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Article: Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Challenging Diagnosis.

Triantopoulou, Charikleia / Gourtsoyianni, Sofia / Karakaxas, Dimitriοs / Delis, Spiros

2023 Volume 13, Issue 12

Abstract: Intraductal papillary mucinous neoplasm of the pancreas (IPMN) was classified as a distinct entity from mucinous cystic neoplasm by the WHO in 1995. It represents a mucin-producing tumor that originates from the ductal epithelium and can evolve from ... ...

Abstract	Intraductal papillary mucinous neoplasm of the pancreas (IPMN) was classified as a distinct entity from mucinous cystic neoplasm by the WHO in 1995. It represents a mucin-producing tumor that originates from the ductal epithelium and can evolve from slight dysplasia to invasive carcinoma. In addition, different aspects of tumor progression may be seen in the same lesion. Three types are recognized, the branch duct variant, the main duct variant, which shows a much higher prevalence for malignancy, and the mixed-type variant, which combines branch and main duct characteristics. Advances in cross-sectional imaging have led to an increased rate of IPMN detection. The main imaging characteristic of IPMN is the dilatation of the pancreatic duct without the presence of an obstructing lesion. The diagnosis of a branch duct IPMN is based on the proof of its communication with the main pancreatic duct on MRI-MRCP examination. Early identification by imaging of the so-called worrisome features or predictors for malignancy is an important and challenging task. In this review, we will present recent imaging advances in the diagnosis and characterization of different types of IPMNs, as well as imaging tools available for early recognition of worrisome features for malignancy. A critical appraisal of current IPMN management guidelines from both a radiologist's and surgeon's perspective will be made. Special mention is made of complications that might arise during the course of IPMNs as well as concomitant pancreatic neoplasms including pancreatic adenocarcinoma and pancreatic endocrine neoplasms. Finally, recent research on prognostic and predictive biomarkers including radiomics will be discussed.
Language	English
Publishing date	2023-06-09
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics13122015
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Article ; Online: Development and implementation of a quality control protocol for B-mode ultrasound equipment.

Tsapaki, Virginia / Tsalafoutas, Ioannis A / Triantopoulou, Sotiria S / Triantopoulou, Charikleia

Journal of ultrasound

2021 Volume 25, Issue 2, Page(s) 155–165

Abstract: Purpose: Quality assurance (QA) of ultrasound (US) equipment is currently required in only a few countries around the world. In Greece, no national or other norms exist for regulating the use of US equipment. However, to obtain accreditation for the ... ...

Abstract	Purpose: Quality assurance (QA) of ultrasound (US) equipment is currently required in only a few countries around the world. In Greece, no national or other norms exist for regulating the use of US equipment. However, to obtain accreditation for the radiology department of a Greek hospital, the establishment and implementation of a quality control (QC) protocol and a QA programme for US equipment was required. Materials and methods: A literature review regarding US QC/QA procedures was performed. The information collected was used as a guide to create a QC/QA protocol and to obtain an appropriate US QC phantom. Drafting and testing of the initial protocol lasted 6 months. Its final version was implemented for 18 months in two US systems and five US transducers. Results: The QC tests included in the protocol evaluate mechanical and electrical safety, image display, uniformity, penetration depth, distance accuracy, greyscale display, anechoic object imaging, geometric distortion, and axial/lateral resolution. The only QC test that failed was the test for uniformity since intense non-uniformities were observed that led to the replacement of two linear transducers. Conclusion: US imaging is considered safe and, where appropriate, is preferred over imaging modalities that use ionizing radiation. However, the lack of QC/QA implies that US image quality is not routinely monitored. Therefore, the possibility of malfunctions that may go undetected and lead to wrong diagnosis cannot be excluded. A QC/QΑ programme can contribute to the elimination of such errors and ensure that performance is maintained over time.
MeSH term(s)	Humans ; Phantoms, Imaging ; Quality Control ; Review Literature as Topic ; Transducers ; Ultrasonography
Language	English
Publishing date	2021-04-08
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2365426-0
ISSN	1876-7931 ; 1971-3495
ISSN (online)	1876-7931
ISSN	1971-3495
DOI	10.1007/s40477-021-00579-7
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Article ; Online: Pericolic or paracolic? The right word in the right place for acute diverticulitis.

Kechagias, Aristotelis / Palomäki, Ari / Dervenis, Christos / Triantopoulou, Charikleia

European radiology

2018 Volume 29, Issue 8, Page(s) 4377–4378

Abstract: Key point: • The term "pericolic" is wrongly used to describe an abscess adjacent to the colon in patients with acute diverticulitis. We explain why the proper term is the word "paracolic." ...

Abstract	Key point: • The term "pericolic" is wrongly used to describe an abscess adjacent to the colon in patients with acute diverticulitis. We explain why the proper term is the word "paracolic."
MeSH term(s)	Abscess/pathology ; Acute Disease ; Colonic Diseases/pathology ; Diverticulitis, Colonic/pathology ; Humans ; Terminology as Topic
Language	English
Publishing date	2018-12-03
Publishing country	Germany
Document type	Letter
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-018-5827-y
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Article: Innovations in macroscopic evaluation of pancreatic specimens and radiologic correlation.

Triantopoulou, Charikleia / Papaparaskeva, Kleo / Agalianos, Christos / Dervenis, Christos

European journal of radiology open

2016 Volume 3, Page(s) 49–59

Abstract: The purpose of this study was to evaluate the feasibility of a novel dissection technique of surgical specimens in different cases of pancreatic tumors and provide a radiologic pathologic correlation. In our hospital, that is a referral center for ... ...

Abstract	The purpose of this study was to evaluate the feasibility of a novel dissection technique of surgical specimens in different cases of pancreatic tumors and provide a radiologic pathologic correlation. In our hospital, that is a referral center for pancreatic diseases, the macroscopic evaluation of the pancreatectomy specimens is performed by the pathologists using the axial slicing technique (instead of the traditional procedure with longitudinal opening of the main pancreatic and/or common bile duct and slicing along the plane defined by both ducts). The specimen is sliced in an axial plane that is perpendicular to the longitudinal axis of the descending duodenum. The procedure results in a large number of thin slices (3-4 mm). This plane is identical to that of CT or MRI and correlation between pathology and imaging is straightforward. We studied 70 cases of suspected different solid and cystic pancreatic tumors and we correlated the tumor size and location, the structure-consistency (areas of necrosis-hemorrhage-fibrosis-inflammation), the degree of vessels' infiltration, the size of pancreatic and common bile duct and the distance from resection margins. Missed findings by imaging or pitfalls were recorded and we tried to explain all discrepancies between radiology evaluation and the histopathological findings. Radiologic-pathologic correlation is extremely important, adding crucial information on imaging limitations and enabling quality assessment of surgical specimens. The deep knowledge of different pancreatic tumors' consistency and way of extension helps to improve radiologists' diagnostic accuracy and minimize the radiological-surgical mismatching, preventing patients from unnecessary surgery.
Language	English
Publishing date	2016-03-11
Publishing country	England
Document type	Journal Article
ISSN	2352-0477
ISSN	2352-0477
DOI	10.1016/j.ejro.2016.02.001
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Article: Massive Scrotal Hematoma due to Ruptured Anastomotic Pseudoaneurysm in a Patient with Aortobifemoral Bypass Surgery: CTA Evaluation.

Smarda, Magdalini / Fagkrezos, Dimitrios / Dodos, Ilias / Potouridis, Anastasios / Staramos, Dimitrios / Triantopoulou, Charikleia / Maniatis, Petros

Case reports in vascular medicine

2019 Volume 2019, Page(s) 9013697

Abstract: A 74-year-old male patient was presented with scrotal swelling and a pulsatile mass of the left femoro-inguinal region. His medical history included hypertension, coronary artery disease, respiratory failure, and an aortobifemoral bypass surgery ... ...

Abstract	A 74-year-old male patient was presented with scrotal swelling and a pulsatile mass of the left femoro-inguinal region. His medical history included hypertension, coronary artery disease, respiratory failure, and an aortobifemoral bypass surgery performed 7 years ago. Ultrasound evaluation revealed a massive scrotal hematoma. Computed tomography angiography (CTA) was conducted, confirming the aortobifemoral graft existence and revealing bilateral anastomotic pseudoaneurysms with the left one being ruptured, resulting in extension of the hematoma to the left femoro-inguinal region and the scrotum. An emergency surgery was performed, where proximal control of the left limb of the synthetic graft as well as distal control of the iliac vessels were accomplished. After the control of the hemorrhage, an iliofemoral bypass with a Polytetrafluoroethylene (PTFE) 6 mm synthetic graft was placed. Unfortunately, the patient passed away during the first postoperative day due to myocardial infarction.
Language	English
Publishing date	2019-11-24
Publishing country	United States
Document type	Case Reports
ZDB-ID	2629916-1
ISSN	2090-6994 ; 2090-6986
ISSN (online)	2090-6994
ISSN	2090-6986
DOI	10.1155/2019/9013697
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Article ; Online: Secondary extramedullary plasmacytoma of sigmoid colon in a patient with multiple myeloma: a case report.

Fagkrezos, Dimitris / Manes, Konstantinos / Paraskeva, Konstantina / Lenos, Michalis / Triantopoulou, Charikleia / Apessou, Dimitra / Maniatis, Petros

Journal of medical case reports

2018 Volume 12, Issue 1, Page(s) 379

Abstract: Background: Extramedullary plasmacytoma is an uncommon tumor that most often involves the nasopharynx or upper respiratory tract. Extramedullary plasmacytoma is a type of plasma cell neoplasm that can present as a primary tumor or secondary to another ... ...

Abstract	Background: Extramedullary plasmacytoma is an uncommon tumor that most often involves the nasopharynx or upper respiratory tract. Extramedullary plasmacytoma is a type of plasma cell neoplasm that can present as a primary tumor or secondary to another plasma cell neoplasm, such as multiple myeloma. Secondary extramedullary plasmacytoma is usually noted in the advanced stages of the disease. Involvement of the gastrointestinal tract occurs in approximately 10% of cases. Case presentation: A 71-year-old Caucasian woman with known diverticular disease of the colon and multiple myeloma diagnosed 3 years previously, with monoclonal bands of immunoglobulin A, lambda light chains, and multiple osteolytic lesions, presented to our hospital with abdominal pain, abdominal discomfort, and pneumoperitoneum. She underwent left colectomy for diverticulitis with perforation, and an extramedullary secondary colonic plasmacytoma was found in histopathological examination of the sigmoid colon. Conclusions: Plasmacytoma is known to occur in extraosseous sites. The stomach and small intestine are the most commonly involved sites in the gastrointestinal tract. Secondary extramedullary plasmacytoma of the colon is rare. Colonic plasmacytoma may have varying clinical presentations, such as inflammatory bowel disease and multiple colonic strictures. Although these cases are rare, treating physicians as well as radiologists, pathologists, and surgeons should be aware of this entity.
MeSH term(s)	Abdominal Pain ; Aged ; Colectomy ; Colon, Sigmoid/pathology ; Diverticulitis/pathology ; Diverticulitis/surgery ; Female ; Humans ; Intestinal Perforation/surgery ; Multiple Myeloma/drug therapy ; Multiple Myeloma/pathology ; Plasmacytoma/pathology ; Plasmacytoma/surgery ; Pneumoperitoneum/diagnostic imaging ; Pneumoperitoneum/pathology ; Radiography, Abdominal ; Tomography, X-Ray Computed ; Treatment Outcome
Language	English
Publishing date	2018-12-25
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2269805-X
ISSN	1752-1947 ; 1752-1947
ISSN (online)	1752-1947
ISSN	1752-1947
DOI	10.1186/s13256-018-1888-4
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Article ; Online: An anatomic anal sphincter-saving procedure for rectal cancers located at anorectal junction.

Mariolis-Sapsakos, Theodoros / Psathas, Giannos / Nikolouzakis, Taxiarchis Konstantinos / Laschos, Konstantinos / Triantopoulou, Charikleia / Bonatsos, Gerasimos / Tsiaoussis, John

World journal of surgical oncology

2019 Volume 17, Issue 1, Page(s) 131

Abstract: Background: This study aims to present the feasibility of the open approach of hemilevator excision (HLE) as a promising alternative of the laparoscopic and/or robotic ones for the treatment of low rectal cancer extending to the ipsilateral puborectalis ...

Abstract	Background: This study aims to present the feasibility of the open approach of hemilevator excision (HLE) as a promising alternative of the laparoscopic and/or robotic ones for the treatment of low rectal cancer extending to the ipsilateral puborectalis muscle. Methods: A 60-year-old male patient with a high-grade differentiated rectal adenocarcinoma at the right side of the lower rectum invading puborectalis muscle. The proposed operation consists of a combination of extralevator abdomino-perineal excision (ELAPE), intersphicteric resection (ISR), and low anterior resection (LAR) since it resects the ipsilateral to tumor levator ani muscle (LAM) from its attachment at the internal obturator fascia and the deep part of ipsilateral external anal sphincter (EAS), while the distal part of dissection is completed in the intersphincteric space taking out the internal anal sphincter (IAS). At the contralateral side of the tumor, the dissection plane follows the classic route of LAR. Results: Pathology proved the oncologic adequacy of resection. MRI at the fourth postoperative week showed clearly the right aspect of anorectal junction free of tumor. Anorectal manometry revealed a fair anorectal function which is in accordance with the findings of clinical assessment of patient after restoring large bowel continuity (post-op Wexner score, 7). Conclusion: This is the first case of the open HLE that seems to be a good alternative compared to ELAPE or conventional APR, as it offers oncologic adequacy and a fair anorectal function.
MeSH term(s)	Anal Canal/surgery ; Humans ; Laparoscopy/methods ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Perineum/surgery ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Rectum/pathology ; Robotic Surgical Procedures/methods
Language	English
Publishing date	2019-08-02
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2118383-1
ISSN	1477-7819 ; 1477-7819
ISSN (online)	1477-7819
ISSN	1477-7819
DOI	10.1186/s12957-019-1672-y
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Article ; Online: Post-traumatic pulmonary pseudocyst with hemopneumothorax following blunt chest trauma

Fagkrezos Dimitris / Giannila Maria / Maniatis Petros / Papailiou John / Triantopoulou Charikleia

Journal of Medical Case Reports, Vol 6, Iss 1, p

a case report

2012 Volume 356

Abstract: Abstract Introduction Post-traumatic pulmonary pseudocyst is an uncommon cavitary lesion of the lung and develops after blunt chest trauma and even more rarely following penetrating injuries. It is generally seen in young adults presenting with cough, ... ...

Abstract	Abstract Introduction Post-traumatic pulmonary pseudocyst is an uncommon cavitary lesion of the lung and develops after blunt chest trauma and even more rarely following penetrating injuries. It is generally seen in young adults presenting with cough, chest pain, hemoptysis, and dyspnea. Post-traumatic pulmonary pseudocyst should be included in the differential diagnosis of cavitary pulmonary lesions. We describe the case of a 60-year-old Caucasian Greek woman who sustained traumatic pulmonary pseudocyst with hemopneumothorax due to a blunt chest trauma after a traffic accident. Case presentation After a traffic accident, a 60-year-old Caucasian Greek woman sustained a hemopneumothorax due to a blunt chest trauma. There was evidence of an extensive contusion in the posterior and lateral segments of the right lower lobe, a finding that was attributed to an early sign of a cavitation, and the presence of a thin-walled air cavity was detected on the anterior segment of the right lower lobe in the control computed tomography taken 24 hours after admission. Our patient was treated by catheter aspiration, and the findings of computed tomography evaluation about one month later showed complete resolution of one of the two air-filled cavitary lesions. The second pseudocyst also disappeared completely, as shown by the control computed tomography scan performed six months later. Conclusions Traumatic pulmonary pseudocyst is a rare complication of blunt chest trauma, and computed tomography is a more valuable imaging technique than chest radiograph for early diagnosis.
Keywords	Traumatic pulmonary pseudocyst ; lung cyst ; blunt chest trauma ; pulmonary contusion ; Medicine ; R
Language	English
Publishing date	2012-10-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
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Article: Radiopaque preventive landmarks' placement during stentless bioprosthesis implantation.

Lama, Niki / Patris, Vasileios / Fagkrezos, Dimitrios / Moschouris, Petros / Giakoumidakis, Konstantinos / Triantopoulou, Charikleia / Maniatis, Petros / Argiriou, Mihalis

Journal of thoracic disease

2018 Volume 10, Issue 6, Page(s) 3158–3165

Abstract: Background: In patients with aortic stenosis, bioprosthetic valves are increasingly used. Although their benefits, they are also presenting limitations, as their time-related degeneration. Reoperation which was, until a few years ago, the only treatment ...

Abstract	Background: In patients with aortic stenosis, bioprosthetic valves are increasingly used. Although their benefits, they are also presenting limitations, as their time-related degeneration. Reoperation which was, until a few years ago, the only treatment for this condition, carries a significant surgical risk, especially in patients with multiple comorbidities, so the benefit of less invasive technique enabling the implantation of aortic valve prosthesis [transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV)] by a percutaneous access is remarkably important. Eligible patients are judged by a heart team, and imaging plays a key role in this selection, focusing on correct identification of bioprosthetic aortic valves type and size, evaluation of patients at increased anatomical risk for coronary artery occlusion. Radiolucency of stentless bioprosthetic valves, represent a significant challenge. Methods: Surgical aortic valve replacements (SAVRs) with a bioprosthesis were performed using a stentless valve with no radiopaque components (Solo Smart, Sorin). The chosen method, in order to evaluate the results of the operation, was computed tomography (CT) scanning (64-slice MDCT, Brilliance, Philips). The study consisted of a thin sliced contrast electrocardiograph (ECG) gated chest CT (1 systolic cardiac phase), trying to simulate the required assessment of aortic root and the radiopaque placed markers. Results: As surgical implant technique varies and may impact the relationship of the prosthetic annulus to the coronary ostia, marking the aortic annulus during the operation in order to have some useful radiopaque landmarks, is a great assistance promoting better orientation and correct identification of the position of the bioprosthetic valve. Although the implantation of metallic vascular clips at the level of aortic annulus (in any commissure or in the middle of any cups) was considered, the decision was to position three metallic clips bellow the aortic annulus in the three stiches ligated during the solo valve implantation. Conclusions: We are suggesting the preventive implantation of radiopaque landmarks, during SAVRs using tissue valves which are lacking fixed anatomic markers, as a guide for a presumptive TAV-in-SAV procedure, keeping in mind that appropriate guidance is crucial and can prevent valve misplacement, coronary obstruction and other potentially lethal complications.
Language	English
Publishing date	2018-07-30
Publishing country	China
Document type	Journal Article
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd.2018.06.16
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Article: CT imaging of primary pancreatic lymphoma: experience from three referral centres for pancreatic diseases.

Boninsegna, Enrico / Zamboni, Giulia A / Facchinelli, Davide / Triantopoulou, Charikleia / Gourtsoyianni, Sofia / Ambrosetti, Maria Chiara / Veneri, Dino / Ambrosetti, Achille / Pozzi Mucelli, Roberto

Insights into imaging

2018 Volume 9, Issue 1, Page(s) 17–24

Abstract: Purpose: To describe CT characteristics of primary pancreatic lymphoma (PPL), a rare disease with features in common with adenocarcinoma.: Materials and methods: Fourteen patients were enrolled. CT: unenhanced scan, contrast-enhanced pancreatic and ... ...

Abstract	Purpose: To describe CT characteristics of primary pancreatic lymphoma (PPL), a rare disease with features in common with adenocarcinoma. Materials and methods: Fourteen patients were enrolled. CT: unenhanced scan, contrast-enhanced pancreatic and venous phases. Image analysis: tumour location; peri-pancreatic vessel encasement; necrosis; enlarged lymph nodes; fat stranding; enlarged bile duct and pancreatic duct; neoplasm longest dimension, volume and density. Results: Histopathological diagnoses: follicular non-Hodgkin lymphoma (5/14), diffuse large B-cell lymphoma (6/14) and high-grade B-cell lymphoma not otherwise specified (3/14). Six of 14 PPLs were located in the pancreatic head and 7/14 in the body-tail; 1/14 involved the whole gland. In 5/14 cases the superior mesenteric artery and vein were encased; splenic vein and artery encasement was depicted in 2 PPLs. Necrosis was present in 2/14. Enlarged retroperitoneal lymph nodes were found in 11 cases and fat stranding in all patients. The bile duct was dilated in six cases and the pancreatic duct in five. Mean neoplasm longest diameter and volume were 8.05 cm and 210.8 cm Conclusions: PPL presents as a large mass lesion with delayed homogeneous enhancement; peri-pancreatic fat stranding and vessel encasement are present, without vascular infiltration. Pancreatic duct dilatation is rare. Key points: • Primary pancreatic lymphoma (PPL) is a rare haematological disease • PPL presents imaging features in common with pancreatic carcinoma but also some distinctive findings • The majority of PPLs are large lesions with delayed homogeneous enhancement • Peri-pancreatic fat stranding and vessel encasement are common in PPL • Vascular infiltration and pancreatic duct dilatation are rare in PPL.
Language	English
Publishing date	2018-01-15
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2543323-4
ISSN	1869-4101
ISSN	1869-4101
DOI	10.1007/s13244-017-0585-y
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