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Pancreatic Neoplasms: HELP
Articles by Elliot K. Fishman
Based on 69 articles published since 2010
(Why 69 articles?)
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Between 2010 and 2020, E. Fishman wrote the following 69 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review Cinematic rendering of pancreatic neoplasms: preliminary observations and opportunities. 2018

Chu, Linda C / Johnson, Pamela T / Fishman, Elliot K. ·The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD, 21287, USA. lindachu@jhmi.edu. · The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 North Wolfe Street, Baltimore, MD, 21287, USA. ·Abdom Radiol (NY) · Pubmed #29550959.

ABSTRACT: Pancreatic cancer is the third most common cause of cancer death and CT is the most commonly used modality for the initial evaluation of suspected pancreatic cancer. Post-processing of CT data into 2D multiplanar and 3D reconstructions has been shown to improve tumor visualization and assessment of tumor resectability compared to axial slices, and is considered the standard of care. Cinematic rendering is a new 3D-rendering technique that produces photorealistic images, and it has the potential to more accurately depict anatomic detail compared to traditional 3D reconstruction techniques. The purpose of this article is to describe the potential application of CR to imaging of pancreatic neoplasms. CR has the potential to improve visualization of subtle pancreatic neoplasms, differentiation of solid and cystic pancreatic neoplasms, assessment of local tumor extension and vascular invasion, and visualization of metastatic disease.

2 Review Lessons learned from 29 lymphoepithelial cysts of the pancreas: institutional experience and review of the literature. 2018

Groot, Vincent P / Thakker, Sameer S / Gemenetzis, Georgios / Noë, Michaël / Javed, Ammar A / Burkhart, Richard A / Noveiry, Behnoud B / Cameron, John L / Weiss, Matthew J / VandenBussche, Christopher J / Fishman, Elliot K / Hruban, Ralph H / Wolfgang, Christopher L / Lennon, Anne Marie / He, Jin. ·Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands. · Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Gastroenterology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Gastroenterology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jhe11@jhmi.edu. ·HPB (Oxford) · Pubmed #29530477.

ABSTRACT: BACKGROUND: Lymphoepithelial cysts (LECs) are rare pancreatic cystic lesions. Since LECs are benign, preoperative diagnosis is important to differentiate from a cystic neoplasm and avoid unnecessary surgery. The aim of this study was to identify clinical, radiographic and cytopathologic features associated with LECs. METHODS: A retrospective review was performed of patients diagnosed with LEC between 1995 and 2017 at our hospital. Clinicopathologic and radiographic imaging features were documented. RESULTS: Of 29 patients with pancreatic LEC, 22 underwent surgical resection. The majority were male (n = 24) with a median age of 55 years (range, 21-74). During the evaluation, all patients underwent a CT, with endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) biopsy (n = 22) and/or MRI/MRCP (n = 11) performed in a smaller number of patients. A combination of exophytic tumor growth on imaging and the presence of specific cytomorphologic features on the EUS-FNA cytology biopsy led to the correct diagnosis of LEC and prevention of unnecessary surgery in 7 patients. DISCUSSION: Differentiating LECs from premalignant pancreatic cystic neoplasms remains difficult. Findings of an exophytic growth pattern of the lesion on abdominal imaging and the presence of specific cytomorphologic features in the EUS-FNA biopsy could help clinicians diagnose LEC preoperatively.

3 Review Pancreaticoduodenectomy with en bloc vein resection for locally advanced pancreatic cancer: a case series without venous reconstruction. 2018

Gage, Michele M / Reames, Bradley N / Ejaz, Aslam / Sham, Johnathan / Fishman, Elliot K / Weiss, Matthew J / Wolfgang, Christopher L / He, Jin. ·Department of Surgery,Johns Hopkins Hospital, Baltimore, MD, USA. · Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA. · Department of Surgery,Johns Hopkins Hospital, Baltimore, MD, USA. jhe11@jhmi.edu. ·Chin Clin Oncol · Pubmed #29486566.

ABSTRACT: Resection with clean margin (R0 resection) is associated with better survival in patients with pancreatic cancer. Over the last decade, advancements in preoperative chemotherapy and radiation therapy in pancreatic cancer have led to expansion of indications for surgical resection. Current guidelines define pancreatic cancer with unreconstructable vascular involvement as locally advanced, or surgically unresectable. We present our experience in managing patients with locally advanced pancreatic cancer with a very unique series of patients who achieved R0 resection despite "unresectable" vascular involvement. Additionally, we review current guidelines, the ability to predict venous resection by imaging, outcomes after venous resection and reconstruction, published patency rates of venous reconstructions, and potential future implications of this novel technique.

4 Review Assessment of iodine uptake by pancreatic cancer following chemotherapy using dual-energy CT. 2018

Kawamoto, Satomi / Fuld, Matthew K / Laheru, Daniel / Huang, Peng / Fishman, Elliot K. ·The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA. skawamo1@jhmi.edu. · , JHOC 3140E, 601 N. Caroline Street, Baltimore, MD, 21287, USA. skawamo1@jhmi.edu. · The Russell H. Morgan Department of Radiology and Radiological Science, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. · Siemens Medical Solutions USA, Inc, Malvern, PA, USA. · Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. · Department of Biostatistics, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. · The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD, USA. ·Abdom Radiol (NY) · Pubmed #29473093.

ABSTRACT: Pancreatic cancer remains a major health problem, and only less than 20% of patients have resectable disease at the time of initial diagnosis. Systemic chemotherapy is often used in the patients with borderline resectable, locally advanced unresectable disease and metastatic disease. CT is often used to assess for therapeutic response; however, conventional imaging including CT may not correctly reflect treatment response after chemotherapy. Dual-energy (DE) CT can acquire datasets at two different photon spectra in a single CT acquisition, and permits separating materials and extract iodine by applying a material decomposition algorithm. Quantitative iodine mapping may have an added value over conventional CT imaging for monitoring the treatment effects in patients with pancreatic cancer and potentially serve as a unique biomarker for treatment response. In this pictorial essay, we will review the technique for iodine quantification of pancreatic cancer by DECT and discuss our observations of iodine quantification at baseline and after systemic chemotherapy with conventional cytotoxic agents, and illustrate example cases.

5 Review Imaging of post-operative pancreas and complications after pancreatic adenocarcinoma resection. 2018

Hafezi-Nejad, Nima / Fishman, Elliot K / Zaheer, Atif. ·Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. · Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA. azaheer1@jhmi.edu. · Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. azaheer1@jhmi.edu. · The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 North Wolfe Street, Hal B164, Baltimore, MD, 21287, USA. azaheer1@jhmi.edu. ·Abdom Radiol (NY) · Pubmed #29094173.

ABSTRACT: Pancreatic ductal adenocarcinoma is one of the leading causes of cancer-related deaths. With surgical resection being the only definitive treatment, improvements in technique has led to an increase in number of candidates undergoing resection by inclusion of borderline resectable disease patients to the clearly resectable group. Post-operative complications associated with pancreaticoduodenectomy and distal pancreatectomy include delayed gastric emptying, anastomotic failures, fistula formation, strictures, abscess, infarction, etc. The utility of dual-phase CT with multiplanar reconstruction and 3D rendering is increasingly recognized as a tool for the assessment of complications associated with vascular resection and reconstruction such as hemorrhage, pseudoaneurysm, vascular thrombosis, and ischemia. Prompt recognition of the complications and distinction from benign post-operative findings such as hepatic steatosis and mesenteric fat necrosis on imaging plays a key role in helping decrease the morbidity and mortality associated with surgery. We discuss, with case examples, some of such common and uncommon findings on imaging to familiarize the abdominal radiologists evaluating post-operative imaging in both acute and chronic post-operative settings.

6 Review Diagnosis and Detection of Pancreatic Cancer. 2017

Chu, Linda C / Goggins, Michael G / Fishman, Elliot K. · ·Cancer J · Pubmed #29189329.

ABSTRACT: Computed tomography is the first-line imaging modality for suspected pancreatic cancer. Magnetic resonance cholangiopancreatography is a second-line modality for suspected pancreatic cancer and is usually reserved for equivocal cases. Both computed tomography and MR are highly sensitive in the detection of pancreatic cancer, with up to 96% and 93.5% sensitivity, respectively. Computed tomography is superior to MR in the assessment of tumor resectability, with accuracy rates of up to 86.8% and 78.9%, respectively. Close attention to secondary signs of pancreatic cancer, such as pancreatic duct dilatation, abrupt pancreatic duct caliber change, and parenchymal atrophy, are critical in the diagnosis of pancreatic cancer. Emerging techniques such as radiomics and molecular imaging have the potential of identifying malignant precursors and lead to earlier disease diagnosis. The results of these promising techniques need to be validated in larger clinical studies.

7 Review Calcified pancreatic and peripancreatic neoplasms: spectrum of pathologies. 2017

Verde, Franco / Fishman, Elliot K. ·Department of Radiology, Johns Hopkins University, 601 N Caroline St, Ste 3235A, Baltimore, MD, 21287, USA. fverde1@jhmi.edu. · Department of Radiology, Johns Hopkins University, 601 N Caroline St, Ste 3235A, Baltimore, MD, 21287, USA. ·Abdom Radiol (NY) · Pubmed #28785786.

ABSTRACT: A variety of pancreatic and peripancreatic neoplasms may contain calcifications. We present a review of common to uncommon pancreatic neoplasms that may contain calcifications to include ductal adenocarcinoma, pancreatic neuroendocrine tumors, serous cystadenomas, solid pseudopapillary tumors, intraductal papillary mucinous neoplasms, mucinous cystic neoplasms, and lymphoepithelial cysts. In addition, duodenal mucinous adenocarcinoma can present as a peripancreatic mass that may contain calcification. Knowledge of the spectrum of calcification patterns can help the interpreting radiologist provide a meaningful differential.

8 Review Abdominal schwannomas: review of imaging findings and pathology. 2017

Lee, Nam Ju / Hruban, Ralph H / Fishman, Elliot K. ·Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA. nlee54@jhmi.edu. · Department of Pathology, Johns Hopkins School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA. · Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, 601 N. Caroline Street, Baltimore, MD, 21287, USA. ·Abdom Radiol (NY) · Pubmed #28265705.

ABSTRACT: Schwannomas are typically slow growing, encapsulated benign neoplasms. Visceral schwannomas are rare, and preoperative diagnosis is challenging, as they are often confused with other neoplasms even with advanced imaging studies. Surgical excision is usually needed to establish a definitive diagnosis, as pathology is the "gold standard." We review the imaging findings of abdominal schwannomas focusing on pancreatic, gastrointestinal, and retroperitoneal/adrenal schwannomas with pathology correlation. We conclude that schwannoma should be included in the broad differential diagnosis of an abdominal mass and that when it is unnecessary radical resection can be avoided.

9 Review Tumor-Vessel Relationships in Pancreatic Ductal Adenocarcinoma at Multidetector CT: Different Classification Systems and Their Influence on Treatment Planning. 2017

Zaky, Ahmed M / Wolfgang, Christopher L / Weiss, Matthew J / Javed, Ammar A / Fishman, Elliot K / Zaheer, Atif. ·From the Department of Surgery (A.M.Z., C.L.W., M.J.W., A.A.J.), the Russell H. Morgan Department of Radiology and Radiological Science (E.K.F., A.Z.), and the Pancreatitis Center (A.Z.), Johns Hopkins Medical Institutions, 601 N Caroline St, JHOC 3235 A, Baltimore, MD 21231. ·Radiographics · Pubmed #27885893.

ABSTRACT: Treatment of pancreatic ductal adenocarcinoma (PDAC) remains a challenge, given its propensity for early systemic spread and growth into the adjacent vital vascular structures. With the advent of newer surgical techniques and chemoradiation therapies, multidetector computed tomography (CT) plays a crucial role in the identification of patients with borderline resectable disease who may benefit from such treatments. Stage III PDAC is divided into two categories-locally advanced, defined by arterial encasement or nonreconstructible portovenous axis involvement; and borderline resectable, defined by limited arterial involvement and/or reconstructible portovenous involvement. A consensus definition for stage III borderline resectable PDAC has been proposed by the Americas Hepato-Pancreato-Biliary Association, the Society of Surgical Oncology, and the Society for Surgery of the Alimentary Tract and has gained widespread use. Evaluation of borderline resectable disease involves the identification of the circumferential and longitudinal relationship of the tumor with its neighboring vessels, markers of vascular invasion, and aberrant anatomic structures that alter the surgical approach. Furthermore, the use of template-based radiology reporting may increase the objectivity of the evaluation and mandate the provision of all of the key descriptors required for a comprehensive evaluation of the disease. In this review, the staging of PDAC at multidetector CT is described, with reference to the evaluation of the tumor-vessel interface as it guides treatment planning, along with a discussion of the key descriptors of PDAC at multidetector CT and their importance. Examples are provided of the imaging findings of borderline resectable disease and different surgical approaches, along with a discussion on the importance of standardized terminology and template-based reporting.

10 Review The many faces of pancreatic serous cystadenoma: Radiologic and pathologic correlation. 2017

Chu, L C / Singhi, A D / Haroun, R R / Hruban, R H / Fishman, E K. ·The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 North Wolfe Street, Halsted B168, 21287 Baltimore, MD, USA. Electronic address: lindachu@jhmi.edu. · Department of Pathology, University of Pittsburgh Medical Center, 15213 Pittsburgh, PA, USA. · The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 North Wolfe Street, Halsted B168, 21287 Baltimore, MD, USA. · The Sol Goldman Pancreatic Cancer Research Center, The Department of Pathology, Johns Hopkins Hospital, 401 North Broadway, 21231 Baltimore, MD, USA. ·Diagn Interv Imaging · Pubmed #27614585.

ABSTRACT: Pancreatic serous cystadenoma can be categorized into microcystic, honeycomb, oligocystic, and solid patterns based on imaging appearance. The presence of typical computed tomography (CT) features helps to differentiate serous cystadenomas from other cystic and solid pancreatic masses. Cases with atypical features present a diagnostic challenge as they can mimic malignant neoplasms. This article reviews pathophysiology, prevalence, CT features, mimickers and recommendations for management of pancreatic serous cystadenoma.

11 Review Imaging features of rare pancreatic tumors. 2016

Barral, M / Faraoun, S A / Fishman, E K / Dohan, A / Pozzessere, C / Berthelin, M-A / Bazeries, P / Barat, M / Hoeffel, C / Soyer, P. ·Department of Body and Interventional Imaging, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris, France; Université Diderot-Paris 7, Sorbonne Paris Cité, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France. Electronic address: matthiasbarral@gmail.com. · Department of Radiology, centre Pierre-et-Marie-Curie, place du 1(er)-Mai, 16016 Algiers, Algeria. · Department of Radiology, Johns Hopkins University, JHOC 3251, 601N, Caroline Street, 21287 Baltimore, MD, USA. · Department of Radiology, McGill University Health Center, 1650 Cedar avenue, Montreal, QC, Canada. · Department of Body and Interventional Imaging, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris, France. · Departement of Medical Imaging, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France. · Departement of Medical Imaging, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims, France. · Université Diderot-Paris 7, Sorbonne Paris Cité, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France. ·Diagn Interv Imaging · Pubmed #27825642.

ABSTRACT: The increasing use of abdominal imaging has led to a growing incidence of traditionally uncommon pancreatic tumors. These rare tumors have specific imaging features whose knowledge may heighten confidence in characterization and may avoid unnecessary surgical procedures when imaging findings suggest a benign condition. Computed tomography (CT) is the modality with which rare pancreatic tumors are incidentally detected in the majority of cases. Magnetic resonance imaging (MRI) is often performed as a second line examination for further characterization. This review provides an update on CT and MRI findings of rare tumors of the pancreas.

12 Review Postoperative Omental Infarct After Distal Pancreatectomy: Appearance, Etiology Management, and Review of Literature. 2015

Javed, Ammar A / Bagante, Fabio / Hruban, Ralph H / Weiss, Matthew J / Makary, Martin A / Hirose, Kenzo / Cameron, John L / Wolfgang, Christopher L / Fishman, Elliot K. ·Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Halsted 608, Baltimore, MD, 21287, USA. · Department of Surgery, Chirurgia Generale e Epatobiliare, G.B. Rossi University Hospital,, University of Verona, Verona, Italy. · Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA. · Department of Radiology, The Johns Hopkins Hospital, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA. efishman@jhmi.edu. ·J Gastrointest Surg · Pubmed #26302877.

ABSTRACT: INTRODUCTION: The clinico-radiological characteristics and the natural history of postoperative omental infarct (OI) in patients who underwent distal pancreatectomy (DP) and splenectomy have not been defined. MATERIALS AND METHODS: Twelve patients who underwent DP over a period of 2 years and were postoperatively diagnosed with OI based on computed tomography (CT) findings were identified. RESULTS: A total of 12 patients were diagnosed with an OI based on their postoperative imaging. Seven (58.3 %) patients had previously undergone laparoscopic DP, one (8.3 %) had undergone a robotic DP, and in one (8.3 %), a laparoscopic DP was converted to an open procedure. The remaining three (25.1 %) were treated with open DP. In five (41.6 %) patients, the diagnosis of OI was made during routine follow-up. One patient underwent surgical resection of OI, and two had drains placed in the mass. Nine patients were managed conservatively. During the study period, on review of CT imaging, the minimum prevalence of postoperative OI after DP was found to be 22.8 %. A review of literature identified nine articles that reported a total of 34 patients who were diagnosed with OI after abdominal surgery. CONCLUSION: The management of an asymptomatic postoperative OI should be conservative while an early invasive intervention should be performed in patients who are symptomatic or have infected OI.

13 Review Pearls and pitfalls of imaging metastatic disease from pancreatic adenocarcinoma: a systematic review. 2015

Zaheer, Atif / Wadhwa, Vibhor / Oh, Joseph / Fishman, Elliot K. ·The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21231; Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD 21231. Electronic address: azaheer1@jhmi.edu. · The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, MD 21231. ·Clin Imaging · Pubmed #25981735.

ABSTRACT: Pancreatic adenocarcinoma is a systemic disease due to the presence of metastatic disease at the time of diagnosis and local recurrence as well as distant metastatic disease after treatment in a majority of patients. Recognition of these metastatic sites may help in accurate staging and assessment of therapeutic response. The authors discuss and illustrate imaging findings of metastatic disease from pancreatic adenocarcinoma in different organ systems with emphasis on entities that can mimic metastatic pancreatic cancer.

14 Review Cross-sectional imaging and the role of positron emission tomography in pancreatic cancer evaluation. 2015

Raman, Siva P / Chen, Yifei / Fishman, Elliot K. ·Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD. · Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD. Electronic address: efishman@jhmi.edu. ·Semin Oncol · Pubmed #25726051.

ABSTRACT: Pancreatic cancer is an extraordinarily morbid malignancy with a poor prognosis. As a result, it is imperative that imaging examinations correctly identify tumors when they are relatively small and potentially still resectable, as well as accurately stage tumors to determine which patients should undergo definitive surgery. Multidetector computed tomography (MDCT) has been established as the most important modality for both initial diagnosis and staging, although positron emission tomography (PET) and magnetic resonance imaging (MRI) both play important ancillary roles. This review discusses how these three modalities play complementary roles in tumor diagnosis and staging.

15 Review Solid-pseudopapillary neoplasm of the pancreas: cytomorphologic findings and literature review. 2014

Bhatnagar, Ramneesh / Olson, Matthew T / Fishman, Elliot K / Hruban, Ralph H / Lennon, Anne M / Ali, Syed Z. ·Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Md., USA. ·Acta Cytol · Pubmed #24969629.

ABSTRACT: BACKGROUND: Solid-pseudopapillary neoplasm (SPN) is a rare pancreatic malignancy with an excellent prognosis. It is most commonly diagnosed in young women. This article comprehensively reviews the clinical, pathological and radiological features of this neoplasm, as well as its clinical management. METHODS: A literature review of SPN was performed of all articles published in the English language in PubMed prior to November 1, 2013. Cytomorphological features, histopathology, immunohistochemistry, patient general demographics, molecular studies, radiologic imaging and clinical management were reviewed. RESULTS: SPN displays distinct cytomorphological features on fine-needle aspiration - thin, delicate, branching vessels in a 'Chinese character' pattern lined by one to several layers of loosely cohesive neoplastic cells. Nuclear features include indented or grooved nuclei with an evenly distributed chromatin pattern and small inconspicuous nucleoli. SPN is characteristically immunoreactive for CD10, β-catenin (in an abnormal nuclear pattern), CD99 in a perinuclear dot-like pattern, α1-antitrypsin, and progesterone receptor. Almost all SPNs harbor an activating point mutation in exon 3 of the β-catenin gene (CTNNB1). Clinicopathological features generally do not correlate with prognosis, and most patients experience excellent long-term survival. CONCLUSIONS: SPN can mimic other neoplasms of the pancreas, which can lead to diagnostic challenges in a limited cytologic specimen. Distinct cytomorphological features can help distinguish SPNs from other pancreatic neoplasms. Complete surgical resection as well as resection of metastatic disease is preferred given a low rate of tumor recurrence and long periods of disease-free intervals.

16 Review The early detection of pancreatic cancer: what will it take to diagnose and treat curable pancreatic neoplasia? 2014

Lennon, Anne Marie / Wolfgang, Christopher L / Canto, Marcia Irene / Klein, Alison P / Herman, Joseph M / Goggins, Michael / Fishman, Elliot K / Kamel, Ihab / Weiss, Matthew J / Diaz, Luis A / Papadopoulos, Nickolas / Kinzler, Kenneth W / Vogelstein, Bert / Hruban, Ralph H. ·Authors' Affiliations: Departments of Medicine; Surgery; · Surgery; Pathology; Oncology; · Authors' Affiliations: Departments of Medicine; · Pathology; Oncology; Department of Epidemiology, the Bloomberg School of Public Health, Baltimore, Maryland. · Oncology; Radiation Oncology; and. · Authors' Affiliations: Departments of Medicine; Pathology; Oncology; · Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine; and. · Surgery; · Oncology; · Pathology; Oncology; · Pathology; Oncology; rhruban@jhmi.edu. ·Cancer Res · Pubmed #24924775.

ABSTRACT: Pancreatic cancer is the deadliest of all solid malignancies. Early detection offers the best hope for a cure, but characteristics of this disease, such as the lack of early clinical symptoms, make the early detection difficult. Recent genetic mapping of the molecular evolution of pancreatic cancer suggests that a large window of opportunity exists for the early detection of pancreatic neoplasia, and developments in cancer genetics offer new, potentially highly specific approaches for screening of curable pancreatic neoplasia. We review the challenges of screening for early pancreatic neoplasia, as well as opportunities presented by incorporating molecular genetics into these efforts.

17 Review A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? 2014

Law, Joanna K / Ahmed, Aadil / Singh, Vikesh K / Akshintala, Venkata S / Olson, Matthew T / Raman, Siva P / Ali, Syed Z / Fishman, Elliot K / Kamel, Ihab / Canto, Marcia I / Dal Molin, Marco / Moran, Robert A / Khashab, Mouen A / Ahuja, Nita / Goggins, Michael / Hruban, Ralph H / Wolfgang, Christopher L / Lennon, Anne Marie. ·From the *Division of Gastroenterology, †Department of Pathology, ‡Department of Radiology, Johns Hopkins University School of Medicine, §Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, and ∥Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. ·Pancreas · Pubmed #24622060.

ABSTRACT: OBJECTIVE: The aim of the study was to determine if there had been any change in the number of solid-pseudopapillary neoplasm (SPN) cases detected and their evaluation or management over time. METHODS: A systematic review of SPN was performed of all articles published in English in PubMed and Scopus. RESULTS: A total of 2744 patients with SPN were identified in 484 studies published between 1961 and 2012; 87.8% of the cases were reported between 2000 and 2012. A total of 2408 (87.8%) were females, and the mean age was 28.5 (SD, 13.7) years. The most common symptom was abdominal pain in 63.6% of the cases and incidentally detected in 38.1% of the cases. There were 2285 patients who underwent pancreatic resection. The mean tumor size was 8.6 (SD, 4.3) cm. Follow-up was reported for 1952 (90.5%) patients, with a mean follow-up of 36.1 (SD, 32.8) months. Disease-free survival was documented in 1866 (95.6%) patients with recurrence in 86 (4.4%) patients; the median time to recurrence was 50.5 months. CONCLUSIONS: The number of SPNs reported in the literature has seen a 7-fold increase in the number of cases reported since 2000 compared with before. Solid-pseudopapillary neoplasms continue to be primarily found in young women and present with nonspecific symptoms. Surgery remains the mainstay of treatment with an excellent long-term prognosis.

18 Review Magnetic resonance imaging of cystic pancreatic lesions in adults: an update in current diagnostic features and management. 2014

Barral, Matthias / Soyer, Philippe / Dohan, Anthony / Laurent, Valérie / Hoeffel, Christine / Fishman, Elliot K / Boudiaf, Mourad. ·Department of Abdominal Imaging, Hôpital Lariboisière-APHP and Université Diderot-Paris 7, 2, rue Ambroise Paré, 75010, Paris, France, matthias_barral@yahoo.fr. ·Abdom Imaging · Pubmed #24263208.

ABSTRACT: Magnetic resonance (MR) imaging has become a widespread diagnostic solving tool for the detection and characterization of a large range of pancreatic cystic lesions. Benign and malignant cystic lesions of the pancreas including serous microcystic adenoma, mucinous cystic tumor, intraductal papillary mucinous tumor, solid pseudopapillary tumor, and also the less common lesions such as cystic endocrine tumors, cystic metastases, and lymphangiomas have suggestive MR imaging presentation that allows them to be differentiated from each other. Knowledge of MR imaging findings of cystic pancreatic lesions is critical to help suggest the diagnosis and chose the best therapeutic approach. The purpose of this review is to discuss and illustrate MR imaging features that are helpful for pancreatic cystic lesion detection and characterization and to provide an update in current MR imaging diagnostic features and management.

19 Review The diagnosis and surgical treatment of pancreatoblastoma in adults: a case series and review of the literature. 2013

Salman, Bulent / Brat, Gabriel / Yoon, Yoo-Seok / Hruban, Ralph H / Singhi, Aatur D / Fishman, Elliot K / Herman, Joseph M / Wolfgang, Christopher L. ·Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. ·J Gastrointest Surg · Pubmed #24081396.

ABSTRACT: INTRODUCTION: Pancreatoblastoma is an extremely rare pancreatic neoplasm in adults. The aim of this study is to report our experience with adult pancreatoblastoma as well as review the cases reported in the literature in order to provide guidelines for the management of patients with this rare neoplasm. METHODS: We have encountered three cases of pancreatoblastoma in adults at our institution in addition to the 30 cases reported to date in literature. RESULTS: The median age of pancreatoblastoma in adults is 37 years (range, 18-78 years); men and women are similarly affected (male/female = 16/17). The behavior of pancreatoblastoma is clearly that of a malignant neoplasm, with local invasion, recurrence, and metastasis. Among the adult reported cases, at diagnosis or operation, metastasis and/or local invasion was found in 14 of 31 adult patients (46 %) (2 patients had no data) The survival was significantly higher in patients with resected tumor (resection only and resection + adjuvant chemo/radiotherapy) when compared to unresected patients (palliative chemo/radiotherapy and no treatment), (p = 0.008, HR = 0.20). CONCLUSION: When disease is localized, the treatment of choice is a complete surgical resection. The role of adjuvant chemotherapy or radiotherapy is still unclear based on the very small number of patients treated.

20 Review Recent progress in pancreatic cancer. 2013

Wolfgang, Christopher L / Herman, Joseph M / Laheru, Daniel A / Klein, Alison P / Erdek, Michael A / Fishman, Elliot K / Hruban, Ralph H. ·Associate Professor, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; Associate Professor, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD; Associate Professor, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD. ·CA Cancer J Clin · Pubmed #23856911.

ABSTRACT: Pancreatic cancer is currently one of the deadliest of the solid malignancies. However, surgery to resect neoplasms of the pancreas is safer and less invasive than ever, novel drug combinations have been shown to improve survival, advances in radiation therapy have resulted in less toxicity, and enormous strides have been made in the understanding of the fundamental genetics of pancreatic cancer. These advances provide hope but they also increase the complexity of caring for patients. It is clear that multidisciplinary care that provides comprehensive and coordinated evaluation and treatment is the most effective way to manage patients with pancreatic cancer.

21 Review Routine use of precontrast and delayed acquisitions in abdominal CT: time for change. 2013

Johnson, Pamela T / Fishman, Elliot K. ·Department of Radiology, Johns Hopkins Hospital, 601 N. Caroline Street, Room 3140D, Baltimore, MD 21287, USA. Pjohnso5@jhmi.edu ·Abdom Imaging · Pubmed #23132390.

ABSTRACT: OBJECTIVE: With major efforts being made to reduce radiation exposure in CT, one area of practice that requires additional improvement is limiting the number of acquisitions for body CT imaging. This review article defines best MDCT practice in terms of tailored abdominal CT protocols, designed to maximize lesion detection while limiting radiation exposure. CONCLUSIONS: The literature defines optimal acquisitions for a range of abdominal CT indications, with precontrast and delayed acquisitions being least commonly indicated.

22 Review Incidentally detected cystic lesions of the pancreas on CT: review of literature and management suggestions. 2013

Zaheer, Atif / Pokharel, Sajal S / Wolfgang, Christopher / Fishman, Elliot K / Horton, Karen M. ·Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC 3235 A, Baltimore, MD 21231, USA. azaheer1@jhmi.edu ·Abdom Imaging · Pubmed #22534872.

ABSTRACT: PURPOSE: To facilitate a better understanding of incidentally noted cystic pancreatic lesions, since these lesions often pose a challenge regarding appropriate management. METHODS: This article reviews pathophysiology, prevalence, significance, and recommendations for management of the various pancreatic cystic lesions. Illustrative cases are demonstrated. RESULTS: Diagnostic benign lesions can be left alone. Cross-sectional imaging can be used to follow-up benign appearing lesions and to stage more aggressive ones. Endoscopic ultrasound with fine needle aspiration and cyst fluid analysis can be performed on certain indeterminate lesions. Lesions with high malignant potential should undergo resection. CONCLUSIONS: A better understanding of the variety of incidentally detected pancreatic cystic lesions can help direct appropriate management.

23 Review Metastatic disease to the pancreas: pathologic spectrum and CT patterns. 2013

Ahmed, Sameer / Johnson, Pamela T / Hruban, Ralph / Fishman, Elliot K. ·School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA. ·Abdom Imaging · Pubmed #22349804.

ABSTRACT: Metastases to the pancreas are rare; nevertheless, early detection allows for appropriate treatment and improved outcomes for metastatic disease. Computed tomography plays a pivotal role in characterizing these tumors, as demonstrated in this pictorial review. Given significant differences in prognosis and treatment, it is crucial to differentiate primary and secondary pancreatic lesions; however, this may not be possible based on imaging features alone.

24 Review Multimodality imaging of pancreatic cancer-computed tomography, magnetic resonance imaging, and positron emission tomography. 2012

Raman, Siva P / Horton, Karen M / Fishman, Elliot K. ·Department of Radiology, Johns Hopkins University, Baltimore, MD, USA. srsraman3@gmail.com ·Cancer J · Pubmed #23187837.

ABSTRACT: Pancreatic adenocarcinoma continues to have a dismal prognosis, with curative surgery (resection with negative margins) possible in only a small percentage of patients. Not only does radiological imaging play a major role in diagnosing the primary lesion at presentation, but it is also crucial for staging of locoregional disease and distant metastases, both of which are critical for selecting appropriate candidates for surgery. Over the last 2 decades, computed tomography has become the dominant imaging modality for both the diagnosis and staging of pancreatic cancer, with advances in multidetector computed tomography technology improving the ability to identify small tumors and demonstrate subtle degrees of vascular involvement by tumor. However, magnetic resonance imaging and positron emission tomography are now playing an increasing role in pancreatic cancer imaging. These 3 imaging modalities each have specific strengths and benefits and should be used in a complementary fashion.

25 Review Pancreatic imaging mimics: part 2, pancreatic neuroendocrine tumors and their mimics. 2012

Raman, Siva P / Hruban, Ralph H / Cameron, John L / Wolfgang, Christopher L / Fishman, Elliot K. ·Department of Radiology, Johns Hopkins University, JHOC 3251, 601 N Caroline St, Baltimore, MD 21287, USA. srsraman3@gmail.com ·AJR Am J Roentgenol · Pubmed #22826391.

ABSTRACT: OBJECTIVE: This pictorial essay reviews the imaging appearance of pancreatic neuroendocrine tumors, as well as a number of mimics on CT. CONCLUSION: Pancreatic neuroendocrine tumors have a distinct appearance, typically characterized by a well-defined hypervascular mass best visualized on arterial phase images. However, a number of other lesions can mimic the CT appearance of pancreatic neuroendocrine tumors, including pancreatic metastases, acinar cell carcinoma, pancreatoblastoma, solitary fibrous tumor, pancreatic hamartoma, serous adenoma, intrapancreatic splenules, exophytic gastrointestinal stromal tumors, and peripancreatic paragangliomas.

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