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Pancreatic cystic neoplasm is a general term for a large class of pancreatic tumors,including mucinous cystic neoplasm,serous cystic neoplasm,and pancreatic intraductal papillary mucinous neoplasm.Due to the limitations of the current techniques in differential diagnosis and disease staging,different centers have great discrepancies in their treatment.The 103rd annual meeting of American College of Surgeons (ACS)as a grand meeting in the field of surgery bringed together a large number of clinical research results every year.Therefore,authors selected and reviewed contents about pancreatic cystic neoplasm,with a view to provide new ideas in terms of its management and further research.
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Objective To investigate MSCT features of the intraductal papillary mucinous tumor of the pancreas.Methods The CT findings of 40 cases of intraductal papillary mucinous tumors confirmed by pathology were retrospectively analyzed,and the location,size,shape,edge and enhancement of the tumor were observed.Results Malignant (n=8):all of them were mainly pancreatic duct type,including 6 cases in the head of pancreas and 2 cases in the tail.All of them were multi-room,with 7 cases of cystic wall nodules and 7 cases of uneven septum thickening.The diameter of tumor cystic lesion was(41.0±0.5)mm on average,and the widest diameter of the dilated pancreatic duct was (6.9±1.0) mm.The cystic wall,wall nodule and interval were mild and moderate enhancement in the arterial phase,and continuous strengthening in the portal and delayed phases.Borderline(n=15):8 cases of main pancreatic duct type,1 case of branch pancreatic duct type,and 6 cases of mixed type.There were 10 cases in the head of the pancreas and 5 in the tail of the pancreas.There were 10 cases of multi room in the lesion,and the CT findings were composed of multiple clusters of small cystic lesions,with 3 cases of tuberous nodules on the cyst wall and 4 cases of irregular thickening of the cysts.5 cases were single room type,with capsule wall smooth and whole.The diameter of tumor cystic lesion was (28.0±0.5) mm on average,and the maximum diameter of the dilated pancreatic duct was (5.2±0.3) mm.The cystic wall and interval were mild and moderate enhancement in the arterial phase,and mild and continuous strengthening in the portal and delayed phases.Benign (n=17):1 case of main pancreatic duct type,10 cases of pancreatic duct type and 6 cases of mixed type;There were 12 cases in the head of the pancreas and 5 in the tail.All of them were single cystic type,and the cyst wall was smooth.The diameter of the tumor cystic lesion was (26±0.3) mm on average and the maximum diameter of the dilated pancreatic duct was (3.5±0.4) mm.There was no enhancement of the cystic wall in the arterial phase,mild enhancement in the portal phase,and mild continuous delayed phase in 2 cases,no enhancement in 15 cases.Conclusion MSCT expression of the intraductal papillary mucinous tumor of the pancreas has its characteristic features,which is helpful for the diagnosis and treatment of the disease.
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Objective To investigate the clinical features and surgical indications of subtypes of intraductal papillary mucinous neoplasm (IPMN) of the pancreas,and analyze its malignant risk factors.Methods The retrospective case-control study was conducted.The clinicopathological data of 77 patients with IPMN of the pancreas who were admitted to the First Hospital of Peking University from January 2008 to December 2016 were collected.The subtypes of IPMN of the pancreas detected by preoperative imaging examination included main-duct type (MD-IPMN) in 46 patients,branch-duct type (BD-IPMN) in 12 patients,mixed type (MT-IPMN) in 19 patients.The surgical indications were consulted from the Guideline for the diagnosis and treatment of pancreatic cystic lesions composed by the Pancreatic Surgery Group of Surgery Branch of China Medical Association.Surgical procedure was selected according to the location and size of the IPMN.Four to 6 cycles of chemotherapy with S-1 and/or Gemcitabine were conducted for patients with malignant IPMN according to the tolerance and baseline characteristics.Observation indicators included:(1) comparison of the clinical features MD-IPMN,MT-IPMN and BD-IPMN;(2) surgical and postoperative conditions;(3) results of postoperative pathological examination and malignant risk factors analysis;(4) accuracy evaluation of Sendai and Fukuoka guidelines for the diagnosis of malignant IPMN of the pancreas;(5) follow-up results and survival.Patients were followed up by outpatient examination and telephone interview till December 2016.The postoperative adjuvant therapy,tumor recurrence and metastasis of malignant IPMN patients and postoperative survival condition of all the patients were collected.Measurement data with normal distribution were expressed as (x)±s or average (range),and pairwise comparison was analyzed by t test.Measurement data with skewed distribution were expressed by median (range).Comparison between count data and univariate analysis were done by chi-square test.Multiple factors analysis was done by Logistic regTession model.The survival curve was drawn and the survival rate were calculated by Kaplan-Meier method.The comparison of survival was done by Log-rank test.Results (1) Comparison of clinical features between MD-IPMN,MT-IPMN and BD-IPMN:The numbers of patients with symptoms,jaundice,those complicated with diabetes and elevated CA19-9 were 55,20,43 and 28 in MD-IPMN and MT-IPMN,and 6,0,3 and 1 in BD-IPMN,with statistically significant difference (x2=5.421,3.516,5.525,3.834,P＜0.05).(2) Surgical and postoperative conditions:the operations for all the 77 patients were successfully done,including pancreaticoduodenectomy with or without preservation of pylorus on 45 patients,resection of head of pancreas with duodenum preservation on 3 patients,distal pancreatectomy on 23 patients,distal pancreatectomy combined with partial resection of spleen and stomach on 2 patients (with greater curvature of stomach involvement),segmental pancreatectomy on 2 patients,total pancreatectomy on 2 patients.A total of 26 surgery-related complications were detected,including pancreatic fistulas (13),delayed gastric emptying (9),wound infection (2),abdominal hemorrhage (2),and all the complications were improved by conservative treatment.There was no perioperative mortality.The mean duration of hospital stay of the 77 patients was 16 days (range,6-68 days).(3) Results of postoperative pathological examination and malignant risk factor analysis:① results of postoperative pathological examination:no residual tumor was detected at the resection margin in all the 77 patients,including 47 with benign IPMN (29 with adenoma and 18 with mid-severe atypical hyperplasia and without lymph node involvement) and 30 with malignant IPMN (all of them were invasive malignancy,including 17 patients with negative lymph node metastasis and 13 with positive lymph node metastasis).② Malignant risk factor analysis of IPMN:multivariate analysis showed that age,jaundice,elevated carcinoembryonic antigen (CEA),elevated CA19-9,tumor diameter,tumor subtypes were associated with malignancy (x2 =6.531,14.755,10.243,12.062,6.416,6.143,P ＜ 0.05).Multivariate analysis showed that jaundice,elevated CEA,elevated CA19-9,tumor diameter ≥3.0 cm,MD-IPMN were independent risk factors influencing the malignancy of IPMN (OR =9.656,42.853,23.243,34.387,69.883,95％ confidence interval:1.392-66.968,2.088-879.674,2.991-180.628,3.313-356.878,1.247-3 915.467,P＜0.05).(4) Accuracy evaluation of the Sendai and Fukuoka guidelines in diagnosis of malignant IPMN.The sensitivity,specificity,positive and negative predictive values were 100.0％(30/30),14.9％ (7/47),42.9％ (30/70) and 100.0％ (7/7) for the Sendai guideline and 86.7％ (26/30),48.9％ (23/47),52.0％ (26/50),85.2％ (23/27) for the Fukuoka guideline in diagnosis of malignant IPMN,with no significant difference in the sensitivity between the 2 guidelines (x2=2.250,P＞0.05),while significant difference in the specificity between the 2 guidelines were detected (x2 =12.500,P＜0.05).(5) Follow-up and survival:Seventy of 77 patients were followed up,including 42 with benign IPMN and 28 with malignant IPMN.The median survival time was 35.0 months (range,6.0-94.0 months).All the malignant IPMN patients received adjuvant therapy.The 1-,3-,5-year overall survival rates of 47 patient with benign IPMN were 100.0％,96.2％and 96.2％,respectively,and 1 patient died of cardiac infarction.The 1-,3-,5-year overall survival rates of 30 patients with malignant IPMN were 96.6％,81.8％,38.6％,respectively,and 11 patients died of tumor recurrence or metastasis with median time of tumor recurrence or metastasis of 20.5 months (6.0-61.6 months).The 1-,3-,5-year overall survival rates of 17 patients with negative lymph node metastasis were 100.0％,100.0％ and 60.0％,respectively,and the 1-,3-,5-year overall survival rates of 13 patients with positive lymph node metastasis were 91.7％,57.1％ and 0,respectively.There was statistically significant difference between patients with benign and malignant IPMN (x2 =12.530,P＜0.05).There was statistically significant difference between patients with negative lymph node metastasis and those with positive lymph node metastasis (x2 =16.977,P＜ 0.05).Conclusions Patients with MD-IPMN or MT-IPMN are more vulnerable to be complicated with diabetes,jaundice,elevated CA19-9 and high malignancy,and thus surgery is recommended.Jaundice,elevated CEA and CA19-9,tumor diameter≥3.0 cm,MD-IPMN are the independent risk factors influencing the malignancy of IPMN.
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Objective To investigate the clinical features and surgical indications of subtypes of intraductal papillary mucinous neoplasm (IPMN) of the pancreas,and analyze its malignant risk factors.Methods The retrospective case-control study was conducted.The clinicopathological data of 77 patients with IPMN of the pancreas who were admitted to the First Hospital of Peking University from January 2008 to December 2016 were collected.The subtypes of IPMN of the pancreas detected by preoperative imaging examination included main-duct type (MD-IPMN) in 46 patients,branch-duct type (BD-IPMN) in 12 patients,mixed type (MT-IPMN) in 19 patients.The surgical indications were consulted from the Guideline for the diagnosis and treatment of pancreatic cystic lesions composed by the Pancreatic Surgery Group of Surgery Branch of China Medical Association.Surgical procedure was selected according to the location and size of the IPMN.Four to 6 cycles of chemotherapy with S-1 and/or Gemcitabine were conducted for patients with malignant IPMN according to the tolerance and baseline characteristics.Observation indicators included:(1) comparison of the clinical features MD-IPMN,MT-IPMN and BD-IPMN;(2) surgical and postoperative conditions;(3) results of postoperative pathological examination and malignant risk factors analysis;(4) accuracy evaluation of Sendai and Fukuoka guidelines for the diagnosis of malignant IPMN of the pancreas;(5) follow-up results and survival.Patients were followed up by outpatient examination and telephone interview till December 2016.The postoperative adjuvant therapy,tumor recurrence and metastasis of malignant IPMN patients and postoperative survival condition of all the patients were collected.Measurement data with normal distribution were expressed as (x)±s or average (range),and pairwise comparison was analyzed by t test.Measurement data with skewed distribution were expressed by median (range).Comparison between count data and univariate analysis were done by chi-square test.Multiple factors analysis was done by Logistic regTession model.The survival curve was drawn and the survival rate were calculated by Kaplan-Meier method.The comparison of survival was done by Log-rank test.Results (1) Comparison of clinical features between MD-IPMN,MT-IPMN and BD-IPMN:The numbers of patients with symptoms,jaundice,those complicated with diabetes and elevated CA19-9 were 55,20,43 and 28 in MD-IPMN and MT-IPMN,and 6,0,3 and 1 in BD-IPMN,with statistically significant difference (x2=5.421,3.516,5.525,3.834,P＜0.05).(2) Surgical and postoperative conditions:the operations for all the 77 patients were successfully done,including pancreaticoduodenectomy with or without preservation of pylorus on 45 patients,resection of head of pancreas with duodenum preservation on 3 patients,distal pancreatectomy on 23 patients,distal pancreatectomy combined with partial resection of spleen and stomach on 2 patients (with greater curvature of stomach involvement),segmental pancreatectomy on 2 patients,total pancreatectomy on 2 patients.A total of 26 surgery-related complications were detected,including pancreatic fistulas (13),delayed gastric emptying (9),wound infection (2),abdominal hemorrhage (2),and all the complications were improved by conservative treatment.There was no perioperative mortality.The mean duration of hospital stay of the 77 patients was 16 days (range,6-68 days).(3) Results of postoperative pathological examination and malignant risk factor analysis:① results of postoperative pathological examination:no residual tumor was detected at the resection margin in all the 77 patients,including 47 with benign IPMN (29 with adenoma and 18 with mid-severe atypical hyperplasia and without lymph node involvement) and 30 with malignant IPMN (all of them were invasive malignancy,including 17 patients with negative lymph node metastasis and 13 with positive lymph node metastasis).② Malignant risk factor analysis of IPMN:multivariate analysis showed that age,jaundice,elevated carcinoembryonic antigen (CEA),elevated CA19-9,tumor diameter,tumor subtypes were associated with malignancy (x2 =6.531,14.755,10.243,12.062,6.416,6.143,P ＜ 0.05).Multivariate analysis showed that jaundice,elevated CEA,elevated CA19-9,tumor diameter ≥3.0 cm,MD-IPMN were independent risk factors influencing the malignancy of IPMN (OR =9.656,42.853,23.243,34.387,69.883,95％ confidence interval:1.392-66.968,2.088-879.674,2.991-180.628,3.313-356.878,1.247-3 915.467,P＜0.05).(4) Accuracy evaluation of the Sendai and Fukuoka guidelines in diagnosis of malignant IPMN.The sensitivity,specificity,positive and negative predictive values were 100.0％(30/30),14.9％ (7/47),42.9％ (30/70) and 100.0％ (7/7) for the Sendai guideline and 86.7％ (26/30),48.9％ (23/47),52.0％ (26/50),85.2％ (23/27) for the Fukuoka guideline in diagnosis of malignant IPMN,with no significant difference in the sensitivity between the 2 guidelines (x2=2.250,P＞0.05),while significant difference in the specificity between the 2 guidelines were detected (x2 =12.500,P＜0.05).(5) Follow-up and survival:Seventy of 77 patients were followed up,including 42 with benign IPMN and 28 with malignant IPMN.The median survival time was 35.0 months (range,6.0-94.0 months).All the malignant IPMN patients received adjuvant therapy.The 1-,3-,5-year overall survival rates of 47 patient with benign IPMN were 100.0％,96.2％and 96.2％,respectively,and 1 patient died of cardiac infarction.The 1-,3-,5-year overall survival rates of 30 patients with malignant IPMN were 96.6％,81.8％,38.6％,respectively,and 11 patients died of tumor recurrence or metastasis with median time of tumor recurrence or metastasis of 20.5 months (6.0-61.6 months).The 1-,3-,5-year overall survival rates of 17 patients with negative lymph node metastasis were 100.0％,100.0％ and 60.0％,respectively,and the 1-,3-,5-year overall survival rates of 13 patients with positive lymph node metastasis were 91.7％,57.1％ and 0,respectively.There was statistically significant difference between patients with benign and malignant IPMN (x2 =12.530,P＜0.05).There was statistically significant difference between patients with negative lymph node metastasis and those with positive lymph node metastasis (x2 =16.977,P＜ 0.05).Conclusions Patients with MD-IPMN or MT-IPMN are more vulnerable to be complicated with diabetes,jaundice,elevated CA19-9 and high malignancy,and thus surgery is recommended.Jaundice,elevated CEA and CA19-9,tumor diameter≥3.0 cm,MD-IPMN are the independent risk factors influencing the malignancy of IPMN.
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Introducción: La neoplasia mucinosa intraductal papilar (NMIP) del páncreas es una masa quística dependiente del sistema ductal pancreático. Presentación del caso: Paciente de 65 años, femenino, antecedentes mórbidos de diabetes mellitus tipo 2 sin tratamiento e hipertensión arterial esencial en tratamiento. Consulta por cuadro clínico de 9 horas caracterizado por epigastralgia opresiva/urente de inicio súbito, con irradiación en faja a dorso, intensidad EVA 10/10, asociado a náuseas, sin vómitos, diarrea ni fiebre. Ingresa hemodinámicamente estable, afebril, hidratada, sin signos de irritación peritoneal, sin masas palpables y con ruidos hidroaéreos presentes. Destaca en exámenes de laboratorio: amilasa 390 UI/L, lipasa 1760.9 U/L.Se diagnostica pancreatitis aguda y por sospecha de etiología biliar se realiza colangiopancreatografia por resonancia magnética (CPRM). Como hallazgo se describe formación quística de 13mm a nivel de la transición entre cuerpo y cola del páncreas, compatible con NMIP de rama secundaria y se diagnostica pancreatitis aguda leve Balthazar B de etiología litiásica. Se realiza manejo de la pancreatitis y debido a las características del NMIP encontrado el plan es seguimiento tomográfico en 2 a 3 años. Discusión: Las NMIP son hallazgos imagenológicos frecuentemente incidentales, pues la mayoría de los pacientes se mantienen asintomáticos. La característica imagenológica habitual corresponde a una lesión quística multilocular lobulada situada en el proceso unciforme y en contigüidad con el conducto pancreático principal dilatado. Según las características de la lesión, el manejo puede ser quirúrgico o seguimiento. Las tasas de supervivencia global a 5 años se acercan a 61-87%
Introduction: Pancreatic intraductal papillary mucinous neoplasm (IPMN) is a cystic mass dependent on the pancreatic ductal system. Case report: Female, 65 years old, with morbid history of type 2 diabetes without treatment and essential hypertension under treatment. Consults by clinical profile of 9 hours characterized by oppressive/ burning epigastralgia of sudden onset, with irradiation in sash to back, intensity EVA 10/10, associated with nausea, without vomiting, diarrhea or fever. Is hemodynamically stable, afebrile, hydrated, with no signs of peritoneal irritation, with no palpable masses and with bowel sounds present. Highlights in laboratory tests: amylase 390 UI / L, lipase 1760.9 U / L. Acute pancreatitis is diagnosed and due the suspicion of biliary etiology a magnetic resonance cholangiopancreatography is performed. A cystic formation of 13mm is described at the transition level between body and tail of the pancreas, compatible with branch duct type IPMN and acute mild pancreatitis Balthazar B of lithiasic etiology is diagnosed. Management of pancreatitis is performed and because of the characteristics of the IPMN found the plan is tomographic follow-up in 2 to 3 years. Discussion: IPMN are frequently incidental imaging findings, as most patients remain asymptomatic. The usual imaging characteristic corresponds to a lobulated multilocular cystic lesion located in the unicular process and in contiguity with the main dilated pancreatic duct. Depending on the characteristics of the lesion, the management may be surgical or follow-up. The 5-year survival rates approach 61-87%.
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Humans , Female , Aged , Pancreatic Intraductal Neoplasms/therapy , Pancreatic Intraductal Neoplasms/diagnostic imaging , Pancreatitis/drug therapy , Pancreatitis/diagnostic imagingABSTRACT
Objective To explore the imaging findings of branch duct intraductal papillary mucinous neoplasms (BD-IPMNs). Methods A total of 45 BD-IPMNs were confirmed by pathology after surgery.The clinical data and imaging findings were retrospec-tively reviewed.Image analysis included characteristics and the nature of the lesions.Finally,an ROC curve was performed to evaluate the differential diagnostic efficacy between benign and malignant lesions using the imaging findings.Results There were statistically significant differences for differential diagnosis of malignant and benign BD-IPMNs in the maximum diameter of the lesions and the MPD,walls,wall nodules,shape,and the atrophy of pancreatic parenchyma (P < 0.05 ).The diagnostic sensitivity,specificity, AUC and Kappa value of benign and malignant BD-IPMNs were 94.3%,90%,92.1% and 0.81 (P =0.000 1)respectively.Conclu-sion The imaging technology is valuable in diagnosing and differentiating malignant from benign BD-IPMNs.
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Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) and intraductal papillary mucinous neoplasm of the pancreas (IPMN-P) have striking similarities and are recognized as counterparts. However, simultaneous occurrence of IPMN-B and IPMN-P is extremely rare. A 66 year-old female presented with recurrent epigastric pain and fever. During the past 9 years, she had three clinical episodes related to intrahepatic duct stones and IPMN-P in the pancreas head and was managed by medical treatment. Laboratory test results at admission revealed leukocytosis (12,600/mm3) and elevated CA 19-9 level (1,200 U/mL). Imaging study demonstrated liver abscess in the Couinaud's segment 4, IPMN-B in the left lobe, and IPMN-P in the whole pancreas with suspicious malignant change. Liver abscess was drained preoperatively, followed by left lobectomy with bile duct resection and total pancreatectomy with splenectomy. On histologic examination, non-invasive intraductal papillary mucinous carcinoma arising from various degree of dysplastic mucosa of the liver and pancreas could be observed. However, there was no continuity between the hepatic and pancreatic lesions. This finding in our case supports the theory that double primary lesions are more likely explained by a diffuse IPMN leading to synchronous tumors arising from both biliary and pancreatic ducts rather than by a metastatic process. Herein we present a case of simultaneous IPMN of the bile duct and pancreas which was successfully treated by surgical management.
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Aged , Female , Humans , Adenocarcinoma, Mucinous/diagnosis , Adenocarcinoma, Papillary/diagnosis , Bile Duct Neoplasms/diagnosis , Bile Ducts, Intrahepatic/pathology , CA-19-9 Antigen/analysis , Carcinoma, Pancreatic Ductal/diagnosis , Hepatectomy , Leukocytosis/diagnosis , Pancreatectomy , Pancreatic Neoplasms/diagnosis , Tomography, X-Ray ComputedABSTRACT
BACKGROUNDS/AIMS: Appropriate management for multifocal branch duct type intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas is still controversial. This study was intended to reveal surgical outcomes of surgical resection for multifocal BD-IPMNs, with BD-IPMNs in the remnant pancreas. METHODS: Between January 1995 and December 2013, 699 patients underwent the pancreatic resection due to IPMN of pancreas in our institution. Among them, 37 patients showed multifocal BD-IPMNs. After excluding patients who had BD-IPMNs completely resected, medical records of 22 patients with remained BD-IPMNs in the remnant pancreas were retrospectively reviewed. RESULTS: Mean patient age was 65+/-6.4 years. Types of surgery included central pancreatectomy (n=1), distal pancreatectomy (n=14), and standard pylorus-preserving pancreaticoduodenectomy (n=7). Specimen pathology showed that IPMN was either at low/intermediate-grade dysplasia (n=17) or at high-grade dysplasia (n=2). Three patients had IPMN associated with invasive carcinoma. Their mean follow-up period was 40.4 months. During follow-up, one mortality occurred 35.2 months after the operation which was not associated with IPMN. There was no clinically significant disease progression or recurrence of IPMN in the remnant pancreas during the follow-up period. CONCLUSIONS: Our results support that we can safely preserve the pancreas parenchyma with multifocal BD-IPMNs. Benign-looking multifocal BD-IPMNs in the remnant pancreas do not affect the survival of patients.
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Humans , Disease Progression , Follow-Up Studies , Medical Records , Mortality , Mucins , Pancreas , Pancreatectomy , Pancreaticoduodenectomy , Pathology , Recurrence , Retrospective StudiesABSTRACT
Objective To investigate the relationship between the immunohistochemical types and the pathological types of pancreatic intraductal papillary mucinous neoplasms (IPMN).Methods Literatures on the diagnosis and treatment of pancreatic IPMN published before June 30,2011 in the PubMed database were retrieved.The literatures adopted were scored by the case reports quality assessment list.The correlation analysis between the immunohistochemical types and the gender,pathological types,characteristics of benign or malignant tumor and morphological types were analyzed.All data were analyzed using the Pearson chi-square test or multiple regression analysis.Results Thirteen literatures were adopted,the scores were 31-45 (full mark:50),and the mean score was 37.The clinical data of 826 pancreatic IPMN patients who were comfirmed by pathological examination were collected,and there were 4 immunohistochemical types:(1) The gastric type (363 patients).Of the 271 patients who underwent gender analysis,there were 195 males and 76 females,with the median age of 65.6 years.Of the 225 patients who underwent pathological types analysis,there were 146 cases of adenoma,34 cases of borderline tumor,24 cases of carcinoma in situ,21 cases of invasive carcinoma,the benign tumor was accounted for 86.68％ (293/338).Of the 215 patients who underwent morphological type analysis,there were 34 cases of main pancreatic duct type,151 cases of branch duct type and 30 cases of mixed type.(2) The intestinal type (327 patients).Of the 269 patients who underwent gender analysis,there were 184 males and 85 females,with the median age of 64.5 years.Of the 262 patients who underwent pathological types analysis,there were 28 cases of adenoma,43 cases of borderline tumor,91 cases of carcinoma in situ,100 cases of invasive carcinoma,the benign tumor was accounted for 29.21％ (85/291).Of the 151 patients who underwent morphological type analysis,there were 63 cases of main pancreatic duct type,54 cases of branch duct type and 34 cases of mixed type.(3) The pancreatobiliary type (92 patients).Of the 78 patients who underwent gender analysis,there were 41 males and 37 females,with the median age of 69.2 years.Of the 81 patients who underwent pathological types analysis,there were 4 cases of adenoma,1 case of borderline tumor,21 cases of carcinoma in situ,55 cases of invasive carcinoma,the benign tumor was accounted for 5.75％ (5/87).Of the 34 patients who underwent morphological type analysis,there were 7 cases of main pancreatic duct type,18 cases of branch duct type and 9 cases of mixed type.(4) The oncocytic type (44 patients).Of the 37 patients who underwent gender analysis,there were 24 males and 13 females,with the median age of 60.3 years.Of the 33 patients who underwent pathological types analysis,there were 18 cases of carcinoma in situ,15 cases of invasive carcinoma,and all of them were with malignant tumors.Of the 36 patients who underwent morphological type analysis,there were 9 cases of main pancreatic duct type,16 cases of branch duct type and 11 cases of mixed type.The immunohistochemical type of pancreatic IPMN was correlated with gender,pathological type and characteristics of maglignant or benign tumors (x2=10.626,281.839,333.212,r =0.097,0.569,0.625,P ＜ 0.05).The result of the chi-square test between the immunohistochemical types and the morphological types was statistically significant (x2 =50.732,P ＜ 0.05),but there was no correlation between them (r =0.010,P ＞ 0.05).Conclusion The immunohistochemical type of pancreatic IPMN is correlated with gender,pathological type and the characteristics of maglignant or benign tumors,which provide references for the diagnosis and prognosis evaluation of pancreatic IPMN.
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ObjectiveTo detect the expressions of β-catenin protein in different pancreatic tissues ( NP,PanINs,IPMNs and PDAC) and evaluate its significance during the carcinogenesis of PDAC.Methods The expression of β-catenin protein in 12 samples of normal pancreatic tissues,52 samples of IPMN (IPMA 20 foci,IPMB 13 foci,IPMC 19 foci),PanINs 118 foci (PanIN-1 73 foci,PanIN-2 29 foci,PanIN-3 16 foci),50 cases of PDAC was determined by using immunohistochemistry. The correlation between β-catenin expression and clinicopathologic characteristics of PDAC was analyzed. Results β-catenin was mainly expressed in cell membrane of NP,the quantity was 4.38 ± 2.11 ; in PanINs,PDAC and IPMN,β-catenin membrane expression was significantly decreased or absent,the β-catenin membrane expressions of PanIN-1,PanIN-2,PanIN-3,PDAC,IPMA,IPMB,IPMC were 5.22 ±2.21,2.24 ±2.31,1.44 ±1.37,2.71 ±2.08,4.85 ±2.28,4.15 ±2.51,2.68 ±2.75.The cytoplasm expression of PanIN-1 was 12.3％ (9/73),while the nuclear expression was 0 ; and the corresponding values were 34.5％ (10/29) and 3.4％ ( 1/29 ) in PanIN-2; 43.8％ (7/16) and 12.5％ (2/16) in PanIN-3; 44.0％ (22/50) and 10.0％ (5/50) in PDAC.The IHCS of β-catenin membrane expression decreased with the severe tissue atypia along the progressive multistage.The β-catenin membrane expression was significantly associated with tumor size,neural infiltration and lymphatic metastasis ( P ＜ 0.05 ).Ectopic cytoplasm expression was significantly associated with tumor size (P＜0.05 ). Ectopicnuclear expression was significantly associated with tumor differentiation (P＜0.01).The membrane or ectopic cytoplasm expression of β-catenin was significantly associated with postoperative survival.ConclusionsAbnormal Wnt/β-catenin signal activation induces decreased β-catenin membrane expression and increased ectopic expression,which is an important mechanism of pathogenesis and development of PDAC,and promotes the growth and metastasis of PDAC.The expression of β-catenin was associated with postoperative survival.
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La neoplasia mucinosa papilar intraductal (NMPI) es un tumor pancreático raro que cada día se diagnostica más debido al aumento de los estudios de imágenes para la evaluación del páncreas; los pacientes con este tipo de tumores pueden presentarse a los servicios de urgencias con dolor abdominal agudo que en múltiples ocasiones se cronifica y se acompaña de episodios repetitivos de pancreatitis. En el presente artículo describimos un caso de un paciente NMPI como causa de pancreatitis aguda, quien consulta a urgencias por dolor abdominal severo.
Intraductal papillary mucinous neoplasms (IPMNs) are rare pancreatic tumors that are diagnosed more and more frequently as imaging for evaluation of the pancreas becomes more widespread. Patients with these tumors may arrive at an emergency room with acute abdominal pain that often becomes chronic, accompanied by repeated episodes of pancreatitis. In this paper we describe the case a patient with IPMN which was a cause of acute pancreatitis. This patient came to the emergency room for severe abdominal pain.
Subject(s)
Humans , Male , Middle Aged , Abdominal Pain , Neoplasms , Pancreatic Neoplasms , PancreatitisABSTRACT
Objective: To investigate the expression of protein MUC1 and MUC2 in intraductal papillary mucinous neoplasms (IPMNs) and its significance. Methods: Immunohistochemical method (En Vision) was used to analyze the expression of protein MUC1 and MUC2 in 18 IPMNs and 9 pancreatic ductal adenocarcinomas. Results: Expression of protein MUC1 was detected in 4 of the 18 (22%) IPMNs (including 1 with pancreatic intraductal papillary-mucinous carcinoma) and all the 9 (100%) the pancreatic ductal adenocarcinomas, with the latter significantly higher than the former(P<0.01). Expression of protein MUC2 was detected in 17 of the 18 (94.4%) IPMNs and in 1 of the 9 (11.1%) pancreatic ductal adenocarcinomas, with the former significantly higher than the latter(P< 0.01). The expression levels of MUC2 were significantly different in IPMNs of different types (IPMA, IPMB, and IPMC, P<0.05). Conclusion: IPMNs have high expression of MUC2 and the expression is associated with the pathological types of IPMN. MUC1 expression may serve as a marker of malignant IPMNs and is worth further studying.
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Objective: To investigate the expression of DNA methylation transferase 1 (DNMT1) and histone deacetylase 1 (HDAC1) proteins in intraductal papillary mucinous neoplasms (IMPNs) and its possible clinical significance. Methods: The presence of DNMT1 and HDAC1 proteins in the 48 IPMNs and 54 pancreatic ductal adenocarcinomas (PDACs) were examined using SP immunohistochemical method and were statistically analyzed. Results: The expression levels of both DNMT1 and HDAC1 increased in a malignancy-dependent manner:normal pancreatic ductal →IPMA,IPMB → IPMC → PDAC. And both of them were positive in IPMNs of different subtypes. Conclusion: Higher expression of DNMT1 and HDAC1 is an early event of pancreatic malignancy. Expression of them can reflect the malignancy transformation of IPMNs, but can not be used for histological typing of IPMNs.
ABSTRACT
Intraductal papillary mucinous neoplasms of the bile ducts (IPMNs-B) are uncommon lesions that are characterized by innumerable papillary fronds that contain fine vascular cores, enriched mucin production and bile duct dilatation. IPMNs-B are histologically similar to intraductal papillary mucinous neoplasms of the pancreas and they are occasionally associated with hepatolithiasis. IPMNs-B are considered to be relatively low-grade malignancy and they merit consideration for aggressive surgery. Thus, early and precise diagnosis is important to maximize patient survival. From July 2002 to March 2006, we identified four patients with IPMNs-B at our hospital. In three patients, intrahepatic or extrahepatic bile duct stones were associated with their condition. Computed tomography and magnetic resonance cholangiography were done in all four cases and this demonstrated marked dilatation of the biliary tree. Endoscopic retrograde cholangiography was done in two cases and a large amount of mucin that was draining from the patulous orifice of the duodenal papilla was seen on endoscopy. However, two cases were initially misdiagnosed as intrahepatic cholangiocarcinoma or choledochal cyst with intrahepatic bile duct stones. All the cases underwent ipsilateral hemihepatectomy with caudate lobectomy. Histologically, one case showed to be adenoma, one case was borderline and two cases were invasive adenocarcinoma.