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Pancreatic cystic lesions can be benign, premalignant or malignant. The recent increase in detection and tremendous clinical variability of pancreatic cysts has presented a significant therapeutic challenge to physicians. Mucinous cystic neoplasms are of particular interest given their known malignant potential. This review article provides a brief but comprehensive review of premalignant pancreatic cystic lesions with advanced endoscopic ultrasound (EUS) management approaches. A comprehensive literature search was performed using PubMed, Cochrane, OVID and EMBASE databases. Preneoplastic pancreatic cystic lesions include mucinous cystadenoma and intraductal papillary mucinous neoplasm. The 2012 International Sendai Guidelines guide physicians in their management of pancreatic cystic lesions. Some of the advanced EUS management techniques include ethanol ablation, chemotherapeutic (paclitaxel) ablation, radiofrequency ablation and cryotherapy. In future, EUS-guided injections of drug-eluting beads and neodymium:yttrium aluminum agent laser ablation is predicted to be an integral part of EUS-guided management techniques. In summary, International Sendai Consensus Guidelines should be used to make a decision regarding management of pancreatic cystic lesions. Advanced EUS techniques are proving extremely beneficial in management, especially in those patients who are at high surgical risk. [ABSTRACT FROM AUTHOR]

Introduction: Mammalian liver has highly regenerative capacity following resection or injury by restoring its original mass. However, in the endstage liver disorders, regeneration usually fails and orthotropic liver transplantation (OLT) seems to be the only curative approach. Cellular therapy is a promising approach that may preclude the need for OLT. Adult or embryonic hepatocytes and mesenchymal stem cells (MSCs) can be used for this purpose. Among them, MSCs are extrahepatic stem cells derived from bone marrow, adipose tissue, pancreatic epithelial progenitor cells, neural and umbilical cord blood-derived somatic stem cells have been shown to possess the potential to trans-differentiate into hepatic cells. Aim: To show the comparative, regenerative and curative effect of bone marrow MSCs on rats having hepatic fibrosis produced by common bile duct ligation (CBDL) model. Methods: Rats were divided into three groups; 1- CBDL rats that were given MSCs (CBDL+MSC), 2- CBDL rats that were given phosphate-buffered saline (PBS) (CBDL+PBS), 3- Healthy rats that were sham operated and given MSCs (Healthy+MSCs). Effect of MSC treatment were measured at three levels: morphological, phenotypical and functional. We analyzed the in vivo functional. Morphologically, MSCs were labeled with GFP to check the localization of stem cells and to get an idea for the regenerative capacity in the injured liver. Phenotypically, immunological studies were carried out to highlight the immune-regulatory effect of stem cells as to prevent apoptosis of hepatocytes, effects on the levels of regulatory T cells and pro-inflammatory T helper subsets such as Th1. Cytokine secretions from anti-CD2, anti- CD3 and anti-CD28 stimulated splenocytes (lymphocyte subtypes in spleen) were evaluated. Results: Histologically, liver fibrosis developed in CBDL rats while the entire group of healthy rats did not show any alteration in liver architecture. MSCs suppressed the rat splenocyte proliferation significantly more in CBDL+MSC compared with CBDL+PBS group (p<0,05). NK cells in peripheral blood increased significantly more in CBDL+MSC compared with CBDL+PBS (p<0.05). Peripheral CD4+ CD25+ ratio increased in CBDL+PBS compared with CBDL+MSC. MSCs suppressed the proinflammatory cytokine levels in CBDL+MSC. Discussion: Our findings suggest bone marrow derived MSCs may be effective in alleviating the hepatic injury by suppressing the spelonocyte proliferation, increasing the circulating peripheral NK cell population and CD4+CD25+ cells and by suppressing the proinflammatory cytokines in rats. Thus, MSC injection treatment may appear promising in liver injury and future clinical therapies are warranted. [ABSTRACT FROM AUTHOR]

Background and Aims: Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant syndrome characterized by tumors arising from endocrine glands with no specific genotype-phenotype correlation. Herein, we report the largest Turkish kindred with MEN1 inherited a scarce MEN1 mutation gene., Materials and Methods: Sixty-four year-old man, referred to our gastroenterology outpatient clinic for evaluation of pancreatic mass lesion, was diagnosed with MEN1-syndrome after endoscopic ultrasound guided sampling of the mass revealing pancreatic neuroendocrine tumor (pNET), and accompanying primary hyperparathyroidism (PHPT) and pituitary tumor. Genetic analysis by whole gene Sanger sequencing of MEN1 gene identified a frame-shift mutation in exon 10 (c.1680&#95;1683delTGAG). All the relatives of the index case were proposed for clinical and genetic evaluation for MEN1-syndrome., Results: Of the 25 relatives of the index case, 17 were diagnosed MEN1-syndrome. Eighteen members among all relatives consented to genetic analysis and 11 had the same mutation as the index case. All the mutation positive members had MEN1, while none of mutation negative subjects had any sign of MEN1-syndrome. The frequencies of PHPT, pNET and pituitary tumors in this kindred were 94.1% (16/17), 29.4% (5/17) and 29.4% (5/17) respectively., Conclusion: We report rare MEN1 gene mutation which was descibed in a single sporadic patient before. It inherited in at least three generations of a large family, which has proven strong dominant effect on MEN1 phenotype. Further researches may be conducted to clarify potential candidacy of this mutation, as a hotspot for MEN1 patients, especially in Turkish population.

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors found in the gastrointestinal (GI) tract, with the stomach being the most common site. They represent a distinct group of GI tumors originating from the interstitial cells of Cajal and are characterized by gain-of-function mutations of KIT. KIT oncoprotein serves as both diagnostic and therapeutic targets. Prognosis is related to size, mitotic activity, and site of the tumor. Asymptomatic, small endoscopic ultrasonography (EUS)-suspected GISTs are increasingly encountered with the wide availability of endoscopic/endosonographic examination. The majority of small GISTs are biologically indolent, albeit possibly harboring c-KIT gene mutations. An ongoing controversy exists regarding the management and surveillance policy for small gastric GISTs. A number of reports on the management of GISTs have been published, not confidently addressing the issue of gastric GISTs of small size. This work provides an overview on the current state of management considerations, specifically focusing on small EUS-suspected gastric GISTs, which are increasingly encountered by clinicians.