Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Serous cyst adenomas: These cysts are mostly benign and commonly occur in
middle-aged women. They usually are located in the body or tail of the pancreas.
Typically they are small and cause no symptoms. Rarely they cause abdominal
pain.
Mucinous cyst adenomas: Thirty percent of these cysts contain
cancer, and
those that do not contain cancer are considered precancerous. They also are more
common in middle-aged women and are usually located in the body or tail of the
pancreas.
Intraductal papillary mucinous neoplasm (IPMN): These cysts have a high
likelihood of being or becoming cancerous. At the time of diagnosis, there is a
40%-50% chance of already being cancerous. These cysts are more common among
middle-aged men and are more commonly located in the head of the pancreas. The
cysts typically produce large amounts of mucous which can be seen draining out
of the ampulla of Vater at the time of
endoscopic retrograde
cholangio-pancreatography (ERCP), a test that visualizes the ampulla of Vater and
the pancreatic duct. These cysts can cause abdominal pain, jaundice and
pancreatitis.
Solid pseudopapillary tumor of the pancreas: These are rare tumors found
mainly in young Asian and black females. They may reach a large size, and can
become malignant. Prognosis is excellent after complete surgical
resection of
these tumors.
How are pancreatic cysts diagnosed?
Since the majority of pancreatic cysts are small and produce no symptoms,
they often are discovered incidentally when abdominal scans (ultrasound,
CT scan, or
MRI) are performed to investigate unrelated symptoms. Unfortunately, ultrasound,
CT, and MRI scans cannot reliably distinguish benign cysts (cysts that usually
need no treatment) from precancerous and cancerous cysts (cysts that usually
require surgical removal).
Endoscopic ultrasound (EUS) is becoming increasingly useful in determining
whether a pancreatic cyst is benign, precancerous, or cancerous. During EUS, an
endoscope with a small ultrasound transducer on its tip is inserted through the
mouth, esophagus, and stomach into the duodenum. From this location very close
to the pancreas, liver, and gallbladder, accurate and detailed images can be
obtained of the liver, pancreas and the gallbladder.
During EUS fluid from cysts and samples of tissue also can be obtained by
passing special needles through the endoscope and into the cysts or tumors. The
process of obtaining tissue or fluid with a thin needle is called
fine needle
aspiration (FNA).
The fluid obtained by FNA can be analyzed for cancerous cells (cytology),
amylase content, and for tumor markers [tumor markers, such as CEA (carcinoembryonic
antigen), are proteins
produced in large quantities by tumor cells]. For example, pancreatic pseudocyst
fluid will typically have high amylase levels but low CEA levels. A benign
serous cyst adenoma will have low amylase and low CEA levels, whereas a
precancerous or cancerous mucinous cyst adenoma will have low amylase levels but
high CEA levels.
The cells obtained by fine needle aspiration can be examined under a microscope for cancer or
precancerous cells.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Pancreatic cancer is a malignant tumor of the pancreas. Pancreatic cancer has been called a "silent" disease because early pancreatic cancer usually does not cause symptoms.
Cysts are saclike structures that can occur throughout the body and usually contain a semisolid, liquid, or gaseous substance. Infections, tumors, genetic conditions, chronic inflammatory conditions, and wear and tear can cause cysts. Though some cysts may be palpable, others may not produce any symptoms. Treatment depends upon the location and cause of the cyst.
Pancreatitis is a rare disease in which the pancreas becomes inflamed, occurring when digestive enzymes are activated and begin attacking the pancreas causing damage to the gland. There are two types of pancreatitis, acute and chronic. Most commonly caused by alcohol or gallstones, it can lead to bleeding in the gland, serious tissue damage, infection, and cysts. Enzymes and toxins may then enter the bloodstream and seriously injure organs, such as the heart, lungs, and kidney.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Cushing's syndrome, sometimes referred to as hypercortisolism, is a hormonal disorder caused by prolonged exposure to high levels of the hormone cortisol. Symptoms may include obesity, thinning arms and legs, a rounded face, and increased fat around the neck. Some causes of Cushing's syndrome is from taking glucocorticoid hormones such as prednisone for inflammatory diseases. Treatment for Cushing's syndrome depends on the cause.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
Polycystic kidney disease (PKD) is characterized by numerous cysts in the kidneys. Polycystic kidney disease is a genetic disorder. There are two major inherited forms of PKD, autosomal dominant PKD, and autosomal recessive PKD. Symptoms include headaches, urinary tract infections, blood in the urine, liver and pancreatic cysts, abnormal heart valves, high blood pressure, kidney stones, aneurysms, and diverticulosis. Diagnosis of PKD is generally with ultrasound, CT or MRI scan. There is no cure for PKD, so treatment of symptoms is usually the general protocol.
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