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@#Solid pseudopapillary neoplasm (SPN) is a rare pancreatic neoplasm. This case reports a 63-year-old female previously diagnosed with bilateral adrenocortical carcinoma post resection who presents with persistent epigastric pain. Suspicions for recurrence prompted diagnostics revealing retropancreatic and left suprarenal foci, both suspicious for malignancy. Resection of both tumors yielded a moderately to poorly differentiated retropancreatic carcinoma with differentials not limited to recurrence and pancreatic neuroendocrine tumor with a left suprarenal lymph node. Immunohistochemistry was then done and was consistent with SPN having a strong expression for b-catenin, vimentin, pancytokeratin. It was non-specific to melan-A and negative for chromogranin A, synaptophysin, inhibin-a and CD10. At 6 months’ follow up, patient is clinically well and abdominal CT scan showed no recurrence. SPNs can masquerade as other neoplasms having similar clinical, radiologic and histopathologic features. Immunohistochemistry thus plays a crucial role for accurate diagnosis and management. Surgical resection still remains the treatment of choice and can provide a 95% overall survival rate, while limited evidence supports the use of adjuvant chemotherapy or radiation.
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ImmunohistochemistryABSTRACT
Objective:To study the value of imaging features of extrapancreatic nerve plexus in predicting early postoperative recurrence of ductal adenocarcinoma of pancreatic head.Methods:The clinical, imaging and pathological data of patients with ductal adenocarcinoma of pancreatic head undergoing pancreati-coduodenectomy at the Hepatobiliary Pancreatic Center of Beijing Tsinghua Changgung Hospital, Tsinghua University from January 2014 to April 2022 were retrospectively analyzed. A total of 73 patients were included, including 51 males and 22 females, aged (66.1±9.0) years old. The patients were followed up by telephone or outpatient review, who were divided into two groups according to the recurrence within 6 months after surgery: the recurrence group ( n=26) and the non-recurrence group ( n=47). Streaks or soft-tissue densities in the distribution area of extrapancreatic nerve plexus, difference in CT values between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus, maximum tumor diameter, and regional lymph node enlargement were compared between the two groups. Results:The incidences of streaks or soft-tissue densities showing in the distribution area of extrapancreatic nerve plexus were 80.8%(21/26) in the recurrence group and 51.1%(24/47) in the non-recurrence group, respectively. A CT value difference ≥15 HU between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus occurred in 50.0%(13/26) patients of the recurrence group and 25.5%(27/47) of the non-recurrence group, respectively. Maximum tumor diameter ≥25 mm were found in 80.8% (21/26) patients of the recurrence group and 57.4% (27/47) of the non-recurrence group, respectively. ≥3 reginal lymph node enlargement showed in 65.4% (17/26) patients of the recurrence group and 31.9% (15/47) of the non-recurrence group, respectively (all P<0.05). The risk of early postoperative recurrence increased in patients with a CT value difference ≥15 HU between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus ( OR=3.609, 95% CI: 1.099-11.855), and regional lymph node enlargement ≥ 3 ( OR=4.665, 95% CI: 1.400-15.545) (all P<0.05). And these two independent risk factors were combined to predict early postoperative recurrence of ductal adenocarcinoma of pancreatic head with an area under receiver operating characteristic curve of 0.748, sensitivity of 92.3%, and specificity of 48.9% ( P<0.001). Conclusion:≥ 15 HU CT value difference between the portal and arterial phases of the distribution area of extrapancreatic nerve plexus and ≥ 3 regional lymph node enlargement are independent risk factors for the early postoperative recurrence of pancreatic head ductal adenocarcinoma, which could provide more predictive information preoperatively.
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Objective:To investigate the relationship between the perineural invasion score based on multidetector computed tomography (MDCT) and extrapancreatic perineural invasion (EPNI) in pancreatic ductal adenocarcinoma (PDAC).Methods:The clinical, radiological, and pathological data of 374 patients pathologically diagnosed as pancreatic cancer who underwent radical resection in the First Affiliated Hospital of Naval Medical University from March 2018 to May 2020 were analyzed retrospectively. Patients were divided into EPNI negative group ( n=111) and EPNI positive group (n=263) based on the pathological presence of EPNI. The perineural invasion score was performed for each patient based on radiological images. Univariate and multivariate logistic regression models were used to analyze the association between the perineural invasion score based on MDCT and EPNI in PDAC. Results:There were significant statistical differences between EPNI negative group and positive group on both pathological characteristics (T stage, N stage, invasion of common bile duct, and positive surgical margin) and radiological characteristics (tumor size, vascular invasion, lymph node metastasis, perineural invasion score based on MDCT, pancreatic border, parenchymal atrophy, invasion of duodenum, invasion of spleen and splenic vein and invasion of common bile duct) (all P value <0.05). Univariate analysis revealed that the tumor size, vascular invasion, lymph node metastasis, perineural invasion score based on MDCT, pancreatic border, pancreatic atrophy, invasion of duodenum, invasion of spleen and splenic vein and invasion of common bile duct were independently associated with EPNI. Multivariate analyses revealed that the perineural invasion based on MDCT was an independent risk factor for EPNI in pancreatic cancer (score=1, OR=2.93, 95% CI 1.61-5.32, P<0.001; score=2, OR=5.92, 95% CI 2.68-13.10, P<0.001). Conclusions:The perineural invasion score based on MDCT was an independent risk factor for EPNI in pancreatic cancer and can be used as an evaluation indicator for preoperative prediction of EPNI in PDAC.
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Recent studies revealed a number of interesting extrapancreatic actions of sulfonylureas (SUs),and there existed various mechanisms and targets of extrapancreatic effects among different SUs.We try to explore the impact of extrapancreatic effects on the clinical outcome of patients with type 2 diabetes mellitus (T2DM) based on the data from basic and clinical researches,including the effects of SUs on atherosclerosis,cognitive impairment,risk factors associated with abnormal bone metabolism,as well as the safety of treatment.All together,extrapancreatic effects of novel sulphonylureas (e.g.glimepiride) are associated with the improved clinical outcomes and less adverse effects in patients with T2DM.
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Solid pseudopapillary tumor (SPT) is a low grade malignant tumor in the pancreas, and extrapancreatic SPT is extremely rare. We report a case of a 61-year-old woman who complained abdominal pain with diffuse tenderness. She was diagnosed with extrapancreatic SPT with extensive peritoneal dissemination and hepatic metastases. Although a few cases have reported imaging findings of extrapancreatic SPT, there have been no reports of extrapancreatic SPT with aggressive tumor behavior and dismal prognosis. Although imaging features closely resembled those of classical pancreatic SPTs, malignant transformation of extrapancreatic SPT should be considered when focal discontinuity of the tumor capsule with ill-defined margin and invasion of adjacent structures were identified.
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Female , Humans , Middle Aged , Abdominal Pain , Neoplasm Metastasis , Pancreas , Prognosis , UltrasonographyABSTRACT
Mechanisms of the long known anti-diabetic effects exerted by the fruits of Terminalia chebula are not yet clearly understood. Here, we sought to get a biochemical view of the mechanisms. First, a single injection of streptozotocin (STZ) was given (50 mg/Kg of body weight, bw) to 48 hours old pups of Long-Evans (L-E) rats intraperitoneally (ip) to induce type 2 diabetes (T2DM). At the age of 3 months, a total of twenty male L-E rats, having T2DM were included in this study and divided into 4 groups (n = 5, for each group). T2DM was confirmed by a standard oral glucose tolerance test (OGTT). Next, T2DM rats were orally administered with a single dose of 80% ethanolic extracts of either the fresh or dried fruits for consecutive 28 days. Water and glibenclamide were used as negative and positive control, respectively. Administration of dried (p = 0.001) and fresh (p = 0.02) fruit extracts significantly reduced the fasting serum glucose level as compared to that of water control. Fasting serum lipid profile show that administration of both fresh and dried fruit extracts caused a significant reduction of triglycerides (p = 0.016), total cholesterol (p = 0.001) and low density lipoprotein-cholesterol (p = 0.001). Examinations of antioxidant potential profile demonstrate that dried fruit extracts only decreased the levels of plasma MDA in T2DM rats to a notable extent (62%). Although the fruit extracts could not improve the levels of serum insulin, but increased the liver glycogen content to a remarkable extent (240%). This study indicates that sub-chronic administration of the ethanolic extracts of dried Terminaria chebula mature fruits improve glycemic, lipidemic and anti-oxidative status in T2DM male L-E rats and that the hypoglycemic action may be mediated by an extra-pancreatic mechanism. Abbreviations: STZ= Streptozotocin, T2DM=Type 2 Diabetes Mellitus, OGTT=Oral glucose tolerance test, TG =Triglyceride, HDL-C=High density lipoprotein cholesterol, LDL-C=Low density lipoprotein cholesterol, FSG = Fasting serum glucose, Gliben=Glibenclamide, WC = Water control, TCFF=Ethanolic extract of T. chebula fresh fruit type 2 group, TCDF=Ethanolic extract of T. chebula dry fruit type 2 group, SPSS= Statistical Package for Social Science, ANOVA= Analysis of variance.
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Objective To assess the value of acute physiology and chronic health evaluationⅡ (APACHE-Ⅱ) score and extrapancreatic inflammation on abdominal computed tomography (EPIC) score in predicting outcome of patients with acute pancreatitis (AP).Methods One hundred and forty-seven patients with AP who underwent abdominal computed tomography scan within 24 h and acute physiological examination after admission were studied.To assess their value in predicting severe AP and complications,the APACHE Ⅱ score and EPIC score was calculated and evaluated by calculating receiver operator characteristic (ROC)curves,the sensitivity,the specificity,the Youden index and the area under the ROC curve (AUC).Results Forty-three of 147 patients developed severe AP.The mean scores of APACHE-Ⅱ score and EPIC score two criteria systems was significantly higher in severe AP than that in mild AP (P< 0.01).EPIC score had 0.893 sensitivity,0.870 specificity and the largest AUC for predicting severe AP.EPIC score had the largest AUC in predicting local complications.But the EPIC score was equal to the APACHE-Ⅱ score in AUC to predict systemic complications.Conclusion In patients with AP.EPIC score and APACHE-Ⅱ score combination will estimate the prognosis of disease accurately within 24 h of admission.
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PURPOSE: IPMN (Intraductal papillary mucinous neoplasm) is frequently reported in combination with a variety of extrapancreatic tumors. The IPMN in these patients might represent the phenotypes of genes associated with multiple tumor syndrome. The aim of this study was to confirm the presence of germline mutations in the p53, MLH1, MSH2, BRCA1/2, and E-cadherin genes known to be associated with gastrointestinal malignancies in hereditary tumor syndromes such as Li-Fraumeni syndrome, HNPCC, Hereditary Breast/Ovarian cancer, and Hereditary diffuse gastric cancer. METHODS: 14 patients with IPMN with extrapancreatic tumors (6 gastric cancers, 5 colorectal cancers, 1 gastric GIST, 2 hepatocellular carcinomas, 1 AoV cancer) who underwent resection were enrolled in this study. We performed PCR (Polymerase chain reaction) and direct sequencing analysis for the p53, MLH1, MSH2 and CDH-1 genes. Multiplex PCR, F-CSGE (fluorescent conformation sensitive gel electrophoresis) and direct sequencing was performed for BRCA1/2 genes. RESULTS: We identified two novel mutations in the p53 gene (exon 1, codon 31, GTC>CTC, Glu-->Gln) and the CDH-1 gene (exon 14, codon 2218, CCC>TCC, Pro-->Ser). For BRCA1, we identified 11 identical coding SNP (exon 11, codon 3232, AAG>AGG, Glu-->Gly) among 13 patients with a high allele frequency (46.1%) compared with the 30.1% reported in Korean breast cancer patients. For BRCA2, we identified a coding SNP with an allele frequency of 2.6% (exon 11, codon 2578, AAG>AGG, Met-->Val). CONCLUSION: Germline alterations of the p53 and E-Cadherin genes in IPMN patients with extrapancreatic cancer suggest that IPMN could be a manifestation of multiple tumor syndrome.
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Humans , Breast Neoplasms , Cadherins , Carcinoma, Hepatocellular , Clinical Coding , Codon , Colorectal Neoplasms , Gene Frequency , Genes, p53 , Germ-Line Mutation , Li-Fraumeni Syndrome , Mucins , Multiplex Polymerase Chain Reaction , Phenotype , Polymerase Chain Reaction , Stomach NeoplasmsABSTRACT
BACKGROUND/AIMS: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has a favorable prognosis, but seems to be associated with a high incidence of extrapancreatic tumors. The purpose of this study was to evaluate the incidence and clinicopathological features of extrapancreatic tumors associated with IPMN. METHODS: Thirty-seven patients with IPMN of the pancreas, confirmed by surgical resection and typical findings of endoscopic ultrasonography and CT imaging between October 1, 1998 and August 31, 2006 were included. Seventeen patients were diagnosed with surgical resection and biopsy, and others by typical imaging findings of IPMN. These patients were examined for the development of extrapancreatic tumors. RESULTS: Of 37 patients with IPMN, 14 (38%) had 18 extrapancreatic tumors, and 10 (27%) had 13 extrapancreatic malignancies. Five, six, and two extrapancreatic malignancies had diagnosed before during, and after the diagnosis of IPMN. Gastric adenocarcinoma (3 patients, 23%) and colorectal carcinoma (3 patients, 23%) were the most common neoplasms. Other extrapancreatic tumors included lung cancer (n=2), prostatic cancer (n=1), renal cell carcinoma (n=1), cholangiocelluar carcinoma (n=1), urinary bladder cancer (n=1), and gallbladder cancer (n=1), respectively. As benign tumor, there were two gallbladder adenoma, one gastric adenoma, one colonic adenoma and one benign ovarian cystic neoplasm, respectively. CONCLUSIONS: IPMN is associated with high incidence of extrapancreatic tumors, particularly gastric and colorectal neoplasms. Upper gastrointestinal endoscopy and colonoscopy should be done, and systemic surveillance for the possible occurrence of other tumors may allow early detection of extrapancreatic tumor in patients with IPMN.