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Apr 22 8 tweets 3 min read Twitter logo Read on Twitter
🔮Pancreatic cysts: What's in the Juice by #YanBi from #MayoFL #IMPACT #gitwitter

🎯Pancreatic Cysts Incidence 📈with ↑imaging

🌟90% of P-Cysts are IPMNs (Intraductal Papillary Mucinous Neoplasms)
-70% IPMNs are BD-IPMN (branch duct)
-30% IPMNs are MD-IPMN (main duct) ImageImage
🔮Benign cysts (observation/drainage/sx)
- Pseudocyst
- Serous cystadenoma

⁉️Pre-malignant (observation/sx)
- IPMN
- MCN (mucinous cystic neoplams)

🦀Malignant (sx)
- Cystic neuroendocrine tumor (CNET)
- Solid pseudopapillary neoplasm (SPN)
- Cystic degeneration of PDAC
🎯Cyst fluid CEA >192 distinguishes between mucinous vs. non-mucinous BUT not malignant vs. non-malignant ($$$)

🌟Cyst fluid glucose <50 costs significantly ↓ & does the same as CEA

🎖️CEA and glucose can be combined for even higher sensitivity and specificity
🔮Common P-Cyst fluid genetic markers:

1⃣ SCA (serous cyst adenoma): VHL
2⃣ SPN (serous pseudopapillary neoplasm): CTNNB1
3⃣ IPMN: GNAS
4⃣ MCN: None Image
This article summarizes the several high-risk and worrisome features that should be considered during the initial evaluation of a P-Cyst. See 🖼️↓

wjgnet.com/1007-9327/full… Image
🔥New developments in P-Cysts🌎:
1⃣Imaging:
‼️FDG-PET Is More Sensitive And Specific In Predicting PC Malignancy when compared to CT and MRI

❣️BUT FAPI-PET is better!!
(FAP: fibroblast activation protein)

DOI: 10.2967/jnumed.120.253062 Image
2⃣EUS:
🎯Contrast Enhanced Harmonic EUS is more effective in predicting Malignant IPMN

🎯Confocal laser endomicroscopy (CLE) can accurately differentiate Mucinous from Non-Mucinous lesions. Needle-Based CLE is also gaining traction.
3⃣Pathology: Microforceps is in development

4⃣Biomarkers: Several are in works, including promising DNA-biomarkers

5⃣Treatment: Currently, there is insufficient evidence to support the routine use of cyst ablation, BUT novel techniques are in the works❣️

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More from @

Apr 23
💊Drug Induced pancreatitis (DIP) by @AshkarMotaz from @WUGastro soon returning as @MayoClinicGIHep staff #IMPACT #gitwitter

🥇See tweet 5 for the current classification dx!

📚Hx of DIP: Understanding of DIP has evolved since it was first described in 1950s-60s on case reports ImageImage
🥇First drug-induced acute pancreatitis (AP) classification came out in '96

Subclassified as - definitive, probable, and possible DIP

Limitations of '96 classification:

1⃣DIP is UNCOMMON
2⃣DIP NOT different from AP 2/2 other causes
4⃣Drug re-challenge often not possible Image
🌟DIP classification was updated again in 2006 based on evidence & pattern of clinical presentation.

New challenges‼️

1⃣Inadequate dx criteria for AP
2⃣? ruling our common causes of AP
3⃣Lack of rechallenge
4⃣Idiopathic, microlithiasis, genetic causes intersecting with DIP dx
Read 5 tweets
Apr 22
🌟Pancreatic cancer (PC) Screening by @MajumderShounak #IMPACT #gitwitter

Why care about screening for PC?
10th leading cancer 🦀diagnosis in 🇺🇸 but 3rd leading cancer☠️with 5-year survival is only 11%

🎯Current recommendations suggest against PC screening unless "high-risk" ImageImage
Define "High-risk individual" (HRI)?
1⃣Age
2⃣Fam hx of PC (dx age, relationship)
3⃣Germline mutations

‼️Familial PC = ≥2 first-degree relatives (FDR)
☠️If 2 FDR 6x risk
☠️If 3 FDR 32x risk

🦀Genetic mutations assoc with PC (5.5% cases) - CDKN2A, TP53, MLH1, BRCA2, ATM,
BRCA1
🔍Begin screening age 50 or 10 years younger than the earliest relative affected by PC

Peutz-Jeghers Syndrome (STK11/LKB1)—Age 35
Hereditary Pancreatitis (PRSS1)—Age 40
Familial atypical multiple mole melanoma syndrome (CDKN2A)—Age 40
Read 7 tweets

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