When tumors are resected; routine intraoperative histologic frozen section examinations were done on the pancreatic, bile duct, and retroperitoneal soft tissue margins. A positive pancreatic

or bile duct margin for malignancy mandated further resection until a negative margin was obtained. Persistently positive pancreatic margins for malignancy or main duct IPMN often resulted in a total pancreatectomy at the discretion of the surgeon. Regional lymph nodes routinely resected en bloc with the tumor specimen. The final diagnosis in each patient was made by the result of surgical resection and corresponding histopathology. Histologic interpretation of resected specimens was carried out by experienced gastrointestinal pathologists Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical and interpretation of the cystic lesions was made according to WHO tumor classification

as follows: “(1) a inhibitors mucinous cystic neoplasm (Low Grade Dysplasia (LGD), High Grade Dysplasia (HGD), or malignant) or (2) a nonmucinous cystic lesion including serous, inflammatory, and endocrine. Cystic lesions arising from an intraductal papillary mucinous tumor (IPMN) were considered mucinous” (10). IPMNs were further classified as branched cysts only (BD-IPMN) or involving the main pancreatic duct with or without side-branched Inhibitors,research,lifescience,medical cysts (MD-IPMN). Malignant mucinous cysts demonstrated were defined as the presence of invasive carcinoma; all other neoplasms (including high grade dysplasia) were considered benign. Statistical analysis Continuous variables associations were assessed with an unpaired t test. The association between categorical variables of mucinous and non mucinous cysts was assessed with the Fisher’s exact Inhibitors,research,lifescience,medical test. Mean values of cyst fluid CEA (normal range 0-2.5 ng/ml) and amylase (normal range 25-115 U/L) were correlated to corresponding

surgical histopathology and compared using the Mann-Whitney Test. A p-value less than 0.05 was considered statistically significant. Results During the study period, 134 patients underwent surgery for pancreatic cysts including: 87 (65%) classic or pylorus sparing pancreaticoduodenectomies, 44 (33%) distal pancreatectomies and 3 (2%) total/subtotal pancreatectomies. Of these, 82 Inhibitors,research,lifescience,medical Rolziracetam (61%) patients (28 male; median age 60 years; range; 20-83) patients had a preoperative EUS and comprised the study population (Figure 1). No EUS-related complications were noted in any patient. Figure 1 Algorithm of study population. MCN: mucinous cystic neoplasm; IPMN: intraductal papillary mucinous neoplasm; SCA: serous cystadenoma; PC: pseudocyst. Surgical pathology revealed 66 mucinous and 16 non-mucinous pancreatic cysts (Table 1). Although age was similar between the two groups (p=0.51), mucinous cysts were significantly more common in females (p=0.04). No statistically significant difference in any presenting symptom was noted between the two groups. Abdominal pain was the most common presenting symptom (n=42, 58%), followed by preceding history of pancreatitis (n=24, 33%).