病检85例确诊为乳腺导管内乳头状瘤,5例确诊为乳腺导管内原位癌,3例确诊为乳腺浸润性导管癌,12例确诊为乳腺囊肿等其他良性病变。结论:乳管镜可早期发现乳腺导管内肿瘤,是诊治及手术定位的重要辅助手段。%Objective:To evaluate the application of fiberoptic ductoscopy(FDS)in diagnosis and therapy of intra-ductal papilloma of the breast.Methods:To retrospectively analyze the data of 1 709 cases of nipple discharge diag-nosed and treated by FDS,123 were intraductal papilloma verified by FDS,105 had surgical therapy.Results:Intra-ductal lesions were verified by FDS in 123 cases,105 of them excised the diseased duct and lobus glandularis,85 ca-ses were diagnosed as intraductal papilloma by pothology after operation,5 ductal carcinoma in situ(DCIS),3 breast infitrative ductal carcinoma,12 galactoma and other were benign lesions.Conclusion:FDS is valuable and important in early diagnosis and location of intraductal papilloma.

  6. Gallbladder and bile duct

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930559 An experimental study on effective hep-atic blood flow and hepatic energy metabolismfollowing acute obstructive cholangitis and bil-iary obstruction.SUN Wenbing (孙文兵),et al.Hepatobili Surg,Center,Southwest Hosp,Chongqing 630000.Chin J Digest 1992;12(5):261—263.The changes of effective hepatic blood flow(E-HBF)and hepatic energy metabolism were stud-ied following acutc obstructive cholangitis(AOC)and bile duct ligation(BDL)in rats.The resultsshowed that EHBF was significantly decreased at24hs after and further decreased at 48hs afterBDL.And EHBF was significantly decreased at

  7. Stopping duct quacks: Longevity of residential duct sealants

    Energy Technology Data Exchange (ETDEWEB)

    Sherman, Max H.; Walker, Iain S.; Dickerhoff, Darryl J.

    2000-08-01

    Duct leakage has been identified as a major source of energy loss in residential buildings. Most duct leakage occurs at the connections to registers, plenums or branches in the duct system. At each of these connections a method of sealing the duct system is required. Typical sealing methods include tapes or mastics applied around the joints in the system. Field examinations of duct systems have shown that these seals tend to fail over time periods ranging from days to years. We have used several test methods over the last few years to evaluate the longevity of duct sealants when subjected to temperatures and pressures representative of those found in the field. Traditional cloth duct tapes have been found to significantly under-perform other sealants and have been banned from receiving duct tightness credits in California's energy code (California Energy Commission 1998). Our accelerated testing apparatus has been redesigned since its first usage for improved performance. The methodology is currently under consideration by the American Society for Testing and Materials (ASTM) as a potential new test method. This report will summarize the set of measurements to date, review the status of the test apparatus and test method, and summarize the applications of these results to codes and standards.

  8. Propagation of sound waves in ducts

    DEFF Research Database (Denmark)

    Jacobsen, Finn

    2000-01-01

    Plane wave propagation in ducts with rigid walls, radiation from ducts, classical four-pole theory for composite duct systems, and three-dimentional waves in wave guides of various cross-sectional shape are described....

  9. Surgery for Bile Duct (Cholangiocarcinoma) Cancer

    Science.gov (United States)

    ... Situation Bile Duct Cancer Treating Bile Duct Cancer Surgery for Bile Duct Cancer There are 2 general ... also help plan the operation to remove it. Surgery for resectable cancers For resectable cancers, the type ...

  10. Intraductal approach to breast cancer: the role of mammary ductoscopy.

    Science.gov (United States)

    Deshmane, Vinay

    2010-09-01

    Mammary ductoscopy is a recent advance enabling direct visualisation and sampling of human mammary ducts using a micro endoscope. The majority of pre malignant and malignant changes in the breast arise from the epithelium lining the duct lobular unit, and access to this region by ductoscopy has the potential to revolutionise breast cancer diagnosis and treatment. The ability to sample ductal epithelium may allow identification of early malignant and pre-malignant cytological changes and assist surgical excision, facilitating diagnosis of non palpable cancer before detection on current imaging modalities. Presently, there are three main indications for ductoscopy in clinical practice viz. determining extent of resection for breast cancer, assessment of high risk individuals and in the management of patients with pathological nipple discharge. Our initial experience with ductoscopy in patients with nipple discharge undergoing surgery has been rewarding. Ductoscopy was feasible in 92% of patients. Abnormal findings on ductoscopy were associated with DCIS in 37% and DCIS with early invasive breast cancer in 21%, while normal ductoscopy correlated with a normal pathological assessment.

  11. Propagation of sound waves in ducts

    DEFF Research Database (Denmark)

    Jacobsen, Finn

    2000-01-01

    Plane wave propagation in ducts with rigid walls, radiation from ducts, classical four-pole theory for composite duct systems, and three-dimentional waves in wave guides of various cross-sectional shape are described.......Plane wave propagation in ducts with rigid walls, radiation from ducts, classical four-pole theory for composite duct systems, and three-dimentional waves in wave guides of various cross-sectional shape are described....

  12. Sound propagation through nonuniform ducts

    Science.gov (United States)

    Nayfeh, A. H.

    1976-01-01

    Methods of determining the transmission and attenuation of sound propagating in nonuniform ducts with and without mean flows are discussed. The approaches reviewed include purely numerical techniques, quasi-one-dimensional approximations, solutions for slowly varying cross sections, solutions for weak wall undulations, approximation of the duct by a series of stepped uniform cross sections, variational methods and solutions for the mode envelopes.

  13. Intrahepatic Transposition of Bile Ducts

    Science.gov (United States)

    Delić, Jasmin; Savković, Admedina; Isaković, Eldar; Marković, Sergije; Bajtarevic, Alma; Denjalić, Amir

    2012-01-01

    Objective. To describe the intrahepatic bile duct transposition (anatomical variation occurring in intrahepatic ducts) and to determine the frequency of this variation. Material and Methods. The researches were performed randomly on 100 livers of adults, both sexes. Main research methods were anatomical macrodissection. As a criterion for determination of variations in some parts of bile tree, we used the classification of Segmentatio hepatis according to Couinaud (1957) according to Terminologia Anatomica, Thieme Stuugart: Federative Committee on Anatomical Terminology, 1988. Results. Intrahepatic transposition of bile ducts was found in two cases (2%), out of total examined cases (100): right-left transposition (right segmental bile duct, originating from the segment VIII, joins the left liver duct-ductus hepaticus sinister) and left-right intrahepatic transposition (left segmental bile duct originating from the segment IV ends in right liver duct-ductus hepaticus dexter). Conclusion. Safety and success in liver transplantation to great extent depends on knowledge of anatomy and some common embryological anomalies in bile tree. Variations in bile tree were found in 24–43% of cases, out of which 1–22% are the variations of intrahepatic bile ducts. Therefore, good knowledge on ductal anatomy enables good planning, safe performance of therapeutic and operative procedures, and decreases the risk of intraoperative and postoperative complications. PMID:22550601

  14. Laparoscopic common bile duct exploration.

    Science.gov (United States)

    Stoker, M E; Leveillee, R J; McCann, J C; Maini, B S

    1991-10-01

    Operative common bile duct exploration, performed in conjunction with cholecystectomy, has been considered the treatment of choice for choledocholithiasis in the presence of an intact gallbladder. With the advent of laparoscopic cholecystectomy, the management of common bile duct stones has been affected. More emphasis is being placed on endoscopic sphincterotomy and options other than operative common duct exploration. Because of this increasing demand, we have developed a new technique for laparoscopic common bile duct exploration performed in the same operative setting as laparoscopic cholecystectomy. A series of five patients who successfully underwent common bile duct exploration, flexible choledochoscopy with stone extraction, and T-tube drainage, all using laparoscopic technique, is reported. Mean postoperative length of hospital stay was 4.6 days. Outpatient T-tube cholangiography was performed in all cases and revealed normal ductal anatomy with no retained stones. Follow-up ranged from 6 weeks to 4 months, and all patients were asymptomatic and had normal liver function tests.

  15. Ascariasis of the pancreatic duct.

    Science.gov (United States)

    Klimovskij, Michail; Dulskas, Audrius; Kraulyte, Zita; Mikalauskas, Saulius

    2015-09-15

    Ascariasis is a common helminthic disease worldwide, although Lithuania and other European countries are not considered endemic areas. The presence of the Ascaris worm in the biliary tree causes choledocholithiasis-like symptoms. We report a case of pancreatic duct ascariasis causing such symptoms. A 73-year-old Lithuanian woman underwent endoscopic retrograde cholangiopancreatography (ERCP) suspecting choledocholithiasis. Contrast injection into the common bile duct demonstrated a slightly dilated biliary tree without any filling defects, and the tail of an Ascaris worm protruding from the opening of the papilla Vater. The worm was captured by a snare but escaped deep into the duct. After a small wirsungotomy the worm was retrieved from the pancreatic duct. The patient received a 150 mg dose of levamisole orally repeated 7 days later and was discharged after complete resolution of symptoms. This first reported sporadic case of pancreatic duct ascariasis in Lithuania was successfully treated with ERCP and Levamisole.

  16. Comparison of Papillary Thyroid Carcinoma and Papillary Microcarcinoma in Terms of Clinical Features and Prognostic Factors

    OpenAIRE

    Hakan Korkmaz; Umut Elboğa; Ersin Akarsu; Mehmet Metin Sevim; Mesut Özkaya; Suzan Tabur; Suna Erkılıç; Avni Gökalp; Mustafa Araz

    2016-01-01

    Purpose: In this study, we compared papillary thyroid carcinoma (PTC) and papillary microcarcinoma (PMC) in terms of the clinical features and prognostic factors. For the choice of appropriate treatment method, we researched differences between PTC and PMC retrospectively. Material and Method: A total 714 patients 486 with PTC (68%) and 228 with PMC (32%) who were followed in our hospital were enrolled into the study. Age, sex, background, tumour variants, pathologic features, surgical pro...

  17. Application of mammary ductoscopy in diagnosis of breast intraductal lesions%初探乳管镜在乳腺导管内病变诊断的应用

    Institute of Scientific and Technical Information of China (English)

    毛锦锋; 丁云; 周彦君

    2014-01-01

    目的:评估乳管镜在乳腺导管内病变诊断中的有效性。方法:收集我院370例乳头溢液患者的超声、钼靶与乳管镜检查资料。336例成功接受乳管镜检查的患者中接受开放性手术者290例。其中,实性乳头状瘤213例,多发乳头状瘤病54例,癌前或恶性病变23例。分别将超声、钼靶和乳管镜检查的结果与组织病理学诊断结果进行比较。结果:本次研究发现,超声、钼靶和乳管镜检查在乳腺导管内病变诊断中的敏感性分别为67.6%、66.2%和93.1%。结论:乳管镜是乳腺导管内病变诊断中更为敏感的检查方法。%Objective:To evaluate the efficacy of mammary ductoscopy in the diagnosis of intraductal lesions of breast .Methods:370 patients with nipple discharge undergone breast ultrasound examination,mammography or ductoscopy were included and compared with the histopathologic findings .Of the 336 received mammary ductoscopy,290 were undergone open surgery,and the results revealed that 213 were solid papillary carcinoma;54,inflammatory;and 23,precancerous or malignant lesions.Results:The diagnostic sensitivity by breast ultrasound examination,mammography and mammary ductoscopy for breast intraductal lesions was 67.6%,66.2% and 93.1%,respectively.Conclusion:Mammary ductoscopy appears the most sensitive examination in the diagnosis of intraductal lesions of breast.

  18. PMR Graphite Engine Duct Development

    Science.gov (United States)

    Stotler, C. L.; Yokel, S. A.

    1989-01-01

    The objective was to demonstrate the cost and weight advantages that could be obtained by utilizing the graphite/PMR15 material system to replace titanium in selected turbofan engine applications. The first component to be selected as a basis for evaluation was the outer bypass duct of the General Electric F404 engine. The operating environment of this duct was defined and then an extensive mechanical and physical property test program was conducted using material made by processing techniques which were also established by this program. Based on these properties, design concepts to fabricate a composite version of the duct were established and two complete ducts fabricated. One of these ducts was proof pressure tested and then run successfully on a factory test engine for over 1900 hours. The second duct was static tested to 210 percent design limit load without failure. An improved design was then developed which utilized integral composite end flanges. A complete duct was fabricated and successfully proof pressure tested. The net results of this effort showed that a composite version of the outer duct would be 14 percent lighter and 30 percent less expensive that the titanium duct. The other type of structure chosen for investigation was the F404 fan stator assembly, including the fan stator vanes. It was concluded that it was feasible to utilize composite materials for this type structure but that the requirements imposed by replacing an existing metal design resulted in an inefficient composite design. It was concluded that if composites were to be effectively used in this type structure, the design must be tailored for composite application from the outset.

  19. Cholangioscopy in bile duct disease: a case series.

    Science.gov (United States)

    Moura, Eduardo Guimarães Hourneaux de; Franzini, Tomazo; Moura, Renata Nobre; Carneiro, Fred Olavo Aragão Andrade; Artifon, Everson Luiz de Almeida; Sakai, Paulo

    2014-01-01

    Direct endoscopic visualization of biliopancreatic duct is certainly one of the greatest advances of therapeutic endoscopy. The use of a single-operator cholangioscopy platform (SpyGlass) is a promising technique in the evaluation of diseases such as indeterminate biliary stricture and giant choledocholitiasis. This is the first Brazilian case series using this technology. We report a case series of 20 patients in whom SpyGlass was used with diagnostic and therapeutic intention. Most patients were female (60%) and the median age was 48 years (ranging from 14 to 94). Choledocholitiasis was the most common indication (12/20), and electrohydraulic lithotripsy was applied in eight (66%). Electrohydraulic lithotripsy was successful in seven (87.5%) patients. Partial stone fragmentation occurred in one patient with large stone causing stone-choledochal disproportion, which was conducted with biliary plastic stent placement and a second scheduled endoscopic approach in 3 months. In cases of undefined etiology of biliary strictures, it was possible to exclude malignancy due to direct visualization (7/8) or biopsy (1/8). One complication occurred (duodenal perforation) after papillary balloon dilation. The use of SpyGlass demonstrated the benefits, especially in cases of large bile duct stones and indeterminate biliary strictures. Other potencial improvements such as reduction on radiation exposure should be confirmed in prospective studies.

  20. Undifferentiated (Anaplastic Carcinoma of the Pancreas with Osteoclast-Like Giant Cells Showing Various Degree of Pancreas Duct Involvement. A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Vlad Maksymov

    2011-03-01

    Full Text Available Context Undifferentiated (anaplastic carcinoma of the pancreas with osteoclast-like giant cells is exceedingly rare. The prognosis of undifferentiated carcinoma is worse than that of poorly differentiated ductal adenocarcinoma of the pancreas; however, undifferentiated carcinoma with osteoclast-like giant cells might have a more favorable prognosis. Case report We report the case of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells, showing an intraductal growth pattern with various degree of pancreas duct involvement in the different areas. As a result, we were able to demonstrate the entire spectrum of changes, ranging from the early, minimal intraluminal growth to the partial or complete occlusion of the branches of the main pancreatic duct, and finally invasion and formation of the large necrotic/degenerated cysts. Conclusions Our findings support the epithelial origin of undifferentiated carcinoma of the pancreas with osteoclast-like giant cells. In early stages, the affected pancreatic duct epithelium was intermingled with nonepithelial component and had an immunoprofile distinctive from the epithelial lining of the uninvolved (normal pancreatic ducts. Distinctive immunoprofile (CK 5/6, p63 and p53 positive of the epithelial component and p63 and p53 positivity of the nonepithelial component should be explained and further investigated in the similar cases. Our findings support prior assertions that undifferentiated carcinoma of the pancreas with osteoclast-like giant cells may develop from carcinoma in situ within the main pancreatic duct or its branches

  1. WARTHIN TUMOR LIKE PAPILLARY CARCINOMA OF THYROID: A RARE OCCURENCE

    Directory of Open Access Journals (Sweden)

    Shikha

    2015-12-01

    Full Text Available INTRODUCTION Among the thyroid cancers, papillary carcinoma is the most common type. Warthin tumor like papillary carcinoma of thyroid is a rare variant of papillary carcinoma. The distinguishing feature of this rare variant is papillary formations lined by tumor cells with oncocytic cytoplasm with nuclear features of papillary carcinoma and lymphoplasmacytic infiltrate in the papillary stalks with striking histological resemblance to Warthin’s tumor of salivary glands. A 46 years old female with complaints of painless swelling of the neck for four years and gradually increasing in size, measuring 3x2.5 cm on the right lobe of the thyroid gland. The swelling moved with deglutition, non-tender and firm to hard in consistency. Thyroid function was within normal limits. FNAC suggested a diagnosis of oxyphilic variant of papillary carcinoma of thyroid. It showed syncytial aggregates, sheets of cells and few papillary structures with focal nuclear crowding. The patient underwent bilateral total thyroidectomy and neck dissection. Microscopic examination showed predominantly follicles and small papillary structures lined by cells having eosinophilic cytoplasm and clear nucleus. There was lymphoid stroma in the core of papillae and interfolllicular areas. Hyalinized collagen, dystrophic calcification and follicles without colloid matter infiltrating the hyalinised area were seen. No lymphovascualr tumour embolization were noted. This tumor is found more commonly in women with Hashimoto’s thyroiditis. The prognosis is favourable as conventional papillary carcinoma. About 8% of Warthin’s tumor are detected in extraparotid locations.

  2. 14 CFR 29.1103 - Induction systems ducts and air duct systems.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Induction systems ducts and air duct systems. 29.1103 Section 29.1103 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF....1103 Induction systems ducts and air duct systems. (a) Each induction system duct upstream of the...

  3. Migratory intralaryngeal thyroglossal duct cyst

    Directory of Open Access Journals (Sweden)

    Karlatti Pradeep

    2010-01-01

    Full Text Available Intralaryngeal thyroglossal duct cysts are rare; a migrating one, rarer still. Such a case may be a cause for confusion and it is important to understand this entity and its typical findings.

  4. Therapeutic effect of intraductal irrigation of the salivary gland: A technical report.

    Science.gov (United States)

    Lee, Chena; Kim, Jo-Eun; Huh, Kyoung-Hoe; Yi, Won-Jin; Heo, Min-Suk; Lee, Sam-Sun; Choi, Soon-Chul

    2017-06-01

    Obstructive and inflammatory disease often occurs in the major salivary glands, and no predictive treatment has yet been developed for this condition. The aim of this report was to introduce an intraductal irrigation procedure and to illustrate its application to practical patient cases. Two patients complaining of pain and swelling in the parotid gland during meals who underwent sialography were diagnosed as having sialodochitis with sialadenitis. Intraductal irrigation was then performed on the parotid gland on the side of the complaint. The irrigation procedure was conducted in the same manner as the sialography procedure, except that saline was used as the filling solution. Symptom severity was evaluated with a numerical rating scale (NRS) at the initial visit and a month after the irrigation. The initial NRS value of patient 1 was 10. The value decreased to 6 and then to 0 after 2 irrigation procedures. The NRS value of patient 2 regarding the symptoms involving the left parotid gland decreased from 4-5 to 1 after 4 irrigation procedures performed at 1-month intervals. Intraductal irrigation of the salivary gland may be a simple, safe, and effective treatment option for patients with obstructive and inflammatory disease of the salivary gland that is capable of resolving their symptoms.

  5. Therapeutic effect of intraductal irrigation of the salivary gland: A technical report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chena [Dept. of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul (Korea, Republic of); Kim, Jo Eun; Huh, Kyoung Hoe; Yi, Won Jin; Lee, Sam Sun; Choi, Soon Chul [Dept. of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    2017-06-15

    Obstructive and inflammatory disease often occurs in the major salivary glands, and no predictive treatment has yet been developed for this condition. The aim of this report was to introduce an intraductal irrigation procedure and to illustrate its application to practical patient cases. Two patients complaining of pain and swelling in the parotid gland during meals who underwent sialography were diagnosed as having sialodochitis with sialadenitis. Intraductal irrigation was then performed on the parotid gland on the side of the complaint. The irrigation procedure was conducted in the same manner as the sialography procedure, except that saline was used as the filling solution. Symptom severity was evaluated with a numerical rating scale (NRS) at the initial visit and a month after the irrigation. The initial NRS value of patient 1 was 10. The value decreased to 6 and then to 0 after 2 irrigation procedures. The NRS value of patient 2 regarding the symptoms involving the left parotid gland decreased from 4-5 to 1 after 4 irrigation procedures performed at 1-month intervals. Intraductal irrigation of the salivary gland may be a simple, safe, and effective treatment option for patients with obstructive and inflammatory disease of the salivary gland that is capable of resolving their symptoms.

  6. TWO NEW DUCT LEAKAGE TESTS

    Energy Technology Data Exchange (ETDEWEB)

    ANDREWS,J.W.

    1998-12-01

    Two variations on the tests for duct leakage currently embodied in ASHRAE Standard 152P (Method of Test for Determining the Design and Seasonal Efficiencies of Residential Thermal Distribution Systems) are presented. Procedures are derived for calculating supply and return duct leakage to/from outside using these new variations. Results of these tests are compared with the original ones in Standard 152P on the basis of data collected in three New York State homes.

  7. Duct Leakage Repeatability Testing

    Energy Technology Data Exchange (ETDEWEB)

    Walker, Iain [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Sherman, Max [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2014-01-01

    Duct leakage often needs to be measured to demonstrate compliance with requirements or to determine energy or Indoor Air Quality (IAQ) impacts. Testing is often done using standards such as ASTM E1554 (ASTM 2013) or California Title 24 (California Energy Commission 2013 & 2013b), but there are several choices of methods available within the accepted standards. Determining which method to use or not use requires an evaluation of those methods in the context of the particular needs. Three factors that are important considerations are the cost of the measurement, the accuracy of the measurement and the repeatability of the measurement. The purpose of this report is to evaluate the repeatability of the three most significant measurement techniques using data from the literature and recently obtained field data. We will also briefly discuss the first two factors. The main question to be answered by this study is to determine if differences in the repeatability of these tests methods is sufficient to indicate that any of these methods is so poor that it should be excluded from consideration as an allowed procedure in codes and standards.

  8. Symptomatic papillary tumour of the pulmonary valve

    OpenAIRE

    Cooper, Linda Carol

    1982-01-01

    Papillary ‘tumours’ are small pedunculated lesions of the valve cusps and result from wear-and-tear. They are therefore frequent post-mortem findings in older patients. The vast majority are clinically silent, though occasionally such lesions when on the aortic valve may produce symptoms of myocardial or cerebral ischaemia. None has been known to cause symptoms when in the right side of the heart.

  9. Inflammatory papillary hyperplasia: A systematic review

    Science.gov (United States)

    Gual-Vaqués, Patricia; Jané-Salas, Enric; Egido-Moreno, Sonia; Ayuso-Montero, Raúl; Marí-Roig, Antoni

    2017-01-01

    Introduction Inflammatory papillary hyperplasia (IPH) is a benign lesion of the palatal mucosa. It is usually found in denture-wearers but also has been reported in patients without a history of use of a maxillary prosthesis use. Objetives The aim of this study is to review the literature to assess the prevalence of denture stomatitis and inflammatory papillary hyperplasia and the etiological factors associated. Material and Methods A search was carried out in PubMed (January 2005 to October 2015) with the key words “inflammatory papillary hyperplasia”, “denture stomatitis”, “granular stomatitis” and “Newton’s type III” The inclusion criteria were studies including at least a sample of 50 apparently healthy patients, articles published from 2005 to 2015 written in English. The exclusion criteria were reviews and non-human studies. Results Out of the 190 studies obtained initially from the search 16 articles were selected to be included in our systematic review. The prevalence of denture stomatitis was 29.56% and 4.44% for IPH. We found 5 cases of denture stomatitis among non-denture-wearer individuals. All IPH cases were associated with the use of prosthesis. Smoking and continued use of ill-fitting dentures turned out to be the most frequent risk factors for developing IPH. Conclusions IPH is a rare oral lesion and its pathogenesis still remains unclear. Its presentation among non-denture-wearers is extremely unusual. Key words:Inflammatory papillary hyperplasia, denture stomatitis, prevalence, granular stomatitis, Newton’s type III stomatitis. PMID:27918740

  10. Determinants of papillary cancer of the thyroid

    Energy Technology Data Exchange (ETDEWEB)

    Wingren, G.; Hatschek, T.; Axelson, O. (University Hospital, Linkoeping (Sweden))

    1993-10-01

    Determinants of papillary thyroid cancer were evaluated in a questionnaire-based case-control study from southeastern Sweden. A total of 104 cases, diagnosed from 1977 to 1987, and 387 randomly selected controls were included in the analyses. Female subjects with papillary cancer reported a work history as dentists/dental assistants, telephone operators, teachers, and day nursery personnel, and an occupational contact with chemicals and video display terminals more often than did controls. The 11 male cases more often reported working as mechanics and metal workers and having occupational contact with solvents. Other factors associated with increased risk for female papillary cancer were having private well water at the birth address; leisure time exposure to combustion smoke; low intake of cruciferous vegetables and seafood; and a family history of goiter, heart disease, biliary disorder, or female genital cancer. Diagnostic radiographic examinations, especially to the head, neck, or upper back/chest area, or repeated dental examinations, were also found to be associated with this form of cancer. With regard to the possible influence from hormonal factors among women less than age 50 years at time of diagnosis, an increased risk was found for a pregnancy soon after puberty. Tendencies toward a decreasing risk with increasing age at first pregnancy as well as an increasing risk with increasing number of pregnancies were found as well. Multiparity seemed to potentiate the effect from prior radiographic examinations.

  11. State of the Science and the Intraductal Approach for Breast Cancer: Proceedings Summary of The Sixth International Symposium on the Intraductal Approach To Breast Cancer Santa Monica, California, 19–21 February 2009

    Directory of Open Access Journals (Sweden)

    Rochman Susan

    2009-07-01

    Full Text Available Abstract Researchers are using the intraductal approach to advance breast cancer risk assessment, prevention, diagnosis, and treatment. Procedures and technologies that can access and interrogate the ductal-alveolar systems include nipple aspiration, ductal lavage and ductoscopy. Ductoscopic papillectomy, ductoscopic margin evaluation, and intraductal therapy are considered promising investigational and innovative treatments. These techniques are used to explore the biology of the normal breast; collect and analyze breast fluid and cells to identify biomarkers that can be used in breast cancer detection and risk assessment; and to identify new ways to find and administer therapeutic and/or preventive agents to the breast tissue. This report summarizes the latest research findings in these areas, presented at The 6th International Symposium on the Intraductal Approach to Breast Cancer in 2009.

  12. State of the Science and the Intraductal Approach for Breast Cancer: Proceedings Summary of The Sixth International Symposium on the Intraductal Approach To Breast Cancer Santa Monica, California, 19–21 February 2009

    Science.gov (United States)

    Rochman, Susan; Mills, Dixie; Kim, Julian; Kuerer, Henry; Love, Susan

    2009-01-01

    Researchers are using the intraductal approach to advance breast cancer risk assessment, prevention, diagnosis, and treatment. Procedures and technologies that can access and interrogate the ductal-alveolar systems include nipple aspiration, ductal lavage and ductoscopy. Ductoscopic papillectomy, ductoscopic margin evaluation, and intraductal therapy are considered promising investigational and innovative treatments. These techniques are used to explore the biology of the normal breast; collect and analyze breast fluid and cells to identify biomarkers that can be used in breast cancer detection and risk assessment; and to identify new ways to find and administer therapeutic and/or preventive agents to the breast tissue. This report summarizes the latest research findings in these areas, presented at The 6th International Symposium on the Intraductal Approach to Breast Cancer in 2009.

  13. Risk Factors associated with Paraurethral Duct Dilatation following Gonococcal Paraurethral Duct Infection in Men

    Science.gov (United States)

    Fan, Wenge; Zhang, Qingsong; Wang, Lin; Ye, Xun; Jiang, Tingwang

    2016-01-01

    No studies have explored the risk factors for paraurethral duct dilatation following paraurethral duct infection by Neisseria gonorrhoeae in men undergoing ceftriaxone therapy. The present study was performed to explore the risk factors for paraurethral duct dilatation following paraurethral duct infection by N. gonorrhoeae in men undergoing ceftriaxone therapy and thus guide clinical interventions. We compared the demographic, behavioral, and clinical data of men with paraurethral duct infection by N. gonorrhoeae with and without dilatation of the paraurethral duct. Univariate analysis showed significant differences in age, disease course of the infected paraurethral duct, Chlamydia trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae between the patient and control groups (Pgonorrhoeae in men. Age, C. trachomatis infection in the paraurethral duct, and a history of paraurethral duct infection by N. gonorrhoeae are also risk factors. Thus, educating patients to undergo timely therapy and treating the C. trachomatis infection may be effective interventions. PMID:27861521

  14. An isolated nasolacrimal duct osteoma.

    Science.gov (United States)

    Kim, Joo Yeon; Kwon, Jae Hwan

    2013-07-01

    Osteomas of the nose and paranasal sinus are common benign tumors that can extend to surrounding structures and result in orbital or intracranial involvement. Presenting symptoms include facial pain, headache, cerebral symptoms, ocular symptoms, and so on, depending on the location and size of the tumor. They commonly occur within the frontal, ethmoid, maxillary, and sphenoid sinuses; however, there are rare cases of reported osteomas in the nasal cavity, turbinate, or orbit. Our case report describes a patient with nasolacrimal duct osteoma who presented with ipsilateral ocular pain, epiphora, and medial canthal swelling. We performed intranasal dacryocystorhinostomy using a nasal endoscope and removed the lacrimal duct osteoma. This report describes symptoms and management of an isolated nasolacrimal duct stone with a review of the literature.

  15. Three-dimensional echocardiography of a tricuspid valve papillary fibroelastoma

    Directory of Open Access Journals (Sweden)

    Atooshe Rohani

    2017-01-01

    Full Text Available Papillary fibroelastomas (PFE on tricuspid valve (TV are rare, accounting for fewer than 11% of all PFE. Most often they are asymptomatic, and detect on mitral valve. We report a case of a typical chest pain found to be due to papillary fibroelastoma of the tricuspid valve.

  16. Prognostic factors in papillary and follicular thyroid carcinomas

    DEFF Research Database (Denmark)

    Godballe, C; Asschenfeldt, P; Jørgensen, K E;

    1998-01-01

    carcinomas. The analyses were based on cause-specific and crude survival. In univariate analysis, age at diagnosis, tumor size, presence of distant metastases, histology (papillary contra follicular type), extrathyroidal invasion, necrosis in primary tumor, and p53 expression were significant prognostic...... prognostic indicator, which might be of value in the treatment planning in patients with papillary or follicular thyroid carcinomas....

  17. Papillary Cystadenocarcinoma of the Parotid Gland: A Rare Case Report.

    Science.gov (United States)

    Telugu, Ramesh Babu; Job, Anjana Juanita; Manipadam, Marie Therese

    2016-06-01

    Papillary cystadenocarcinoma is a rare malignant neoplasm of the salivary gland, characterized by noticeable cystic and solid areas with papillary endophytic projections. These tumours lack features that characterize cystic variants of several more common salivary gland carcinomas. It was first described in 1991 by World Health Organization as a separate entity and cystadenocarcinoma with or without papillary component in the AFIP classification. Most of these tumours occurred in the major salivary glands followed by minor salivary glands. Cystadenocarcinoma is the malignant counterpart of cystadenoma. We report a case of papillary cystadenocarcinoma of parotid. A 40-year-old lady presented with gradually progressive swelling below the right ear associated with occasional pain. Clinical and radiological features suggested benign neoplasm. Right lobe superficial parotidectomy was performed. The histopathologic diagnosis showed papillary cystadenocarinoma of the parotid gland. Histologic confirmation of stromal invasion is required to differentiate it from the benign lesion. Conservative wide local surgical excision is the treatment of choice.

  18. [Solid and papillary tumor of the pancreas].

    Science.gov (United States)

    Spay, G; Mosnier, J F; Mangnas, D

    A patient who was treated in 1978 by duodenopancreatectomy for a tumour of the second duodenum survived for 15 years before death caused by trauma. The pathology slides were therefore reassessed and led, a posteriori, to the diagnosis of solid papillary tumour of the pancreas according to the new criteria described by Kloppel. The 86 references found in the literature reported 139 cases although many were too vague to be retained. Precise diagnosis can only be obtained on the basis of immunohistochemistry and ultra-structure criteria as described here.

  19. Ultrasonographic imaging of papillary thyroid carcinoma variants

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Jung Hee [Dept. of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2017-04-15

    Ultrasonography (US) is routinely used to evaluate thyroid nodules. The US features of papillary thyroid carcinoma (PTC), the most common thyroid malignancy, include hypoechogenicity, spiculated/microlobulated margins, microcalcifications, and a nonparallel orientation. However, many PTC variants have been identified, some of which differ from the classic type of PTC in terms of biological behavior and clinical outcomes. This review describes the US features and clinical implications of the variants of PTC. With the introduction of active surveillance replacing immediate biopsy or surgical treatment of indolent, small PTCs, an understanding of the US characteristics of PTC variants will facilitate the individualized management of patients with PTC.

  20. MITRAL VALVE PAPILLARY FIBROELASTOMA:CASE REPORT

    Institute of Scientific and Technical Information of China (English)

    HUANG Ying(黄英); JIANG Mier(蒋米尔); Yves GLOCK

    2003-01-01

    Objective To evaluate the transesophageal echocardiography(TEE) and surgical treatment to cardiac papillary fibroelastomas (CPFE). Methods CPFE is a rare benign tumor occuring mainly in valves and often revealed by serious cerebral, coronary and peripheral embolism or even sudden death. We report a case of mitral PFE diagnosed by transesophageal echocardiography (TEE), and surgical resection was performed. Results Surgical intervention is successful, and the follow-up courses are uneventful. Conclusion TEE is helpful to diagnosis and guiding the operation. Operation is recommended to prevent recurrent embolization complications.

  1. Clinical application of localization needle under mammary ductoscopy for surgical excision of intraductal neoplasms%乳管镜下置定位针在乳管内肿瘤手术中的应用价值

    Institute of Scientific and Technical Information of China (English)

    朱旬; 邢春根; 金涛; 蔡立春

    2010-01-01

    Objective To evaluate the clinical value of breast localization needle placed via mammary ductoscopy in surgical treatment of patients with intraductal neoplasms. Methods In this study,76 patients with intraductal neoplasms diagnosized by mammary ductoscopy from January 2009 to March 2010 in the Second Affiliated Hospital of Soochow University were randomly divided into two groups.For methylene blue group,ducts with the lesion were marked by methylene blue injection before operation.For localization needle group,ducts were marked by localization needle placed via ductoscopy.The operative time,specimen weight,incision length and diagnostic coincidence rate were compared among the two groups. Results Compared to the methylene blue group,the localization needle group had a significantly shorter operative time (31 ± 8 min vs.42 ± 9 min),lighter specimen weight (1.51 ± 1.36 g vs.2.95 ± 2.07 g),and shorter incision (23.2 ± 7.8 mm vs.34.4 ± 7.1 mm).All the breast cancer cases dianosised by mammary ductoscopy were confirmed by postoperative pathology,but the localization needle group had a higher diagnostic coincidence rate than the methylene blue group (94.7% vs. 76.3%). Conclusion Localization needle under mammary ductoscopy is a reliable technique for localizing intraductal neolasms.The surgical excision guided by localization needle is accurate and less traumatic,and should be a routine method marking the tumor involved duct before operation.%目的 探讨经乳管镜置定位针引导的方法在乳管内肿瘤手术中的应用价值.方法 2009年1月至2010年3月,苏州大学附属第二医院76例采用乳管镜检查发现乳管内肿瘤的患者随机分为2组,每组各38例,分别在美兰标记和置定位针后进行手术,比较两组手术时间、切除标本重量、切口长度及手术前后诊断符合率.结果 定位组手术时间短于美兰组(31±8 min vs.42±9 min);定位组手术切除标本重量轻于美兰组(1.51±1.36 g vs.2.95±2

  2. Fragmentation of common bile duct and pancreatic duct stones by extracorporeal shock-wave lithotripsy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ham Gyum [Ansan Junior College, Seoul (Korea, Republic of); Son, Soon Yong; Lee, Won Hong [Asan Medical Center, Seoul (Korea, Republic of)

    1998-06-01

    To determine its usefulness and safety of extracorporeal shock-wave lithotripsy in common bile duct and pancreatic duct stones, we analyzed the results of 13 patients with common bile duct stones and 6 patients with pancreatic duct stones which were removed by endoscopic procedures using the balloon or basket, who was performed the extracorporeal shock-wave lithotripsy using the ultrasonography for stone localization with a spark gap type Lithotriptor(Dornier MPL 9000, Germany). Fragmentation and complete clearance of the common bile duct and pancreatic duct stones were obtained in 19 of 19 patients(100%). Apart from transient attacks of fever in 2 of 13 patients with common bile duct stones(15%) and mild elevation of serum amylase and lipase in 2 of 6 patients with pancreatic duct stones(33%), no other serious side effects were observed. In our experiences, extracorporeal shock-wave lithotripsy is a safe and useful treatment for endoscopically unretrievable common bile duct and pancreatic duct stones.

  3. Vitellointestinal Duct Anomalies in Infancy

    Science.gov (United States)

    Kadian, Yogender Singh; Verma, Anjali; Rattan, Kamal Nain; Kajal, Pardeep

    2016-01-01

    Background: Vitellointestinal duct (VID) or omphalomesenteric duct anomalies are secondary to the persistence of the embryonic vitelline duct, which normally obliterates by weeks 5–9 of intrauterine life. Methods: This is a retrospective analysis of a total of 16 patients of symptomatic remnants of vitellointestinal duct from period of Jan 2009 to May 2013. Results: Male to female ratio (M:F) was 4.3:1 and mean age of presentation was 2 months and their mode of presentation was: patent VID in 9 (56.25%) patients, umbilical cyst in 2(12.25%), umbilical granuloma in 2 (12.25%), and Meckel diverticulum as content of hernia sac in obstructed umbilical hernia in 1 (6.25%) patient. Two patients with umbilical fistula had severe electrolyte disturbance and died without surgical intervention. Conclusion: Persistent VID may have varied presentations in infancy. High output umbilical fistula and excessive bowel prolapse demand urgent surgical intervention to avoid morbidity and mortality. PMID:27433448

  4. Fan/Ram Duct Program

    Science.gov (United States)

    1973-10-01

    mwm^mmmt c INPUT I ] H—f TRANSIENT ROUTINE P"" CONTROL """I FAN ] COMPRESSOR MAIN BURNER I DUCT HZ HIGH TURBINE in— LOW TURBINE I...and pressure ratio. 6. Low Turbine Low turbine characteristics, identical In form to those of the high turbine, are shown in figures 27 and 28. 7

  5. Papillary thyroid microcarcinoma might progress during pregnancy.

    Science.gov (United States)

    Shindo, Hisakazu; Amino, Nobuyuki; Ito, Yasuhiro; Kihara, Minoru; Kobayashi, Kaoru; Miya, Akihiro; Hirokawa, Mitsuyoshi; Miyauchi, Akira

    2014-05-01

    Papillary thyroid cancer occasionally occurs in women of childbearing age. As papillary thyroid microcarcinoma (PTMC) rarely grows or becomes clinically apparent, observation without surgery is an appropriate strategy for patients with low-risk PTMC. Human chorionic gonadotropin possesses weak thyroid-stimulating activity. The aim of this study was to assess the effect of pregnancy on PTMC. We studied 9 patients with PTMC who became pregnant between 2005 and 2011. Twenty-seven age-matched nonpregnant female PTMC patients from a database we used in our previous report served as controls. Tumor enlargement was defined as an increase in the diameter of the tumor of 3 mm or more. PTMC enlargement occurred in 44.4% (4/9 patients) of the pregnant subjects, whereas it occurred only in 11.1% (3/27 patients) of the controls (p=0.0497). Three of the pregnant patients who exhibited tumor enlargement underwent surgery after delivery. No relationship was detected between the changes in the serum thyroglobulin level, the serum thyrotropin level, and tumor size during pregnancy. Immunohistochemical examinations did not detect the estrogen receptor in the tumors of the three patients who underwent surgery. This study is an initial report indicating that the risk of PTMC enlargement might increase during pregnancy. PTMC should be carefully followed-up for possible disease aggravation during pregnancy. Even if a PTMC enlarges during pregnancy, the patient's prognosis will probably not worsen.

  6. Papillary thyroid carcinoma: Debate at rest

    Directory of Open Access Journals (Sweden)

    A A Sonkar

    2010-01-01

    Full Text Available Introduction: Papillary thyroid cancer (PTC is the most common well-differentiated cancer of the thyroid and is one of the fastest growing group of cancers probably because of the increased use of ultrasound (HRUSG in the evaluation of the thyroid in recent years. Materials and Methods: A MEDLINE and OVID database search was performed to collect information on papillary thyroid carcinoma. Recently published consensus guidelines were also used as an additional resource. Conclusions: The controversy regarding the extent of thyroidectomy in patients of PTC is relatively settled, with total thyoidectomy being the preferred approach with nodules> 1.5 cm in size. Lymph node (LN metastases do not seem to affect the overall survival, but they do increase the recurrence rate. It is worthwhile to offer LN dissection at initial surgery if LNs are ultrasonologically diagnosed to harbor malignancy. In experts hands, the rate of recurrent laryngeal nerve injury and hypoparathyroidism is negligible in a neck dissection in initial surgery and remains negligible if carried out in a redo or completion scenario.

  7. 胰腺导管内乳头状黏液性肿瘤的CT诊断%CT Diagnosis of Intraductal Papillary Mucinous Neoplasm of Pancreas

    Institute of Scientific and Technical Information of China (English)

    傅爱燕; 叶彤; 曾蒙苏; 史讯; 纪元

    2007-01-01

    目的:探讨胰腺导管内乳头状黏液性肿瘤(IPMN)的螺旋CT诊断价值.材料和方法:回顾性分析经手术病理证实的14例胰腺IPMN的螺旋CT表现.结果:主胰管型IPMN 3例,表现为主胰管扩张伴管壁结节样突起;分支胰管型IPMN 5例,表现为分叶状单发囊性病变或葡萄串样多发囊性病变伴腔内分隔或结节样突起;混合型IPMN 6例,表现为主胰管扩张和囊性病变合并存在.CT诊断IPMN恶变6例,病理诊断导管内乳头状黏液腺癌7例.结论:螺旋CT能够显示胰腺IPMN的病理特征,并可做出分型.

  8. 胰腺导管内乳头状黏液性肿瘤的研究进展%Advances in Studies on Intraductal Papillary Mutinous Neoplasms

    Institute of Scientific and Technical Information of China (English)

    王雷; 蔡全才; 李兆申

    2009-01-01

    胰腺导管内乳头状黏液性肿瘤(IPMNs)是一类以胰腺导管上皮乳头样增生和分泌大量黏液为特点的一类肿瘤,大量黏液堵塞主胰管或分支胰管并使之扩张.近年埘IPMNs的流行病学、病理特征与肿瘤基因表达、诊断处理原则方面均有了新的认识.本文就IPMNs的研究进展作一综述.

  9. Advances in pancreatitic intraductal papillary mucinous neoplasms%胰腺导管内乳头状黏液性肿瘤研究进展

    Institute of Scientific and Technical Information of China (English)

    王伟; 李兆申; 高军

    2008-01-01

    胰腺导管内乳头状黏液性肿瘤(pancreatic intraepithelial neoplasias,IPMNs)是新近被认识的一种胰腺囊性肿瘤.在不同类型胰腺肿瘤中,IPMNs预后相对较好,具有与一般胰腺肿瘤不同的分子及临床病理特征:按照乳头状结构及黏蛋白的表达又可将其分为多个亚型,不同亚型又具有不同的病理特点.病理学家提出IPMNs是胰腺癌发生过程中的重要阶段,深入研究IPMNs及其不同亚型的病理特点及其所蕴含的分子变化,将能更好的揭示IPMNs的发病机制及生物学特征.本文回顾相关文献,从分子特征、病理特征、诊断治疗及预后判断等不同角度对目前IPMNs的研究进展作一综述.

  10. Histochemical Study of N-acetylgalactosamine Containing Glycoconjugate in Intraductal Carcinoma of the Breast by HPA Lectin

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Arab

    2006-01-01

    Full Text Available Introduction: Glycoconjugates are a class of glycoproteins or glycolipids, their terminal sugars are responsible for cell-cell and/or cell-extracellular matrix interactions. Aberrant glycosylation of these compounds are one of the most important aspects of cellular transformation, metastasis and escape of tumoral cells from immune system and resistance to antineoplastic drugs. Recent studies showed that patients with HPA (helix pomatia agglutinin positive intraductal carcinoma cells have worse prognosis compared to patients with HPA negative cells. The aim of the present study was to define the presence of GalNac terminal sugar in glycoconjugate of different grades of intraductal breast carcinoma and to compare the degree and the pattern of reactivity of tumoral cells to HPA lectin. Materials and Methods: The paraffin blocks belonging to 20 patients of intraductal carcinoma was chosen from pathology archive of Khatam-Al-Anbia hospital in Zahedan and 5-7 micrometer sections were prepared. Two expert pathologists determined histopathological grading independently. The lectin histochemistry was performed using HPA. The same observers determined histochemical grading. Data were analyzed by NPAR (non-parametric test of Mann Whitney. Results: Results of this study revealed that the pattern and the degree of histochemical reactivity of neoplastic cells differ in all grades of intraductal carcinoma. Histochemical staining showed significant difference between grades of intraductal carcinoma of the breast (p<0.003. The lowest reactivity was seen in grade I and the highest in grade III. Furthermore, the reaction of tumoral cells was primarily confined to apical surfaces of cells in grade I, to the Golgi zone in grade II, and to a diffuse cytoplasmic distribution in grade III. Conclusion: Our data suggest that the HPA reactivity of tumoral cells were different in all grades of intraductal carcinoma. The tumor cells showed aberrant glycosylation, which

  11. The role of breast ductoscopy in evaluation of nipple discharge: a chinese experience of 419 patients.

    Science.gov (United States)

    Yang, Xiaoqin; Li, Hongjiang; Gou, Juxiang; Tan, Qiuwen; Wang, Liping; Lin, Xiaoyan; Feng, Xiaojuan; Jiang, Yixue; Zhang, Shu; Lv, Qing

    2014-01-01

    The aim of this study is to report our experience with ductoscopic evaluation for screening patients with nipple discharge and evaluate any potential indications and benefits of ductoscopy. From January 2010 to December 2012, 419 female patients with nipple discharge were enrolled in this study. All patients involved in this study showed no mass in ultrasound and mammography. Data concerning age, clinical characteristics of nipple discharge, nipple discharge cytology, ductoscopic and postsurgical diagnosis, and complications were statistically analyzed. Ductoscopy examinations were completed in 405 patients (96.66%). For these 405 patients, there were 519 ductoscopic investigations. 112 (27.65%) patients were found to have intraductal papillary lesions of which 62 were operated in our hospital. Postsurgical diagnosis showed 8 (12.9%) malignancy including 6 DCIS and 2 invasive ductal carcinomas. All of the 8 patients meet at least two criteria of pathologic nipple discharge (single duct, spontaneous, bloody nipple discharge). The other patients with nonpapillary lesions are still under surveillance. By univariate analysis, patients with unilateral, single duct, spontaneous and bloody nipple discharge were more likely to have intraductal papillary lesions. By multivariate analysis, unilateral, spontaneous, and bloody nipple discharge showed statistically significant correlations with intraductal papillary lesions revealed by ductoscopy. Ductoscopy is a safe and efficient investigation in preoperative screening of the patients with nipple discharge. Clinical characteristics have predictive value in selection of patients for ductoscopical investigation. Patients with clinical characteristics of unilateral, spontaneous, and bloody nipple discharge were more likely to have intraductal papillary lesions revealed by ductoscopy.

  12. Noninvasive study of anatomic variations of the bile and pancreatic duct using magnetic resonance cholangiopancreatography; Estudio no invasivo de variantes anatomicas de la via biliar y pancreatica mediante colangiopancreatografia por resonancia magnetica (CPRM)

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez, E.; Falco, J.; Campo, R.; Martin, J.; Brullet, E. [SDI-UDIAT Corporacio Sanitaria Parc Tauli. Sabadell (Spain); Espinos, J. [Hospital Mutua de Tarrasa (Spain)

    1999-07-01

    To identify anatomic variations of the bile duct and pancreatic duct and papillary anomalies by means of magnetic resonance cholangiopancreatography (MRCP) and determine their correlation with endoscopic retrograde cholangiopancreatography (ERCP) findings. Eighty-five patients were selected by means of a prospective study comparing MRCP and ERCP. Coronal and axial HASTE images and coronal and oblique coronal RARE images were acquired in all the patients. Four of the studies (6%) were excluded because of poor technical quality. Anatomic variations were observed in 26 cases (30.5%), including trifurcation (n=7; 27%), right hepatic duct draining into left hepatic duct (n=2, 7.7%), right hepatic duct draining into common bile duct (n=4; 15.4%), extrahepatic confluence (n=2; 7.7%), medial cystic duct (n=2; 7.7%), parallel cystic duct (n=3; 11.5%), juxtapapillary duodenal diverticulum (n=3; 11.5%) and pancreas divisum (n=3; 11.5%). A good correlation was observed between the MRCP and ERCP findings. The introduction of MRCP into the noninvasive study of biliary disease may be useful in the detection of anatomic variations relevant to laparoscopic surgery and other endoscopic and interventional techniques. (Author) 11 refs.

  13. Cribriform-Morular Variant of Papillary Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Bahar AKKAYA

    2009-09-01

    Full Text Available Cribriform-morular variant of papillary thyroid carcinoma is a rare histological subtype of papillary thyroid carcinoma. This subtype is commonly reported in patients with familial adenomatous polyposis. However, cases not associated with polyposis have also been reported. The differential diagnosis of this entity from other aggressive thyroid neoplasms is important. A 29-year old man presented with a solitary mass in the left thyroid lobe underwent total thyroidectomy. Pathologic examination of the specimen revealed cribriform-morular variant of papillary thyroid carcinoma. After diagnosis, colonoscopy revealed a normal colon without polyposis. Herein, we report a case not associated with polyposis and discuss with the literature.

  14. Diffuse sclerosing variant of papillary thyroid carcinoma: case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seung Chan; Kim, Dong Wook [Masan Samsung Hospital, Sungkyunkwan University, School of Medicine, Masan (Korea, Republic of)

    2006-07-15

    Diffuse sclerosing papillary carcinoma (DSPC) is a variant of papillary thyroid carcinoma (PTC), but it shows more aggressive clinical course and a poorer prognosis than the other types of PTC. Most PTCs show a focal nodular pattern in the thyroid on the imaging modalities, but DSPC reveals a diffuse infiltrating configuration in the thyroid without any focal nodular lesion. To our knowledge, there are scant radiological reports of diffuse sclerosing variant of papillary thyroid carcinoma. In this report, we present the case of a patient with DSPC who showed the characteristic findings on sonography and computed tomography.

  15. [Viscoelastic properties of relaxed papillary muscle at physiological hypertrophy].

    Science.gov (United States)

    Smoliuk, L T; Lisin, R V; Kuznetsov, D A; Protsenko, Iu L

    2012-01-01

    Viscoelastic properties of relaxed rat papillary muscles at physiological hypertrophy (intensive swimming for 5 weeks) have been obtained. It has been ascertained that viscoelastic properties of hypertrophied muscles are not significantly distinguished from those of control papillary muscles. A three-dimensional model of myocardial fascicle has been verified in compliance with experimental data of biomechanical tests of hypertrophied muscles. Elastic and viscous parameters of structural elements of the model negligibly differ from the parameters of the model of a control muscle. It is shown that physiological hypertrophy has a slight influence on viscoelastic properties of papillary muscles.

  16. Malar Bone Metastasis Revealing a Papillary Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Ihsen Slim

    2012-01-01

    Full Text Available Papillary thyroid carcinoma is the most common form of differentiated thyroid carcinoma. It is generally confined to the neck with or without spread to regional lymph nodes. Metastatic thyroid carcinomas are uncommon and mainly include lung and bone. Metastases involving oral and maxillofacial region are extremely rare. We described a case of malar metastasis revealing a follicular variant of papillary thyroid carcinoma, presenting with pain and swelling of the left cheek in a 67-years-old female patient with an unspecified histological left lobo-isthmectomy medical history. To our knowledge, this is the first recorded instance of a malar metastasis from a follicular variant of papillary thyroid carcinoma.

  17. Papillary Carcinoma Arising from the Pyramidal Lobe of the Thyroid

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Gi; Lee, Sarah; Kim, Eun Kyung; Moon, Hee Jung; Kwak, Jin Young [Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2012-03-15

    The authors present a rare case of papillary carcinoma arising from the pyramidal lobe of the thyroid in a 54-year-old woman, who presented with a right submental palpable mass. An ultrasound evaluation depicted a 3 cm mixed echoic mass from the thyroid cartilage level without a focal lesion in the thyroid gland. Surgical specimens obtained during bilateral thyroidectomy confirmed papillary carcinoma of the pyramidal lobe. To the authors' knowledge, this is the first case report to describe papillary carcinoma arising from the pyramidal lobe of the thyroid gland

  18. Intracystic papillary breast cancer: a clinical update

    Science.gov (United States)

    Reefy, Sara Al; Kameshki, Rashid; Sada, Dhabya Al; Elewah, Abdullah Al; Awadhi, Arwa Al; Awadhi, Kamil Al

    2013-01-01

    Introduction: Intracystic (encysted) papillary cancer (IPC) is a rare entity of breast cancer accounting for approximately (1–2%) of all breast tumours [1], usually presenting in postmenopausal women and having an elusive natural history. The prediction of the biological behaviour of this rare form of breast cancer and the clinical outcome showed its overall favourable prognosis; however, its consideration as a form of ductal carcinoma in situ with non-invasive nature is to be reconsidered as it has been shown to present histologically with invasion of basement membrane and even metastasis [2]. The objective of this review is to shed some light on this rare, diagnostically challenging form of breast cancer, including its radiological, histological, and molecular characteristics and its pathological classification. The final goal is to optimize the clinical management including the role of sentinel lymph node biopsy (SLNB), general management with adjuvant radiotherapy (RT), mammary ductoscopy, and hormonal treatment. Methods: A literature review, facilitated by Medline, PubMed, and the Cochrane database, was carried out using the terms ‘Intracystic (encysted) papillary breast cancer’. Results: Intracystic papillary breast cancer (IPC) is best managed in the context of a multidisciplinary team. Surgical excision of the lump with margins in excess of 2 mm is considered satisfactory. Sentinel lymph node biopsy (SLNB) is recommended as data have shown the possibility of the presence of invasive cancer in the final histology. RT following IPC alone is of uncertain significance as this form of cancer is usually low grade and rarely recurs. However, if it is associated with DCIS or invasive cancer and found in young women, radiotherapy may be prudent to reduce local recurrence. Large tumours, centrally located or in cases where breast conserving surgery is unable to achieve a favourable aesthetic result, a skin sparing mastectomy with the opportunity for immediate

  19. Current surgical treatment for bile duct cancer

    Institute of Scientific and Technical Information of China (English)

    Yasuji Seyama; Masatoshi Makuuchi

    2007-01-01

    Since extrahepatic bile duct cancer is difficult to diagnose and to cure, a safe and radical surgical strategy is needed. In this review, the modes of infiltration and spread of extrahepatic bile duct cancer and surgical strategy are discussed. Extended hemihepatectomy, with or without pancreatoduodenectomy (PD), plus extrahepatic bile duct resection and regional lymphadenectomy has recently been recognized as the standard curative treatment for hilar bile duct cancer. On the other hand, PD is the choice of treatment for middle and distal bile duct cancer. Major hepatectomy concomitant with PD (hepatopancreatoduodenectomy) has been applied to selected patients with widespread tumors. Preoperative biliary drainage (BD) followed by portal vein embolization (PVE) enables major hepatectomy in patients with hilar bile duct cancer without mortality. BD should be performed considering the surgical procedure, especially, in patients with separated intrahepatic bile ducts caused by hilar bile duct cancer. Right or left trisectoriectomy are indicated according to the tumor spread and biliary anatomy. As a result, extended radical resection offers a chance for cure of hilar bile duct cancer with improved resectability, curability, and a 5-year survival rate of 40%. A 5-year survival rate has ranged from 24% to 39% after PD for middle and distal bile duct cancer.

  20. Papillary endothelial hyperplasia (Masson's tumor) in children.

    Science.gov (United States)

    Liné, A; Sanchez, J; Jayyosi, L; Birembaut, P; Ohl, X; Poli-Mérol, M-L; François, C

    2016-06-23

    The intravascular papillary endothelial hyperplasia (IPEH/Masson's tumor) is a rare benign tumor of the skin and subcutaneous vessels. We report, in four pediatric cases, clinical presentation, care (diagnostic and surgical) of Masson's tumor in children. Two boys (two years) and two girls (four and six years) showed a pain subcutaneous tumor (one to five centimeters). They were in the transverse abdominal muscle, between two metatarsals, at the front of thigh and in the axilla. Imaging performed (MRI, Doppler ultrasound) evoked either a hematoma, a lymphangioma or hemangioma. The indication for removal was selected from pain and/or parental concern. The diagnosis was histologically. A lesion persisted in residual form (incomplete initial resection), and is currently not scalable for eleven years.

  1. Application value of fiberoptic ductoscopy in the treatment of intraductal space occupying lesions%纤维乳管镜对乳腺导管内占位性病变的诊断及辅助手术治疗的应用价值

    Institute of Scientific and Technical Information of China (English)

    赵嫚; 乔婉晴; 涂巍

    2011-01-01

    Objective To evaluate the application value of fiberoptic ductoscopy in the treatment of intraductal occupying lesions with nipple discharge. Methods From September 2005 to December 2009 a total of 523 nipple discharge patients were examined using fiberoptic ductoscopy (FDS) in our hospital, among them 209 patients were found suffering intraductal space occupying lesions with nipple discharge, with diagnostic rate of 39. 96% . Of the 209 patients, 193 had benign lesions and were treated with ductoscopically guided duct excision, and 16 patients had malignant lesions, including intraductal papilloma canceration in 6 cases, ductal carcinoma in situ in 3 cases, infiltrating duct carcinoma in 6 cases and intraductal papilloma with calcification, severe atypical hyperplasia of breast adenosis and local canceration in 1 case, and were managed with breast conserving surgery in 5 cases, simple mastectomy in 3, modified radical mastectomy in 4 and modified radical mastectomy plus immediate prosthesis implantation in 4. FDS plus probe location method was used for all operations. All patients were pathologically confirmed. The follow up time was 556 months with median time of 25 months. Results The 193 patients with benign lesions were all cured, and the follow up showed that except 2 patients lost to follow up, the rest had no recurrence. For the 16 patients with malignant lesions, no recurrence, metastasis or death was found. Conclusions FDS is of clinical value in diagnosing intraductal occupying lesions with nipple discharge, and help to obtain accurate location and satisfactory therapeutic effect.%目的 评价纤维乳管镜(FDS)对伴有乳头溢液的乳腺导管内占位性病变的诊治的应用价值.方法 2005年9月至2009年12月本院采用FDS检查乳头溢液患者523例,发现乳腺导管内占位性病变209例(39.96%).209例乳腺导管内占位性病变患者中,193例良性病变,均行手术治疗;16例恶性病变(乳头状瘤恶变6例,导管原

  2. Papillary Hemangiomas and Glomeruloid Hemangiomas Are Distinct Clinicopathological Entities

    NARCIS (Netherlands)

    Suurmeijer, Albert J. H.

    2010-01-01

    The author reviews and compares the clinicopathological features of papillary hemangiomas and glomeruloid hemangiomas, 2 rare, cutaneous intravascular capillary-type vascular lesions with overlapping morphological details. Immunostaining for collagen IV highlighted discriminating features in these l

  3. Papillary Hemangiomas and Glomeruloid Hemangiomas Are Distinct Clinicopathological Entities

    NARCIS (Netherlands)

    Suurmeijer, Albert J. H.

    2010-01-01

    The author reviews and compares the clinicopathological features of papillary hemangiomas and glomeruloid hemangiomas, 2 rare, cutaneous intravascular capillary-type vascular lesions with overlapping morphological details. Immunostaining for collagen IV highlighted discriminating features in these l

  4. Renal papillary necrosis and pyelonephritis accompanying fenoprofen therapy.

    Science.gov (United States)

    Husserl, F E; Lange, R K; Kantrow, C M

    1979-10-26

    Renal papillary necrosis occurred after fenoprofen calcium administration in a patient with systemic lupus erythematosus and urinary tract infection. Possible mechanisms of renal damage may be hypersensitivity, decreased blood flow, and decreased production of a prostaglandin E-like substance.

  5. Acute severe mitral regurgitation: consideration of papillary muscle architecture

    Directory of Open Access Journals (Sweden)

    Pascoe Edward

    2008-01-01

    Full Text Available Abstract We present a case of an individual who presented with acute severe mitral regurgitation in the setting of an inferior ST elevation myocardial infarction. Both transthoracic and transesophageal echocardiography demonstrated a posteriorly directed eccentric jet of severe mitral regurgitation with flail anterior mitral valve leaflet attached presumably to the anterior papillary muscle. Intraoperative findings demonstrated rupture of the postero-medial papillary muscle attached via chords to the anterior mitral valve leaflet. This case serves to remind us that both the anterior and posterior leaflets of the mitral valve are attached to both papillary muscle heads. The direction and eccentricity of the mitral regurgitant jet on echocardiography helps to locate the leaflet involved, but not necessarily the coexisting papillary muscle pathology.

  6. Papillary Microcarcinoma in Multinodular Goiter with Lymphocytic Thyroiditis

    Directory of Open Access Journals (Sweden)

    Javalgi A.P

    2015-04-01

    Full Text Available Multi nodular goitre (MNG is one of the common presentations of various thyroid diseases. Hitherto issue is whether MNG is significantly associated with malignancy. Various studies have reported a 7 to 17% incidence of malignancy in MNG; most common documented is papillary carcinoma. Here we present a case of 40 year old woman with complains of neck swelling, since 10 months. No history of hypertension and other endocrine disorders. The laboratory investigation shows subclinical hyperthyroidism. Ultrasonography (USG of anterior neck showed a hypoechoic nodule at right lobe. Cytological diagnosis of colloid goitre was made and hemithyroidectomy was performed and specimen sent for histopathology. The case on histopathology was diagnosed as papillary microcarcinoma in multinodular goiter with lymphocytic thyroiditis which was further confirmed by immunohistochemistry. Recent studies have suggested that the micro-carcinomas classically progress to a clinically evident disease if left untreated. The treatment of papillary microcarcinoma should be similar to papillary thyroid cancer.

  7. Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

    Science.gov (United States)

    Testoni, Pier Alberto; Mariani, Alberto; Aabakken, Lars; Arvanitakis, Marianna; Bories, Erwan; Costamagna, Guido; Devière, Jacques; Dinis-Ribeiro, Mario; Dumonceau, Jean-Marc; Giovannini, Marc; Gyokeres, Tibor; Hafner, Michael; Halttunen, Jorma; Hassan, Cesare; Lopes, Luis; Papanikolaou, Ioannis S; Tham, Tony C; Tringali, Andrea; van Hooft, Jeanin; Williams, Earl J

    2016-07-01

    that is difficult to cannulate, transpancreatic biliary sphincterotomy should be considered if unintentional insertion of a guidewire into the pancreatic duct occurs (moderate quality evidence, strong recommendation).In patients who have had transpancreatic sphincterotomy, ESGE suggests prophylactic pancreatic stenting (moderate quality evidence, strong recommendation). 6 ESGE recommends that mixed current is used for sphincterotomy rather than pure cut current alone, as there is a decreased risk of mild bleeding with the former (moderate quality evidence, strong recommendation). 7 ESGE suggests endoscopic papillary balloon dilation (EPBD) as an alternative to endoscopic sphincterotomy (EST) for extracting CBD stones techniques are available (very low quality evidence, weak recommendation).

  8. Intravascular papillary endothelial hyperplasia: An unusual histopathological entity.

    Science.gov (United States)

    Mahapatra, Qury S; Sahai, Kavita; Malik, Ajay; Mani, N S

    2015-01-01

    Intravascular papillary endothelial hyperplasia (Masson's tumor) is a benign lesion of the skin and subcutaneous tissue consisting of a reactive proliferation of endothelial cells with papillary formations related to a thrombus. It poses a diagnostic challenge as the clinical signs and symptoms are nonspecific and may mimic a soft tissue sarcoma. The diagnosis is based on histopathology. Here we report two cases of Masson's hemangioma occurring on the upper lip and on the left hand.

  9. Intravascular papillary endothelial hyperplasia: An unusual histopathological entity

    Directory of Open Access Journals (Sweden)

    Qury S Mahapatra

    2015-01-01

    Full Text Available Intravascular papillary endothelial hyperplasia (Masson′s tumor is a benign lesion of the skin and subcutaneous tissue consisting of a reactive proliferation of endothelial cells with papillary formations related to a thrombus. It poses a diagnostic challenge as the clinical signs and symptoms are nonspecific and may mimic a soft tissue sarcoma. The diagnosis is based on histopathology. Here we report two cases of Masson′s hemangioma occurring on the upper lip and on the left hand.

  10. Worse Prognosis in Papillary, Compared to Tubular, Early Gastric Carcinoma

    Science.gov (United States)

    Yu, Huiping; Fang, Cheng; Chen, Lin; Shi, Jiong; Fan, Xianshan; Zou, Xiaoping; Huang, Qin

    2017-01-01

    Purpose: Papillary early gastric carcinoma (EGC) is uncommon but shows worse prognosis in our most recent study in a Chinese population with unknown reasons. The aim of the present study was to further investigate risk factors for worse prognosis in patients with papillary adenocarcinoma, compared to those with tubular adenocarcinoma. Methods: We searched the electronic pathology databank for radical gastrectomy cases over an 8-year period at a single medical center in Nanjing, China, and identified consecutive 240 EGC cases that were classified as either papillary (n=59) or tubular (n=181) EGC tumors in accordance with the World Health Organization (WHO) gastric cancer diagnosis criteria. We investigated and compared clinicopathologic risk factors for prognosis between papillary and tubular EGC groups. All patients were followed up and their 5-year survival rate was compared statistically with the Kaplan-Meier method with a log rank test. Results: Compared to tubular EGCs, papillary EGCs were significantly more common in elderly patients, more frequently occurred in the proximal stomach with protruding/elevated growth patterns, submucosal invasion, and a micropapillary component. Although lymphovascular invasion (16.9%), nodal (13.6%) and distant (11.8%) metastases in papillary EGCs were more frequent than those (8.3%, 7.2%, and 3.7%, respectively) in tubular EGCs, the differences approached but did not reach statistically significant levels. Significant risk factors for nodal metastasis included lymphovascular invasion in both EGC groups, but the ulcerative pattern and submucosal invasion only in tubular EGCs. The 5-year survival rate was significantly worse in papillary (80.5%) than in tubular (96.8%) EGCs. Conclusions: Compared to tubular EGCs, papillary EGCs diagnosed with the WHO criteria in Chinese patients were more frequent in elderly patients, proximal stomach and showed the significantly worse 5-year survival rate with more protruding/elevated growth

  11. [Common bile duct stones and their complications].

    Science.gov (United States)

    Millat, B; Borie, F

    2000-12-01

    At the time of cholecystectomy for symptomatic cholelithiasis, 7-20% of patients have common bile duct stones. Nearly one third of them are asymptomatic. Routine cholangiography during cholecystectomy allows the diagnosis and treatment of common bile duct stones during the same operation. Selective indication for the diagnosis of common bile duct stones based on the positive predictive value of indicators limits treatment to symptomatic cases. No single indicator is however completely accurate in predicting common bile duct stones and the natural history of asymptomatic cases is uncertain. Endoscopic stone extraction preceding cholecystectomy is not superior to one-stage surgical treatment. Diagnosis and treatment of common bile duct stones are feasible laparoscopically. Complications of common bile duct stones are cholangitis and acute pancreatitis; if severe, they require specific therapeutic approaches.

  12. Decitabine in Treating Patients With Metastatic Papillary Thyroid Cancer or Follicular Thyroid Cancer Unresponsive to Iodine I 131

    Science.gov (United States)

    2014-08-20

    Recurrent Thyroid Cancer; Stage IVA Follicular Thyroid Cancer; Stage IVA Papillary Thyroid Cancer; Stage IVB Follicular Thyroid Cancer; Stage IVB Papillary Thyroid Cancer; Stage IVC Follicular Thyroid Cancer; Stage IVC Papillary Thyroid Cancer

  13. Methods of evaluating cleanliness of ventilation ducts

    Institute of Scientific and Technical Information of China (English)

    曹勇; 罗运有; 于丹; 甘丽斯

    2009-01-01

    A testing system for evaluating cleanliness of ventilation ducts was constructed. Comparisons of four evaluation methods for quantifying the amount of dust on the inner surface of ventilation ducts are presented. The experimental results show that the wiping by solvent method is more efficient than that by the wiping method,especially used on low cleanliness duct surface. The gravimetric tape method is an efficient method of collecting dust samples on the duct surface with low amounts of dust,particularly used to check the cleanliness level after the cleaning work. The optical method can be set up rapidly and is useful for fieldwork measurements.

  14. Malignant phyllodes tumor of the breast with liposarcomatous differentiation and intraductal hyperplasia.

    Science.gov (United States)

    Ayadi-Kaddour, Aïda; Zeddini, Abdelfatteh; Braham, Emna; Ismail, Olfa; Mlika, Mona; Guelmami, Karim; El Mezni, Faouzi

    2015-01-01

    Phyllodes tumor of the breast is a biphasic fibroepithelial neoplasm. 10 to 20% of phyllodes tumor show malignant transformation, often in the form of stroma, which usually shows fibrosarcomatous differentiation and rarely heterologous sarcomatous elements. Liposarcomatous differentiation is not common among phyllodes tumors. The correct diagnosis of heterologous liposarcomatous differentiation in a malignant PT requires identification of the biphasic component of the tumor. We reported a case of malignant phyllodes tumor which initially transformed into liposarcoma, in addition to a very rare intraductal hyperplasia and flat epithelial atypia. The patient was a 75-year-old woman, with a lump in the left breast without axillary lymphadenopathy. She also have a positive family history of breast carcinoma. She underwent surgery and still alive and disease free after one year.

  15. The evaluation of extensive intraductal component (EIC) in breast carcinoma using MR mammography

    Energy Technology Data Exchange (ETDEWEB)

    Saito, Yasuhiro; Mineta, Masayuki; Yamada, Tomonori [Asahikawa Medical Univ. (Japan)] [and others

    1997-10-01

    Twenty-one patients with breast cancer underwent MR mammography (MRM) for evaluation of extensive intraductal component (EIC). Linear or small nodular structures continuing to main tumor, irregular margin, and early stain on dynamic scan were considered to be suggestive of EIC. The sensitivity, specificity and accuracy of detecting EIC were 88.9%, 91.7% and 90.5%, respectively. Misleading structures or pathological conditions to distinguish from EIC on MRM were interstitial connective tissue, interstitial spreading of the cancer, mastitis, and vessels. Although MRM appears to be very useful in evaluating EIC of the breast cancer, it is necessary for the radiologist to understand that there are several misleading signal intensities or abnormal enhancement to discriminate from EIC. (author)

  16. Collecting duct-derived cells display mesenchymal stem cell properties and retain selective in vitro and in vivo epithelial capacity.

    Science.gov (United States)

    Li, Joan; Ariunbold, Usukhbayar; Suhaimi, Norseha; Sunn, Nana; Guo, Jinjin; McMahon, Jill A; McMahon, Andrew P; Little, Melissa

    2015-01-01

    We previously described a mesenchymal stem cell (MSC)-like population within the adult mouse kidney that displays long-term colony-forming efficiency, clonogenicity, immunosuppression, and panmesodermal potential. Although phenotypically similar to bone marrow (BM)-MSCs, kidney MSC-like cells display a distinct expression profile. FACS sorting from Hoxb7/enhanced green fluorescent protein (GFP) mice identified the collecting duct as a source of kidney MSC-like cells, with these cells undergoing an epithelial-to-mesenchymal transition to form clonogenic, long-term, self-renewing MSC-like cells. Notably, after extensive passage, kidney MSC-like cells selectively integrated into the aquaporin 2-positive medullary collecting duct when microinjected into the kidneys of neonatal mice. No epithelial integration was observed after injection of BM-MSCs. Indeed, kidney MSC-like cells retained a capacity to form epithelial structures in vitro and in vivo, and conditioned media from these cells supported epithelial repair in vitro. To investigate the origin of kidney MSC-like cells, we further examined Hoxb7(+) fractions within the kidney across postnatal development, identifying a neonatal interstitial GFP(lo) (Hoxb7(lo)) population displaying an expression profile intermediate between epithelium and interstitium. Temporal analyses with Wnt4(GCE/+):R26(tdTomato/+) mice revealed evidence for the intercalation of a Wnt4-expressing interstitial population into the neonatal collecting duct, suggesting that such intercalation may represent a normal developmental mechanism giving rise to a distinct collecting duct subpopulation. These results extend previous observations of papillary stem cell activity and collecting duct plasticity and imply a role for such cells in collecting duct formation and, possibly, repair.

  17. Twenty-Year Outcome Following Central Duct Resection for Bloody Nipple Discharge

    Science.gov (United States)

    Nelson, R Scott; Hoehn, James L.

    2006-01-01

    Background: Patients found with pathologic nipple discharge present a diagnostic dilemma to surgeons. No one diagnostic test, including cytology or radiologic imaging, has proved superior to any other in the differentiation of benign versus malignant sources of pathologic nipple discharge. Ductoscopy has been introduced as a way to assist with identification of potential sources of pathologic nipple discharge. Ductoscopy is also useful in the resection of deep or peripheral masses that may be missed with standard blind resection. This report evaluates the risk of missed malignancy following central duct resection (CDR). Methods: Records of 56 patients who underwent CDR for pathologic nipple discharge greater than 15 years previous were reviewed. Data including type of nipple discharge, future biopsy, and pathology reports were all examined. Results: Of the 56 patients, 36 had bloody, 18 serous, and 2 green initial discharges. Fifty-seven percent were found to have intraductal papilloma as the source of discharge, with fibrocystic disease and ductal ectasia providing the next most common causes. One woman was found to have ductal cancer and one lobular carcinoma in situ at time of CDR. Patients were followed for a mean period of 22 years. Fourteen women required future biopsy. Of these, 10 had benign disease and 4 had cancer, 3 on the ipsilateral side. The 3 women with breast cancer were 9, 13, and 17 years from initial resection. Conclusions: CDR for pathologic nipple discharge is an effective way to diagnose and treat pathologic nipple discharge without missing underlying cancers. PMID:16552204

  18. Measure Guideline: Sealing and Insulating of Ducts in Existing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Aldrich, R.; Puttagunta, S.

    2011-12-01

    This document begins with a discussion on potential cost and performance benefits of duct sealing and insulating. It continues with a review of typical duct materials and components and the overall procedures for assessing and improving the duct system.

  19. Measure Guideline. Sealing and Insulating Ducts in Existing Homes

    Energy Technology Data Exchange (ETDEWEB)

    Aldrich, R. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States); Puttagunta, S. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States)

    2011-12-01

    This document begins with a discussion on potential cost and performance benefits of duct sealing and insulating. It continues with a review of typical duct materials and components and the overall procedures for assessing and improving the duct system.

  20. Origin and types of calcium oxalate monohydrate papillary renal calculi.

    Science.gov (United States)

    Grases, Fèlix; Costa-Bauzá, Antonia; Gomila, Isabel; Conte, Antonio

    2010-12-01

    Subepithelial hydroxyapatite calcification of renal papilla is thought to be involved in the formation of calcium oxalate monohydrate (COM) papillary calculi. To assess the mechanism of formation, we sought to correlate the fine structure of papillary renal calculi with specific pathophysiologic conditions and urinary alterations. The study included 831 COM papillary renal calculi with established fine inner structures. A total of 24 patients with chronic stone formation were randomly selected, and their urine was collected and analyzed. The case history and lifestyle habits of these patients were obtained. The 831 papillary calculi could be classified into 1 of 4 main groups. Type I included small calculi in which COM columnar crystals begin to develop in the concave zone in close contact with papillary tissue. Type II calculi contained a hydroxyapatite core located in or near the concave zone. Type III consisted of calculi that developed on the tip of the papillae and in the concave zone, containing hydroxyapatite, calcified tissue, and calcified tubules. Type IV consisted of papillary calculi in which the core, which is situated near, but not in, the concave zone, is formed by intergrown COM crystals and organic matter. Many factors, including urinary alterations (eg, hyperoxaluria), associated diseases (eg, hypertension, diabetes), and consumption or exposure to cytotoxic substances (eg, analgesic abuse) were associated with these types of calculi. Our findings have indicated that injury is the first cause of papillary COM calculus formation, with the location of the injury determining the morphology of the resulting calculus. Copyright © 2010 Elsevier Inc. All rights reserved.

  1. Comprehensive Molecular Characterization of Papillary Renal Cell Carcinoma

    Science.gov (United States)

    Linehan, W. Marston; Spellman, Paul T.; Ricketts, Christopher J.; Creighton, Chad J.; Fei, Suzanne S.; Davis, Caleb; Wheeler, David A.; Murray, Bradley A.; Schmidt, Laura; Vocke, Cathy D.; Peto, Myron; Al Mamun, Abu Amar M.; Shinbrot, Eve; Sethi, Anurag; Brooks, Samira; Rathmell, W. Kimryn; Brooks, Angela N.; Hoadley, Katherine A.; Robertson, A. Gordon; Brooks, Denise; Bowlby, Reanne; Sadeghi, Sara; Shen, Hui; Weisenberger, Daniel J.; Bootwalla, Moiz; Baylin, Stephen B.; Laird, Peter W.; Cherniack, Andrew D.; Saksena, Gordon; Haake, Scott; Li, Jun; Liang, Han; Lu, Yiling; Mills, Gordon B.; Akbani, Rehan; Leiserson, Mark D.M.; Raphael, Benjamin J.; Anur, Pavana; Bottaro, Donald; Albiges, Laurence; Barnabas, Nandita; Choueiri, Toni K.; Czerniak, Bogdan; Godwin, Andrew K.; Hakimi, A. Ari; Ho, Thai; Hsieh, James; Ittmann, Michael; Kim, William Y.; Krishnan, Bhavani; Merino, Maria J.; Mills Shaw, Kenna R.; Reuter, Victor E.; Reznik, Ed; Shelley, Carl Simon; Shuch, Brian; Signoretti, Sabina; Srinivasan, Ramaprasad; Tamboli, Pheroze; Thomas, George; Tickoo, Satish; Burnett, Kenneth; Crain, Daniel; Gardner, Johanna; Lau, Kevin; Mallery, David; Morris, Scott; Paulauskis, Joseph D.; Penny, Robert J.; Shelton, Candace; Shelton, W. Troy; Sherman, Mark; Thompson, Eric; Yena, Peggy; Avedon, Melissa T.; Bowen, Jay; Gastier-Foster, Julie M.; Gerken, Mark; Leraas, Kristen M.; Lichtenberg, Tara M.; Ramirez, Nilsa C.; Santos, Tracie; Wise, Lisa; Zmuda, Erik; Demchok, John A.; Felau, Ina; Hutter, Carolyn M.; Sheth, Margi; Sofia, Heidi J.; Tarnuzzer, Roy; Wang, Zhining; Yang, Liming; Zenklusen, Jean C.; Zhang, Jiashan (Julia); Ayala, Brenda; Baboud, Julien; Chudamani, Sudha; Liu, Jia; Lolla, Laxmi; Naresh, Rashi; Pihl, Todd; Sun, Qiang; Wan, Yunhu; Wu, Ye; Ally, Adrian; Balasundaram, Miruna; Balu, Saianand; Beroukhim, Rameen; Bodenheimer, Tom; Buhay, Christian; Butterfield, Yaron S.N.; Carlsen, Rebecca; Carter, Scott L.; Chao, Hsu; Chuah, Eric; Clarke, Amanda; Covington, Kyle R.; Dahdouli, Mahmoud; Dewal, Ninad; Dhalla, Noreen; Doddapaneni, HarshaVardhan; Drummond, Jennifer; Gabriel, Stacey B.; Gibbs, Richard A.; Guin, Ranabir; Hale, Walker; Hawes, Alicia; Hayes, D. Neil; Holt, Robert A.; Hoyle, Alan P.; Jefferys, Stuart R.; Jones, Steven J.M.; Jones, Corbin D.; Kalra, Divya; Kovar, Christie; Lewis, Lora; Li, Jie; Ma, Yussanne; Marra, Marco A.; Mayo, Michael; Meng, Shaowu; Meyerson, Matthew; Mieczkowski, Piotr A.; Moore, Richard A.; Morton, Donna; Mose, Lisle E.; Mungall, Andrew J.; Muzny, Donna; Parker, Joel S.; Perou, Charles M.; Roach, Jeffrey; Schein, Jacqueline E.; Schumacher, Steven E.; Shi, Yan; Simons, Janae V.; Sipahimalani, Payal; Skelly, Tara; Soloway, Matthew G.; Sougnez, Carrie; Tam, Angela; Tan, Donghui; Thiessen, Nina; Veluvolu, Umadevi; Wang, Min; Wilkerson, Matthew D.; Wong, Tina; Wu, Junyuan; Xi, Liu; Zhou, Jane; Bedford, Jason; Chen, Fengju; Fu, Yao; Gerstein, Mark; Haussler, David; Kasaian, Katayoon; Lai, Phillip; Ling, Shiyun; Radenbaugh, Amie; Van Den Berg, David; Weinstein, John N.; Zhu, Jingchun; Albert, Monique; Alexopoulou, Iakovina; Andersen, Jeremiah J; Auman, J. Todd; Bartlett, John; Bastacky, Sheldon; Bergsten, Julie; Blute, Michael L.; Boice, Lori; Bollag, Roni J.; Boyd, Jeff; Castle, Erik; Chen, Ying-Bei; Cheville, John C.; Curley, Erin; Davies, Benjamin; DeVolk, April; Dhir, Rajiv; Dike, Laura; Eckman, John; Engel, Jay; Harr, Jodi; Hrebinko, Ronald; Huang, Mei; Huelsenbeck-Dill, Lori; Iacocca, Mary; Jacobs, Bruce; Lobis, Michael; Maranchie, Jodi K.; McMeekin, Scott; Myers, Jerome; Nelson, Joel; Parfitt, Jeremy; Parwani, Anil; Petrelli, Nicholas; Rabeno, Brenda; Roy, Somak; Salner, Andrew L.; Slaton, Joel; Stanton, Melissa; Thompson, R. Houston; Thorne, Leigh; Tucker, Kelinda; Weinberger, Paul M.; Winemiller, Cythnia; Zach, Leigh Anne; Zuna, Rosemary

    2016-01-01

    Background Papillary renal cell carcinoma, accounting for 15% of renal cell carcinoma, is a heterogeneous disease consisting of different types of renal cancer, including tumors with indolent, multifocal presentation and solitary tumors with an aggressive, highly lethal phenotype. Little is known about the genetic basis of sporadic papillary renal cell carcinoma; no effective forms of therapy for advanced disease exist. Methods We performed comprehensive molecular characterization utilizing whole-exome sequencing, copy number, mRNA, microRNA, methylation and proteomic analyses of 161 primary papillary renal cell carcinomas. Results Type 1 and Type 2 papillary renal cell carcinomas were found to be different types of renal cancer characterized by specific genetic alterations, with Type 2 further classified into three individual subgroups based on molecular differences that influenced patient survival. MET alterations were associated with Type 1 tumors, whereas Type 2 tumors were characterized by CDKN2A silencing, SETD2 mutations, TFE3 fusions, and increased expression of the NRF2-ARE pathway. A CpG island methylator phenotype (CIMP) was found in a distinct subset of Type 2 papillary renal cell carcinoma characterized by poor survival and mutation of the fumarate hydratase (FH) gene. Conclusions Type 1 and Type 2 papillary renal cell carcinomas are clinically and biologically distinct. Alterations in the MET pathway are associated with Type 1 and activation of the NRF2-ARE pathway with Type 2; CDKN2A loss and CIMP in Type 2 convey a poor prognosis. Furthermore, Type 2 papillary renal cell carcinoma consists of at least 3 subtypes based upon molecular and phenotypic features. PMID:26536169

  2. Radiated noise of ducted fans

    Science.gov (United States)

    Eversman, Walter

    The differences in the radiated acoustic fields of ducted and unducted propellers of the same thrust operating under similar conditions are investigated. An FEM model is created for the generation, propagation, and radiation of steady, rotor alone noise and exit guide vane interaction noise of a ducted fan. For a specified number of blades, angular mode harmonic, and rotor angular velocity, the acoustic field is described in a cylindrical coordinate system reduced to only the axial and radial directions. It is found that, contrary to the usual understanding of the Tyler and Sofrin (1962) result, supersonic tip speed rotor noise can be cut off if the tip Mach number is only slightly in excess of unity and if the number of blades is relatively small. If there are many blades, the fundamental angular mode number is large, and the Tyler and Sofrin result for thin annuli becomes more relevant. Shrouding of subsonic tip speed propellers is a very effective means of controlling rotor alone noise.

  3. The Fourth International Symposium on the Intraductal Approach to Breast Cancer, Santa Barbara, California, 10–13 March 2005

    Science.gov (United States)

    King, Bonnie L; Love, Susan M; Rochman, Susan; Kim, Julian A

    2005-01-01

    Intraductal approaches encompass procedures and technologies that are designed to access and interrogate the ductal–alveolar systems of the human breast, and include nipple aspiration, ductal lavage, random periareolar fine needle aspiration, and ductoscopy. These approaches are being used to collect and analyze fluids and cells to develop methods for breast cancer detection and risk assessment; to introduce imaging technologies to explore the mammary tree for abnormalities; to administer therapeutic and/or preventive agents directly to the breast tissue; and to explore the biology of the normal mammary gland. The latest research findings in these areas, presented at The 4th International Symposium on the Intraductal Approach to Breast Cancer in 2005, are summarized in this report. PMID:16168138

  4. Double-duct liquid metal magnetohydrodynamic engine

    Science.gov (United States)

    Haaland, Carsten M.

    1995-01-01

    An internal combustion, liquid metal (LM) magnetohydrodynamic (MHD) engine and an alternating current (AC) magnetohydrodynamic generator, are used in combination to provide useful AC electric energy output. The engine design has-four pistons and a double duct configuration, with each duct containing sodium potassium liquid metal confined between free pistons located at either end of the duct. The liquid metal is forced to flow back and forth in the duct by the movement of the pistons, which are alternatively driven by an internal combustion process. In the MHD generator, the two LM-MHD ducts pass in close proximity through a Hartmann duct with output transformer. AC power is produced by operating the engine with the liquid metal in the two generator ducts always flowing in counter directions. The amount of liquid metal maintained in the ducts may be varied. This provides a variable stroke length for the pistons. The engine/generator provides variable AC power at variable frequencies that correspond to the power demands of the vehicular propulsion. Also the engine should maintain nearly constant efficiency throughout the range of power usage. Automobiles and trucks could be powered by the invention, with no transmission or power converter devices being required.

  5. A rare case of bile duct cyst

    Institute of Scientific and Technical Information of China (English)

    Qing-Gang Wang; Shu-Tian Zhang

    2009-01-01

    Choledochal cyst is an uncommon disease usually seen in young women and can be divided into five types. We report a 66-year-old woman who was diagnosed with types Ⅱ and Ⅱ bile duct cyst simultaneously after surgery, which is a rare type of bile duct cyst.

  6. New cannulation method for pancreatic duct cannulation-bile duct guidewire-indwelling method

    Science.gov (United States)

    Sakai, Yuji; Ishihara, Takeshi; Tsuyuguchi, Toshio; Tawada, Katsunobu; Saito, Masayoshi; Kurosawa, Jo; Tamura, Ryo; Togo, Seiko; Mikata, Rintaro; Tada, Motohisa; Yokosuka, Osamu

    2011-01-01

    The patient was a 58-year-old male with symptomatic alcoholic chronic pancreatitis. Since a 10 mm calculus was observed in the pancreatic body and abdominal pain occurred due to congestion of pancreatic juice, endoscopic retrograde cholangiopancreatography was conducted for assessment of the pancreatic duct and treatment of pancreatic calculus. Pancreatogram was slightly and insufficiently obtained by injecting the contrast media via the common channel of the duodenal main papilla. We tried to cannulate selectively into the pancreatic duct for a clear image. However, the selective cannulation of the pancreatic duct was difficult because of instability of the papilla. On the other hand, selective cannulation of the bile duct was relatively easily achieved. Therefore, after the imaging of the bile duct, a guidewire was retained in the bile duct to immobilize the duodenal papilla and cannulation of the pancreatic duct was attempted. As a result, selective pancreatic duct cannulation became possible. It is considered that the bile duct guidewire-indwelling method may serve as one of the useful techniques for cases whose selective pancreatic duct cannulation is difficult (“selective pancreatic duct difficult cannulation case”). PMID:22110840

  7. Pancreatic duct holder for facilitating duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy.

    Science.gov (United States)

    Sugiyama, Masanori; Suzuki, Yutaka; Abe, Nobutsugu; Ueki, Hisayo; Masaki, Tadahiko; Mori, Toshiyuki; Atomi, Yutaka

    2009-01-01

    Duct-to-mucosa pancreatojejunostomy after pancreatoduodenectomy may be technically difficult, particularly in cases in which the remnant pancreas is soft with a small main pancreatic duct. We devised a pancreatic duct holder for duct-to-mucosa pancreatojejunostomy. The holder has a cone-shaped tip. A one-third circle of the tip is cut away, which makes a slit. As the tip is inserted gently into the pancreatic duct, the duct can be adequately expanded. The holder provides a good surgical field for anastomosis. A slit of the tip allows needle insertion. The holder facilitates stitches of the jejunum also. Twelve patients underwent pancreatoduodenectomy, followed by duct-to-mucosa pancreatojejunostomy using the holder. The holder allowed 8 or more stitches in duct-to-mucosa anastomosis, even in patients with a small pancreatic duct. No patients developed prolonged pancreatic leakage or pancreatic fistula postoperatively. In conclusion, the pancreatic duct holder is a simple and useful tool for facilitating duct-to-mucosa pancreatojejunostomy.

  8. Bile duct hamartomas (von Mayenburg complexes) mimicking liver metastases from bile duct cancer: MRC findings

    Institute of Scientific and Technical Information of China (English)

    Yasuhiko Nagano; Kenichi Matsuo; Katsuya Gorai; Kazuya Sugimori; Chikara Kunisaki; Hideyuki Ike; Katsuaki Tanaka; Toshio Imada; Hiroshi Shimada

    2006-01-01

    We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography (MRC) revealed a diagnosis of bile duct hamartomas. At exploration for pancreaticoduodenectomy, liver palpation revealed disseminated nodules at the surface of the liver. These nodules showed gray-white nodular lesions of about 0.5cm in diameter scattered on the surface of both liver lobes, which were looked like multiple liver metastases from bile duct cancer. Frozen section of the liver biopsy disclosed multiple bile ducts with slightly dilated lumens embedded in the collagenous stroma characteristics of multiple bile duct hamartomas (BDHs). Only two reports have described the MRC features of bile duct hamartomas. Of all imaging procedures, MRC provides the most relevant features for the imaging diagnosis of bile duct hamartomas.

  9. Papillary Carcinoma Arising in Struma Ovarii

    Directory of Open Access Journals (Sweden)

    Yavuz Yalçın

    2015-09-01

    Full Text Available Struma ovarii, which is classified as benign or malignant, is a mature ovarian teratoma consisting mainly of the thyroid tissue. Here, we present the case of malign struma ovarii in a patient with right adnexal mass. In a 53-year-old female, who was referred to our hospital with pelvic pain, abdominopelvic imaging revealed a cystic lesion measuring 15x14 cm in diameter in the right adnexa. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Microscopic evaluation revealed a 1.5x1x0.5 cm papillary carcinoma focus in frozen sections of the mural nodule which was observed inside the cyst. Following the surgical procedure, the patient’s TSH levels were kept low by thyroxine treatment, and it was decided to follow the patient by annual measurement of thyroglobulin levels and pelvic imaging. There is not a common consensus on optimal treatment of malignant struma ovarii. Treatment options depend on cases or case series. Turk Jem 2015; 19: 112-114

  10. Integrated Genomic Characterization of Papillary Thyroid Carcinoma

    Science.gov (United States)

    Agrawal, Nishant; Akbani, Rehan; Aksoy, B. Arman; Ally, Adrian; Arachchi, Harindra; Asa, Sylvia L.; Auman, J. Todd; Balasundaram, Miruna; Balu, Saianand; Baylin, Stephen B.; Behera, Madhusmita; Bernard, Brady; Beroukhim, Rameen; Bishop, Justin A.; Black, Aaron D.; Bodenheimer, Tom; Boice, Lori; Bootwalla, Moiz S.; Bowen, Jay; Bowlby, Reanne; Bristow, Christopher A.; Brookens, Robin; Brooks, Denise; Bryant, Robert; Buda, Elizabeth; Butterfield, Yaron S.N.; Carling, Tobias; Carlsen, Rebecca; Carter, Scott L.; Carty, Sally E.; Chan, Timothy A.; Chen, Amy Y.; Cherniack, Andrew D.; Cheung, Dorothy; Chin, Lynda; Cho, Juok; Chu, Andy; Chuah, Eric; Cibulskis, Kristian; Ciriello, Giovanni; Clarke, Amanda; Clayman, Gary L.; Cope, Leslie; Copland, John; Covington, Kyle; Danilova, Ludmila; Davidsen, Tanja; Demchok, John A.; DiCara, Daniel; Dhalla, Noreen; Dhir, Rajiv; Dookran, Sheliann S.; Dresdner, Gideon; Eldridge, Jonathan; Eley, Greg; El-Naggar, Adel K.; Eng, Stephanie; Fagin, James A.; Fennell, Timothy; Ferris, Robert L.; Fisher, Sheila; Frazer, Scott; Frick, Jessica; Gabriel, Stacey B.; Ganly, Ian; Gao, Jianjiong; Garraway, Levi A.; Gastier-Foster, Julie M.; Getz, Gad; Gehlenborg, Nils; Ghossein, Ronald; Gibbs, Richard A.; Giordano, Thomas J.; Gomez-Hernandez, Karen; Grimsby, Jonna; Gross, Benjamin; Guin, Ranabir; Hadjipanayis, Angela; Harper, Hollie A.; Hayes, D. Neil; Heiman, David I.; Herman, James G.; Hoadley, Katherine A.; Hofree, Matan; Holt, Robert A.; Hoyle, Alan P.; Huang, Franklin W.; Huang, Mei; Hutter, Carolyn M.; Ideker, Trey; Iype, Lisa; Jacobsen, Anders; Jefferys, Stuart R.; Jones, Corbin D.; Jones, Steven J.M.; Kasaian, Katayoon; Kebebew, Electron; Khuri, Fadlo R.; Kim, Jaegil; Kramer, Roger; Kreisberg, Richard; Kucherlapati, Raju; Kwiatkowski, David J.; Ladanyi, Marc; Lai, Phillip H.; Laird, Peter W.; Lander, Eric; Lawrence, Michael S.; Lee, Darlene; Lee, Eunjung; Lee, Semin; Lee, William; Leraas, Kristen M.; Lichtenberg, Tara M.; Lichtenstein, Lee; Lin, Pei; Ling, Shiyun; Liu, Jinze; Liu, Wenbin; Liu, Yingchun; LiVolsi, Virginia A.; Lu, Yiling; Ma, Yussanne; Mahadeshwar, Harshad S.; Marra, Marco A.; Mayo, Michael; McFadden, David G.; Meng, Shaowu; Meyerson, Matthew; Mieczkowski, Piotr A.; Miller, Michael; Mills, Gordon; Moore, Richard A.; Mose, Lisle E.; Mungall, Andrew J.; Murray, Bradley A.; Nikiforov, Yuri E.; Noble, Michael S.; Ojesina, Akinyemi I.; Owonikoko, Taofeek K.; Ozenberger, Bradley A.; Pantazi, Angeliki; Parfenov, Michael; Park, Peter J.; Parker, Joel S.; Paull, Evan O.; Pedamallu, Chandra Sekhar; Perou, Charles M.; Prins, Jan F.; Protopopov, Alexei; Ramalingam, Suresh S.; Ramirez, Nilsa C.; Ramirez, Ricardo; Raphael, Benjamin J.; Rathmell, W. Kimryn; Ren, Xiaojia; Reynolds, Sheila M.; Rheinbay, Esther; Ringel, Matthew D.; Rivera, Michael; Roach, Jeffrey; Robertson, A. Gordon; Rosenberg, Mara W.; Rosenthall, Matthew; Sadeghi, Sara; Saksena, Gordon; Sander, Chris; Santoso, Netty; Schein, Jacqueline E.; Schultz, Nikolaus; Schumacher, Steven E.; Seethala, Raja R.; Seidman, Jonathan; Senbabaoglu, Yasin; Seth, Sahil; Sharpe, Samantha; Mills Shaw, Kenna R.; Shen, John P.; Shen, Ronglai; Sherman, Steven; Sheth, Margi; Shi, Yan; Shmulevich, Ilya; Sica, Gabriel L.; Simons, Janae V.; Sipahimalani, Payal; Smallridge, Robert C.; Sofia, Heidi J.; Soloway, Matthew G.; Song, Xingzhi; Sougnez, Carrie; Stewart, Chip; Stojanov, Petar; Stuart, Joshua M.; Tabak, Barbara; Tam, Angela; Tan, Donghui; Tang, Jiabin; Tarnuzzer, Roy; Taylor, Barry S.; Thiessen, Nina; Thorne, Leigh; Thorsson, Vésteinn; Tuttle, R. Michael; Umbricht, Christopher B.; Van Den Berg, David J.; Vandin, Fabio; Veluvolu, Umadevi; Verhaak, Roel G.W.; Vinco, Michelle; Voet, Doug; Walter, Vonn; Wang, Zhining; Waring, Scot; Weinberger, Paul M.; Weinstein, John N.; Weisenberger, Daniel J.; Wheeler, David; Wilkerson, Matthew D.; Wilson, Jocelyn; Williams, Michelle; Winer, Daniel A.; Wise, Lisa; Wu, Junyuan; Xi, Liu; Xu, Andrew W.; Yang, Liming; Yang, Lixing; Zack, Travis I.; Zeiger, Martha A.; Zeng, Dong; Zenklusen, Jean Claude; Zhao, Ni; Zhang, Hailei; Zhang, Jianhua; Zhang, Jiashan (Julia); Zhang, Wei; Zmuda, Erik; Zou., Lihua

    2014-01-01

    Summary Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Here, we describe the genomic landscape of 496 PTCs. We observed a low frequency of somatic alterations (relative to other carcinomas) and extended the set of known PTC driver alterations to include EIF1AX, PPM1D and CHEK2 and diverse gene fusions. These discoveries reduced the fraction of PTC cases with unknown oncogenic driver from 25% to 3.5%. Combined analyses of genomic variants, gene expression, and methylation demonstrated that different driver groups lead to different pathologies with distinct signaling and differentiation characteristics. Similarly, we identified distinct molecular subgroups of BRAF-mutant tumors and multidimensional analyses highlighted a potential involvement of oncomiRs in less-differentiated subgroups. Our results propose a reclassification of thyroid cancers into molecular subtypes that better reflect their underlying signaling and differentiation properties, which has the potential to improve their pathological classification and better inform the management of the disease. PMID:25417114

  11. Salivary Duct Cyst: Histo-pathologic Correlation

    Directory of Open Access Journals (Sweden)

    Divya Vinayachandran

    2013-01-01

    Full Text Available Non-neoplastic cysts of the salivary glands are uncommon and represent 2-5% of all salivary gland lesions. They are mainly mucoceles or salivary duct cysts. Unlike a mucocele, which is surrounded by granulation tissue, the salivary duct cyst is lined by epithelium. Salivary duct cysts are more common in the oral minor salivary glands and rarely occur in the major salivary glands, show a marked predilection for the superficial lobe of the parotid, and represent 10% of all salivary gland cysts. Neoplastic differentiation of the lining of the salivary duct cyst has been reported. We report a case of a salivary duct cyst of the left parotid gland, with a review of radiographic and histopathologic features.

  12. Simultaneous Laryngeal Squamous Cell Carcinoma and Papillary Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Bighan Khademi

    2011-04-01

    Full Text Available The association of squamous cell carcinoma of the larynx with thyroid papillary carcinoma is an unusual finding. From 2004 to 2011, approximately 250 patients underwent laryngectomies due to squamous cell carcinoma of the larynx at the Otolaryngology Department of Khalili Hospital, affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. In three patients, synchronous occurrence of squamous cell carcinoma and thyroid papillary carcinoma was found. Histopathologic study of the lymph nodes revealed metastatic papillary thyroid carcinoma in one case. We report three cases of thyroid papillary carcinoma incidentally found on histological examinations of resected thyroid lobes, as a procedure required for treatment of head and neck squamous cell carcinoma. In comparison, laryngeal squamous cell carcinoma needs more aggressive treatment than well-differentiated thyroid carcinoma. The prevalence of thyroid papillary carcinoma, as an incidental finding in our study was 0.01%. Therefore, preoperative evaluation of the thyroid gland by ultrasonography and fine needle aspiration biopsy of suspicious lesions is recommended in patients who are candidates for open laryngectomy.

  13. Intraparenchymal papillary meningioma of brainstem: case report and literature review

    Directory of Open Access Journals (Sweden)

    Jiang Xiao-Bing

    2012-01-01

    Full Text Available Abstract Both intraparenchymal papillary meningioma and papillary meningioma with cyst formation of brainstem have never been reported. The authors present an extremely rare case of patient with intraparenchymal papillary meningioma of brainstem. A 23-year-old Chinese male presented with a 4-month history of progressive left upper limb and facial nerve palsy. Magnetic resonance imaging revealed a cystic-solid, heterogeneously enhancing mass in pons and right cerebral peduncle with no dural attachment. The tumor was totally removed via subtemporal approach. During surgery, the lesion was found to be completely intraparenchymal. Histological and immunohistochemical examinations were compatible with the diagnosis of papillary meningioma. The lesion recurred nine months after primary surgery, a second surgery followed by radiotherapy was performed. Till to now (nearly 2 years after the treatment, the patient is tumor free survival. Intraparenchymal meningioma of brainstem with cystic formation is very rare, however, it should be considered as a differential diagnosis of a brainstem neoplasm. The present case strongly recommended that postoperative radiotherapy was essential for the patients with papillary meningiomas.

  14. Hyalinizing trabecular tumor and papillary carcinoma of the thyroid

    Institute of Scientific and Technical Information of China (English)

    ZHU Hong; QI Ji-ping; WANG Ying-wei; SONG Yue-jia; ZHANG Zhi-yi

    2010-01-01

    Background Hyalinizing trabecular tumor (HTT) is a rare thyroid neoplasm, which shares some histologic features with thyroid papillary carcinoma (TPC). Clinically, it is frequently misdiagnosed as papillary carcinoma, even for some experienced pathologists. The aim of this study was to investigate whether HTT is variant of TPC or HTT is an independent entity of thyroid neoplasm.Methods The expression of CK19, galectin-3, HBME-1 and MIB-1 was detected by immunohistochemical staining in 12 cases of hyalinizing trabecular tumor and 20 cases of thyroid papillary carcinoma.Results Two of the 12 HTT samples were positive or focally positive for CK19. Four of the 12 samples of HTT presented positive to galectin-3; 3 were stained strongly and the other one was focally positive. None of the 12 samples of HTT was positive for HBME-1. Five in 12 HTT samples were stained in nucleus for MIB-1. Almost all the 20 cases of thyroid papillary carcinoma were intensely stained for CK19, galectin-3 and HBME-1. Fifteen in 20 cases of thyroid papillary carcinoma showed nuclear staining for MIB-1.Conclusions HTT is an independent thyroid neoplasm, not a variant of TPC. This study could help in the differential diagnosis of HTT from TPC. CK19, galectin-3 and HBME-1 are adequate to identify HTT and TPC, but MIB-1 does not play an important role in discrimination between HTT and TPC.

  15. Papillary thyroid microcarcinoma presenting as skull base metastasis

    Institute of Scientific and Technical Information of China (English)

    YAN Bo; LIU Dian-gang; L(U) Hai-li; ZHANG Qiu-hang

    2010-01-01

    @@ Papillary thyroid carcinoma (PTC) is the most common type of well-differentiated thyroid cancer and is considered to be a relatively indolent tumor in which distant metastasis and death are rare.1 The metastasis of PTC is usually to regional lymph nodes, especially the cervical and mediastinal nodes. Metastases to the brain are rare, and constitute 0.1%-5.0% of distant metastases of papillary carcinoma.2 Skull metastasis is uncommon,and is found in 2.5%-5.8% of cases of thyroid cancer.3 Skull base metastasis of PTC is extremely rare, with only eight reported cases in the literature involving the clivus,cavernous sinus, sella turcica, and the petrous apex and ridge.4 A metastatic lesion can arise from histologically benign and silent thyroid neoplasms,5 and differential diagnosis between ectopic and metastatic thyroid cancer can be difficult,6 therefore, the management of thyroid cancer is controversial after removal of metastatic disease.Here we reported a case of papillary thyroid microcarcinoma (PTMC) that was manifested as a solitary clivus metastasis and discussed the diagnostic and therapeutic management strategies. The 73-year-old patient presented with visual impairment in the right eye,and epistaxis. The patient subsequently underwent complete total thyroidectomy after a diagnosis of papillary microcarcinoma. This finding emphasizes that clinically significant metastases can arise from thyroid papillary microcarcinoma. Total thyroidectomy and careful review of the histology are necessary to prevent delay in proper diagnosis.

  16. The Efficacy of Endoscopic Papillary Balloon Dilation for Patients with Acute Biliary Pancreatitis

    Directory of Open Access Journals (Sweden)

    Wei-Chih Sun

    2015-01-01

    Full Text Available Background. No study investigated the efficacy and safety of endoscopic papillary balloon dilation (EPBD for the treatment of acute biliary pancreatitis (ABP. Method. We retrospectively reviewed the effects of EPBD on patients with ABP from February 2003 to December 2012. The general data, findings of image studies, details of the procedure, and outcomes after EPBD were analyzed. Result. Total 183 patients (male/female: 110/73 were enrolled. The mean age was 65.9 years. Among them, 155 patients had mild pancreatitis. The meantime from admission to EPBD was 3.3 days. Cholangiogram revealed filling defects inside the common bile duct (CBD in 149 patients. The mean dilating balloon size was 10.5 mm and mean duration of the dilating procedure was 4.3 minutes. Overall, 124 patients had gross stones retrieved from CBD. Four (2.2% adverse events and 2 (1.1% intraprocedure bleeding incidents but no procedure-related mortality were noted. Bilirubin and amylase levels significantly decreased after EPBD. On average, patients resumed oral intake within 1.4 days. The clinical parameters and outcomes were similar in patients with different severity of pancreatitis. Conclusion. EPBD can be effective and safe for the treatment of ABP, even in patients presenting with severe disease.

  17. A case of eosinophilic cholangitis: Imaging findings of contrast-enhanced ultrasonography, cholangioscopy, and intraductal ultrasonography

    Institute of Scientific and Technical Information of China (English)

    Naoki Matsumoto; Masahiko Sugitani; Kiyoshi Yokoyama; Kazuhiko Nakai; Toshiki Yamamoto; Takeshi Otani; Masahiro Ogawa; Naohide Tanaka; Ariyoshi Iwasaki; Yasuyuki Arakawa

    2007-01-01

    A 38-year-old woman was referred to our institution due to epigastralgia. She presented with obstructive jaundice and eosinophilia. Endoscopic retrograde cholangiopancreatography showed diffuse narrowing from the distal common bile duct to the bifurcation of the hepatic ducts. An endoscopic plastic biliary stent was inserted; the specimen obtained from the common bile duct wall revealed dense infiltration by eosinophils.Treatment was started with prednisolone 60 mg daily.The patient's biliary stenosis and eosinophilia gradually improved. Eosinophilic infiltration in the lungs or stomach is relatively common, but it is rare in the common bile dud. Most of the reported cases of eosinophilic cholangitis presented with eosinophilia; our patient's eosinophil count was over 1000/mm3. Since our patient had allergies to pollen and house dust, a relationship between the allergies and the eosinophilic cholangitis was suspected, but no cause was identified.

  18. Spinal papillary meningioma : A case report and review of the literature

    NARCIS (Netherlands)

    Meinsma-van de Tuin, M; Molenaar, WM; Mooij, JJA

    2000-01-01

    A rare case of a spinal papillary meningioma in a 19-year-old adolescent is described. Six months after radical resection the patient showed dissemination along the cerebrospinal pathway. Papillary meningiomas are rare tumours with a relatively high incidence in childhood. Most papillary meningiomas

  19. Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment

    Directory of Open Access Journals (Sweden)

    Oguz Dilek

    2007-07-01

    Full Text Available Abstract Background Anomalous biliary opening especially the presence of the ampulla of Vater in the duodenal bulb is a very rare phenomenon. We report clinical implications, laboratory and ERCP findings and also therapeutic approaches in 53 cases. Methods The data were collected from the records of 12.158 ERCP. The diagnosis was established as an anomalous opening of the common bile duct (CBD into the duodenal bulb when there is an orifice observed in the bulb with the absence of a papillary structure at its normal localization and when the CBD is visualized by cholangiography through this orifice without evidence of any other opening. Results A total of 53 cases were recruited. There was an obvious male preponderance (M/F: 49/4. Demographic data and ERCP findings were available for all, but clinical characteristics and laboratory findings could be obtained from 39 patients with full records. Thirty – seven of 39 cases had abdominal pain (95% and 23 of them (59% had cholangitis as well. Elevated AP and GGT were found in 97.4% (52/53. History of cholecystectomy was present in 64% of the cases, recurrent cholangitis in 26% and duodenal ulcer in 45%. Normal papilla was not observed in any of the patients and a cleft-like opening was evident instead. The CBD was hook shaped at the distal part that opens to the duodenal bulb. Pancreatic duct (PD was opening separately into the bulb in all the cases when it was possible to visualize. Dilated CBD in ERCP was evident in 94% and the CBD stone was demonstrated in 51%. PD was dilated in four of 12 (33% cases. None of them has a history of pancreatitis. Endoscopically, Papillary Balloon Dilatation instead of Sphincterotomy carried out in 19 of 27 patients (70% with choledocholithiazis. Remaining eight patients had undergone surgery (30%. Clinical symptoms were resolved with medical treatment in 16(32% patients with dilated CBD but no stone. Perforation and bleeding were occurred only in two patients

  20. A Case of Patella Metastasis of Papillary Thyroid Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Han, Eun Ji; Choi, Woo Hee; Chung, Yong An; Sohn, Hyung Sun; Kang, Chang Suk [College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2009-02-15

    A 73-year-old man presented with a chief complaint of progressive left knee pain for two months. He had a history of total thyroidectomy and central lymph node dissection due to papillary thyroid carcinoma three months ago. MRI images revealed a solid mass in the left patella. A solid mass demonstrated low signal on T1 weighed image, and high signal on T2 weighed image. And whole body bone scan showed focal photon defect in same lesion of left patella. The histologic result of left knee lesion was adenocarcinoma, consistent with metastatic papillary thyroid carcinoma. Although patellar metastasis of papillary thyroid carcinoma is very rare, when knee pain and radiologic abnormality are noted, differential diagnosis of metastasis is necessary.

  1. [Kartagener syndrome and papillary thyroid carcinoma: an unusual combination].

    Science.gov (United States)

    Ren, Jingyuan; Wang, Xurui; He, Zhongyin

    2015-11-01

    A case of a papillary thyroid carcinoma in a patient with situs inversus with associated bronchiectasis and chronic sinusitis (Kartagener's syndrome) is reported. A 61-year-old male patient has the symptoms of nasal obstruction. nasal purulent discharge and headache for 2 years. Physical examination: right nasal purulent in right nasal cavity and multiple lychee-like opaque mass in right middle meatus. A nodule, one centimeter in diameter, locates in the upper pole of right thyroid. Evidence of full situs inversus viscerum can be confirmmed by chest radiographs and ultrasound doppler. Pathology: right nasal polyps, the right small papillary thyroid cancer. TEM Tip primary ciliary dyskinesia. Clinical diagnosis: Kartagener syndrome, papillary thyroid carcinoma (T1a N0 M0, I period), chronic sinusitis-nasal polyps.

  2. Papillary thyroid carcinoma presenting as an asymptomatic pelvic bone metastases

    Directory of Open Access Journals (Sweden)

    Siddiq S

    2010-05-01

    Full Text Available Thyroid carcinoma is rare comprising 1% of all malignancies and commonly presents as a neck lump. Papillary thyroid carcinoma unlike follicular thyroid carcinoma tends not to metastasise to distant sites.We present a case of papillary thyroid carcinoma presenting as a solitary asymptomatic pelvic bone metastases and highlight current management of bone metastases. A 59-year old female was found on abdominal computerised tomography to have an incidental finding of a 4.5 cm soft tissue mass in the right iliac bone. Biopsy of the lesion confirmed metastatic thyroid carcinoma. There was no history of a neck lump, head and neck examination was normal. Further imaging confirmed focal activity in the right lobe of the thyroid. A total thyroidectomy and level VI neck dissection was performed and histology confirmed follicular variant of papillary carcinoma.Early detection of bone metastases have been shown to improve prognosis and thyroid carcinoma should be considered as a potential primary malignancy.

  3. Bile Duct Adenoma with Oncocytic Features

    Directory of Open Access Journals (Sweden)

    E. J. Johannesen

    2014-01-01

    Full Text Available Bile duct adenomas are benign bile duct proliferations usually encountered as an incidental finding. Oncocytic bile duct neoplasms are rare and the majority are malignant. A 61-year-old male with a diagnosis of colorectal adenocarcinoma was undergoing surgery when a small white nodule was discovered on the surface of the right lobe of his liver. This lesion was composed of cytologically bland cells arranged in tightly packed glands. These cells were immunopositive for cytokeratin 7, negative for Hep Par 1, contained mucin, and had a Ki67 proliferation index of 8%. The morphology, immunophenotype, presence of mucin, and normal appearing bile ducts, as well as the increased Ki67 proliferation rate, were consistent with a bile duct adenoma with oxyphilic (oncocytic change. Oncocytic tumors in the liver are rare; the first described in 1992. Only two bile duct adenomas with oncocytic change have been reported and neither of them had reported mucin production or the presence of normal appearing bile ducts within the lesion.

  4. Synchronous Parathyroid and Papillary Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Shi-Dou Lin

    2005-02-01

    Full Text Available Concomitant thyroid disease is not unusual among patients with primary hyperparathyroidism. However, the simultaneous occurrence of parathyroid and thyroid carcinoma is extremely rare. We report a 38-year-old man with primary hyperparathyroidism who presented with osteitis fibrosa cystica complicated with pathologic femoral neck fracture. Preoperative investigation for exclusion of multiple endocrine neoplasia did not find evidence of medullary thyroid carcinoma or pheochromocytoma, but imaging studies revealed the presence of nodules in the right lobe and a parathyroid lesion over the left inferior pole of the thyroid gland. Total thyroidectomy, left parathyroidectomy, and bipolar hemiarthroplasty of the left hip were then performed simultaneously. The resected specimens were pathologically identified as papillary thyroid carcinoma and parathyroid carcinoma, respectively. After the operation, 131I ablation therapy was administered at a dose of 120 mCi. Additional doses of 30 mCi were given yearly as serum thyroglobulin level became elevated. Serum calcium level remained normal during yearly follow-up. Although parathyroid carcinoma is an uncommon cause of parathyroid hormone-dependent hypercalcemia, it should nonetheless be given due consideration because its surgical approach differs from that of parathyroid adenoma. As the coexistence of parathyroid and non-medullary thyroid carcinoma has previously been reported, the possibility of both malignancies must also be considered in the setting of primary hyperparathyroidism with thyroid nodules. If confirmed with preoperative parathyroid scintigraphic and other laboratory studies, an optimal outcome may be achieved with complete resection of both tumors at the time of initial operation, followed by adjunctive therapy.

  5. Prognostic and Bioepidemiologic Implications of Papillary Fibroelastomas.

    Science.gov (United States)

    Tamin, Syahidah S; Maleszewski, Joseph J; Scott, Christopher G; Khan, S K; Edwards, William D; Bruce, Charles J; Oh, Jae K; Pellikka, Patricia A; Klarich, Kyle W

    2015-06-09

    Papillary fibroelastomas (PFE) are benign neoplasms with little available outcome data. This study sought to describe the frequency and clinical course of patients with surgically removed PFE and echocardiographically suspected, but unoperated, PFE. Mayo Clinic pathology and echocardiography databases (January 1, 1995, to December 31, 2010) were queried, resulting in 511 patients: group 1 (n = 185), including patients with surgically removed, histopathologically confirmed PFE; group 1a (n = 94; 51%) with PFE removed at primary surgery; and group 1b (n = 91; 49%) with PFE removal at time of another cardiac surgery. Group 2 (n = 326) patients had echocardiographic evidence of PFE but no cardiac surgery to remove PFE. Group 1 had mean age of 63 ± 14 years (116 women [63%]). During the study period, we identified 112 cardiac myxomas in the pathology database and 142 in the echocardiographic database. Mean age in group 2 was 67 ± 14 years (162 women [50%]). PFE occurred most commonly on cardiac valves (n = 400 [78%]). In group 1, transient ischemic attack or stroke was the presenting symptom in 58 patients (32%). With surgical removal of valvular PFE, the valve was preserved in 92 (98%). Recurrence was documented in 3 patients (1.6%). Follow-up stroke risk in groups 1, 1a, and 1b at 1 year was 2%, 0%, and 4%; at 5 years, 8%, 5%, and 11%, respectively. Cerebrovascular accident risk in group 2 at 1 and 5 years was 6% and 13%. In patients with echocardiographically suspected PFE who do not undergo surgical removal, rates of cerebrovascular accident and mortality are increased. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. Marine-Lenhart syndrome with papillary thyroid carcinoma

    Directory of Open Access Journals (Sweden)

    Hulusi Atmaca

    2015-01-01

    Full Text Available Graves′ disease with accompanying functioning nodules is known as Marine-Lenhart syndrome. Autonomously functioning thyroid nodules (AFTNs also within Graves′ thyroid tissue are almost always bening in nature. A 45-year-old man developed hyperthyroidism due to the coexistence of Graves′ disease and AFTN. Total thyroidectomy was performed. The hyperfunctioning nodule with centrally hypoactive foci detected by technetium-99m thyroid scanning was histologically diagnosed as papillary thyroid carcinoma that was 2.5 cm in diameter. We report the presence of papillary thyroid carcinoma within AFTN in patients with Marine-Lenhart syndrome, which has not been reported so far.

  7. External irradiation in treatment of papillary carcinoma of the thyroid.

    Science.gov (United States)

    Lenio, P T

    1976-03-01

    A retrospective review of thirty patients with papillary carcinoma of the thyroid with metastatic or direct extension of their disease was undertaken. These thirty patients were treated by a standard surgical procedure and postoperative high dose orthoirradiation with an average twenty-one year follow-up period. Results of this treatment are compared with those of eighty similar patients treated by surgery alone. The primary treatment of papillary carcinoma of the thyroid remains surgical but with a consideration that irradiation may be of benefit in certain instances.

  8. Paraurethral Skene's duct cyst in a newborn

    Science.gov (United States)

    Moralioğlu, Serdar; Bosnalı, Oktav; Celayir, Ayşenur Cerrah; Şahin, Ceyhan

    2013-01-01

    Paraurethral or Skene's duct cysts are rare causes of interlabial masses in neonates. The diagnosis of Skene's duct cysts in the neonatal period is based on its location, in relation to the urethra, and the demonstration of transitional epithelium in the cyst wall. The distinguishing features of paraurethral cysts are the displacement of urethral meatus by the mass and a cyst containing milky fluid. Thus, we report a case of a Skene's duct cyst in a newborn which was treated by incision and drainage. PMID:24049387

  9. Comparative analysis of gene expression profiles of papillary thyroid microcarcinoma and papillary thyroid carcinoma

    Directory of Open Access Journals (Sweden)

    Kim Hoon

    2010-01-01

    Full Text Available Purpose: Papillary thyroid carcinomas (PTCs measuring 1.0 cm or less were separately defined as papillary thyroid microcarcinomas (PTMs by the World Health Organization, emphasizing on their benign behavior. However, some reported that PTMs may have aggressive behavior, can cause regional, or even distant metastases. But till now, the characteristics of PTMs were only reviewed and described by the clinicopathological parameters, and no analysis of PTM by the gene level is available. We report on the gene expression profiles of PTMs by the oligonucleotide microarrays and the results of comparative analysis with those of PTCs. Materials and Methods: The gene expression profiles of 25 pairs of PTMs and their normal thyroid tissue counterparts, and 11 pairs of PTCs and their normal counterparts, were analyzed by Affymetrix Human Genome U133A. Data were analyzed by the SAM and the DAVID 2008 program to detect differentially expressed genes in supervised sample classification. Results: Two-hundred thirteen statistically significant up-regulated genes and -183 significant down-regulated genes of PTMs compared with their normal counterpart thyroid tissues, which were mainly cell adhesion-related genes and immune response genes, were detected. Two-hundred sixty-one up-regulated and -157 down-regulated genes of PTCs were also detected. In the comparative analyses of gene expression profiles of PTMs and PTCs, no significant difference was found. Conclusion: PTM should not be considered as the simple occult indolent thyroid cancer, but as the earlier stage of disease which eventually evolves into PTC, because the gene expression profiles of PTMs were not different from those of PTCs.

  10. Intraduktal papillærmucinøs neoplasi i pancreas

    OpenAIRE

    Andersen, Erik Hanstein

    2007-01-01

    Abstract Intraductal papillary mucinous neoplasm of the Pancreas (IPMN) is a potentially malignant neoplasm which produces mucin. It was first described in 1982, and has been described with increasing frequency since. This article is a review of the litterature available through searches in PubMed in June 2006. Classical findings in IPMN patients are dilated pancreatic ducts, mural nodules and visible mucin at the Papilla of Vateri at ERCP. Demonstration of a communication between...

  11. Transition duct assembly with modified trailing edge in turbine system

    Energy Technology Data Exchange (ETDEWEB)

    McMahan, Kevin Weston; Schott, Carl Gerard; Ingram, Clint Luigie; Siden, Gunnar Leif; Pierre, Sylvain

    2016-10-04

    Transition duct assemblies for turbine systems and turbomachines are provided. In one embodiment, a transition duct assembly includes a plurality of transition ducts disposed in a generally annular array and comprising a first transition duct and a second transition duct. Each of the plurality of transition ducts includes an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of each transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The transition duct assembly further includes an aerodynamic structure defined by the passages of the first transition duct and the second transition duct. The aerodynamic structure includes a pressure side, a suction side, and a trailing edge, the trailing edge having a modified aerodynamic contour.

  12. Reference values of MRI measurements of the common bile duct and pancreatic duct in children

    Energy Technology Data Exchange (ETDEWEB)

    Gwal, Kriti; Bedoya, Maria A.; Patel, Neal; Darge, Kassa; Anupindi, Sudha A. [University of Pennsylvania Perelman School of Medicine, Department of Radiology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Rambhatla, Siri J. [Beth Israel Medical Center, Department of Pediatrics, Newark, NJ (United States); Sreedharan, Ram R. [University of Pennsylvania, Departments of Gastroenterology, Hepatology and Nutrition, The Children' s Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, PA (United States)

    2015-08-15

    Magnetic resonance imaging/cholangiopancreatography (MRI/MRCP) is now an essential imaging modality for the evaluation of biliary and pancreatic pathology in children, but there are no data depicting the normal diameters of the common bile duct (CBD) and pancreatic duct. Recognition of abnormal duct size is important and the increasing use of MRCP necessitates normal MRI measurements. To present normal MRI measurements for the common bile duct and pancreatic duct in children. In this retrospective study we searched all children ages birth to 10 years in our MR urography (MRU) database from 2006 until 2013. We excluded children with a history of hepatobiliary or pancreatic surgery. We stratified 204 children into five age groups and retrospectively measured the CBD and the pancreatic duct on 2-D axial and 3-D coronal T2-weighted sequences. We performed statistical analysis, using logistic and linear regressions to detect the age association of the visibility and size of the duct measurements. We used non-parametric tests to detect gender and imaging plane differences. Our study included 204 children, 106 (52%) boys and 98 (48%) girls, with a median age of 33 months (range 0-119 months). The children were distributed into five age groups. The common bile duct was visible in all children in all age groups. The pancreatic duct was significantly less visible in the youngest children, group 1 (54/67, 80.5%; P = 0.003) than in the oldest children, group 5 (22/22, 100%). In group 2 the pancreatic duct was seen in 19/21 (90.4%), in group 3 52/55 (94.5%), and in group 4 39/39 (100%). All duct measurements increased with age (P < 0.001; r-value > 0.423), and the incremental differences between ages were significant. The measurement variations between the axial and coronal planes were statistically significant (P < 0.001); however these differences were fractions of millimeters. For example, in group 1 the mean coronal measurement of the CBD was 2.1 mm and the axial

  13. Transmission of wave energy in curved ducts

    Science.gov (United States)

    Rostafinski, W.

    1973-01-01

    A formation of wave energy flow was developed for motion in curved ducts. A parametric study over a range of frequencies determined the ability of circular bends to transmit energy for the case of perfectly rigid walls.

  14. Ducted propagation of chorus waves: Cluster observations

    Directory of Open Access Journals (Sweden)

    K. H. Yearby

    2011-09-01

    Full Text Available Ducted propagation of whistler waves in the terrestrial magnetosphere-ionosphere system was discussed and studied long before the first in-situ spacecraft measurements. While a number of implicit examples of the existence of ducted propagation have been found, direct observation of ducts has been hampered by the low sampling rates of measurements of the plasma density. The present paper is based on Cluster observations of chorus waves. The ability to use measurements of the spacecraft potential as a proxy for high time resolution electron density measurements is exploited to identify a number of cases when increased chorus wave power, observed within the radiation belts, is observed simultaneously with density enchantments. It is argued that the observation of ducted propagation of chorus implies modification of numerical models for plasma-wave interactions within the radiation belts.

  15. General Information about Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  16. Treatment Options for Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  17. Stages of Extrahepatic Bile Duct Cancer

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  18. Treatment Option Overview (Extrahepatic Bile Duct Cancer)

    Science.gov (United States)

    ... duct cancer include jaundice and pain in the abdomen. These and other signs and symptoms may be ... Dark urine . Clay colored stool . Pain in the abdomen . Fever . Itchy skin. Nausea and vomiting . Weight loss ...

  19. INTERIOR DUCT SYSTEM DESIGN, CONSTRUCTION, AND PERFORMANCE

    Energy Technology Data Exchange (ETDEWEB)

    Janet E.R. Mcllvaine; David Beal; Philip Fairey

    2001-10-10

    By removing air distribution and conditioning equipment from unconditioned spaces, homeowners stand to benefit substantially with respect to both energy savings and indoor air quality. Duct leakage introduces: Greater heating and cooling loads from air at extreme temperatures and humidity levels; Outside air and air from unconditioned spaces that may contain air borne contaminants, combustion gases, pollen, mold spores, and/or particles of building materials; and Higher whole-house infiltration/exfiltration rates. Exemplary studies conducted since 1990 have demonstrated the prevalence of duct leakage throughout the United States and measured energy savings of approximately 20% during both heating and cooling seasons from leakage reduction. These all dealt with duct leakage to and/or from unconditioned spaces. In the building science community, leakage within the conditioned space is generally presumed to eliminate the negative consequences of duct leakage with the exception of possibly creating pressure imbalances in the house which relates to higher infiltration and/or exfiltration. The practical challenges of isolating ducts and air handlers from unconditioned spaces require builders to construct an air-tight environment for the ducts. Florida Solar Energy Center researchers worked with four builders in Texas, North Carolina, and Florida who build a furred-down chase located either in a central hallway or at the edges of rooms as an architectural detail. Some comparison homes with duct systems in attics and crawl spaces were included in the test group of more than 20 homes. Test data reveals that all of the duct/AHU systems built inside the conditioned space had lower duct leakage to unconditioned spaces than their conventional counterparts; however, none of the homes was completely free of duct leakage to unconditioned spaces. Common problems included wiring and plumbing penetrations of the chase, failure to treat the chase as an air tight space, and misguided

  20. Effect of shear on duct wall impedance.

    Science.gov (United States)

    Goldstein, M.; Rice, E.

    1973-01-01

    The solution to the equation governing the propagation of sound in a uniform shear layer is expressed in terms of parabolic cylinder functions. This result is used to develop a closed-form solution for acoustic wall impedance which accounts for both the duct liner and the presence of a boundary layer in the duct. The effective wall impedance can then be used as the boundary condition for the much simpler problem of sound propagation in uniform flow.

  1. Gas Explosions Mitigation by Ducted Venting

    OpenAIRE

    2007-01-01

    The mitigation of effects of gas and dust explosions within industrial equipment is effective if venting the combustion products to safe location. The presence of relief duct is however likely to increase the severity of the explosion with respect to equipment vented to open atmosphere, due to secondary explosions occurring in the initial sections of duct, frictional drag and inertia of the gas column, acoustic and Helmholtz oscillations. The weights of these phenomena on explosion e...

  2. Energy Conservation Through Duct Leakage Reduction

    Science.gov (United States)

    2004-02-26

    Energy Conservation Through Duct Leakage Reduction February 26, 2004 Rich Glatt – Lindab Inc. Report Documentation Page Form ApprovedOMB No. 0704...4. TITLE AND SUBTITLE Energy Conservation Through Duct Leakage Reduction 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6...Wall – DW that installs like SW - easiest installing DW system on the market – Eliminates the need for costly flanged connections – SMACNA Leakage

  3. Thyroglossal duct cyst cancer most likely arises from a thyroid gland remnant.

    Science.gov (United States)

    Rossi, Esther D; Martini, Maurizio; Straccia, Patrizia; Cocomazzi, Alessandra; Pennacchia, Ilaria; Revelli, Luca; Rossi, Armando; Lombardi, Celestino Pio; Larocca, Luigi M; Fadda, Guido

    2014-07-01

    Thyroglossal duct cancer is a rare entity, occurring in 1.5 % of all thyroglossal duct cysts (TDC). A definitive consensus about its neoplastic origin has not been established as two contrasting theories exist, one proposing an origin in extra-thyroid remnants and the other a metastatic localization of a primary thyroid cancer. We compare morphological and molecular characteristics of both thyroglossal and thyroid carcinomas in a case series from our institute. We evaluated histology of 80 TDC. In 12 cases, prior cytological evaluation had been performed by liquid-based cytology (LBC). The BRAF gene was examined for mutations, and the histology of both thyroglossal duct and synchronous thyroid carcinoma was reevaluated. In 9 out of 80 (11 %) TDC cases, a papillary thyroid cancer (PTC) was diagnosed. In five out of nine (56 %) thyroglossal carcinomas, a synchronous thyroid cancer was diagnosed: 3 PTC and 2 follicular variant PTC (FVPC). In five thyroglossal carcinomas, mutated BRAF (V600E) was found, three in PTC and in thyroglossal as well as in the synchronous tumor in the thyroid. All the patients are in a disease-free status and still alive. Our results suggest that the majority of thyroglossal carcinomas most likely develop as a primary malignancy from a thyroid remnant. Neither the presence of V600E BRAF mutations nor that of a well-differentiated thyroid carcinoma changed the outcome or disease-free survival. We suggest that a diagnosis of thyroglossal carcinoma should be followed by a detailed evaluation of the thyroid gland. In the absence of clinical and radiological thyroid alterations, follow-up as for thyroid cancer is the correct management.

  4. A Comparison of Simulation Capabilities for Ducts

    Energy Technology Data Exchange (ETDEWEB)

    Miller, William A [ORNL; Smith, Matt K [ORNL; Gu, Lixing [Florida Solar Energy Center (FSEC); New, Joshua Ryan [ORNL

    2014-11-01

    Typically, the cheapest way to install a central air conditioning system in residential buildings is to place the ductwork in the attic. Energy losses due to duct-attic interactions can be great, but current whole-house models are unable to capture the dynamic multi-mode physics of the interactions. The building industry is notoriously fragmented and unable to devote adequate research resources to solve this problem. Builders are going to continue to put ducts in the attic because floor space is too expensive to closet them within living space, and there are both construction and aesthetic issues with other approaches such as dropped ceilings. Thus, there is a substantial need to publicly document duct losses and the cost of energy used by ducts in attics so that practitioners, builders, homeowners and state and federal code officials can make informed decisions leading to changes in new construction and additional retrofit actions. Thus, the goal of this study is to conduct a comparison of AtticSim and EnergyPlus simulation algorithms to identify specific features for potential inclusion in EnergyPlus that would allow higher-fidelity modeling of HVAC operation and duct transport of conditioned air. It is anticipated that the resulting analysis from these simulation tools will inform energy decisions relating to the role of ducts in future building energy codes and standards.

  5. Double common bile duct: A case report

    Institute of Scientific and Technical Information of China (English)

    Srdjan P Djuranovic; Milenko B Ugljesic; Nenad S Mijalkovic; Viktorija A Korneti; Nada V Kovacevic; Tamara M Alempijevic; Slaven V Radulovic; Dragan V Tomic; Milan M Spuran

    2007-01-01

    Double common bile duct (DCBD) is a rare congenital anomaly in which two common bile ducts exist. One usually has normal drainage into the papilla duodeni major and the other usually named accessory common bile duct (ACBD) opens in different parts of upper gastrointestinal tract (stomach, duodenum, ductus pancreaticus or septum). This anomaly is of great importance since it is often associated with biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction (APBJ) and upper gastrointestinal tract malignancies. We recently recognized a rare case of DCBD associated with APBJ with lithiasis in better developed common bile duct. The opening site of ACBD was in the pancreatic duct. The anomaly was suspected by transabdominal ultrasonography and finally confirmed by endoscopic retrograde cholangiopancreatography (ERCP) followed by endoscopic sphincterotomy and stone extraction. According to the literature, the existence of DCBD with the opening of ACBD in the pancreatic duct is most frequently associated with APBJ and gallbladder carcinoma. In case of DCBD, the opening site of ACBD is of greatest clinical importance because of its close implications with concomitant pathology. The adequate diagnosis of this rare anomaly is significant since the operative complications may occur in cases with DCBD which is not recognized prior to surgical treatment.

  6. Primary Papillary Mucinous Adenocarcinoma of the Ureter Mimicking Genitourinary Tuberculosis

    Directory of Open Access Journals (Sweden)

    Hanni Gulwani

    2010-01-01

    Full Text Available Primary adenocarcinomas of the renal pelvis and ureter are rare and account for less than 1% of all malignancies at this site. We report a case of primary papillary mucinous adenocarcinoma of the ureter that clinically mimicked genitourinary tuberculosis. Early diagnosis is important for the better outcome.

  7. Uptake of /sup 131/I by a papillary meningioma

    Energy Technology Data Exchange (ETDEWEB)

    Preisman, R.A. (Rees-Stealy Medical Clinic, San Diego, CA); Halpern, S.E.; Shishido, R.; Waltz, T.; Callipari, F.; Reit, R.

    1977-08-01

    Significant uptake of /sup 131/I commonly occurs in thyroid malignancies, especially if the remaining normal thyroid tissue is removed prior to scanning. We report a case showing marked uptake of /sup 131/I by a papillary meningioma of the thoracic spinal cord. To our knowledge, this radionuclide has not been previously shown to accumulate in a meningioma.

  8. ETS-1 oncoprotein expression is decreased in aggressive papillary ...

    African Journals Online (AJOL)

    E.A. Ibrahim

    2016-10-19

    Oct 19, 2016 ... of the urinary bladder: An immunohistochemical study. E.A. Ibrahim. ∗ ... The value of ETS-1 in papillary transitional cell carcinoma of the urinary bladder. 121 ... Organization 2004 system [14] and staged into: stages 0 and I (early bladder ... according to the percentage of cells with positive nuclear staining;.

  9. Papillary thyroid carcinoma in Denmark 1996-2008

    DEFF Research Database (Denmark)

    Londero, Stefano Christian; Krogdahl, Annelise; Bastholt, Lars

    2013-01-01

    A rise in the incidence of thyroid cancer has been reported in several countries, and the increase is only seen in the papillary type. Increased detection due to higher resolution ultrasound and fine needle aspiration has been proposed as the explanation, recent registry studies however question...

  10. Papillary Thyroid Carcinoma in Denmark, 1996-2008

    DEFF Research Database (Denmark)

    Londero, Stefano Christian; Krogdahl, Annelise; Bastholt, Lars

    2014-01-01

    BACKGROUND: Regional as well as national series show an increasing incidence of thyroid cancer largely small size papillary thyroid carcinoma (PTC). Prognostic scoring systems have been developed, but these do not take into account the rapidly changing case mix, and adjustments may be required...

  11. Clinical and pathological features of papillary renal cell carcinoma ...

    African Journals Online (AJOL)

    M.M. Gargouri

    2016-08-21

    Aug 21, 2016 ... adults. This type of tumor contains more than 75% of tubulo-papillary structures and is divided histologically ... Clinical data including presenting symptoms, preoperative findings, pathological features .... tula in one, pulmonary embolism in one and wound infection in 3 ... Cytogenetic studies suggest that.

  12. Gene-expression Classifier in Papillary Thyroid Carcinoma

    DEFF Research Database (Denmark)

    Londero, Stefano Christian; Jespersen, Marie Louise; Krogdahl, Annelise;

    2016-01-01

    BACKGROUND: No reliable biomarker for metastatic potential in the risk stratification of papillary thyroid carcinoma exists. We aimed to develop a gene-expression classifier for metastatic potential. MATERIALS AND METHODS: Genome-wide expression analyses were used. Development cohort: freshly...

  13. Papillary Thyroid Carcinoma: Ectopic Malignancy versus Metastatic Disease

    Directory of Open Access Journals (Sweden)

    Yanery’s Agosto-Vargas

    2017-01-01

    Full Text Available Papillary thyroid carcinoma frequently metastasizes to regional lymph nodes. However, cervical lymph node metastasis as a sole manifestation of occult papillary thyroid carcinoma is rarely observed. Ectopic thyroid is an uncommon condition defined as the presence of thyroid tissue at a site other than pretracheal area. Approximately 1–3% of all ectopic thyroid tissue is located in the lateral neck. This entity may represent the only functional thyroid tissue in the body. Malignant transformation of ectopic thyroid is uncommon; but even rarer is the development of papillary carcinoma on it. We present a case of a 33-year-old man with an incidental lateral neck mass diagnosed after a motor vehicle accident. Total thyroidectomy and lymph node resection were completed without evidence of papillary thyroid carcinoma. Malignant transformation of heterotopic thyroid tissue was the final diagnosis. The possibility of an ectopic thyroid cancer should be considered in the differential diagnosis of a pathological mass in the neck. The uniqueness of this case strives in the rarity that the thyroid gland was free of malignancy, despite ectopic tissue being positive for thyroid carcinoma. Management strategies, including performance of total thyroidectomy, neck dissection, and treatment with radioiodine, should be based on individualized risk assessment.

  14. Detection of Trabeculae and Papillary Muscles in Cardiac MR Images

    NARCIS (Netherlands)

    Spreeuwers, Lieuwe Jan; Bangma, S.J.; Meerwaldt, R.J.H.W.; Vonken, E.J.; Breeuwer, M.

    2005-01-01

    With the improvement of the quality of MR imagery, more and more details become visible. Only 5-10 years ago cardiac images of the heart were still so unsharp that finer details of the heart like the papillary muscles and the trabeculae were hardly visible and it was simply impossible to determine

  15. Detection of Trabeculae and Papillary Muscles in Cardiac MR Images

    NARCIS (Netherlands)

    Spreeuwers, L.J.; Bangma, S.J.; Meerwaldt, R.J.H.W.; Vonken, E.J.; Breeuwer, M.

    2005-01-01

    With the improvement of the quality of MR imagery, more and more details become visible. Only 5-10 years ago cardiac images of the heart were still so unsharp that finer details of the heart like the papillary muscles and the trabeculae were hardly visible and it was simply impossible to determine t

  16. Metastatic papillary carcinoma of the thyroid in a patient previously ...

    African Journals Online (AJOL)

    The subject of this presentation is a 50-year-old lady who was diagnosed with ... Keywords: Graves' disease, papillary thyroid carcinoma, radioactive iodine ... de la thyroïde chez un patient traité antérieurement pour la maladie de Basedow.

  17. Papillary carcinoma of the thyroid gland: Features and associated pathology

    Directory of Open Access Journals (Sweden)

    Vuković Miloš

    2017-01-01

    Full Text Available Introduction: Papillary carcinoma is the most common malignant tumor of the thyroid gland, which is clinically manifested as painless and (impalpable node in the glandular parenchyma. The aim: Analysis of demographic features of the patients with papillary thyroid carcinoma, localization and histomorphology characteristics, as well as associated pathology. Materials and Methods: We analyzed the medical records of 38 patients, to whom pathohistological diagnosis of papillary thyroid carcinoma was given, in the period from January 2011 to December 2015, at the Center for Pathology and Histology, Clinical Center of Vojvodina, Novi Sad. Results: Pathohistologically, 38 papillary carcinoma of the thyroid gland were verified, where 71.05% were females. The average age of patients was 50 years. In our study, the average tumor size was 12.4 mm, while it was some larger in male patients (13.7 mm, compared to female (11.1 mm. Tumor node was more frequent in the right lobe (34.21%. In 34.21% of patients coexistence of the goiter was found, 18.42% had associated Hashimoto's thyroiditis, while 10.52% had associated adenoma of the thyroid gland. Conclusion: Papillary carcinoma is 2.5-3 times more frequent in females, usually in the second half of the 5th decade of life, while the males suffer at some later ages. The largest number of patients belong to stage T1, while the most frequent associated disease is goiter. Thyroidectomy with pathohistological TNM staging is imperative for continued adequate clinical treatment and monitoring of patients.

  18. Transduodenal exploration of the common bile duct in patients with nondilated ducts.

    Science.gov (United States)

    Ratych, R E; Sitzmann, J V; Lillemoe, K D; Yeo, C J; Cameron, J L

    1991-07-01

    Exploration of the small common bile duct can be technically difficult and is associated with a significant risk of ductal injury or late stricture, or both. Transduodenal common duct exploration after sphincteroplasty (TCDE/S) is an alternative method of duct exploration that avoids choledochotomy. Cholecystectomy followed by TCDE/S was performed upon 28 patients with nondilated ducts and suspected choledocholithiasis. Common duct stones were retrieved in 17 patients. Failure to retrieve stones in the remaining 11 patients was attributed to either false-positive results of cholangiography, forceful passage of stones into the duodenum during the initial insertion of a Fogarty catheter through the cystic duct or a false-negative finding at duct exploration. There was no perioperative mortality. Two patients had asymptomatic postoperative hyperamylasemia. One patient had postoperative pancreatitis, hyperbilirubinemia and cholangitis that resolved with antibiotic therapy by the eighth postoperative day. Other complications included wound infection, delayed gastric emptying, pneumonia and otitis media. The over-all morbidity rate was 28.6 per cent. Long term follow-up was obtained in all 28 patients. All patients in the follow-up group are free of recurrent biliary tract disease. TCDE/S appears to be a safe and effective method of exploring the nondilated common bile duct.

  19. Breast ductoscopy and the evolution of the intra-ductal approach to breast cancer.

    Science.gov (United States)

    Dooley, William C

    2009-01-01

    Interest in breast endoscopy came from Oriental investigators in the early 1990s where bloody nipple discharge is a more common presentation of breast cancer. The early techniques using a single microfiber scope without ductal distension was successful in navigating only the first 1-3 cm of the ducts and fraught with technical problems such as scope breakage and poor image quality. In spite of these barriers there has been increasing use of this technology in Japan and more widespread acceptance as the technology of scope design improved. Dooley and others tested a new method of obtaining a rich cytologic specimen from the ducts of high-risk women known as ductal lavage recently. The success of this procedure was that it detected severe cytologic and malignant atypia in clinically and radiographically normal breasts. Reproducibly, the same breast duct could be cannulated and severely atypical cytology obtained. The problem arose in identifying the lesion within the breast, which was the source for the atypia. New American multi-fiber microendoscopes were applied to solve this problem in an initial series of patients with abnormal cytology to identify the lesions. Success of that series lead to wider application of the imaging technology and eventual adoption of this imaging modality help to guide during all non-mastectomy breast surgery where fluid could be elicited from the nipple to identify the duct connecting to the lesion for which surgery was being performed. Initial reports have demonstrated the types of operative findings in certain sub-populations early in the use of this technology.

  20. The "flying" bile duct: avulsion of the common bile duct in a plane crash survivor.

    LENUS (Irish Health Repository)

    Mohan, H

    2012-02-01

    Blunt trauma is an unusual cause of extrahepatic bile duct injury. This is a case of a 51-year-old gentleman who sustained a significant seatbelt injury in a plane crash. Laparotomy, performed due to persistent abdominal pain, revealed that the common bile duct (CBD) was completely avulsed from the duodenum. Following insertion of drains and transfer to a hepatobiliary centre, the devascularised CBD was excised and replaced with a roux-en-y hepaticojejunostomy. Necrotic tissue was debrided from the pancreatic head. A persistent bile leak developed from the sub-hepatic drain. Repeat laparotomy revealed a bile leak from small ducts on the liver surface. Ligation of the ducts and bioglue sealing of the area were successfully performed. Subsequent to this a pancreatic fistula developed from the main pancreatic duct, which has since resolved. This unusual case illustrates the need for prompt recognition and early repair to optimise outcomes in traumatic CBD injury.

  1. Significance of periductal lymphatic and blood vascular densities in intraductal carcinoma of the breast.

    Science.gov (United States)

    El-Gohary, Yasser M; Metwally, Ghada; Saad, Reda S; Robinson, Morton J; Mesko, Thomas; Poppiti, Robert J

    2009-01-01

    We investigated the significance of periductal lymphatic and blood vascular densities in intraductal carcinomas (IDC) of the breast. Thirty five cases of pure IDC treated by partial or total mastectomy were reviewed. Seven cases with normal breast tissue and 48 cases of invasive breast carcinoma were included as controls. All cases were immunostained with D2-40 and CD31. Positively stained microvessels were counted in densely vascular/lymphatic foci (hot spots) at 400x (=0.17 mm(2)) in the periductal areas. IDC without comedonecrosis showed a mean periductal D2-40 lymphatic microvessel density (LMD) of 5.8 +/- 5 (range 0-18), and a CD31 microvessel density (MD) of 14 +/- 8.9 (range 1-40). IDC with comedonecrosis showed periductal D2-40 LMD of 8.4 +/- 3.8 (range 4-18), and a CD31 MD of 24.3 +/- 7.6 (range 14-40). There was a significant difference between periductal D2-40 LMD and CD31 MD counts in IDC with and without comedonecrosis. There was a positive correlation of periductal D2-40 LMD and CD31 MD counts with high nuclear grade (r = 0.39 and 0.56) of IDC as well as with the presence of comedonecrosis (r = 0.49 and 0.59). Both D2-40 LMD and CD31 MD did not correlate significantly with tumor size, estrogen status, or progesterone status. As IDC with comedonecrosis and/or high nuclear grade has a worse prognosis than IDC without comedonecrosis and/or with low nuclear grade, it appears that lymphatic and blood vascular density evaluated by D2-40 and CD31, respectively, are independent prognostic indicators for patients with IDC of the breast and may be an indicator of early or unrecognized invasion or "regression."

  2. Management of pancreaticobiliary disease using a new intra-ductal endoscope: The Texas experience

    Institute of Scientific and Technical Information of China (English)

    Douglas S Fishman; Paul R Tarnasky; Sandeep N Patel; Isaac Raijman

    2009-01-01

    AIM: To evaluate a new single-operator mini-endoscope,Spyglass(R), for its performance, feasibility and safety in the management of pancreaticobiliary disease.METHODS: In a multicenter retrospective analysis of patients undergoing intraductal endoscopy, we evaluated 128 patients (71 men, mean age 57.6years). Indications were therapeutic (TX) in 72 (56%)and diagnostic (DX) in 56 (44%).RESULTS: Peroral endoscopy was performed in 121and percutaneous in seven. TX indications included CBD stones in 41, PD stones in six, and biliary strictures in 25. DX indications included abnormal LFT's in 15,abnormal imaging in 38 and cholangiocarcinoma staging in three. Visualization of the stone(s) was considered good in 31, fair in six, and poor in four.Advancement of the electrohydraulic lithotripsy probe was not possible in three patients and proper targeting of the lesion was partial in four patients. A holmium laser was used successfully in three patients. Ductal clearance was achieved in 37 patients after one procedure and in four patients after two procedures.Diagnosis of biliary strictures was modified in 20/29 and confirmed to be malignant in 10/23. Of the modified patients, no diagnosis was available in 17. Spyglass(R) Demonstrated malignancy in 8/17 and non-malignancy in nine. Suspected pathology by imaging studies and abnormal LFT's was modified in 43/63 (66%). Staging of cholangiocarcinoma demonstrated multicentric cholangiocarcinoma in 2/3. There was no morbidity associated with the use of Spyglass(R).CONCLUSION: Spyglass Spyscope(R) Is a first generation, single operator miniature endoscope that can evaluate and treat various biliary and pancreatic tract diseases.

  3. Diagnostic accuracy of fiberoptic ductoscopy plus in vivo iodine staining for intraductal proliferative lesions

    Institute of Scientific and Technical Information of China (English)

    FENG Xin-zhi; SONG Ying-hua; ZHANG Feng-xia; JIANG Chuan-wu; MEI Hong; ZHAO Bin

    2013-01-01

    Background lodine staining during endoscopy has been successfully used to detect early carcinomatous and precancerous lesions in the esophagus,cervix,and oral cavity.The objective of this study was to determine the diagnostic accuracy of fiberoptic ductoscopy (FDS) plus in vivo iodine staining for intraductal proliferative lesions of the breast.Methods We performed periodic acid-Schiff (PAS) and in vitro iodine staining on 52 and 64 specimens of benign mammary hyperplasia,respectively,and 57 and 53 specimens of ductal carcinoma in situ (DCIS),respectively.Next,FDS was performed on 177 recurrent nipple discharge patients who were randomly divided into two groups.One group was iodine-staining group in which 92 patients were randomly selected to undergo iodine staining during FDS,and the remaining 85 were assigned to the control group.Biopsy specimens of suspicious lesions were obtained and subjected to histopathological examination.Results Following PAS staining,benign mammary hyperplasia lesions were positively stained,while negligible PAS positivity was observed in the DCIS lesions (P <0.05).Following in vitro iodine staining,benign mammary hyperplasia specimens appeared dark brown,whereas DCIS samples appeared significantly lighter or unstained.Compared with the pathological examination results,FDS with iodine staining showed an agreement rate in the diagnosis of ductal intraepithelial neoplasia (DIN),sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and Youden index of 97.82%,98.83%,83.33%,5.93,0.014,and 0.8216,respectively; the corresponding values for FDS without iodine staining were 88.24%,89.16%,50.00%,1.78,0.217,and 0.3916,respectively.Conclusion FDS with iodine staining was superior to conventional FDS for the diagnosis of DIN and is valuable for breast cancer prevention.

  4. Transurethral resection of the ejaculatory duct.

    Science.gov (United States)

    Paick, J S

    2000-05-01

    Complete bilateral ejaculatory duct obstruction has long been recognized as an uncommon, treatable form of male infertility. Partial ejaculatory duct obstruction reflects a disturbance of ejaculation where sperm quality is impaired during transit through the distal vas deferens and ejaculatory ducts. With the advent and increased use of high-resolution transrectal ultrasonography, abnormalities of the distal ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. In an infertile man with oligospermia or azoospermia with low ejaculate volume, normal secondary sexual characteristics, testes and hormonal profile and dilated seminal vesicles, midline cyst, or calcification on transrectal ultrasonography, ejaculatory duct obstruction is suggested. Of course, other causes of infertility may be concomitantly present and need to be searched for and treated as well. In selected cases, transurethral resection has resulted in marked improvement in semen parameters and pregnancies have been achieved. As is the case with all surgical procedures, proper patient selection and surgical experience are necessary to obtain optimal results. However, it appears that the treatments currently available for relief of ejaculatory obstruction are not optimally effective. Only approximately one half of treated patients will have an improvement in semen parameters and only about one quarter of treated patients will contribute to a pregnancy. What remains to be determined is how to manage the additional nearly 50% of patients who do not benefit from transurethral resection of ejaculatory obstruction. Based on my experience, I suggest that transrectal ultrasonography should be the first diagnostic procedure used when infertile men are suspected of having ejaculatory duct obstruction; however, vasography should still be considered for a more

  5. Salivary duct carcinoma of the parotid gland

    Directory of Open Access Journals (Sweden)

    Mona Mlika

    2012-01-01

    Full Text Available Salivary duct carcinoma of the parotid gland is an uncommon tumor, highly aggressive. About 200 cases have been reported in the English literature. Pathomorphologically, these tumors showed great similarities to ductal carcinoma of the female breast, which is why they described this tumor as "salivary duct carcinoma." The authors describe a new case of salivary duct carcinoma of the parotid gland. We present the case of a 50-year-old patient with progressive facial paralysis. The MRI examination of the head showed two ill-defined formations. A malignant tumor was strongly suspected, so that a total left parotidectomy with excision of the adjacent facial nerve and left lymph node dissection was performed. Microscopic examination concluded to a salivary duct carcinoma of the left parotid gland negative with Her2/neu antibody with lymph node metastasis. There were no recurrences or metastases within 3 years of follow-up. Salivary duct carcinoma of the parotid gland is a rare tumor with an aggressive behavior. This is due to its propensity to infiltrate distant organs. The diagnosis is based on microscopic examination. Treatment modalities are non-consensual, but some authors advocate the necessity of aggressive approach, especially in tumors negative with Heur2/neu antibody. This is due to the fact that the overexpression of this antigen was reported to be associated with a poor prognosis.

  6. Characterization of flow in a scroll duct

    Science.gov (United States)

    Begg, E. K.; Bennett, J. C.

    1985-01-01

    A quantitative, flow visualization study was made of a partially elliptic cross section, inward curving duct (scroll duct), with an axial outflow through a vaneless annular cutlet. The working fluid was water, with a Re(d) of 40,000 at the inlet to the scroll duct, this Reynolds number being representative of the conditions in an actual gas turbine scroll. Both still and high speed moving pictures of fluorescein dye injected into the flow and illuminated by an argon ion laser were used to document the flow. Strong secondary flow, similar to the secondary flow in a pipe bend, was found in the bottom half of the scroll within the first 180 degs of turning. The pressure field set up by the turning duct was strong enough to affect the inlet flow condition. At 90 degs downstream, the large scale secondary flow was found to be oscillatory in nature. The exit flow was nonuniform in the annular exit. By 270 degs downstream, the flow appeared unorganized with no distinctive secondary flow pattern. Large scale structures from the upstream core region appeared by 90 degs and continued through the duct to reenter at the inlet section.

  7. Numerical simulation of flow past circular duct

    Institute of Scientific and Technical Information of China (English)

    Ze-gao YIN; Xian-wei Cao; Hong-da SHI; Jian MA

    2010-01-01

    The Renormalization Group(RNG)k-ε turbulence model and Volume of Fluid(VOF)method were employed to simulate the flow past a circular duct in order to obtain and analyze hydraulic parameters.According to various upper and bottom gap ratios,the force on the duct was calculated.When the bottom gap ratio is 0,the drag force coefficient,lift force coefficient,and composite force reach their maximum values,and the azimuth reaches its minimum.With an increase of the bottom gap ratio from 0 to 1,the drag force coefficient and composite force decrease sharply,and the lift force coefficient does not decreases so much,but the azimuth increases dramatically.With a continuous increase of the bottom gap ratio from 1 upward,the drag force coefficient,lift force coefficient,composite force,and azimuth vary little.Thus,the bottom gap ratio is the key factor influencing the force on the circular duct.When the bottom gap ratio is less than 1,the upper gap ratio has a remarkable influence on the force of the circular duct.When the bottom gap ratio is greater than 1,the variation of the upper gap ratio has little influence on the force of the circular duct.

  8. Convolution seal for transition duct in turbine system

    Energy Technology Data Exchange (ETDEWEB)

    Flanagan, James Scott; LeBegue, Jeffrey Scott; McMahan, Kevin Weston; Dillard, Daniel Jackson; Pentecost, Ronnie Ray

    2015-05-26

    A turbine system is disclosed. In one embodiment, the turbine system includes a transition duct. The transition duct includes an inlet, an outlet, and a passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The transition duct further includes an interface feature for interfacing with an adjacent transition duct. The turbine system further includes a convolution seal contacting the interface feature to provide a seal between the interface feature and the adjacent transition duct.

  9. A case of papillary microcarcinoma of the thyroid with abundant colloid (masquerading as colloid goiter with papillary hyperplasia: Cytological evaluation with histopathological correlation

    Directory of Open Access Journals (Sweden)

    Elancheran Muthalagan

    2015-01-01

    Full Text Available Papillary thyroid carcinoma (PTC is the most common malignant neoplasm of the thyroid. On fine-needle aspiration (FNA cytology smears of conventional PTC, the background usually shows scanty, bubble gum-like colloid. But the macrofollicular variant and papillary microcarcinoma reveals abundant thin colloid in the background. We report a case of papillary carcinoma of thyroid in a 37-year-old female with abundant thin colloid, obscuring the nuclear morphology in many clusters, along with the presence of typical nuclear features within occasional clusters in FNA cytology and hence, masquerading as colloid goiter with papillary hyperplasia. Histopathological examination of the total thyroidectomy specimen revealed papillary microcarcinomatous focus in a background of nodular hyperplasia. The differential diagnosis of PTC should be entertained even in colloid-rich FNA smears if the typical nuclear features are present. Hence, a meticulous search for any fragment with nuclear features of PTC is mandatory before labeling the smears as benign nodular hyperplasia.

  10. Ultrasonographic features of metastatic lymph nodes in papillary thyroid microcarinomas and macrocarcinomas

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Young Gyung; Kang, Hee; Joh, Young Doc; Jeong, Kyung Soon; Kim, Beom Su [Dept. of Radiology, Kosin University Gospel Hospital, Busan(Korea, Republic of)

    2015-02-15

    To analyze ultrasonographic (US) features of metastatic lymph nodes (LNs) in papillary thyroid microcarcinomas (PTMC) and in papillary thyroid macrocarcinomas. The study reviewed US findings of 273 patients with pathologically confirmed papillary thyroid carcinoma (PTC) and metastatic LNs based on the US examination. Patients were divided into two groups: PTMC and papillary thyroid macrocarcinomas. The 273 patients with PTC included 87 with PTMC and 186 with papillary thyroid macrocarcinoma. No significant difference of US features in patients with lateral neck node metastasis was found between PTMC (n = 96) and macrocarcinoma (n = 29). In central neck node metastasis, round shape was the most frequent findings in both groups (p < 0.001). There was no significant difference in US features of metastatic LNs between PTMC and papillary thyroid macrocarcinomas. Therefore, careful evaluation of the whole neck should be made.

  11. Papillary and Nonpapillary Calcium Oxalate Monohydrate Renal Calculi: Comparative Study of Etiologic Factors

    Directory of Open Access Journals (Sweden)

    Enrique Pieras

    2006-01-01

    Full Text Available Calcium oxalate monohydrate (COM renal calculi can be classified into two groups: papillary and nonpapillary. In this paper, a comparative study between etiologic factors of COM papillary and nonpapillary calculi is performed. The study included 40 patients with COM renal calculi. The urine of these individuals was analyzed. Case history, lifestyle, and dietetic habits were obtained.No significant differences between urinary biochemical data of both groups were observed; 50% of COM papillary stone formers and 40% of COM nonpapillary stone formers had urolithiasis family history. A low consumption of phytate-rich products was observed for both groups. A relationship between profession with occupational exposure to cytotoxic products and COM papillary renal lithiasis was detected.The results suggest that COM papillary calculi would be associated to papillary epithelium alterations together with a crystallization inhibitors deficit, whereas COM nonpapillary calculi would be associated to the presence of heterogeneous nucleants and a crystallization inhibitors deficit.

  12. FLUID FLOW IN ROTATING HELICAL SQUARE DUCTS

    Institute of Scientific and Technical Information of China (English)

    Chen Hua-jun; Zhang Ben-zhao; Zhang Jin-suo

    2003-01-01

    A numerical study is made for a fully developed laminar flow in rotating helical pipes.Due to the rotation, the Coriolis force can also contribute to the secondary flow.The interaction between rotation, torsion, and curvature complicates the flow characteristics.The effects of rotation and torsion on the flow transitions are studied in details.The results show that there are obvious differences between the flow in rotating ducts and in helical ducts without rotation.Certain hitherto unknown flow patterns are found.The effects of rotation and torsion on the friction factor are also examined.Present results show the characteristics of the fluid flow in rotating helical square ducts.

  13. Acoustic energy in ducts - Further observations

    Science.gov (United States)

    Eversman, W.

    1979-01-01

    The transmission of acoustic energy in uniform ducts carrying uniform flow is investigated with the purpose of clarifying two points of interest. The two commonly used definitions of acoustic 'energy' flux are shown to be related by a Legendre transformation of the Lagrangian density exactly as in deriving the Hamiltonian density in mechanics. In the acoustic case the total energy density and the Hamiltonian density are not the same which accounts for two different 'energy' fluxes. When the duct has acoustically absorptive walls neither of the two flux expressions gives correct results. A reevaluation of the basis of derivation of the energy density and energy flux provides forms which yield consistent results for soft walled ducts.

  14. Breast Intraductal Papillomas without Atypia in Radiologic-Pathologic Concordant Core Needle Biopsies: Predictors of Upgrade to Carcinoma at Excision

    Science.gov (United States)

    Pareja, Fresia; Corben, Adriana; Brennan, Sandra; Murray, Melissa P.; Bowser, Zenica; Jakate, Kiran; Sebastiano, Christopher; Morrow, Monica; Morris, Elizabeth; Brogi, Edi

    2016-01-01

    Background The surgical management of breast intraductal papilloma without atypia (IDP) identified at core needle biopsy (CNB) is controversial. We assessed the rate of upgrade to carcinoma at surgical excision, and identified parameters predictive of upgrade. Methods We identified women with CNB diagnosis of intraductal papilloma without atypia or carcinoma at our center between 2003 and 2013. Radiologic-pathologic concordance was assessed for all cases, and discordant cases were excluded. We correlated the radiologic and clinicopathologic features of patients with CNB diagnosis of IDP with upgrade to carcinoma at surgical excision. Results Our study population consists of 189 women with 196 IDPs; 166 women (171 IDPs) underwent excision. The upgrade rate was 2.3% (4/171). The upgrade lesions were 2 invasive lobular carcinomas and 2 cases of ductal carcinoma in situ (DCIS). One case of DCIS involved the residual IDP, whereas the other 3 carcinomas were ≥8 mm away. Twenty-four women (25 IDPs) did not undergo excision, and had stable imaging at follow-up (median of 23.5 months). Conclusions The upgrade rate at excision of IDP diagnosed at CNB with radiologic-pathologic concordance is 2.3%. Our findings suggest that observation is appropriate for patients with radiologic-pathologic concordant CNB yielding IDP, regardless of its size. PMID:27315013

  15. Xylometazoline hydrochloride nasal spray combined with laser artificial nasolacrimal duct implantation for nasolacrimal duct obstruction

    Directory of Open Access Journals (Sweden)

    Xiao-Zhao Yang

    2017-02-01

    Full Text Available AIM: To study the role of xylometazoline hydrochloride nasal spray in combination therapy of nasolacrimal duct obstruction and to investigate the effect of nasal inflammation on nasolacrimal duct obstruction. METHODS: Totally 279 patients with nasolacrimal duct obstruction were collected, who received lacrimal passage irrigation, CT angiography for lacrimal passage and nasal endoscope before treated by lacrimal laser forming and artificial nasolacrimal duct implantation combined with xylometazoline hydrochloride nasal spray. In group A, 137 patients were treated with antibiotic eye drop and non-steroidal anti-inflammatory drugs after operations. In group B, 142 patients were treated with xylometazoline hydrochloride nasal spray besides the same treatment for group A. RESULTS:In the 279 patients 217(77.8%, in which 105 cases(76.6%were in group A and 112 cases(78.9%were in group B, were suffered with nasal inflammation, including nasal mucosal hyperemia, inferior turbinate hypertrophy, middle turbinate hypertrophy. At 3mo after the ducts were drawn, efficacy of group B was 95.8%, which was significant better than that of group A(86.1%, PCONCLUSION: Nasal inflammation was an important factor in the incidence of nasolacrimal duct obstruction, which shoud pay more attention in the process of diagnosis and treatment. Combination therapy could improve the cure rate of nasolacrimal duct obstruction.

  16. Percutaneous treatment of benign bile duct strictures

    Energy Technology Data Exchange (ETDEWEB)

    Koecher, Martin [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)]. E-mail: martin.kocher@seznam.cz; Cerna, Marie [Department of Radiology, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Havlik, Roman [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Kral, Vladimir [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Gryga, Adolf [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic); Duda, Miloslav [Department of Surgery, University Hospital, I.P.Pavlova 6, 775 20 Olomouc (Czech Republic)

    2007-05-15

    Purpose: To evaluate long-term results of treatment of benign bile duct strictures. Materials and methods: From February 1994 to November 2005, 21 patients (9 men, 12 women) with median age of 50.6 years (range 27-77 years) were indicated to percutaneous treatment of benign bile duct stricture. Stricture of hepatic ducts junction resulting from thermic injury during laparoscopic cholecystectomy was indication for treatment in one patient, stricture of hepaticojejunostomy was indication for treatment in all other patients. Clinical symptoms (obstructive jaundice, anicteric cholestasis, cholangitis or biliary cirrhosis) have appeared from 3 months to 12 years after surgery. Results: Initial internal/external biliary drainage was successful in 20 patients out of 21. These 20 patients after successful initial drainage were treated by balloon dilatation and long-term internal/external drainage. Sixteen patients were symptoms free during the follow-up. The relapse of clinical symptoms has appeared in four patients 9, 12, 14 and 24 months after treatment. One year primary clinical success rate of treatment for benign bile duct stricture was 94%. Additional two patients are symptoms free after redilatation (15 and 45 months). One patient is still in treatment, one patient died during secondary treatment period without interrelation with biliary intervention. The secondary clinical success rate is 100%. Conclusion: Benign bile duct strictures of hepatic ducts junction or biliary-enteric anastomosis are difficult to treat surgically and endoscopically inaccessible. Percutaneous treatment by balloon dilatation and long-term internal/external drainage is feasible in the majority of these patients. It is minimally invasive, safe and effective.

  17. Classiifcation of iatrogenic bile duct injur y

    Institute of Scientific and Technical Information of China (English)

    Wan-Yee Lau; Eric C.H. Lai

    2007-01-01

    BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classiifcation systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords"bile duct injury", "cholecystectomy", and “classiifcation”. Additional papers were identiifed by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classiifed using the Bismuth's classiifcation. This classiifcation, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the ifnal outcome after surgical repair. However, the Bismuth's classiifcation does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg’s classiifcation made Bismuth’s classiifcation much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classiifcation systems to complement the Bismuth's classiifcation. CONCLUSIONS:None of the classiifcation system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classiifcation system will be published in the near future.

  18. Does Ultrasound-Guided Directional Vacuum-Assisted Removal Help Eliminate Abnormal Nipple Discharge in Patients with Benign Intraductal Single Mass?

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Jung Min; Cho, Na Ri Ya; Moon, Woo Kyung [Seoul National University Hospital, Seoul (Korea, Republic of); Park, Jeong Seon [Hanyang University Hospital, Seoul (Korea, Republic of); Chung, Se Yeong [Seoul National University Boramae Hospital, Seoul (Korea, Republic of); Jang, Mi Jung [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2009-12-15

    To evaluate whether the removal of an intraductal mass using an ultrasound (US)-guided directional vacuum-assisted device can eliminate symptoms in patients presenting with abnormal nipple discharge. Between March 2004 and October 2006, 36 patients who presented with abnormal nipple discharge, underwent US-guided, 11-gauge vacuum-assisted biopsy for a benign intraductal single mass on US. The ability of the procedure to eliminate nipple discharge was evaluated by physical examination during follow-up US. Lesion characteristics, biopsy variables, and histologic features were analyzed to identify factors affecting symptom resolution. Of the 36 lesions, 25 (69%) were intraductal papillomas, 10 (28%) were fibrocystic changes, and one (3%) was a fibroadenoma. The nipple discharge disappeared in 69% (25 of 36) of the women at a mean follow-up time of 25 months (range 12-42 month). There was no difference in the lesion characteristics, biopsy variables, and the histologic features between groups that eliminated the symptom compared those with persistent nipple discharge. US-guided directional vacuum-assisted removal of an intraductal mass appears to eliminate nipple discharge in only 69% of patients and thus, it should not be considered as an alternative to surgical excision.

  19. High Prevalence of Papillary Thyroid Microcarcinoma in Danish Patients

    DEFF Research Database (Denmark)

    Rossing, Maria; Nygaard, Birte; Bennedbæk, Finn Noe

    2012-01-01

    with a cold thyroid nodule undergoing US-guided FNA were prospectively registered. 408 patients underwent thyroid surgery, resulting in 50 cancers and in addition 37 patients had an incidental finding of papillary thyroid microcarcinomas. Based on the diagnostic FNA, we found sensitivity and specificity...... worldwide, but our results suggest that the most frequent occurring cancer is an incidental papillary thyroid microcarcinoma of which the clinical significance has yet to be established....... for malignancy. Cancer incidence was 13% among females and 9% among males. The accuracy of a diagnostic set-up based on clinical examination, scintigraphy, US, and US-guided FNA was determined with a 48% rate of histopathological validation in the cohort. The overall thyroid cancer incidence has increased...

  20. Solid papillary carcinoma of the breast: A review

    Directory of Open Access Journals (Sweden)

    ZACKARIAH VK CLEMENT

    2017-01-01

    Full Text Available Solid papillary carcinoma of breast is a low-grade tumour originating in the ductal epithelium. It is commonly seen in post-menopausal women and account for <1% of all breast cancers. Patients can be asymptomatic, have nipple discharge or present with abnormal mammographic findings. Despite of some radiological features solid papillary carcinoma cannot be accurately diagnosed on imaging alone. The most important characteristic of this tumour is its behaviour and interesting pathological feature of lack of myoepithelial cells at the periphery. Its diagnosis can be challenging and its management is still debated. Management varies from breast conserving surgery to mastectomy. Currently there is no evidence to support the role of sentinel lymph node biopsy, radiotherapy and hormonal therapy. Therefore, accurate diagnosis with adequate local excision with breast conserving surgery is the optimal treatment.

  1. Papillary carcinoma thyroid with anastomosing channels: An unusual morphology

    Directory of Open Access Journals (Sweden)

    Varsha Dalal

    2017-01-01

    Full Text Available Papillary thyroid carcinoma (PTC is the most common thyroid malignancy, accounting for 70%–80% of all thyroid malignancies. It is biologically indolent and has an excellent prognosis. Variations in histopathologic patterns are known to influence prognosis and often result in a diagnostic dilemma. We report an unusual case of a 35-year-old female with papillary carcinoma of a thyroid isthmus showing anastomosing channels on histopathology, a distinctive pattern that has not been described in PTC. Similar to tumor cells, the lining cells of these channels were also positive for thyroid transcription factor 1, thyroglobulin, and cytokeratin-19 and negative for CD34 and CD31. The diagnosis of PTC should rely on nuclear morphology rather than architecture. Pathologists should be aware of different variants because some of these variants show aggressive behavior and poor outcome. The present report highlights the distinctive pattern of PTC, recognition of which is important to avoid any diagnostic pitfall.

  2. Papillary thyroid carcinoma in three siblings with familial adenomatous polyposis.

    Science.gov (United States)

    Civitelli, S; Tanzini, G; Cetta, F; Petracci, M; Pacchiarotti, M C; Civitelli, B

    1996-01-01

    The authors report three siblings (two sisters and their aunt, aged 20, 22 and 36, respectively) with familial adenomatous polyposis (FAP) and papillary thyroid carcinoma. After diagnosis of FAP, a single, non palpable nodule was revealed in each patient by routine screening ultrasonography of the gland. The diagnosis of papillary carcinoma was made by fine-needle-aspiration biopsy of the nodules and confirmed by histologic examination of surgical specimens. A review of the literature reveals about 40 reports of such an association, that is considered not fortuitous. Nevertheless, in this family the association seems to be a distinctive, clinical feature of the syndrome, affecting three out of five members intensively screened for extracolonic lesions.

  3. Nonlinear acoustic propagation in rectangular ducts

    Science.gov (United States)

    Nayfeh, A. H.; Tsai, M.-S.

    1974-01-01

    The method of multiple scales is used to obtain a second-order uniformly valid expansion for nonlinear acoustic wave propagation in a rectangular duct whose walls are treated with a nonlinear acoustic material. The wave propagation in the duct is characterized by the unsteady nonlinear Euler equations. The results show that nonlinear materials attenuate sound more than linear materials except at high acoustic frequencies. The nonlinear materials produce higher and combination tones which have higher attenuation rates than the fundamentals. Moreover, the attenuation rates of the fundamentals increase with increasing amplitude.

  4. Inverse potential scattering in duct acoustics.

    Science.gov (United States)

    Forbes, Barbara J; Pike, E Roy; Sharp, David B; Aktosun, Tuncay

    2006-01-01

    The inverse problem of the noninvasive measurement of the shape of an acoustical duct in which one-dimensional wave propagation can be assumed is examined within the theoretical framework of the governing Klein-Gordon equation. Previous deterministic methods developed over the last 40 years have all required direct measurement of the reflectance or input impedance but now, by application of the methods of inverse quantum scattering to the acoustical system, it is shown that the reflectance can be algorithmically derived from the radiated wave. The potential and area functions of the duct can subsequently be reconstructed. The results are discussed with particular reference to acoustic pulse reflectometry.

  5. Preconditioning the Helmholtz Equation for Rigid Ducts

    Science.gov (United States)

    Baumeister, Kenneth J.; Kreider, Kevin L.

    1998-01-01

    An innovative hyperbolic preconditioning technique is developed for the numerical solution of the Helmholtz equation which governs acoustic propagation in ducts. Two pseudo-time parameters are used to produce an explicit iterative finite difference scheme. This scheme eliminates the large matrix storage requirements normally associated with numerical solutions to the Helmholtz equation. The solution procedure is very fast when compared to other transient and steady methods. Optimization and an error analysis of the preconditioning factors are present. For validation, the method is applied to sound propagation in a 2D semi-infinite hard wall duct.

  6. Flow Investigation inside A Curved Square Duct

    Directory of Open Access Journals (Sweden)

    Dipyaman Gangopadhyay

    2017-05-01

    Full Text Available This paper presents the results of an experimental work with measurement of wall static pressure of 90°C shaped Curved duct. The test duct is made up of transparent perspex sheets to facilitate the flow visualization study. The duct has an inlet to exit area ratio of 1.0 with centerline distance of 750 mm. The inlet aspect ratio of the test duct has been fixed at 1.0. The velocities for the proposed investigations are to be measured by using a Pitot tube.Wall pressures are measured with the help of an inclinedmanometer with the inclination of 35°. The manometer had two tubes emanating from it: one left open to the atmosphere and the other connected to the steel pipes attached to the four walls of the curved duct. The difference in the readings helped us calculate the static pressure and thereby the normalized pressure. Wall pressure distribution along the curved and parallel walls of the duct at 0°, 22.5°, 45°, 67.5° and 90° measuring sections was measured. All the experimental data has been processed by an Intel i3 CPU, 3 GB RAM PC and analyzed to give the distribution of static pressure in the square duct.The main purpose of this investigation is to show the development of secondary flow which happens when the flow takes place through the bend in the curvature. This secondary flow arises as a result of a centrifugal force acting when the flow moves through the bend. The investigation is carried out at three different velocities 20 m/s, 40 m/s and 60 m/s. The distribution of normalized pressure which is the ratio of static pressure to the dynamic pressure is mapped and shown in the form of contours by using the software package SURFER.The trend of wall static pressure development on the walls of C shaped duct shows that as the flow proceeds towards the curvature, there exists a high pressure gradient between the outside face and inside face due the centrifugal force acting along the curvature. This shows the bulk shifting of flow towards

  7. Detection of Trabeculae and Papillary Muscles in Cardiac MR Images

    OpenAIRE

    Spreeuwers, Lieuwe Jan; Bangma, S.J.; Meerwaldt, R.J.H.W.; Vonken, E.J.; Breeuwer, M.

    2005-01-01

    With the improvement of the quality of MR imagery, more and more details become visible. Only 5-10 years ago cardiac images of the heart were still so unsharp that finer details of the heart like the papillary muscles and the trabeculae were hardly visible and it was simply impossible to determine their outlines with any measure of accuracy. With the improved image quality it becomes feasible to extract information about these small structures. Studying the operation of these tiny muscles can...

  8. Primary papillary thyroid carcinoma previously treated incompletely with radiofrequency ablation

    OpenAIRE

    Kim Hoon; Ryu Woo; Woo Sang; Son Gil; Lee Eun; Lee Jae; Bae Jeoung

    2010-01-01

    Radiofrequency ablation (RFA) recently has been applied to benign thyroid nodules, mainly for the cosmetic reasons, and limited cases of local recurrences or focal distant metastases of well-differentiated thyroid cancer, in the high-risk reoperative condition or for the palliative purpose. But no report has been made on the RFA for primary thyroid cancer to date. We report on a patient with primary papillary carcinoma of thyroid gland who had undergone RFA before the cytological diagnosis of...

  9. Cytokeratin 19 immunoreactivity in the diagnosis of papillary thyroid carcinoma

    Directory of Open Access Journals (Sweden)

    Debdas Bose

    2012-01-01

    Full Text Available Context: The diagnosis of papillary thyroid carcinoma (PTC is based on nuclear features. These features may be present in focal areas in benign thyroid diseases and follicular adenoma (FA, leading to diagnostic difficulty. Aims: To evaluate the expression and pattern of the distribution of cytokeratin 19 (CK19 in PTC and compare its reactivity with other neoplastic and non-neoplastic conditions to assess its potential as a useful marker for PTC. Materials and Methods: Twenty two cases of papillary carcinoma (usual type, follicular and diffuse sclerosing variant, eight follicular adenomas, eight multinodular goiters (MNG were collected for a period of two years and six months. Sections were taken from thyroidectomy specimens fixed in 10% buffered neutral formalin. Hematoxylin and eosin staining and immunohistochemical staining for CK19 were done using standard protocol. Results were semiquantitatively scored as follows: 1+ (75%, and then analyzed. Statistical Analysis and Results: All 22 (100% papillary carcinomas showed diffuse and strong (3+ and 4+ CK19 expression. Six out of eight (75% FAs and four out of eight (50% MNG were positive for CK19, but it was of weaker intensity (1+ and 2+ and focal in distribution. Conclusion: Focal CK19 staining may be found in benign disease, but diffuse and strong positivity is characteristic of PTC, which can be used in the diagnosis of PTC in lesions of equivocal morphological appearances.

  10. Cellular pleomorphism in papillary tumors of the pineal region

    Science.gov (United States)

    Magalhães, Juliana; Rostad, Steven; Foltz, Greg; Pytel, Peter; Rodriguez, Fausto J.

    2015-01-01

    Papillary tumor of the pineal region (PTPR) is a recently recognized entity. We present the pathologic findings of two cases of PTPR as examples, and discuss the presence of cellular pleomorphism in these tumors. Patient 1 is a 48-year-old man with a pineal region mass. The tumor had unique biphasic patterns, papillary/pseudopapillary areas, and increased mitotic activity. Juxtaposed areas had marked pleomorphism, including nuclear enlargement, smudgy chromatin, nuclear pseudoinclusions, and cytoplasmic vacuolation. Mitoses were absent in these areas. Immunohistochemical staining revealed strong S100 expression. CAM 5.2 and CK18 were strongly positive in a patchy fashion. MIB1 labeling indices were high in classic PTPR regions but very low in pleomorphic areas. Patient 2 was a 35-year-old male with a pineal region tumor characterized by papillary architecture and overall cellular monotony, rare mitoses, and pleomorphism as a more isolated finding, with associated nuclear enlargement and crowding. S100 and CAM 5.2 labeling were present, and MIB1 labeling index was very low throughout the tumor. We discuss the pathologic and phenotypic features of PTPR. Variable pleomorphism may be present, reflected in size variation and nuclear hyperchromasia, but was not accompanied by increased proliferative activity in these cases, suggesting a degenerative phenomenon. PMID:22622671

  11. Cellular pleomorphism in papillary tumors of the pineal region.

    Science.gov (United States)

    Magalhães, Juliana; Rostad, Steven; Foltz, Greg; Pytel, Peter; Rodriguez, Fausto J

    2013-04-01

    Papillary tumor of the pineal region (PTPR) is a recently recognized entity. We present the pathologic findings of two cases of PTPR as examples, and discuss the presence of cellular pleomorphism in these tumors. Patient 1 is a 48-year-old man with a pineal region mass. The tumor had unique biphasic patterns, papillary/pseudopapillary areas, and increased mitotic activity. Juxtaposed areas had marked pleomorphism, including nuclear enlargement, smudgy chromatin, nuclear pseudoinclusions, and cytoplasmic vacuolation. Mitoses were absent in these areas. Immunohistochemical staining revealed strong S100 expression. CAM 5.2 and CK18 were strongly positive in a patchy fashion. MIB1 labeling indices were high in classic PTPR regions but very low in pleomorphic areas. Patient 2 was a 35-year-old male with a pineal region tumor characterized by papillary architecture and overall cellular monotony, rare mitoses, and pleomorphism as a more isolated finding, with associated nuclear enlargement and crowding. S100 and CAM 5.2 labeling were present, and MIB1 labeling index was very low throughout the tumor. We discuss the pathologic and phenotypic features of PTPR. Variable pleomorphism may be present, reflected in size variation and nuclear hyperchromasia, but was not accompanied by increased proliferative activity in these cases, suggesting a degenerative phenomenon.

  12. [A Case of Metachronous Multiple Thyroid Papillary Carcinoma with FAP].

    Science.gov (United States)

    Tajima, Yusuke; Kumamoto, Kensuke; Yamamoto, Azusa; Chika, Noriyasu; Watanabe, Yuichiro; Matsuzawa, Takeaki; Ishibashi, Keiichiro; Mochiki, Erito; Iwama, Takeo; Akagi, Kiwamu; Ishida, Hideyuki

    2015-11-01

    Familial adenomatous polyposis (FAP) is an autosomal dominantly inherited disorder, the result of a germ line mutation in the adenomatous polyposis coli (APC) gene. FAP can be associated with various extracolonic lesions, including thyroid cancer, which frequently occurs in women. We report the case of a 36-year-old woman diagnosed as having FAP with multiple metachronous thyroid papillary carcinomas. She underwent left thyroidectomy at the age of 19 years without a diagnosis of FAP. Multiple polyps in her stomach were detected by medical examination and more than 100 polyps in the colon were found by colonoscopy. She was referred to our hospital after a diagnosis of non-profuse FAP. Multiple tumors with a maximum diameter of 10mm were detected in the right lobe of the thyroid gland during the preoperative examination. Papillary carcinoma was suspected based on fine-needle aspiration cytology. We performed a right thyroidectomy after prophylactic colectomy. Pathological findings revealed a cribriform-morula variant of papillary thyroid carcinoma. The patient remains well after 2 year 6 months with no recurrence.

  13. Is familial papillary thyroid microcarcinoma more aggressive than sporadic form?

    Science.gov (United States)

    Lee, Cho Rok; Park, Seulkee; Kang, Sang-Wook; Lee, Jandee; Jeong, Jong Ju; Chung, Woong Youn; Park, Cheong Soo

    2017-01-01

    Purpose With the increasing incidence of papillary thyroid microcarcinoma (PTMC), familial papillary thyroid microcarcinoma (FPTMC) is now recognized more frequently. However, the biological behavior of FPTMC is poorly understood. The aim of this study was to investigate the prevalence of FPTMC and its biological aggressiveness. Methods Between March 2006 and July 2010, 2,414 patients underwent primary surgical therapy for PTMC and 149 (6.2%) were further classified as FPTMC. To determine the biological aggressiveness of FPTMC, we compared the clinicopathological features and prognosis between FPTMC and sporadic PTMC (SPTMC). Results The male-to-female ratio was higher in FPTMC than in sporadic papillary thyroid microcarcinoma (SPTMC: 1:4.5 vs. 1:7.2, P = 0.041). The central lymph node (LN) metastasis rate was significantly higher in FPTMC than in SPTMC (36.2% vs. 24.2%, P = 0.002). The local recurrence rate was also higher in FPTMC than in SPTMC (4.5% vs. 0.6%, P patients to detect local recurrence.

  14. What Should You Ask Your Doctor about Bile Duct Cancer?

    Science.gov (United States)

    ... support? Along with these sample questions, be sure to write down some of your own. For instance, you ... Diagnosed? How is Bile Duct Cancer Staged? Survival Statistics for Bile Duct Cancers Resectable Versus Unresectable Bile ...

  15. Higher order mode propagation in nonuniform circular ducts

    Science.gov (United States)

    Cho, Y. C.; Ingard, K. U.

    1980-01-01

    This paper presents an analytical investigation of higher order mode propagation in a nonuniform circular duct without mean flow. An approximate wave equation is derived on the assumptions that the duct cross section varies slowly and that mode conversion is negligible. Exact closed form solutions are obtained for a particular class of converging-diverging circular duct which is here referred to as 'circular cosh duct'. Numerical results are presentd in terms of the transmission loss for the various duct shapes and frequencies. The results are applicable to studies of multimodal propagation as well as single mode propagation. The results are also applicable to studies of sound radiation from certain types of contoured inlet ducts, or of sound propagation in a converging-diverging duct of somewhat different shape from a cosh duct.

  16. Is spontaneous closure of a patent arterial duct common?

    Science.gov (United States)

    Hoffman, Julien I E

    2017-01-01

    As closing a patent arterial duct is relatively simple, safe, and successful, most children with a patent arterial duct have it closed soon after diagnosis. The larger ducts are closed to prevent congestive heart failure, pulmonary vascular disease, or aneurysmal dilatation of the ductus, and smaller ducts are closed to prevent infective endocarditis. Consequently, there is no opportunity to determine whether spontaneous closure or diminution in size of the patent arterial duct is common. If the duct does become smaller, flow through it may be so low that no murmur is produced - the silent ductus. The frequency and best management of the silent patent arterial duct are unknown, and we do not know whether these tiny ducts are the last stage before spontaneous closure.

  17. Breast cancer in intraductal carcinogen-treated non-human primates.

    Science.gov (United States)

    Lillie, Madeline A; Ambrus, Clara M; Pickren, John W; Akhter, Selina; Islam, Abul; Ambrus, Julian L

    2004-01-01

    Eight female Macaca arctoides monkeys were given dimethylbenzanthracene (DMBA) directly into the milk ducts. During a 4-year observation period, ending with euthanasia and autopsy, no mammary cancers were noticed. However, one animal developed a superficial localized squamous cell carcinoma. DMBA is highly carcinogenic in rodents, e.g. producing a high incidence of breast cancer in C3H mice. It was concluded that carcinogenicity testing should be extended beyond testing in rodents to non-human primates in order to distinguish "primary rodent carcinogens" from those highly active in primates as well. Studies are in progress to study carcinogens in human cell lines transplanted into nu/nu mice.

  18. Accessory papillary muscles and papillary muscle hypertrophy are associated with sudden cardiac arrest of unknown cause.

    Science.gov (United States)

    Uhm, Jae-Sun; Youn, Jong-Chan; Lee, Hye-Jeong; Park, Junbeom; Park, Jin-Kyu; Shim, Chi Young; Hong, Geu-Ru; Joung, Boyoung; Pak, Hui-Nam; Lee, Moon-Hyoung

    2015-10-15

    The present study was performed for elucidating the associations between the morphology of the papillary muscles (PMs) and sudden cardiac arrest (SCA). We retrospectively reviewed history, laboratory data, electrocardiography, echocardiography, coronary angiography, and cardiac CT/MRI for 190 patients with SCA. The prevalence of accessory PMs and PM hypertrophy in patients with SCA of unknown cause was compared with that in patients with SCA of known causes and 98 age- and sex-matched patients without SCA. An accessory PM was defined as a PM with origins separated from the anterolateral and posteromedial PMs, or a PM that branched into two or three bellies at the base of the anterolateral or posteromedial PM. PM hypertrophy was defined as at least one of the two PMs having a diameter of ≥1.1cm. In 49 patients (age 49.9±15.9years; 38 men) the cause of SCA was unknown, whereas 141 (age 54.2±16.6years; 121 men) had a known cause. The prevalence of accessory PMs was significantly higher in the unknown-cause group than in the known-cause group (24.5% and 7.8%, respectively; p=0.002) or the no-SCA group (7.1%, p=0.003). The same was true for PM hypertrophy (unknown-cause 12.2%, known-cause 2.1%, p=0.010; no SCA group 1.0%, p=0.006). By logistic regression, accessory PM and PM hypertrophy were independently associated with sudden cardiac arrest of unknown cause. An accessory PM and PM hypertrophy are associated with SCA of unknown cause. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  19. Methylation of CpG islands of p16(INK4a) and cyclinD1 overexpression associated with progression of intraductal proliferative lesions of the breast.

    Science.gov (United States)

    Liu, Tieju; Niu, Yun; Feng, Yumei; Niu, Ruifang; Yu, Yong; Lv, Ajuan; Yang, Yi

    2008-11-01

    P16(INK4a) is a tumor suppressor gene frequently inactivated by aberrant promoter hypermethylation. In this study, p16(INK4a) methylation was evaluated in intraductal proliferative lesions of the breast, using real-time quantitative polymerase chain reaction (MethyLight) and methylation-sensitive restriction endonuclease polymerase chain reaction. Immunohistochemistry was performed to compare and validate the methylation analysis. P16(INK4a) methylation associated with oncogene cyclinD1 expression, detected through the use of in situ hybridization and immunohistochemistry, was likewise characterized. P16(INK4a) methylation displayed varying significance among different types of intraductal proliferative lesions. Both the positive rate and the median quantitative methylation value increased with the evolution of intraductal proliferative lesions through the use of quantitative and qualitative assays. P16(INK4a) methylation was positively correlated to cyclinD1 overexpression. This study demonstrated that p16(INK4a) methylation served as the silencing mechanism of p16(INK4a) protein expression and played a crucial role in the intraductal proliferative lesions' progression. In the differential diagnosis of intraductal proliferative lesions, quantitative DNA methylation analysis of p16(INK4a) by MethyLight may be used as a surrogate, especially to distinguish atypical ductal hyperplasia from usual ductal hyperplasia and low-grade ductal carcinoma in situ. Furthermore, this study discovered that flat epithelial atypia do not share similar molecular profiles of p16(INK4a) epigenetic modification with atypical ductal hyperplasia and low-grade ductal carcinoma in situ.

  20. Algebraically growing waves in ducts with sheared mean flow

    Science.gov (United States)

    Nayfeh, A. H.; Telionis, D. P.

    1974-01-01

    Analysis of the behavior of standing and traveling acoustic waves in a smooth duct with a fluid flow having a sheared mean velocity profile, when the waves grow algebraically as they travel along the duct axis. It is shown that standing waves growing algebraically with the axial distance cannot exist in a smooth duct when the duct wall have a finite resistance. The existence of traveling waves subject to the same law of growth is also dismissed under realistic flow conditions.

  1. Mammographic findings predicting an extensive intraductal component in early stage invasive breast cancer : analysis on microcalcification

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jeong Ah; Kim, Mi Hye; Lee, Mi Kyung; Oh, Ki Keun [College of Medicine, Yonsei University, Seoul (Korea, Republic of); Kim, Eun Kyung [Pundang CHA General Hospital, College of Medicine, Pochon CHA University, Seoul (Korea, Republic of)

    2000-05-01

    To analyze the mammographic findings of extensive intraductal component (EIC)-positive early invasive breast carcinoma and to determine the mammographic features which predict an EIC positivity in an invasive carcinoma. The mammographic and pathologic findings in 71 patients aged 34-79 (mean 50) years in whom stage I or II invasive breast carcinoma had been diagnosed were retrospectively analysed. The mammographic findings were assigned to one of three groups: mass, mass with microcalcification, or microcalcification only. The shape and distribution of a calcification were classified according to the BI-RADS lexicon, and its extent was classified as either more or less than 3 cm. To detect the presence or absence of EIC and the type of ductal carcinoma in situ (DCIS), the findings were re-examined by means of slide mappings. Twenty-eight of 71 patients (39%) showed ECI positivity. The mammographic findings of EIC-positive invasive cancer (n=3D28) were mass with microcalcification (n=3D14), microcalcification only (n=3D7) and mass only (n=3D7). The mammographic finding which predicted EIC positivity was mass with microcalcification (PPV:0.67, NPV:0.33, p=3D0.02). A mammographic of mass only (n=3D39) showed a significantly high negative predictive value for EIC positivity. (PPV 0.18, NPV 0.82, P less than 0.01). A comparison of cases with or without calcification showed that those with microcalcifications (n=3D32) showed a significantly high PPV of 0.66 (NPV:0.34, p less than 0.01) while those without calcification (n=3D39) showed a significantly high NPV of 0.82 (PPV:0.18, p less than 0.01). There were no significant differences in positive predictive values for EIC between the shape, distribution and extent of calcifications. Whenever microcalcification with or without mass is seen on mammographs obtained during early breast cancer, we can predict EIC-positivity, regardless of shape or distribution according to the BI-RADS lexicon. (author)

  2. Laser-guided repair of complex bile duct strictures.

    NARCIS (Netherlands)

    Gulik, T. van; Beek, J.; Reuver, P. de; Aronson, D.C.; Delden, O. van; Busch, O.; Gouma, D.

    2009-01-01

    BACKGROUND: The repair of bile duct strictures (BDS) requires identification of healthy bile duct proximal to the stenosis. Identification may be difficult in complex bile duct injuries after cholecystectomy or partial liver resection. AIM: We describe a technique to identify the prestenotic bile du

  3. Persistent Mullerian Duct Syndrome (PMDS With Large Intraabdominal Seminoma

    Directory of Open Access Journals (Sweden)

    Della Harigovind

    2017-07-01

    Full Text Available Persistent Mullerian Duct Syndrome, a form of male pseudohermaphroditism is characterized by the presence of the Mullerian duct derivatives in an otherwise phenotypically as well as genotypically normal male. We report a case of large intra abdominal seminoma in a male patient with cryptorchidism, along with persistence of Mullerian duct derivatives (uterus.

  4. A case of fascioliasis in common bile duct

    Energy Technology Data Exchange (ETDEWEB)

    Ham, Soo Youn; Park, Cheol Min; Chung, Kyu Byung; Lee, Chang Hong; Park, Seung Chul; Choi, Sang Yong; Lim, Han Jong [Korea University College of Medicine, Seoul (Korea, Republic of)

    1989-10-15

    A case of Fascioliasis of common bile duct is confirmed by visualization of adult fluke. Fascioliasis caused by Fasciola hepatica, is common parasitic disease in cattle and sheep. Human is an accidental host. ERCP demonstrated irregular linear conglomerated filling defects in common bile duct. Through surgical intervention, we found adult flukes of F. hepatica and adenomatous hyperplasia of common bile duct.

  5. Surgical treatment of congenital biliary duct cyst

    Directory of Open Access Journals (Sweden)

    Wang De-chun

    2012-03-01

    Full Text Available Abstract Background It is acknowledged that total cyst excision is a safe and ideal surgical treatment for congenital biliary duct cyst, compared to simple internal drainage. The aim of this study was to determine the optimal operation occasion and the effect of laparoscopy on congenital biliary duct cyst based upon total cyst excision. Methods From January 2002 to January 2011, 217 patients were admitted to Southwest Hospital for congenital biliary duct cyst. To determine the optimal surgery occasion, we divided these subjects into three groups, the infant group (age ≤ 3 years, the immaturity group (3 18 years, and then evaluated the feasibility, risk and long-term outcome after surgery in the three groups. To analyze the effect of laparoscopic technique on congenital biliary duct cyst, we divided the patients into the laparoscopy and the open surgery groups. Results Among the three groups, the morbidity from cholangiolithiasis before surgical treatment had obvious discrepancy (p 0.05. Similarly, no significant discrepancy was observed in the morbidity from postoperative complications or long-term postoperative complications (p > 0.05 between the laparoscopic and the open surgery groups. Conclusions We conclude that total cyst excision should be performed as early as possible. The optimal treatment occasion is the infant period, and laparoscopic resection may be a new safe and feasible minimally invasive surgery for this disease.

  6. Idea Bank: Duct Tape Note Twister

    Science.gov (United States)

    McHenry, Molly

    2008-01-01

    In this article, the author relates how she observed a middle school math teacher deliver a miserable class. She realized that she did the same thing to her music students. To engage her students, she developed "Note Twister," a music reading game using duct tape to form musical notes and the basic premise behind the game, "Twister." She finds…

  7. Calcium influx pathways in rat pancreatic ducts

    DEFF Research Database (Denmark)

    Hug, M J; Pahl, C; Novak, I

    1996-01-01

    A number of agonists increase intracellular Ca2+ activity, [Ca2+]i, in pancreatic ducts, but the influx/efflux pathways and intracellular Ca2+ stores in this epithelium are unknown. The aim of the present study was to characterise the Ca2+ influx pathways, especially their pH sensitivity, in nati...

  8. Laser Beam Duct Pressure Controller System.

    Science.gov (United States)

    the axial flow of a conditioning gas within the laser beam duct, by matching the time rate of change of the pressure of the flowing conditioning gas...to the time rate of change of the pressure in the cavity of an operably associated laser beam turret.

  9. Familial occurrence of congenital bile duct dilatation

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Congenital bile duct dilatation (CBD) that developed in a parent and son is presented.Familial occurrence of CBD is rare,with only a few male cases having been reported.Since the initial report of CBD occurring in siblings in 1981,a total of 20 cases (10 pairs) have been published as of 2007.Clinical and genetic features of CBD are discussed.

  10. Heat Transfer in a Superelliptic Transition Duct

    Science.gov (United States)

    Poinsatte, Philip; Thurman, Douglas; Hippensteele, Steven

    2008-01-01

    Local heat transfer measurements were experimentally mapped using a transient liquid-crystal heat transfer technique on the surface of a circular-to-rectangular transition duct. The transition duct had a length-to-diameter ratio of 1.5 and an exit-plane aspect ratio of 3. The crosssectional geometry was defined by the equation of a superellipse. The cross-sectional area was the same at the inlet and exit but varied up to 15 percent higher through the transition. The duct was preheated to a uniform temperature (nominally 64 C) before allowing room temperature air to be suddenly drawn through it. As the surface cooled, the resulting isothermal contours on the duct surface were revealed using a surface coating of thermochromic liquid crystals that display distinctive colors at particular temperatures. A video record was made of the surface temperature and time data for all points on the duct surfaces during each test. Using this surface temperature-time data together with the temperature of the air flowing through the model and the initial temperature of the model wall, the heat transfer coefficient was calculated by employing the classic one-dimensional, semi-infinite wall heat transfer conduction model. Test results are reported for inlet diameter-based Reynolds numbers ranging from 0.4x106 to 2.4x106 and two grid-generated freestream turbulence intensities of about 1 percent, which is typical of wind tunnels, and up to 16 percent, which may be more typical of real engine conditions.

  11. Small Undifferentiated Pancreatic Adenocarcinoma which Mimics IPMN at Imaging

    Directory of Open Access Journals (Sweden)

    Mirko D’Onofrio

    2009-07-01

    Full Text Available Context To present the case of an unusual presentation at imaging of a very small solid undifferentiated pancreatic adenocarcinoma which mimics a side-branch intraductal papillary mucinous neoplasm. Case report The patient came to our hospital for a revaluation of a cystic pancreatic lesion. Ultrasound (US and contrast-enhanced ultrasound (CEUS examinations were carried out. A small cystic lesion of about 1.5 cm in diameter was seen in the posterior aspect of the pancreatic uncinate process A very small, solid, vascularized nodule was detected at CEUS within the lesion. Consequently, the patient underwent CT and MRI. MRI confirmed the presence of an intralesional nodule and communication with the main pancreatic duct was demonstrated, suggesting the diagnosis of intraductal papillary mucinous neoplasm with solid intralesional tissue. A pylorus preserving pancreaticoduodenectomy was carried out. An undifferentiated adenocarcinoma having a notable peripheral inflammatory reaction and dilated branch duct was finally diagnosed. Conclusion To our knowledge, we present for the first time, the case of a very small solid undifferentiated pancreatic adenocarcinoma of the uncinate process which mimicked a side-branch intraductal papillary mucinous neoplasm at imaging. The cystic appearance may be an epiphenomenon of a solid lesion and this possibility has to be considered when one encounters incidental cystic lesions at imaging.

  12. The effect of duct surface character on methane explosion propagation

    Institute of Scientific and Technical Information of China (English)

    LIN Bai-quan; YE Qing; JIAN Cong-guang; WU Hai-jin

    2007-01-01

    The effect of duct surface character on methane explosion propagation was experimentally studied and theoretically analyzed. The roughness has effect on methane explosion propagation. The flame propagation velocity and the peak value pressure of methane explosion in rough duct are larger than the parameters in smooth duct. The heat exchange of the surface has effect on methane explosion propagation. The propagation velocity of flame and strength of explosion wave in the duct covered by heat insulation material are larger than those in duct with good heat transmittability.

  13. Magnetic resonance imaging of extrahepatic bile duct disruption

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Yon-Cheong; Wang, Li-Jen; Chen, Chi-Jen [Department of Radiology, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan); Chen, Ray-Jade [Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Gueishan, 33333 Taoyuan (Taiwan)

    2002-10-01

    Blunt injury of the extrahepatic bile duct is rare and hence a large series of scientific study of its MRI is difficult to perform. We present the MRI and MR cholangiography of a case of blunt extrahepatic bile duct injury proven at surgery. The diagnosis could be established based on MRI findings of an abrupt tapering of the extrahepatic bile duct with a retracted end, a discordant small-caliber proximal duct, massive ascites, and a hematoma in proximity to the bile duct injury. This non-invasive MRI study is a promising imaging modality to evaluate biliary tract injury. (orig.)

  14. Performance Study and CFD Predictions of a Ducted Fan System

    Science.gov (United States)

    Abrego, Anita I.; Chang, I-Chung; Bulaga, Robert W.; Rutkowski, Michael (Technical Monitor)

    2002-01-01

    An experimental investigation was completed in the NASA Ames 7 by 10-Foot Wind Tunnel to study the performance characteristics of a ducted fan. The goal of this effort is to study the effect of ducted fan geometry and utilize Computational Fluid Dynamics (CFD) analysis to provide a baseline for correlation. A 38-inch diameter, 10-inch chord duct with a five-bladed fixed-pitch fan was tested. Duct performance data were obtained in hover, vertical climb, and forward flight test conditions. This paper will present a description of the test, duct performance results and correlation with CFD predictions.

  15. Transition duct with divided upstream and downstream portions

    Energy Technology Data Exchange (ETDEWEB)

    McMahan, Kevin Weston; LeBegue, Jeffrey Scott; Maldonado, Jaime Javier; Dillard, Daniel Jackson; Flanagan, James Scott

    2015-07-14

    Turbine systems are provided. In one embodiment, a turbine system includes a transition duct comprising an inlet, an outlet, and a duct passage extending between the inlet and the outlet and defining a longitudinal axis, a radial axis, and a tangential axis. The outlet of the transition duct is offset from the inlet along the longitudinal axis and the tangential axis. The duct passage includes an upstream portion extending from the inlet and a downstream portion extending from the outlet. The turbine system further includes a rib extending from an outer surface of the duct passage, the rib dividing the upstream portion and the downstream portion.

  16. Dispersion properties of ducted whistlers, generated by lightning discharge

    Directory of Open Access Journals (Sweden)

    D. L. Pasmanik

    2005-06-01

    Full Text Available Whistler-mode wave propagation in magnetospheric ducts of enhanced cold plasma density is studied. The case of the arbitrary ratio of the duct radius to the whistler wavelength is considered, where the ray-tracing method is not applicable. The set of duct eigenmodes and their spatial structure are analysed and dependencies of eigenmode propagation properties on the duct characteristics are studied. Special attention is paid to the analysis of the group delay time of one-hop propagation of the whistler wave packet along the duct. We found that, in contrast to the case of a wide duct, the group delay time in a rather narrow duct decreases as the eigenmode number increases. The results obtained are suggested for an explanation of some types of multi-component whistler signals.

  17. Curved Duct Noise Prediction Using the Fast Scattering Code

    Science.gov (United States)

    Dunn, M. H.; Tinetti, Ana F.; Farassat, F.

    2007-01-01

    Results of a study to validate the Fast Scattering Code (FSC) as a duct noise predictor, including the effects of curvature, finite impedance on the walls, and uniform background flow, are presented in this paper. Infinite duct theory was used to generate the modal content of the sound propagating within the duct. Liner effects were incorporated via a sound absorbing boundary condition on the scattering surfaces. Simulations for a rectangular duct of constant cross-sectional area have been compared to analytical solutions and experimental data. Comparisons with analytical results indicate that the code can properly calculate a given dominant mode for hardwall surfaces. Simulated acoustic behavior in the presence of lined walls (using hardwall duct modes as incident sound) is consistent with expected trends. Duct curvature was found to enhance weaker modes and reduce pressure amplitude. Agreement between simulated and experimental results for a straight duct with hard walls (no flow) was excellent.

  18. Rationale for Measuring Duct Leakage Flows in Large Commercial Buildings

    Energy Technology Data Exchange (ETDEWEB)

    Wray, Craig P.; Diamond, Richard C.; Sherman, Max H.

    2005-07-01

    Industry-wide methods of assessing duct leakage are based on duct pressurization tests, and focus on ''high pressure'' ducts. Even though ''low pressure'' ducts can be a large fraction of the system and tend to be leaky, few guidelines or construction specifications require testing these ducts. We report here on the measured leakage flows from ten large commercial duct systems at operatin