Pankreasın Neoplastik Kistik Tümörlerinde Pratikler - Bir Eğitim veAraştırma Hastanesi Deneyimi

Amaç: Çoğunlukla insidental olarak rastlanan ve malign olma ihtimalinden dolayı pankreasın neoplastik kistik lezyonlarının, Amerikan Gastroenteroloji Derneğinin 2015 kılavuzu örnekli-ğinde, pratik noktalarını ortaya koymayı amaçladık .Gereçler ve Yöntem: Pankreas neoplastik kistik tümörlü 25 hasta retrospektif olarak incelendi. Hastaların yaşları, cinsi-yetleri, ilk ön tanılarını aldıklarında insidental mi semptomatik mi olduğu, ilk yönlendirici radyolojik tetkikikin USG, BT, MR (+/- MRCP) veya diğer yönlendirici faktörler ve takiplerinde EUS bulguları (aspirasyon sıvısında amilaz, CEA, CA 19-9, ince iğne hücre aspirasyon sonuçları) değerlendirildi. Tüm hastaların yönlendirme sonrası eksikleri giderilerek MR-MR-CP ve EUS’ları tamamlandı. Hastaların takip ve cerrahisi de-ğerlendirildi.Bulgular: 25 hastanın 18 (%72)’si kadın, 7 (%28)’i erkekti. Ortalama yaş 57,3 olup 30-77 aralığında değişmekteydi. Se-röz kistik tümörlü 10 (%40), Müsinöz kistik tümörlü 6 (%24), intraduktal papiller müsinöz tümörlü 8 (%32), solid psödopa-piller tümörlü 1 (%4) hasta değerlendirildi. MR-MRCP ve EUS bulguları tanı koymada uyumlu ve tamamlayıcıydı. Ameliyat edilen 7 (%28) hastanın patoloji sonuçları uyumlu olup 1 (%4) hastada invaziv kanser tesbit edildi.Sonuç: Pankreasın neoplastik kistik tümörleri çoğunlukla in-sidental olarak tesbit edilir. Malign potansiyel taşıyabilece-ğinden dolayı ileri tetkikler MR-MRCP ve EUS (sıvı ve hücre aspiratı incelemeleri dahil) ile yapılmalı; tanı, takip ve cerrahi kararı uygun ve pratik yönlendirmeleri nedeniyle AGA 2015 kı-lavuzuna göre verilmelidir.

Practices in Pancreatic Neoplastic Cystic Tumors - A Training and Research Hospital Experience

Objective: Neoplastic cystic tumors of the pancreas are mostly incidentally detected and they carry risk of malignancy. We ai-med to reveal practical points of the management according to 2015 guideline of the American Gastroenterology Association.Material and Methods: Twenty-five patients with pancreatic neoplastic cystic tumors were retrospectively analyzed. Pa-tients' ages, genders, whether they were incidental or sympto-matic when they received their initial pre-diagnosis with USG, CT, MR (+/- MRCP) or other guiding factors and EUS findings (amylase, CEA, CA 19-9 in the aspiration fluid and cell as-piration results) were evaluated. MR-MRCP and EUSs of all patients were completed. The follow-up and surgery of the pa-tients were evaluated.Results: Of the 25 patients, 18 (72%) were female and 7 (28%) were male. The average age was 57.3 and ranged from 30-77. Ten (40%) patients with serous cystic tumor, 6 (24%) with mu-cinous cystic tumor, 8 (32%) with intraductal papillary muci-nous tumor, and 1 (4%) with solid pseudopapillary tumor were evaluated. MR-MRCP and EUS findings were compatible and complementary in diagnosis. Pathology results of 7 (28%) ope-rated patients were compatible and 1 (4%) patient had invasive cancer.Conclusion: Neoplastic cystic tumors of the pancreas are most-ly detected incidentally. Further investigations should be done with MR-MRCP and EUS (including fluid and cell aspirate exa-minations) as they may have malignant potential; The diagno-sis, follow-up and surgical decision should be made according to the AGA 2015 guideline due to its appropriate and practical guidance.

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