Background: Current efforts in the identification of new biomarkers are directed towards an accurate differentiation between benign and premalignant cysts. Thermal Liquid Biopsy (TLB) has been previously applied to inflammatory and tumor diseases and could offer an interesting point of view in this type of pathology. Methods: In this work, twenty patients (12 males and 8 females, average ages 62) diagnosed with a pancreatic cyst benign (10) and premalignant (10) cyst lesions were recruited, and biological samples were obtained during the endoscopic ultrasonography procedure. Results: Proteomic content of cyst liquid samples was studied and several common proteins in the different groups were identified. TLB cyst liquid profiles reflected protein content. Also, TLB serum score was able to discriminate between healthy and cysts patients (71% sensitivity and 98% specificity) and between benign and premalignant cysts (75% sensitivity and 67% specificity). Conclusions: TLB analysis of plasmatic serum sample, a quick, simple and non-invasive technique that can be easily implemented, reports valuable information on the observed pancreatic lesion. These preliminary results set the basis for a larger study to refine TLB serum score and move closer to the clinical application of TLB providing useful information to the gastroenterologist during patient diagnosis.

Pancreatic cystic lesions (PCLs) are a heterogeneous group of lesions with increasing incidence, usually identified incidentally on imaging studies (multidetector computed tomography (MDCT), magnetic resonance imaging (MRI), or endoscopic ultrasound (EUS))

The diagnosis of mucinous cystic neoplasm (MCN) during pregnancy is rare and presents unique challenges. We analyzed all reported cases of pregnancy-associated MCNs to assess malignant potential and identify predictive factors. A total of 69 patients with MCN were included: 65 from systematic literature search and 4 cases from our institutional databases. Data included patient demographics, symptoms, diagnostics, surgical management, histopathology, and clinical outcomes. The median age was 33 years (range 20-47). 74% (49/66) presented with symptoms. Tumor-related complications occurred in 27% (16/60), including acute pancreatitis in eight and cyst rupture in four. Median MCN diameter at diagnosis was 12.0 cm (1.5-30). Median tumor growth during pregnancy was 2.5 cm (0.5-20) over a median period of 2.75 months (1-78). All patients underwent surgical resection: 29% (20/69) in second trimester and 59% (41/69) postpartum. Postoperative complications occurred in four patients, all including pancreatic fistula or fluid collection. Fetal complications were reported in eight cases, without tumor-related mortality. 20% (13/66) had invasive adenocarcinoma (IC), 14% (9/66) high-grade dysplasia (HGD), and rates were similar if resected during pregnancy or postpartum. Symptomatic presentation and high-risk imaging features significantly correlated with malignant MCN. During the median follow-up of 24 months (2-154), local recurrence occurred in three patients and one patient died. Pregnancy-related MCNs were typically large, symptomatic, and grew rapidly. A third of tumors harbored IC or HGD. Prompt surgical resection, typically during the second trimester appears safe, with a low rate of maternal and fetal complications.