Pancreatic Cysts after Endoscopic Ultrasonography-Guided Ethanol and/or Paclitaxel Ablation Therapy: Another Mimic of Pancreatic Pseudocysts.

Abstract

BACKGROUND:

Endoscopic ultrasound-guided ablation (EUS-A) therapy is a minimally invasive procedure for pancreatic-cystic tumors in patients with preoperative comorbidities or in patients who are not indicated for surgical resection. However, histopathologic characteristics of pancreatic cysts after ablation have not been well-elucidated.

METHODS:

Here, we analyzed pathological findings of 12 surgically resected pancreatic cysts after EUS-A with ethanol and/or paclitaxel injection.

RESULTS:

Mean patient age was 49.8 ± 13.6 years with a 0.3 male/female ratio. Clinical impression before EUS-A was predominantly mucinous cystic neoplasms. Mean cyst size before and after ablation therapy was similar (3.7 ± 1.0 cm vs. 3.4 ± 1.6 cm; p = 0.139). Median duration from EUS-A to surgical resection was 18 (range, 1-59) months. Mean percentage of the residual neoplastic lining epithelial cells were 23.1 ± 37.0%. Of the resected cysts, 8 cases (67%) showed no/minimal (<5%) residual lining epithelia, while the remaining 4 cases (33%) showed a wide range of residual mucinous epithelia (20-90%). Ovarian-type stroma was noted in 5 cases (42%). Other histologic features included histiocytic aggregation (67%), stromal hyalinization (67%), diffuse egg shell-like calcification along the cystic wall (58%), and fat necrosis (8%).

CONCLUSION:

Above all, diffuse egg shell-like calcification along the pancreatic cystic walls with residual lining epithelia and/or ovarian-type stroma were characteristics of pancreatic cysts after EUS-A. Therefore, understanding these histologic features will be helpful for precise pathological diagnosis of pancreatic cystic tumor after EUS-A, even without knowing the patient's history of EUS-A.

• Authors: Soyeon An, You-Na Sung, Sung Joo Kim, Dong-Wan Seo, Sun-Young Jun, Seung-Mo Hong
• Journal: Pathobiology : journal of immunopathology, molecular and cellular biology (Pathobiology) Vol. 89 Issue 1 Pg. 49-55 ( 2022) ISSN: 1423-0291 [Electronic] Switzerland
• PMID: 34515187 (Publication Type: Journal Article)
• Copyright: © 2021 The Author(s) Published by S. Karger AG, Basel.

Chemical References

• Ethanol
• Paclitaxel

Topics

• Adult
• Endosonography
• Ethanol
• Female
• Humans
• Male
• Middle Aged
• Paclitaxel
• Pancreatic Cyst (diagnostic imaging, surgery)
• Pancreatic Neoplasms (diagnostic imaging, drug therapy)
• Pancreatic Pseudocyst