RESUMO
BACKGROUND: The presence of ovarian-type stroma defines mucinous cystic neoplasm (MCN). Criteria for surgical resection differ between current consensus guidelines (IAP, AGA, and Europe). This meta-analysis aims to describe pre-surgical clinical parameters that predict malignant transformation of MCN of the pancreas. METHODS: A systematic review and meta-analysis of articles published from 2006 to the time of manuscript authorship in December 2022. The electronic databases included English publications in Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, and Scopus. RESULTS: 17 studies were identified and included 1058 patients with MCN treated with pancreatectomy. The mean cohort age was 48.2 years (standard deviation [SD] ± 7.9) with an expected female predominance (96 %). The presenting symptom for most was abdominal pain (55.6 %), however, nearly 20 % of patients were asymptomatic. Most patients were treated with distal pancreatectomy (70.5 %), and the mean tumor size was 45 mm. The rate of invasive cancer was 13.8 %. Cysts with mural nodules had a higher risk of developing invasive tumors than those that did not (OR 26.47, 95%CI 12.57-55.74, p < 0.001, I2:0 %). Other clinical factors such as the presence of intramural calcifications or an elevated serum CA 19-9 (>37U/mL) were not predictive of malignancy. CONCLUSION: The present meta-analysis did not clarify establishing reliable predictors for malignant transformation other than mural modularity, which may represent tumors that have already undergone transformation. It may be used as a criterion in treatment decision-making.
RESUMO
Las miasis humanas son ectoparasitosis causadas por larvas de varias especies de moscas que producen distintas formas clínicas, afectan piel, cavidades y heridas. Estas prevalecen en regiones tropicales. Se presenta un caso de miasis foruncular en un hombre de 32 años, turista, infestado en una zona tropical húmeda de la región costera del Pacífico del Ecuador. Acude a consulta con un cuadro clínico de 30 días de evolución, y refiere picadura de insecto que creció hasta formar elevación indurada prurítica, no dolorosa, en piel de flanco izquierdo del abdomen. Al examen físico se observó una lesión foruncular de 3 x 2 cm rodeada de placa eritematosa con el centro abierto observándose un agujero central que descargaba un líquido sero-sanguinolento con movimientos. Por extracción manual se obtuvo una sola larva que por sus características externas se identificó como Dermatobia hominis. El resto del examen físico y exámenes de laboratorio fueron normales. Las actividades turísticas o de trabajo a estas zonas tropicales expone a las personas al riesgo de contraer miasis, por ende, es necesario información y medidas de prevención(AU)
Human myases are ectoparasitic infections caused by larvae of several fly species. They present various clinical manifestations, affecting the skin, cavities and wounds. Myases prevail in tropical regions. A case is presented of furuncular myasis in a male 32-year-old tourist infected in a humid tropical area from the Pacific coastal region of Ecuador. The patient presented with a clinical status of 30 days' evolution, reporting an insect bite that grew to form a painless indurated pruritic nodule on the skin of his left flank of the abdomen. Physical examination found a 3 x 2 cm furuncular lesion surrounded by erythematous plaque and an open center which discharged a serosanguineous fluid with movement. A single larva was obtained by manual extraction, which was identified as Dermatobia hominis based on its external characteristics. The remaining physical examination and laboratory tests were normal. Tourist and work activities in these tropical areas expose people to the risk of contracting myasis. Information and prevention measures are therefore necessary(AU)