MCN - (Mother cyst) >95% in pre-menopausal women Mostly in body and tail of pancreas Thick-walled cyst, lined by Ovarian type stroma. Cyst contains mucinous / hemorrhagic material. Does not communicate with PD (unlike IPMN) 10-20% have in-dwelling cancer One review found - no dysplasia in cysts <3 cm in size LN mets is rare. Distal pancreatectomy usually suffices. Doesnt result in metachronous lesions. Surveillance isnt really necessary SCA - (Grandmother cyst) 75% of SCAs seen in post-menopausal women Can be anywhere in pancreas Honeycombing, with tiny cysts containing clear fluid distributed around central scarring. Central scarring may bear calcification in 30% cases Microcystic SCAs can undergo degeneration and become macrocystic variants zero risk of malignancy, but they can continue to grow and cause obstructive symptoms SPN - (daughter lesion) - Solid Pseudopapillary Neoplasm 90% of lesion occur in young women, in teens / twenties Anywhere in pancreas Solid / Solid-cys
CEA Levels: CEA >192 is 60% sensitive and 90% specific for mucinous cysts (ipmn/mcn) This was based on a study of 70 lesions in 2004 and has stuck till date CEA < 5 has excellent negative predictive value for mucinous cysts CEA > 5, therefore can still be a mucinous neoplasm and needs to be taken in context. Other markers such as Ca 72-4, CA 19-9, CA 15-3, CA 125 have lower accuracy than CEA Amylase levels: · Amylase < 250 IU/L is highly unlikely to be connected to PD (eg SCA) · MCN usually have very low / low amylase (one study suggested it has similar amylase to ipmn) Glucose: · Glucose is very low in mucinous tumors & pseudocysts (those with communication to PD)– usually less than 2.8 mmol/l Glucose < 2.8 mmol/l has Sens/Spec of 90/90 ( more accurate) compared to CEA >192 (sens/spec 60/90) for identification of mucinous cysts
IDA Ferritin: (BSG 2021 / UTD) Ferritin is the universal intracellular protein containing Iron – a soluble and non-toxic form. It is the primary iron storage protein in prokaryotes and eukaryotes. Ferritin w/o iron is called apo-ferritin . Each ferritin molecule can store up to 4,500 atoms of iron within it. Iron deficiency anaemia: 1) Low MCH is more sensitiv e for Iron deficiency than Low MCV. 2) Low Ferritin is single most important serological marker of IDA. Serum ferritin assessed by assays is usually apo-ferritin, but reflects intra-cellular ferritin stores in RES (macrophages in liver, spleen, LN etc ) in absence of inflammation. Fe < 15 – indicative of absent iron stores Fe <45 – indicative of low iron stores In anaemia of chronic disease / CHF - TSat <20% with Fe <100 is suggestive of Fe deficiency Fe > 150 unlikely to represent low iron stores even in face of inflammation . 3) Transf
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