Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Nonmucinous Cystadenoma of the Pancreas with Pancreatobiliary Phenotype and Ovarian-like Stroma. Case Report of a Recently Described Entity

Adriana Fabiola Romano-Munive M.D.*, Mario C Peláez M.D., Jorge Hernández-Calleros M.D., Carlos Chan-Nuñez M.D., Luis Uscanga-Domínguez M.D.

Gastroenterology Department, National Institute of Medical Sciences and Nutrition Salvador Zubirán

Abstract: The World Health Organization (WHO) classification of cystic pancreatic tumors defines mucinous cystic neoplasms as large, thick-walled, septated cysts with no communication with the main pancreatic duct, associated with the presence of ovarian-like stroma. Serous cystic neoplasms, on the contrary, present with a cuboidal or simple squamous epithelium and fibrous or hyalinized stroma without ovarian-like stroma. We present the case of a 23-year-old woman presenting with abdominal pain related to a new type of cystic pancreatic neoplasm characterized by non-mucinous pancreaticobiliary cystic epithelium and ovarian-like stroma that was surgically removed.

Keywords: pancreas, pancreatic cysts, cystadenoma

Citation: Adriana Fabiola Romano-Munive M.D., Mario C Peláez M.D., Jorge Hernández-Calleros M.D., Carlos Chan-Nuñez M.D., Luis Uscanga-Domínguez M.D., Nonmucinous Cystadenoma of the Pancreas with Pancreatobiliary Phenotype and Ovarian-like Stroma. Case Report of a Recently Described Entity. American Journal of Medical Case Reports, 3 (12). 391-393. January 2015. doi:10.12691/ajmcr-3-12-2

1. Introduction

The World Health Organization (WHO) classification of cystic pancreatic tumors defines mucinous cystic neoplasms (MCNs) as large, thick-walled, septated cysts with no communication with the main pancreatic duct [1]. Histologically, these cysts are characterized by the presence of ovarian-like stroma, high columnar mucoproductor epithelium with foveolar gastric differentiation, and dysplastic changes [2].

The identification of serous cystic tumors requires cuboidal or simple squamous epithelium and fibrous or hyalinized stroma. The typical serous cystic tumor is formed by many tiny cysts and has a honeycomb appearance [4].

Recently, a different cystic pancreatic tumor has been described that typically has a non-dysplastic cuboidal epithelium, ovarian-like stroma, and contains clear or serous fluid without mucin. Despite the presence of ovarian-like stroma, this pancreatic cyst differs from MCN because it does not have any epithelial dysplastic changes, and contains non-mucinous pancreaticobiliary cystic epithelium with serous fluid. A pancreatobiliary phenotype is also found in intraductal papillary mucinous neoplasms of the pancreas (IPMNs) and cystic neoplasms of the extrahepatic bile duct [5].

We present the case of this newly described cystic neoplasm characterized by ovarian-like stroma and a serous-like epithelium and fluid content.

2. Case Report

A 23-year-old Hispanic woman with no significant past family and medical history sought medical attention for epigastric and left upper quadrant intermittent abdominal pain, which was present during the past 18 months. Physical examination was unremarkable. Laboratory work including complete blood count, glucose, creatinine, blood urea nitrogen, liver function tests, and lipase were normal. Abdominal contrast-enhanced computed tomography and endoscopic ultrasound showed a unilocular cystic neoplasm measuring 4.9×5.8×5.7 cm dependent of the tail of the pancreas; a cyst wall measuring 3 mm; and no communication between the cyst and main pancreatic duct. Cyst fluid analysis reported amylase 45 733 IU/L, carcinoembryonic antigen 116 ng/mL and carbohydrate antigen 19-93 271 U/mL. (Figure 1).

MCN was suspected and laparoscopic distal pancreatectomy and splenectomy were performed with margin between tumor and cut surface of 2 cm. (Figure 2). Pathological examination showed a cystic neoplasm with non-mucin-producing cuboidal epithelium and ovarian-like stroma. Final diagnosis was a nonmucinous cystadenoma with pancreaticobiliary phenotype and ovarian-like stroma with negative surgical margins (Figure 3).

The patient was discharged 4 days after surgery without complications. At a 6 month follow-up visit, she was asymptomatic.

Figure 1. Evaluation of the patient by computed tomography. Axial view showed a unilocular cystic neoplasm dependent of the tail of the pancreas

Figure 2. Surgical specimen of laparoscopic distal pancreatectomy and splenectomy. Cyst is observed in the pancreatic tail

Figure 3. Nonmucinous cystadenoma of the pancreas with pancreatobiliary phenotype. Cuboidal epithelium and ovarian-like stroma are shown (Hematoxylin-eosin stained slide)

3. Discussion

According to current international consensus guidelines for the management of IPMN and MCN of the pancreas [6], we decided upon surgical management because the cyst was >3 cm, and cyst-related symptoms were present and MCN was suspected. Pathological examination revealed the presence of serous cystadenoma-like cyst epithelium and content surrounded by MCN-associated ovarian-like stroma. This latter cystic neoplasm is not considered in the WHO classification and it has been recently described in a series of nine cases from two institutions. In that series, the neoplasms predominated in young women with a mean age of 45 years (range, 24-64 years) and their size ranged from 1.7 to 7 cm (average 4.8cm) [5] (Table 1).

Table 1. Previous published cases

These patients are similar to our case, long-term outcome and prognosis is uncertain owing to the short-term follow-up reported in our patient. However, the lack of dysplastic changes and the absence of literature reports regarding cystadenocarcinoma arising in this specific cystic neoplasm allowed us to consider potential benign behavior. Nevertheless, we cannot overlook the possibility of early incidental diagnosis before malignant changes were present. Information from longer follow-up is needed.

To date, the presence of ovarian-like stroma has been considered synonymous with MCN. However, the present and previous reports prove otherwise, highlighting the need for a thorough examination of any pancreatic cyst before making any therapeutic decisions. Clinical manifestations, imaging characteristics, and cyst fluid analysis (with all its limitations) should be considered as part of the diagnostic approach to any pancreatic cystic lesion. It is a matter of debate whether these 10 cases are sufficient to call for a revision and the introduction of this new cystic neoplasm into the WHO classification.

References

[1]   | Goh BK, Tan YM, Chung YF, et al. A review of mucinous cystic neoplasm of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J Surg. 2006;30(12):2236-45.
[2]   | Cooper CL, O´Toole SA, Kench JG. Classification, morphology and molecular pathology of premalignant lesions of the pancreas. Pathology. 2013;45(3):286-304.
[3]   | Lam MM, Swanson PE, Upton MP, et al. Ovarian-type stroma in hepatobiliary cystadenomas and pancreatic mucinous cystic neoplasms. An immunohistochemical study. Am J Clin Pathol. 2008; 129(2):2118.
[4]   | Farrell JJ, Fernández-del Castillo C. Pancreatic cystic neoplasms: management and unanswered questions. Gastroenterology. 2013;144(6):1303-15.
[5]   | Albores-Saavedra J, Manivel C, Dorantes-Heredia R, et al. Nonmucinous cystadenomas of the pancreas with pancreatobiliary phenotype and ovarian-like stroma. Am J Clin Pathol. 2013;139:599-604.
[6]   | Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183-97.