Recently developed molecular analyses of cyst fluid may provide a promising role in distinction of nonmucinous from mucinous cyst in general and of benign and malignant cysts in particular (3),(23). This series has a few limitations that merit discussion. This is a retrospective study from a single tertiary referral center and thus could have been underpowered to detect a true difference in CEA levels between the two cyst types studied. Only 61% of all resected pancreatic cysts during the study period had preoperative EUS evaluation, and more than half of the cases did not undergo EUS-FNA. This could be explained by the

fact that the decision to resect many of the pancreatic cysts Inhibitors,research,lifescience,medical especially the large ones which may have been symptomatic then was based on conventional imaging features as well as the clinical presentation; therefor EUS with fluid aspiration results may not have felt to influence the treatment course and therefore were not referred for preoperative EUS evaluation. Of those who underwent FNA, cyst fluid analysis Inhibitors,research,lifescience,medical was technically not feasible in about one-third of patients, due to technical reasons or small fluid volume amenable for adequate laboratory testing. Thus, type I error and referral bias is expected since most surgeries in this series

were performed for malignant or highly suspicious premalignant lesions. In conclusion, Inhibitors,research,lifescience,medical the current series suggest that pancreatic cyst fluid amylase and CEA levels may not appear to distinguish BD-IPMNs from MCNs. However; larger Inhibitors,research,lifescience,medical adequately powered studies are needed to evaluate this further. Therefore, clinical picture, cyst imaging morphology and evaluation of the presence (IPMN) or absence (MCN) of pancreatic duct communication remains the up-to-date tools to differentiate these two groups. Footnotes

No Inhibitors,research,lifescience,medical potential conflict of interest. The authors have no conflict of interest to declare related to this work.
A 37 year old G3P1011 pregnant Rapamycin order female presented to her primary care physician with 10 days of nausea, vomiting, back pain, Megestrol Acetate acholia, and dark colored urine. Her symptoms worsened as the day progressed. She initially thought the symptoms were related to her pregnancy, which was 16 weeks at the time of presentation. She had only minimal symptoms during the first trimester, and prenatal evaluations/ultrasounds had all been normal, demonstrating a single intrauterine pregnancy with appropriate growth for dates. No familial cancer syndromes were identified, and there were no known toxic exposures. On initial examination, she was afebrile, and not in acute distress. Murphy’s sign was present. No guarding or rebound was demonstrated. She had a serum bilirubin of 2.8 mg/dL (direct 1.5 mg/dL), and an alkaline phosphatase of 261 u/L. Hepatitis serologies were negative.