Context: Pseudocysts are a common complication of acute and chronic pancreatitis. These are usually located within the pancreas but they can occur at other sites as well, including the mediastinum, neck, pelvis and rarely in the liver as in our case. The diagnosis of intrahepatic pancreatic pseudocyst relies on the demonstration of a high amylase level in the sampled cystic fluid in the absence of infection or neoplasm. Case report: A 60-year-old man with a history of chronic pancreatitis presents with a clinical and laboratory picture suggestive of acute exacerbation of his pancreatitis. A computed tomogram (CT) scan of the abdomen revealed a pancreatic pseudocyst and a cystic lesion involving both lobes of the liver. CT diagnostic aspiration of the intrahepatic cyst revealed high amylase level (greater than 20,000 U/L). The cyst was treated with percutaneous drainage with complete resolution of the cyst. Conclusion: In the setting of pancreatitis, intrahepatic pancreatic pseudocyst should be considered in the differential diagnosis of cystic lesion of the liver.

Mediastinal pancreatic pseudocyst (MPP) is a rare, but known, complication of both acute and chronic pancreatitis. Most pseudocysts are associated with alcoholic pancreatitis. Recent advances in endoscopic techniques have shown promising results, with reduced chances of infection and recurrence than with percutaneous drainage, but limited availability restricts widespread use. Left gastric artery pseudoaneurysm with mediastinal pseudocyst has not been described in the literature to date. We report a successful resolution of hemorrhagic MPP with embolization of pseudoaneurysm and percutaneous trans-hepatic pseudocyst drainage.

Pancreatic pseudocysts are a complication of acute or chronic pancreatitis or result from blunt trauma to the pancreas. It is a localized fluid collection around the pancreas surrounded by a wall of fibrous tissue or inflammation. We present a case of a 56-years old male who presented with abdominal pain and sepsis due to spontaneous rupture of the hemorrhagic pancreatic cyst into the peritoneal cavity and spleen. 56-years old male with medical history of gastroesophageal reflux disease presented with epigastric and left upper quadrant intermittent abdominal pain. Patient denied fever, chills, nausea, and vomiting, family history of pancreatic cancer, anticoagulation use, gallstones, alcohol intake and prior history of pancreatitis. On admission, vitals were B.P 137/82, Pulse 102, RR 16, O2 saturation 92% on room air. Physical exam was significant for left upper quadrant and epigastric tenderness. Labs were lipase 230, amylase 112, lactate 0.7, wbc 7.0, hemoglobin of 15.2 and triglyceride levels were 189mg/dl. Computed tomography (CT) abdomen showed acute pancreatitis and a 4.5 x 4.4 x 2.8 cm cystic lesion between the tail of the pancreas and splenic hilum. Ultrasound of the abdomen showed normal gallbladder with no evidence of biliary ductal dilatation. Magnetic resonance cholangiopancreatography (MRCP) abdomen showed 4.3 cm walled off, possibly hemorrhagic fluid collection, between the spleen and the pancreas. Patient had normal CA-19 level. Patient was evaluated by general surgery who recommended conservative management with repeat CT in 6 weeks with possible pancreatectomy and removal of mass if not resolved. Patient was readmitted 3 days after discharge with worsening abdominal pain and sepsis. Physical exam was significant for epigastric and left upper quadrant tenderness without guarding or rebound. Labs showed lactate 3.4, wbc 11.3, hgb 12.1 and lipase 600. Repeat CT scan showed rupture of the hemorrhagic pancreatic cyst with possible extravasation and enlarged spleen with perisplenic and subcapsular blood represent splenic infarcts. Repeat MRCP confirmed CT findings. Patient was planned for splenectomy and distal pancreatectomy. Most pancreatic pseudocysts resolve spontaneously [1]. Bleeding, infection, rupture, pseudoaneurysm, splenic and biliary complications and portal hypertension are some of the complications if left untreated. Hemorrhage into the pancreatic pseudocyst is a rare complication with a reported incidence of 10-30% with a high mortality rate (40%). Bleeding most commonly involves splenic artery (30–50%), followed by the gastroduodenal artery (17%) and pancreaticoduodenal arteries (11%) [2]. Diagnosis is made by ultrasound, CT scan, MRI or ERCP. Treatment involves either percutaneous drainage, or endoscopic or surgical approach. Spontaneous rupture into the peritoneal cavity is a rare life threatening complication requiring immediate surgical intervention. This case highlights the early recognition of complications of ruptured pancreatic pseudocyst to prevent fatal consequences. References: 1: Lerch MM, Stier A, Wahnschaffe U, Mayerle J: Pancreatic Pseudocysts: Observation, Endoscopic Drainage, or Resection. Deutsches Ärzteblatt International 2009, 106:614-621.10.3238/arztebl.2009.0614. 2: Novacic K1, Vidjak V, Suknaic S, Skopljanac A: Embolization of a large pancreatic pseudoaneurysm converted from pseudocyst (hemorrhagic pseudocyst). JOP 2008, 9:317-21. joplink.net/prev/200805/13.html

Amoebae of the genus Acanthamoeba spp. are free-living unicellular organisms found in disparate ecosystems all over the world. Due to their ability to invade human body, evade its defensive mechanisms and cause extensive tissue damage, Acanthamoeba infection can lead to serious, if rare, diseases, affecting most commonly the eye and the central nervous system. Specific therapy for Acanthamoeba infections is not available. A major reason for therapeutic failure in ameobiasis is the ability of the protist to differentiate into resistant stages. These are cysts, known to be formed under prolonged unfavorable conditions, both in the environment and the infected tissues, and the pseudocysts, less durable but rapidly formed under acute stress. The present thesis focuses on as yet unexplored mechanisms of resistance of cysts and pseudocysts. Moreover, further characteristics distinguishing cysts and pseudocysts as well as the processes involved in their formation are investigated. One of the issues addressed is a presence of protective carbohydrate compounds mannitol and trehalose that participate in defensive reactions against abiotic stress in many organisms. Although putative genes for enzymes of the trehalose and mannitol synthetic pathways are present in the genome of Acanthamoeba, only one of the...

Free-living pathogenic amoebae Acanthamoeba spp. and Balamuthia mandrillaris are causative agents of important diseases of human: rarely occurring but highly fatal granulomatous amoebic encephalitis (both) and keratitis (Acanthamoeba). One of the reasons for the problematic therapy is differentiation into highly resistant cysts often found in affected tissues. In our study we have found that correct encystation in Acanthamoeba requires apart from others, the presence of functioning Golgi apparatus transporting the cyst wall material to the cell surface; glycogen phosphorylase degrading glycogen into glucose which seems to be further used for cellulose synthesis and two non-constitutive cellulose synthases. Acanthamoeba cellulose synthases seem not to be inhibited by known herbicides. In the cyst wall of acanthamoebae we detected cellulose, -mannan, and -1, 3-1, 4-linked glucan [lichenin or mixed-linkage glucan (MLG)]. Cellulose is present in the inner (endocyst) and the outer (exocyst) layers of the cyst wall, whereas-mannan and MLG are found in the endocyst. In a protozoan organism, MLG was detected for the first time. The MLG of Acanthamoeba has a similar composition to that found in barley with high amount of cellobiosyl and cellotriosyl followed by cellotetraosyl units. In contrast, with...