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  #1  
Old 12-02-2012
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Pancreas 5 CM Pancreatic Cyst

A 38-year-old woman is being evaluated for abdominal pain, which has been present for 2 months. Her medical history and physical examination are unremarkable, and she takes no medications. An abdominal CT scan reveals a 5 cm cystic structure in the pancreas. Which of the following is the most appropriate step to take next in the treatment of this patient?

A. Percutaneous drainage
B. Endoscopic drainage
C. Surgical resection
D. Follow-up and repeat imaging in 6 weeks
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  #2  
Old 12-03-2012
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Symptomatic Pseudocyst Percutaneous Drainage
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Old 12-03-2012
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yes ans should be drainage as it is > than 6 wks but can be done percutaneously or endoscopically .......

will go with A
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answer B endoscopic drainage.... cause we cant reach psudocyst percutaneously
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(Correct Answer: C—Surgical resection)

Besides the commonly seen pseudocysts, a number of other cystic lesions may occur in the pancreas, including true cysts and cystic neoplasms. Serous cystic neoplasms are benign, but mucin-producing cystic neoplasms may follow a more malignant course. Mucinous cystic neoplasms present as large cystic collections (cystadenomas and cystadenocarcinomas) and may be relatively asymptomatic. Most cystic neoplasms occur in middle-aged patients, particularly women. They are often mistaken for pseudocysts and inappropriately treated as such. These cystic neoplasms may follow an initially benign course, but when they undergo malignant degeneration, outcomes are as poor as in patients with standard adenocarcinoma. The presence of a cystic collection of the pancreas in a middle-aged (particularly female) patient without a previous history of pancreatitis should immediately suggest a cystic neoplasm, not a pseudocyst. The diagnosis of a cystic neoplasm requires histologic evidence of epithelial or neoplastic tissue in the cyst wall. When these collections are mistaken for pseudocysts, treatment involves drainage, and no tissue is obtained to allow differentiation of a cystic neoplasm from a pseudocyst. The therapy of choice for cystic neoplasms is surgical resection, not drainage.
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Quote:
Originally Posted by heartbeat View Post
(Correct Answer: C—Surgical resection)

Besides the commonly seen pseudocysts, a number of other cystic lesions may occur in the pancreas, including true cysts and cystic neoplasms. Serous cystic neoplasms are benign, but mucin-producing cystic neoplasms may follow a more malignant course. Mucinous cystic neoplasms present as large cystic collections (cystadenomas and cystadenocarcinomas) and may be relatively asymptomatic. Most cystic neoplasms occur in middle-aged patients, particularly women. They are often mistaken for pseudocysts and inappropriately treated as such. These cystic neoplasms may follow an initially benign course, but when they undergo malignant degeneration, outcomes are as poor as in patients with standard adenocarcinoma. The presence of a cystic collection of the pancreas in a middle-aged (particularly female) patient without a previous history of pancreatitis should immediately suggest a cystic neoplasm, not a pseudocyst. The diagnosis of a cystic neoplasm requires histologic evidence of epithelial or neoplastic tissue in the cyst wall. When these collections are mistaken for pseudocysts, treatment involves drainage, and no tissue is obtained to allow differentiation of a cystic neoplasm from a pseudocyst. The therapy of choice for cystic neoplasms is surgical resection, not drainage.

what would be the managment of pancreatic pseudocyst

thank for ur questions they really useful
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Old 12-04-2012
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Quote:
Originally Posted by heartbeat View Post
(Correct Answer: C—Surgical resection)

Besides the commonly seen pseudocysts, a number of other cystic lesions may occur in the pancreas, including true cysts and cystic neoplasms. Serous cystic neoplasms are benign, but mucin-producing cystic neoplasms may follow a more malignant course. Mucinous cystic neoplasms present as large cystic collections (cystadenomas and cystadenocarcinomas) and may be relatively asymptomatic. Most cystic neoplasms occur in middle-aged patients, particularly women. They are often mistaken for pseudocysts and inappropriately treated as such. These cystic neoplasms may follow an initially benign course, but when they undergo malignant degeneration, outcomes are as poor as in patients with standard adenocarcinoma. The presence of a cystic collection of the pancreas in a middle-aged (particularly female) patient without a previous history of pancreatitis should immediately suggest a cystic neoplasm, not a pseudocyst. The diagnosis of a cystic neoplasm requires histologic evidence of epithelial or neoplastic tissue in the cyst wall. When these collections are mistaken for pseudocysts, treatment involves drainage, and no tissue is obtained to allow differentiation of a cystic neoplasm from a pseudocyst. The therapy of choice for cystic neoplasms is surgical resection, not drainage.
thankyou ..it is really informative
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Old 12-04-2012
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Quote:
Originally Posted by hamzarayes View Post
what would be the managment of pancreatic pseudocyst

thank for ur questions they really useful
If < 5cm and Asymptomatic--> leave it
If enlarging or painful--> Percutaneous drainage (as i think)
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Old 12-05-2012
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I found the indications for removal in the UW which are >5cm more than 6 weeks ruture HGe and infection but did not fing the way to do it
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Old 12-06-2012
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Correct Answer

Quote:
Surgical Care

Drainage options are outlined below.

Catheter drainage

Percutaneous aspiration is useful only to establish a diagnosis or as a temporizing measure. It has a 54% failure rate and a 63% recurrence rate. Percutaneous drainage may have a higher complication rate and inpatient mortality rate than surgical drainage.

Percutaneous catheter drainage is the procedure of choice for treating infected pseudocysts, allowing for rapid drainage of the cyst and identification of any microbial organism. A high recurrence and failure rate exist, but catheter drainage may be a good temporizing measure. It is contraindicated in patients with strictures of the main pancreatic duct and in patients with cysts containing bloody or solid material and also poorly compliant patients.



Endoscopic drainage

May be either transpapillary (via ERCP) or transmural.

Transpapillary drainage, while safer and more effective than transmural drainage, requires cyst communication with the pancreatic duct. This technique may be technically challenging because it requires wire passage and stenting through the pancreatic duct to the pseudocyst. The success rate is about 80%. The recurrence rate is 10-14%, and, in most series, the complication rate (mainly pancreatitis) is approximately 13%.

Endoscopic transmural drainage is also possible. This involves performing an endoscopy and finding a bulge within the wall of the stomach or duodenum caused by compression of the pseudocyst. The cyst is generally entered using a needle knife to cut through the gastric or duodenum wall, and a series of pigtail stents are placed through the resulting communication. The method has an 82-89% success rate in very experienced hands. The recurrent rate is 6-18%. The complication rate is 20%, with the most feared complication being bleeding.

One report suggests that there was no real difference in outcome in patients treated with a transpapillary or transmural approach.



Surgical drainage

Is the criterion standard against which all therapies are measured.

Internal drainage is the procedure of choice. A laparoscopic approach has been used in some cases with good results.

In most series, the mortality rate is 3%, and the complication rate is approximately 24%. The success rate is 85-90%.
Recent work suggests that a laparoscopic approach to drainage has a high success rate and a low morbidity rate

Management of pseudocysts requires a team approach. Gastroenterologists, surgeons, and invasive radiologists must work together to determine the necessity, timing, and method of intervention. If nonsurgical drainage is contemplated, it is important to elucidate the anatomy of the pancreatic duct beforehand. This may be done via ERCP or MRI. A large number of patients who fail or have complications with nonsurgical drainage have disruption or stenosis of the pancreatic duct.
http://emedicine.medscape.com/articl...reatment#a1128
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