Pancreatic cystic neoplasm: Definition, Classification, Diagnosis and treatment.Marco Castillo
A brief description of the different pancreatic cystic neoplasms and the pseudocyst, including, eidemiology, classification, risk of malignancy, histology, imaging techniques for diagnosis and treatment.
Pancreatic Cysts: A Contemporary ApproachJarrod Lee
Pancreatic cysts are increasingly found during abdominal imaging. Although the majority will not cause any problems, a minority may enlarge or become malignant. We present a contemporary approach to managing pancreatic cysts, utilizing the latest evidence, technologies and endoscopic procedures. We identify which cysts need surveillance or even surgery, and which can be safely ignored.
Cystic Neoplasms of the Pancreas
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Pancreatic cystic neoplasm: Definition, Classification, Diagnosis and treatment.Marco Castillo
A brief description of the different pancreatic cystic neoplasms and the pseudocyst, including, eidemiology, classification, risk of malignancy, histology, imaging techniques for diagnosis and treatment.
Pancreatic Cysts: A Contemporary ApproachJarrod Lee
Pancreatic cysts are increasingly found during abdominal imaging. Although the majority will not cause any problems, a minority may enlarge or become malignant. We present a contemporary approach to managing pancreatic cysts, utilizing the latest evidence, technologies and endoscopic procedures. We identify which cysts need surveillance or even surgery, and which can be safely ignored.
Cystic Neoplasms of the Pancreas
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Imaging in small bowel tumors Dr. Muhammad Bin Zulfiqar
Here we will discuss CT and MR enterography. We will further discuss the use of negative contrast.
Four important tumors will be discussed.
GB cancer is the 5th most common GIT malignancy(worldwide).200 years later it is still considered to be a highly malignant disease with a poor survival rate
.Here is a brief description regarding
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. A 58yrs male patient presented with complaints
of
Mild pain abdomen
Loss of appetite to OPD.
OUTSIDE USG findings –
Chronic liver disease.
Altered pancretaic parenchymal echotexture
with peripancreatic fat stranding - ?pancreatitis
Advised to undergo CECT abdomen
3. Plain, arterial and delayed phases of CT done
with oral neutral contrast .
4.
5.
6.
7.
8. Plain scan revelaed ,
There is atrophy of body and tail of the
pancreas
Multiple small volume and prominent
peripancreatic and retroperitoneal
lymphnodes with surrounding mesnetric fat
stranding
25. Post Iv contrast scan revealed
There is hypoenhancing irregular soft tissue density
mass involving head, neck and body of pancreas ,
measuring appro 3.7 x 2.1cm. The mass is seen on
both sides of superior mesenetric vessels.
Uncinate process is showing normal enhancement of
the pancreatic parenchyma which is spared
The mass is showing extension into retropancreatic
region encasing the celiac artery, CHA, Proximal GDA,
splenic arteries completely and there is narrowing of
their lumen.
There is mild soft tissue thickening seen surrounding
proximal segments of SMA and IMA also
26. On delayed phase,
There is invasion of portal vein ,its
confluence with SMV and invasion of
proximal splenic vein seen.
In both the phases there is morethan 180
degrees encasement with invasion
There is complete loss of fat plane with
medial wall of duodenum is noted suggestive
of infiltration
27. All these findings suggestive of
Pancreatic malignancy invading the medial
wall of duodenum with its extension into
retroperitoneum encasing the celiac,
common hepatic, gastro duodenal and
splenic arteries with soft tissue thickeing
around SMA, IMA , invasion of portal vein at
junction of SMV and splenic vein , prominent
regional nodes
--- Suggestive of unresectable locally advanced
pancreatic adenocarcinoma.
28. PDA is one of the leading causes of death in
GI malignancies
Most common of pancreatic malignancies(
85-95%)
Males >> female
60-80 years
Most common location in head of the
pancreas ( can be seen in the body and tail
of the pancreas)
Patient presents with abdominal pain weight
loss and obstructive jaundice
29. Initial imaging modality
Appears as well defined focal hypoechoic or
heteroechoic lesion in head / body / tail of
the pancreas. Central necrosis also seen in
few cases
Dilated common bile duct and MPD ( Double
duct sign)
Encasement of celiac trunk and superior
mesenteric vessels can be assessed
Liver metastases
Enlarged peripancreatic , periportal nodes
30.
31.
32. Imaging study of choice
Three-phase (noncontrast, arterial ( 35-40
seconds), and portal venous(90secs) CT scan with
coronal and 3 D reconstruction
Lesion is hypoattenuating relative to the
normally enhancing pancreatic parenchyma in all
the phases
Arterial phase is used to assess the encasement
of peripancreatic arteries
Venous phase is optimal to evaluate the liver
metastasis and encasement or thrombosis of
venous structures and to see peripancreatic
planes
Resectability can be predicted
33. Indirect signs of pancreatic carcinoma
1. Double duct sign
2. Mass-effect or abnormal convex contour of
the pancreas
3.Atrophic distal pancreatic parenchyma
34.
35.
36.
37.
38.
39.
40.
41.
42.
43. There are several additional imaging findings not
explicitly described in the NCCN guidelines criteria
defining resectability that are pertinent for surgical
planning and should be included in the radiology
template:
1. The presence of tumor or bland venous thrombosis;
2. Extension of tumor contact with the common hepatic
artery (CHA) to the level of the origins of right and left
hepatic arteries;
3. Extension of tumor contact to first superior mesenteric
artery (SMA) branch and to most proximal draining vein
into SMV;
4. Presence of increased hazy attenuation/stranding
contact with the vessel, particularly in patients who
received prior radiation therapy
5. Arterial variants, in particular origin of the right hepatic
artery from the SMA.
44. MRI is useful in doubtful cases of pancreatic
head mass in multidetector CT and for better
detection of small liver metastases ,omental,
peritoneal seedlings
Small lesions in pancreas of size 1-2 cm are
better detected
Lesions are hypointense on T1 images and
hypoenhancing on arterial phase, shows
progressive enhancement in delayed images
due to the fibrotic nature of the tumour
45. On MRCP – double duct sign noted
The characteristics of the pancreatic duct
dilation may suggest chronic pancreatitis or
pancreatic carcinoma as the cause.
Dilated MPD is smooth or beaded with an
abrupt or gradual transition in caliber
Irregularly dilated when associated with
chronic pancreatitis
46. Small subcentimetre sized liver metastasis
MRI may further delineate these lesions as
cysts, hemangiomas, or metastases, which
significantly influences patient workup and
prognosis
More sensitive than CT for detecting
peritoneal enhancement and implants, which
are better appreciated in ascites
47.
48.
49.
50.
51.
52.
53.
54. Patients with PDA must be selected for first-line
surgery based on the likelihood of achieving
complete curative resection with negative
margins (R0); in doubtful cases and when the risk
of incomplete resection (R1 or R2) is high,
neoadjuvant chemotherapy and radiation
therapy should be performed.
Excellent spatial resolution makes multidetector
CT the reference standard for initial PDA staging
Particularly effective in assessing unresectability
criteria related to vascular spread.
55. MR imaging has better contrast resolution
compared with multidetector CT , useful for
staging tumors with little or no visibility at
multidetector CT for detecting liver
metastases before decision to perform
resection surgery is made.
Multidetector CT performs markedly less well
for evaluating the response to neoadjuvant
therapy; structural imaging carries a risk of
underestimating the treatment response.
56. In patients undergoing neoadjuvant therapy,
a radiologic response, however limited, and
more specifically decreased vascular
involvement and/or tumor size, indicate high
likelihood of complete resection with
negative margins and therefore support
resection surgery.
57. It is doubtful with a preoperative biliary
drainage is beneficial to the patient by ERCP
Sometimes preoperative biliary drainage may
potential increased risk for post-operative
infections
ENDOSCOPIC ULTRASOUND:
is most sensitive diagnostic tool to evaluate
the lesion is less than 2 cm in size
Useful to get biopsy in suspicious of focal
pancreatitis and pancreatic head mass
58. 1.Periampullary carcinoma (presence of
a bulging papilla sign may suggest the
diagnosis.)
2. Focal pancreatitis
3.Focal fatty infiltration in the head of the
pancreas ( By in and outphase MR imaging)
4. Pancreatic metastatic lesion
5. lymphoma
59.
60.
61.
62.
63. FOCAL AUTOIMMUNE PANCREATITIS –
Hypoattenuating and hypoenhancing
Features that help supporting an
inflammatory process over malignancy :
Pancreatic calcifications
Pseudocysts
Duct penetrating sign
68. PSEUDOCYST (MC)
IPMN
UNILOCULAR SEROUS CYSTADENOMA
LYMPHOEPITHELIAL CYSTS- RARE
PSEUDOCYST
Clinical history of pancreatitis
Imaging finding like pancreatic inflammation
Atrophy or calcification of pancreatic parenchma
Dilatation of MPD & calculi in a thin walled pancreatic duct.
Communication of pseudocyst with pancreatic duct – may be
seen in MRCP
69.
70. SEROUS CYSTADENOMA (m.c)
1-2% of exocrine pancreatic tumors.
60 yrs- “grand mother lesions”
Pain , wt loss, mass
May be associated with VHL disease
Large tumors , multiple cysts separated by fibrous
septa that radiate from centre forming a central
stellate star.
USG : may appear as multilocular cyst or mixed solid &
cystic lesions, posterior acoustic enhancement.
71. A fibrous central scar with or without a characteristic
stellate pattern of calcification is seen in 30% of cases
and, when demonstrated at CT or MR imaging is highly
specific and is considered to be virtually
pathognomonic for serous cystadenoma.
CECT : hypervascular , enhancement of septations –
“swiss cheese” or “honeycombing”, “Spongy lesions”
Arrangement of cysts around a central fibrous scar in a
sunburst pattern with coarse calcifications –
characteristic.
72. Well- defined lesion showing low signal intensity onT1
and intermediate signal on T2 with “cluster of grapes”
appearance.
Tumor septa seen as dark thin strands on T2
Minimal enhancement & delayed enhancement of
central scar occasionally.
ERCP :
CBD or pancreatic duct may be displaced , encased, or
obstructed by the tumor with no communication of
lesion with the MPD.
73.
74.
75.
76. Macrocystic lesions include multilocular cysts with
fewer compartments.The individual compartments are
>2 cm) larger than in serous cystadenomas.
The cystic tumors in this category include
a) Mucinous cystic neoplasms and
b) IPMNs
77. “MOTHER LESIONS” – AROUND 50 Yrs (M.C)
female>> male
rare & comprise of 2.5% of exocrine tumors
body & tail – m.c sites
they do not communicate with the pancreatic duct,
they can cause partial pancreatic ductal obstruction
USG :
large ,well circumscribed multilocular cyst with thick
fibrous walls .
presence of anechoic cavities & posterior acoustic
enhancement.
liver – cystic metastasis( rare )
78.
79. Round to slightly lobulated mass i.e well encapsulated
with smooth external margins & near water attenuation
is seen
Capsular or septal calcifications seen(10-25%)
Internal surface may show nodularity representing
papillary projections
Although peripheral eggshell calcification is not
frequently seen at CT, such a finding is specific for a
mucinous cystic neoplasm and is highly predictive of
malignancy.
83. 50 yrs, mother lesions
Solitary(mc)
Body & tail
Peripheral calci+
Tumor nodule
enhancement+
High signal in cystic
areas suggestive of
old hemorrhage.
60 yrs, grand mother
lesions
Multiple,>6,
Head of pancreas
Central calcifications
Septal enhancement+
84. Intraductal papillary mucus producing neoplasms arising from
MPD or its main branches.
Male > female
60-80 yrs
TYPES- a) MAIN DUCT TYPE
B) BRANCH DUCT TYPE
C) MIXED type(side br tumor extend into MPD)
May present as abdominal mass, diarrhea, dm ,wt. Loss.
IPMN represent spectrum of dysplasias ranging from simple
hyperplasia to carcinoma.
Narrow neck at the cyst- duct junction on ct or mrcp
85. Identification of a septated cyst that communicates
with the main pancreatic duct is highly suggestive of a
side-branch or mixed IPMN
However, it is important to be aware that lack of
communication with the main pancreatic duct at
imaging does not exclude an IPMN.
Currently, MRCP is considered the modality of choice
for demonstrating the morphologic features of the
cyst (including septa and mural nodules), establishing
the presence of communication between the cystic
lesion and the pancreatic duct, and evaluating the
extent of pancreatic ductal dilatation
86. USG : Cystic mass, ductal dilatation or presence of
echogenic contents due to mucin
Branch duct type lesion demonstrates a hypoechoic
mass with lobulated borders in uncinate process of
pancreatic head
MRCP : Thick wall , solid mural nodules, diffuse main
duct dilatation > 10 mm, Intraductal filling defects,
bulging duodenal papilla, papillary projections suggest
malignancy.
Vascular encasement, peripancreatic lymphadenopathy
& metastasis – confirms malignancy.
Side branch lesions > 30 mm diameter- malignant.
87. Because these lesions are considered premalignant,
surgical resection has been recommended.
The occurrence of malignancy is significantly higher in
main duct and mixed IPMNs than in side-branch IPMNs
Septated pancreatic cysts less than 3 cm in diameter
have generally low malignant potential.
Cyst location may also be a factor in decision making,
since a small lesion located in the tail of the pancreas
may require a relatively less aggressive distal
pancreatectomy, whereas a lesion located in the
pancreatic head requires the far more complex
Whipple procedure.
88.
89.
90. Cysts with a solid component may be either unilocular or
multilocular.
True cystic tumors -Mucinous cystic neoplasms,
- IPMNs
- Solid pancreatic neoplasms with a
cystic component or cystic
degeneration i.e
. Islet cell Tumor,
. Solid pseudopapillary tumor,
. Adenocarcinoma of the pancreas &
. Metastasis
91. Neuroendocrine tumors of pancreas.
1) functioning –
Insulinoma(small, <2cm)
gastrinoma(small, mutiple)
glucagonomas(large)
vipoma
somatostatinoma(head, > 3cm)
2) non functioning(large size)
Multicentric
Body & tail – m.c harmonally active tumors
92. Usg : well circumscribed, smooth margins
round- oval , hypoechoic
Ct : small lesions are homogenous
large are heterogenous with cystic areas
hypervascular rim.
Have a distinct capsule,
Peak contrast enhancement in early arterial phase(25-
35 sec) rather than late arterial phase(35-45sec)
MRI : T1 - hypo
T2 – Hyper
T1C+(Gd) – hyperintense (Hypervascular)
93.
94. RARE, LOW GRADE MALIGNANCIES
PRGESTERONE RECEPTORS + > 90%
YOUNG FEMALES “ DAUGHTER LESION “
HEAD OR TAIL- M.C
IMAGING :
USG : LARGE WELL MARGINATED, ENCAPSULATED,
PREDOMINENTLY CYSTIC COMPONENT,
HEMORRHAGE, NECROSIS & CALCIFICATIONS
CT : VARIABLE ATTENUATION WITH THICK ENHANCING
CAPSULE, PERIPHERAL CALCATIONS
MRI : FIBROUS CAPSULE WHICH IS HYPOINTENSE ON BOTH
T1 & T2
95.
96. MR imaging with MR cholangiopancreatography is
considered superior to single-section helical CT for the
detection of small mural nodules.
A mural nodule is seen as an area of low signal intensity
on T2-weighted MR images, and contrast material
enhancement following the injection of gadopentetate
dimeglumine is diagnostic for its presence.