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 (#x3c;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.
Pathobiology

中文翻译：

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内镜超声引导下乙醇和/或紫杉醇消融治疗后的胰腺囊肿：胰腺假性囊肿的另一种模仿

背景：内窥镜超声引导消融（EUS-A）治疗是一种微创手术，用于治疗术前合并症或不适合手术切除的患者的胰腺囊性肿瘤。然而，消融后胰腺囊肿的组织病理学特征尚未得到很好的阐明。方法：在这里，我们分析了用乙醇和/或紫杉醇注射进行 EUS-A 后手术切除的 12 例胰腺囊肿的病理结果。结果：平均患者年龄为 49.8 ± 13.6 岁，男女比例为 0.3。EUS-A 之前的临床印象主要是粘液性囊性肿瘤。消融治疗前后的平均囊肿大小相似（3.7 ± 1.0 cm vs. 3.4 ± 1.6 cm； p= 0.139)。从 EUS-A 到手术切除的中位时间为 18（范围，1-59）个月。残余肿瘤内衬上皮细胞的平均百分比为 23.1 ± 37.0%。在切除的囊肿中，8 例 (67%) 显示无/极少 (#x3c;5%) 残留衬里上皮，而其余 4 例 (33%) 显示范围广泛的残留粘液上皮 (20-90%)。5 例（42%）发现卵巢型间质。其他组织学特征包括组织细胞聚集 (67%)、基质透明化 (67%)、沿囊壁的弥漫性蛋壳样钙化 (58%) 和脂肪坏死 (8%)。结论：最重要的是，沿着胰腺囊壁的弥漫性蛋壳样钙化与残留的衬里上皮和/或卵巢型间质是 EUS-A 后胰腺囊肿的特征。因此，即使不了解患者的EUS-A病史，了解这些组织学特征也将有助于EUS-A后胰腺囊性肿瘤的精确病理诊断。
病理学