Hyperamylasemia

Selleckchem Nintedanib related to lavage cytology occurred in 5 of 44 patients (11.4%), but pancreatitis developed in none of them, and we considered the risk related to the procedure acceptable because of its high sensitivity and specificity. The reason for this low morbidity could be the care taken during the procedure of lavage cytology; that is, 1 mL of saline solution was injected through the injection lumen while 1 mL of the fluid in the pancreatic duct was concomitantly aspirated via the aspiration lumen, thus avoiding an increase in intrapancreatic ductal pressure. It would have been more difficult to aspirate a sufficient volume of mucous pancreatic juice using other commercially available double-lumen catheters because of the thin cross-sectional area of their aspiration lumen. The cross-sectional area of aspiration lumen of our double-lumen cytology catheter

is large because of the coaxial structure of the Z-VAD-FMK ic50 catheter and mucous pancreatic juice could be easily aspirated at a rate of 30 mL per 1 or 2 minutes. As a result, mucin staining of the aspirated material was feasible in all our resected cases. The diagnostic efficacy of smear cytology may vary depending on the level of proficiency of the cytopathologists even if a sufficient number of cells are sampled.7, 20 and 21 On the other hand, the cell block method allows cytological and/or histological evaluation with H&E staining, which is familiar to pathologists.8 Actually, the present study showed a sensitivity of 92% and a specificity of 100% with H&E staining; besides, even the neoplastic epithelium of IPMNs could be examined in each cell block section. Nevertheless, discrepancy during pathological assessment of IPMNs is a clinical issue that needs to be resolved. Although histology was evaluated by experienced pathologists in the present study, a multicenter prospective analysis based on a more objective rule will be required so that it can be assessed even by less experienced pathologists in the near future.22 Furthermore,

the cell block method allows MUCs 1, 2, 5AC, and 6, which are essential to determine the histological subtype of IPMNs; namely, intestinal, gastric foveolar, oncocytic, Rucaparib clinical trial and pancreatobiliary.9, 10 and 11 Subclassification of IPMNs could be useful for the evaluation of the malignant potential of IPMNs.9, 10, 11 and 23 Most intestinal-type IPMNs express MUC2 and MUC5AC but not MUC1 and are thought to progress to invasive mucinous carcinoma, which has a better prognosis compared with pancreatobiliary and oncocytic IPMNs, which are positive for MUC1 and MUC5AC but negative for MUC2 and thought to progress to invasive tubular adenocarcinoma. Most gastric foveolar–type IPMNs express MUC5AC but not MUC1 or MUC2 and have been found to be noninvasive.