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  • ISSN: 2373-9282
    Special Issue entitled: Pancreaticobiliary Disease
    Maryam J Zenali
    Department of Pathology
    University of Vermont
    Review Article
    Abdelnemon Elhosseiny1*, Rania Bakkar2 and Maryam Zenali1
    Abstract: The biliary tree is composed of intrahepatic and extrahepatic ducts and is lined by simple columnar/cuboidal epithelium. Particularly in evaluation of extrahepatic bile ducts, cytology is commonly utilized. Herein we review common indications, methodology and microscopic features as relates to biliary tract cytologic diagnoses. Additionally, we briefly discuss newer techniques that can be used in conjunction with routine procedures, with reported increase in the overall diagnostic yield.
    Suzanne M Tucker*
    Abstract: In infants and children, pancreatic neoplasms occur uncommonly. Histologically, these tumors can resemble pancreatic embryonic elements or more well-differentiated pancreatic structures, in a subset the cellular origin can’t be delineated. This review discusses three of the most classic pediatric pancreatic neoplasms: pancreatoblastoma, solid pseudopapillary neoplasms and pancreatic endocrine neoplasms. These tumors can be a manifestation of a syndromic process and genetic aberrations have been linked to a subset of these neoplasms, as discussed in this paper.
    Mario Velez1* and Eric Ganguly2
    Abstract: Intraductal papillary mucinous neoplasms of pancreas are relatively common, often arise from the pancreatic head, and comprise more than one third of resected pancreatic cysts. In these lesions, the risk of dysplasia or carcinoma varies according to the site of ductal involvement or histologic subtypes. For instance, there is a higher risk of malignancy associated with main rather than branch duct IPMNs and/or with pancreaticobiliary rather than gastric subtype. Other factors altering this risk include cyst size and associated solid mural component. Although in general surgical excision is advocated for all MD-IPMNs when possible, a specific protocol is to follow for management of BD-IPMNs. Additional to specifics on the aforementioned, the present study reviews clinic-pathologic classification schema and provides recently updated guidelines on surveillance and clinical management of IPMNs. Certain molecular features and mutations such as P53 aberration have been linked to the presence of malignancy in IPMNs. Cellular/molecular techniques, newly proposed to increase the yield of diagnosis and/or potential measures of prognosis are also reported in the following review.
    Case Report
    Tricia Murdock1 and Maryam Zenali2*
    Intraductal oncocytic papillary neoplasm (IOPN) is a rare subset of intraductal papillary mucinous neoplasm (IPMN). Herein, we report a case of IOPN in a 77 year-old woman with history of colonic adenocarcinoma and bilateral primary renal tumors and we present a review of related literature.
    Sara Brownschidle1*, Jillian Sullivan2, Kennith Sartorelli3, Scott Potenta4 and Maryam Zenali5
    Abstract: Causes of neonatal cholestasis are varied, complex, and require accurate and timely diagnosis. We present a case of neonatal cholestasis secondary to biliary sludge associated with recent use of diflucan (fluconazole). An infant male presented on the 85th day of life with jaundice, weight loss, hepatosplenomegaly and 10 days of acholic stools. Clinical history was significant for diflucan therapy for oral thrush about one month prior to the presentation. Abnormal labs on presentation included total bilirubin (4.5 mg/dl) with a delta component of 1.5 mg/dl, total alkaline phosphatase (492 U/L) and gamma-glutamyl transpeptidase (GGT of 222 U/L). Cholangiography showed biliary ductal dilatation with debris obstructing the distal common bile duct. Subsequent trans-catheter irrigation of the biliary tree, cholecystectomy, and biopsy of liver was performed. On histology, the gallbladder and cystic duct had bile deposition but otherwise no histologic alteration. Liver biopsy contained canalicular cholestasis, mild ductular proliferation with no significant fibrosis and was otherwise unremarkable; there was no ultra-structural abnormality. The histologic features were in keeping with obstruction and with the operative impression of biliary sludge. A few days post-op, bilirubin levels and liver function tests normalized. Repeat post-operative ultrasounds showed a normal-caliber biliary tree. Seven months after the surgery, the patient is doing very well with normal development.
    Kossivi Dantey1*, Rashmi Kanagal-Shamanna2, Maryam J Zenali1, Andres E Quesada3, Alfonso Quintas-Cardama4 and Nghia Nguyen3
    Abstract: Post-transplant lymphoproliferative disorder (PTLD) is a rare complication of solid organ transplantation. It develops in association with immunosuppression and is usually linked to Epstein - Barr virus (EBV) infection. Risk factors for PTLD include type and duration of immunosuppression, age of the patient, and the type of transplanted organs, amongst others. This report summarizes clinico-radiologic and pathologic features in a case of pancreatic PTLD. Based on the presenting features, initial considerations in this patient included chronic pancreatitis and graft rejection. Due to intractable symptomatology, a total pancreatectomy was performed, leading to the diagnosis of polymorphous PTLD. By clinico-radiologic criteria, there can be overlapping features between chronic pancreatitis, transplant rejection and PTLD. Histologic identification of EBV in atypical lymphoid population and genomic clonality are cornerstones of diagnosis of PTLD. Control of the disease is primarily achieved by reduction or succession of immunosuppression.
    Research Article
    Jessica W. Crothers1*, Lei Zhao2 and Rebecca Wilcox1
    Abstract: The pancreaticoduodenectomy, commonly referred to as the Whipple resection, is the en bloc surgical resection of the pancreas head and uncinate process, duodenum, gallbladder, common bile duct, and common hepatic duct just proximal to the cystic duct takeoff with (conventional) or without (pylorus-sparing) the gastric antrum. Although generally an oncologic procedure, the Whipple resection can be warranted in benign or pre-neoplastic periampullary/ampullary lesions as the intimate structural relationship of the distal common bile duct, pancreatic head and ampulla of Vater creates an opportunity for otherwise benign processes to cause severe obstructive changes.
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