Colloid carcinoma arising from intraductal papillary mucinous neoplasm of pancreas: imaging features and differentiation from ductal adenocarcinoma / 中华放射学杂志

Objective:To investigate the imaging features of colloid carcinoma arising from intraductal papillary mucinous neoplasm (IPMN) of pancreas and the differentiation features from ductal adenocarcinoma arising from IPMN, using the pathological findings as the reference.Methods:Twenty-four patients with pathologically confirmed colloid carcinoma from November 2013 to January 2020 in Changhai Hospital, Navy Medical University were included in this study. The clinical manifestations, imaging features and pathological data were retrospective reviewed. Thirty patients of ductal adenocarcinoma arising from IPMN confirmed by pathology were selected as the control group. CT and MRI features of two groups were blindly analyzed by two radiologists, including the lesions location, type of IPMN, size, components, density or signal, calcification, dilation and size of the main pancreatic duct (MPD), pancreatic parenchymal atrophy, fistula formation. The χ 2 test or Fisher exact probability was used to compare the imaging features between the two groups. Results:As for IPMN with colloid carcinoma, 16 cases were located in the head of the pancreas, 7 cases in the body and tail of the pancreas, and 1 case showed diffused changes of the pancreas. Mass was found in twenty-two cases, with the size of 54.5 (29) mm. Nineteen cases were solid-cystic, 4 were cystic and 1 was solid. Thick wall and internal separation with mild enhancement were displayed. Five cases were found with high signal on T 1WI. Thirteen cases had calcification and 2 cases had gas in the tumor. The size of MPD was (13±5) mm. Pancreatic parenchymal atrophy was found in 21 cases and fistula formation was found in 8 cases. The mass size of IPMN with colloid carcinoma was significantly greater than that of IPMN with ductal adenocarcinoma [31 (16) mm, Z=-3.758, P<0.001]. Solid-cystic mass was more found in IPMN with colloid carcinoma and solid mass was more found in IPMN with ductal adenocarcinoma ( P<0.001). Calcification ( P=0.001), fistula formation ( P=0.031), and high signal on T 1WI ( P=0.034) were more found in IPMN with colloid carcinoma than IPMN with ductal adenocarcinoma. Conclusion:Compared with IPMN with ductal adenocarcinoma, the solid-cystic mass, calcification, fistula formation and high signal on T 1WI were more commonly found in IPMN with colloid carcinoma.

Inhibitory effect of triptolide on growth of subcutaneous tumor of pancreatic cancer in nude mice and its mechanism / 吉林大学学报(医学版)

Objective: To observe the antitumor effect of triptolide in the human pancreatic cancer tumor-bearing nude mice, and to explore its molecular mechanism. Methods: The healthy BALB/ c nude mice were selected and transplanted with the human pancreatic cancer SW1990 cells into the skin of the right hind limb to establish the tumor-bearing model of nude mice. The successful modeling nude mice were divided into model group, gemcitabine group and triptolide group, 10 in each group; another 10 healthy nude mice were selected as control group. The tumor tissue of SW1990 pancreatic cancer tumor-bearing nude mice were weighed and the inhibitory rate of tumor was calculated. The expressions of apoptosis-related proteins Bax and bcl-2 in the pancreas tissue of the nude mice in each group were detected by rmmunohistochemistry. The expression levels of Bax, bcl-2, Caspase-9 and Caspase-3 in the pancreas tissue of the nude mice in each group were detected by Western blotting method. Results: Compared with gemcitabine group, the inhibitory rate of tumor of SW1990 pancreatic cancer in triptolide group was significantly increased (P < 0. 05). The HE staining results showed that compared with model group, the proliferation of pancreatic cancer tumor cells in triptolide group was inhibited. The immunohistochemistry results showed that the expression level of Bcl-2 in the pancreas tissue and the Bcl-2 /Bax ratio of the nude mice in tripptolide group were lower than those in model group (P < 0 . 05). The Western blotting results showed that compared with model group, the expression levels of Bax, Caspase-9 and Caspase-3 in the pancreas tissue of the nude mice in triptolide group were significantly increased (P < 0 . 05), while the expression level of Bcl-2 was significantly decreased (P < 0 . 05). Conclusion: Triptolide can inhibit the growth of tumor tissue in the nude mice; its mechanism may be related to inhibiting the activation of Bcl-2 in pancreatic tumor tissue, promoting the expression of Bax, reducing the ratio of Bcl-2 /Bax, promoting the activation of Caspase-9 and Caspase-3, and inducing the apoptosis of pancreatic cancer transplanted tumor cells.

Clinical and pathological features of solid pseudopapillary neoplasm of the pancreas: An analysis of 14 cases / 临床肝胆病杂志

ObjectiveTo investigate the clinical features, pathological features, differential diagnosis, and prognosis of solid pseudopapillary neoplasm (SPN) of the pancreas. MethodsA retrospective analysis was performed for the clinical data of 14 patients with SPN who were treated in our hospital from January 2014 to February 2018, and related articles were reviewed. ResultsThere were 11 female and 3 male patients with an age of onset of 13-77 years (mean 33.1 years). Most of them attended the hospital due to lesions found by physical examination or the presence of upper abdominal pain. Radiological examination revealed space-occupying lesion in the pancreas. The maximum diameter of the tumor ranged from 0.6 cm to 22 cm. Histological examination showed that most tumors were composed of solid areas and pseudopapillary areas, with a microcystic structure in local lesion. Immunohistochemistry showed positive Vimentin and negative CgA ,Glucagon, Gastrin, and Insulin in all patients. Some patients were positive for β-catenin (13/14), CD10 (10/14), CD56 (9/14), Syn (8/14), AA-T (11/14), PR (8/14), CyclinD1 (9/14), CA19-9 (3/14), CK-pan (9/14), CEA (1/14), and P53 (1/14). Ki-67 index was ≤10% in all 14 patients. ConclusionSPN of the pancreas should be diagnosed with reference to clinical data, imaging examination, histological features, and immunohistochemistry. The microcystic structure has a certain value in the diagnosis of SPN.

Effectiveness and feasibility of concurrent chemoradiotherapy using simultaneous integrated boost-intensity modulated radiotherapy with and without induction chemotherapy for locally advanced pancreatic cancer

PURPOSE: To evaluate the effectiveness and feasibility of chemoradiotherapy (CRT) using simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in locally advanced pancreatic cancer (LAPC) patients. MATERIALS AND METHODS: Between January 2011 and May 2015, 47 LAPC patients received CRT using SIB-IMRT. Prior to SIB-IMRT, 37 patients (78.7%) received induction chemotherapy (IC-CRT group) and remaining 10 patients (21.3%) did not received induction chemotherapy (CRT group). During SIB-IMRT, all patients received concomitant chemotherapy, with gemcitabine (n = 37) and capecitabine (n = 10). RESULTS: At the time of analysis, 45 patients had died and 2 patients remained alive and the median follow-up time was 14.2 months (range, 3.3 to 51.4 months). For all patients, the median times of local progression-free survival (LPFS), progression-free survival (PFS), and overall survival (OS) were 18.1, 10.3, and 14.2 months, respectively. The median time of LPFS between IC-CRT and CRT groups was similar (18.1 months vs. 18.3 months, p = 0.711). IC-CRT group had a higher trend in PFS (10.9 months vs. 4.1 months, p = 0.054) and had significantly higher OS (15.4 months vs. 9.5 months, p = 0.007) than CRT group. In multivariate analysis, the use of induction chemotherapy and tumor response were significant factors associated with OS (p < 0.05, each). During SIBIMRT, toxicity of grade ≥3 was observed in 7 patients (14.9%) in all patients. CONCLUSIONS: CRT using SIB-IMRT is feasible and promising in LAPC patients.

Treatment effect of Da Huang Mu Dan Tang in rats with pancreatic carcinoma and protective effects on liver and kindey function / 吉林大学学报(医学版)

Objective: To establish the pancreatic carcinoma models of rats with dimethybenzanthracene (DMBA)embedding method,to discuss the treatment effect of Da Huang Mu Dan Tang (DHMDT)in the rats with pancreatic carcinoma and the protective effects on the liver and kidney function,and to clarify the mechanisms. Methods:Sixty-five SD male rats were divided into blank control (n=10)and modeling group (n=55).DMBA was embedded in the capsule of pancreas to establish the pancreatic carcinoma models of rats. After 3 months, 50 successfully modeling rats were randomly divided into model,5-FU (intravennous injection,12 mg· kg-1 ), low,middle and high doses of DHMDT (intragastric administration,20,40 and 80 mg· kg-1 )groups.After 10 weeks of administration,the levels of alanine aminotransferase (ALT),aspartate transaminase (AST),urea nitrogen (BUN),creatinine (Cr)and total bilirubin (TBiL)in serum of the rats in various groups were measured;the weights and the inhibitory rates of the pancreatic tumor were detected;TUNEL method was used to analyze the apoptotic rates of tumor tissue;the expression levels of SST2R,Bax and Bcl-2 genes in pancreatic tumor tissue of the rats were detected by Q-PCR method.Results:Compared with model group,after treated for 10 weeks,the levels of ALT,AST,BUN,Cr and TBiL in serum of the rats in low,middle and high doses of DHMDT groups were significantly decreased (P <0.05 or P <0.01);the weights of tumor of the rats in middle and high doses of DHMDT groups were decreased (P <0.05 or P <0.01);the apoptotic rates of the cells in pancreatic tumor tissue of the rats in low,middle and high doses of DHMDT groups were increased (P <0.05 or P <0.01);the expression levels of SST2R gene in pancreatic tumor tissue of the rats in low,middle and high doses of DHMDT groups were significantly increased (P <0.05 or P <0.01);the expression levels of Bax gene in pancreatic tumor tissue of the rats in middle and high doses of DHMDT groups were significantly increased (P < 0.05 or P < 0.01),while the expression levels of Bcl-2 in pancreatic tumor tissue of the rats were significantly decreased (P < 0.05 ). Conclusion:DHMDT has the treatment effect in the rats with pancreatic carcinoma and can promote the apoptosis of tumor cells;DHMDT can protect the liver and kidney function of the rats with pancreatic carcinoma.

Application of levels of serum CA199,C3,C4 and lipid metabolism in clinical diagnosis of pancreatic cancer / 吉林大学学报(医学版)

Objective:To evaluate the diagnostic values of single and combined detection of serum CA199, complement 3 (C3),complement 4 (C4),total cholesterol (TC),triglyceride (TG),and lipid metabolism levels in the patients with pancreatic cancer, and to explore their correlations with TNM stage and pathological stage of pancreatic cancer.Methods:Total 185 subjects were enrolled into the study by three groups:pancreatic cancer patients group (Pc group,n=77),non-digestive system cancer patients group (Ndc group,n=58)and healthy control group (Hc group,n=50).The levels of serum CA199,C3,C4,and high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein A (ApoA), apolipoprotein B (ApoB), apolipoprotein E (ApoE),and lipoprotein a (Lpa)levels were detected.Results:① The serum level of CA199, C3,C4,and ApoE of the patients in Pc group were higher than those in Ndc and Hc groups (P0.05).The levels of C3, C4,and ApoE in Pc group and Ndc group was higher than those in Hc group (P<0.01),and the levels of the biomarkers in Pc group were also higher than those in Ndc group (P<0.01).The levels of HDL-C,ApoA and Lp (a)of the patients in Pc group were significantly lower than those in Ndc and Hc groups (P<0.05).② The area under ROC curve (AUC)of serum CA199,C3,C4,ApoE,HDL-C,and ApoA were 0.916,0.841, 0.788,0.785,0.834,and 0.810,respectively.Furthermore,multiple factor analysis showed that the combined detection of CA199,C3,and HDL-C (AUC=0.968)improved the diagnosis compared with detecting CA199 alone (P<0.05).③ The CA199 level of the patients inⅢ-Ⅳ stage of TNM stage was higher than that in the patients inⅠ-Ⅱ stage (P<0.01).For the pathological stage,the ApoA level in low differentiation group was higher than that in moderate and high differentiation group (P<0.05).There was no statistical difference in other biomarkers between the different TNM stages and pathological stages.Conclusion:The levels of CA199,C3,C4 and ApoE of pancreatic cancer patients are significantly increased, while the levels of HDL-C, ApoA, and Lp (a ) are significantly reduced.Combined detection of CA199,C3,and HDL-C can improve the early diagnosis of pancreatic cancer compared with the single assessment of each biomarker.

Primary pancreatic neuroendocrine neoplasms:a clinicopathological analysis of 60 cases / 临床与实验病理学杂志

Purpose To study the clinicopathological characteristics of primary pancreatic neuroendocrine neoplasms. Method 60 cases of resected pancreatic neuroendocrine neoplasms according to the WHO (2010) classification of the digestive system of neuroen-docrine tumor to evaluate morphological standard, and combining with the literature to discuss the clinicopathological characteristics. Results Among the 60 cases, 23 cases were male patients, the rest were females, with male and female ratio of 1 ∶ 1. 61. The age of the patients were ranged from 19 to 69 years, with mean age of 49. 38 ± 11. 60 years. Tumor maximum diameter ranged from 0. 5 to 16 cm, and the mean diameter was 3. 29 ± 3. 53 cm. 30 cases located in the pancreatic head, 27 cases in the body and end of the pancre-as and 3 cases in the neck. Pathological examination showed the G1 (24 cases), G2 (25 cases), G3 (9 cases), and mixed adenon-euroendocrine carcinoma ( MANEC) in 2 cases. Immunohistochemical staining showed that NSE, CgA, Syn, and CD56 were diffusely positive expression. 45 patients were followed up for 4~80 months, 7 cases died, of which 1 case was G2, 4 cases were G3, and 2 ca-ses were MANEC. Conclusion Primary pancreatic neuroendocrine neoplasms is a relatively rare pancreatic malignant tumor, and the diagnosis is based primarily on histologic features and immunohistochemical examination. Accurate pathological assessment has impor-tant value to guide clinical treatment and prognosis.

CT characteristics of acinar cell carcinoma of pancreas / 中华放射学杂志

Objective To assess CT characteristics of acinar cell carcinoma of pancreas(ACCP).Methods Ten patients (9 males,1 female,median age 62 years ) with ACCP proved histopathologically were collected during January 2001 to August 2010.The unenhanced and contrast-enhanced CT were performed in all patients.Results The tumors were distributed in the uncinate ( n =4 ),head ( n =1 ),neck ( n =1 ),body ( n =2 ),and tail ( n =2 ) of pancreas.The average tumor size is 6.7 cm( range 2.0 to 15.0 cm).Two patients whose size over 10 cm were solid-cystic tumors,the rest were solid. All patients demonstrated a defined border,no-infiltrate to surround organs and blood vessels.The tumors enhanced less than adjacent normal pancreatic parenchyma in arterial phase and portal venous phase.All patients could be seen uniform and partial thin and enhancing capsules.Seven patients had no influence on pancreatic (bile) tube.Three patients caused the main pancreatic duct to expansion,one patients caused intrahepatic and extrahepatic bile ducts to expansion. Conclusion ACCP has distinct characteristics in CT and these characteristics are related to its histopathology findings.

Clinical features and surgical outcomes of solid pseudopapillary tumor of the pancreas / 国际外科学杂志

ObjectiveTo summarize the clinical features and surgical outcomes in solid pseudopapillary tumor of pancreas.MethodsA retrospective clinical analysis was made on 18 cases of solid pseudopapillary tumor of pancreas confirmed by pathological diagnosis from Jan.2000 to Feb.2011.ResultsThe median age of these cases was 27.8 years,ranging from 15 to 46 years.Fifteen cases were female and 3 cases were male.The size of the tumor ranged from 4.0 cm to 15.0 cm,with an average size of 7.1 cm.Eleven of 18 tumors(61.1％ ) had a well-defined capsule,and 5 tumors (27.8％ ) extended beyond the pancreas.Nine of the 18 tumors (50.0％) had a cystic component,and calcification was observed in 3 tumors ( 16.7％ ).The frequency of microscopic venous invasion,lymphatic invasion,and nerve invasion was 16％ (3 of 18),0 and 0 respectively.No lymph node involvement or liver metastasis was observed.Distal pancreatectomy plus splenectomy was done in 5 patients,spleen- preserving distal pancreatectomy in 3,medial pancreatectomy in 1,subtotal stomach- preserving pancreatoduodenectomy in 1,enucleation in 9.Fifteen patients were still alive without recurrent disease or metastasis after a median follow-up of 48 months.Conclusions These results demonstrated that solid pseudopapillary tumor of pancreas occurs mainly in young women,patients with solid pseudopapillary tumor of the pancreas had a favorable outcome after surgical treatment,including enucleation.

Solid pseudopapillary tumor with hepatic metastasis / 대한외과학회지

Solid pseudopapillary tumor of the pancreas is a rare tumor that affects young females with low malignant potential and good prognosis with more than 90% survival at 5 years. Metastasis is very rare. We report the case of a 74-year-old female who had pancreatic solid-pseudopapillary tumor and synchronous hepatic metastasis.

Extended pancreaticoduodenetomy combined with mesentery root resection in treatment of patients with pancreatic and duodenal malignancy involving root of mesentery / 第二军医大学学报

Objective: To search for a method for radical resection of pancreatic and duodena malignancy involving the mesentery root and for the long post-operation survival of patients. Methods: From Jan. 2004 to Aug. 2006, a total of 26 (16 male and 10 female, aged 27-70) patients with pancreatic and duodenal malignancy involving the mesentery root were treated in our department. The patients included 3 with duodenal malignancy and 23 with pancreatic malignancy. Curative resection was performed by the extended pancreaticoduodenetomy (Whipple procedure) combined with mesentery root resection (MRR) for all patients. The outcomes, safety and the post-operation survival rate were analyzed retrospectively. Results: Thirteen patients were treated with Whipple procedures combined with MRR, 9 were treated with partial portal vein/superior mesenteric vein (PV/SMV) and reconstruction of the vessel, and 4 patients received pre-shunt between PV and SMV with artificial vessel graft before the extended Whipple and NMR procedures. The operation time was 2. 5 to 7 (4. 4 ± 1. 1) hour 9 and blood loss was 300 to 5 000 (1 892 ± 1 414) ml with the blood transfusion of 0 to 5 600 (2 100 ± 1 586) ml. There was no death in our group and 7 (27%) had post-operation complication. The post-operation hospital stay was 10 to 30 days. The pathologic examination showed negative surgical margins for all specimens. The tumor size was 4 to 10 (6.17 ± 2.03) cm. After a follow-up of 9 to 38 months, the pain was relieved in all patients. One of the 3 patients with duodenal adenocarcinoma had liver metastasis at 10 months after operation, and the other 2 survived 10 months and 27 months without evidence of tumor reccurence. The patient with pancreatic micro-adenocarcinoma died of local reccurence 9 months after operation. The patient with neuroendocrine carcinoma died of organ failure 24 months after operation. The patient with lymphoma have survived for 24 months after operation. The 1-year and 2-year accumulated survival rates in the 20 cases with pancreatic ductal cancer were 86.6% and 45.6%, respectively. Conclusion: The extended Whipple procedure with MRR is safe and effective. It can obtain RO resection in patients with malignant tumors (over 5 cm in diameter) in the head, neck and uncinate process of the pancreas and duodenal.

Clinical and radiological characteristics of benign and malignant intraductal papillary mucinous tumors of the pancreas / 第二军医大学学报

Objective: To discuss the feasibility of distinguishing benign from malignant intraductal papillary mucinous tumors (IPMT) of the pancreas preoperatively based on the clinical and radiological characteristics. Methods: The clinical data of 40 patients with IPMT treated between July 1996 and March 2007 were analyzed. The diagnoses of all patients were confirmed pathologically after surgical resections. Among the 40 patients, there were 17 benign cases and 23 malignant ones. Results: Malignant IPMT patients had a higher frequency of upper abdominal pain and jaundice than benign patients (P<0.05). The sex difference in incidence of IPMT, time of onset, and loss of body mass were not significantly different between the 2 groups. Radiological results demonstrated that the size of tumor and mural nodules in the lesions were larger in the malignant cases than in the benign cases (P<0.05); besides, the malignant cases also had a more dilated main pancreatic duct (MPD) (P<0.05). Mural nodules and thick irregular septum in the cystic lesions were more frequently seen in malignant cases (P<0.05). There was no significant difference in the site preference between the 2 groups. Conclusion: Benign and malignant IPMT have significant differences in their clinical and radiological characteristics, which provides an important evidence for differentiating the biological types of IPMT and helps surgeons on their decision of surgical planning.

Efficacy and safety of pancreas freezing / 中华胰腺病杂志

Objective To observe the blood biochemical and histological changes before and after pancreas freezing, to provide evidence for cryosurgery for pancreatic cancer. Methods Fifteen healthy pigs were divided into deep frozen group (n = 5), shallow frozen group (n = 5), non-frozen group (n = 3) and normal group (n = 2). After anesthesia and Iaparotomy, a probe of the Argon-Helium Surgical System was inserted into the pancreas, 100% and 10% argon output power were used in deep and shallow frozen group, respectively;and the temperature were - 130 ～ - 140℃ and - 110 ～ - 120℃, respectively;which results in an ice-ball with 15 ～ 20 mm in diameter. Then helium gas was inputted to increase the temperature to 10 ～ 20℃ for three minutes;then the whole process was repeated. A probe was inserted into the pancreas in the non-frozen group only and only laparotomy was performed in non-grozen group normal group and normal group. Serum amylase, IL-6, CRP levels before and after the experiment was determined;the pigs were sacrificed at day 7 and the pancreas was harvested for light microscope and electron microscope examination. Results The frozen pancreatic tissue became pitchy necrosis zone, and it could be distinguished from non-frozen tissue;there were obvious tissue necrosis in the center and para-center of frozen area, and the ultra-structure were destroyed and disappeared, mitochondria degranulation and rough endoplasmic reticulum degrannlation were observed. Serum amylase was elevated in 13 (86.7%) pigs and most returned to normal at 6th day. Serum IL-6 was slightly elevated in 5 (33.3%) pigs. There was no significant difference among all the groups in term of serum CRP. All the pigs were alive until the time of sacrifice. Conclusions Cryosurgery has affirmative fatal ablative effects on pancreatic tissue, and it is safe with no serious complications.

The Efficacy of an Ultrasound-guided Core Needle Biopsy with an 18G Cutting Needle for the Diagnosis of Pancreatic Diseases

PURPOSE: The objective of this study is to evaluate the efficacy and safety of an ultrasound-guided core needle biopsy with an 18G cutting needle in patients suspected of having a pancreatic disease by analyzing the diagnostic performance and complication rate. MATERIALS AND METHODS: The study population comprised 35 consecutive patients who underwent an ultrasound-guided core needle biopsy using a high-speed biopsy gun accompanied with an 18G cutting-type needle between May of 2001 and October of 2005. The diagnostic performance (i.e., the acquisition rate and diagnostic accuracy) and complications associated with core needle biopsies were evaluated for its efficacy and safety. RESULTS: Thirty-six sessions of ultrasound-guided core needle biopsies were performed in 35 consecutive patients. All patients, except two (serous cystadenoma and autoimmune pancreatitis) were diagnosed with various subtypes of pancreatic cancer. The acquisition rate and diagnostic accuracy were 97% (35/36) and 94% (34/36), respectively. A complication occurred only in one patient (3%), which further proved to be a delayed complicaton (i.e., needle tract implantation). CONCLUSION: According to our findings, the ultrasound-guided core needle biopsy is a viable and safe method for the dignosis of pancreatic diseases. Moreover, it enables the diagnosis of the pancreatic cancer subtype.

High-intensity Focused Ultrasound Treatment (HIFU) for the Advanced Pancreatic Cancer

PURPOSE: We wanted to evaluate the levels of effect and safety of high-intensity focused ultrasound ablation (HIFU) for treating patients with advanced pancreatic cancer. MATERIALS AND METHODS: Nineteen sessions of HIFU, with the patients under general anesthesia, were performed in 18 patients with advanced pancreatic cancer. The change of the gray-scale of the target lesion was analyzed during HIFU, and MRI was performed before and after HIFU. We assessed the extent of coagulative necrosis, the change of pain and the complications after HIFU. The change of tumor size and the survival of patients were also evaluated. RESULTS: The average size of tumor was 4 cm in diameter. Eighty nine percent of the target tumors showed increased echogenicity. On MRI, necrosis of the entire target tumor occurred in 79% of the patients. After treatment, effective pain relief was noted in 89% of the patients. There were no major complications. No size increase of the treated tumor was noted during 24 weeks of follow-up for 10 patients. Six patients among 12 patients who were available for follow-up are still alive and they are receiving chemotherapy. Six patients expired due to other disease or progression of metastasis. CONCLUSION: HIFU is a safe method without any major complications, and it is effective for inducing tumor necrosis and achieving pain control for patients with advanced pancreatic cancer.

A Case of Primary Pancreatic T-cell Lymphoma

Primary pancreatic lymphoma is a rare extranodal manifestation of any histopathologic subtype of non-Hodgkin's lymphoma that predominantly involves the pancreas, and it comprises less than 0.5% of all pancreatic malignancies. Histopathologically, most primary pancreatic lymphomas are the B-cell phenotypes, and T-cell lymphomas are extremely rare. We describe here the ultrasonography and computed tomography (CT) findings of a pathologically confirmed pancreatic T-cell lymphoma in a 37-year-old female patient. Ultrasonography showed diffuse pancreatic enlargement and a slightly bulging mass in the head and tail of pancreas that had markedly heterogeneous echogeneity. The lesion abutted onto the adjacent vessels, but there was no evidence of luminal narrowing or obstruction. The CT scan showed diffuse enlargement of the pancreas and the bulging contoured mass at the pancreatic head and tail with inhomogeneous enhancement, including multiple hypodense areas. It also showed the patent peripancreatic vessels and multiple LN enlargements around the pancreas.

A Case of Primary Pancreatic T-cell Lymphoma

Primary pancreatic lymphoma is a rare extranodal manifestation of any histopathologic subtype of non-Hodgkin's lymphoma that predominantly involves the pancreas, and it comprises less than 0.5% of all pancreatic malignancies. Histopathologically, most primary pancreatic lymphomas are the B-cell phenotypes, and T-cell lymphomas are extremely rare. We describe here the ultrasonography and computed tomography (CT) findings of a pathologically confirmed pancreatic T-cell lymphoma in a 37-year-old female patient. Ultrasonography showed diffuse pancreatic enlargement and a slightly bulging mass in the head and tail of pancreas that had markedly heterogeneous echogeneity. The lesion abutted onto the adjacent vessels, but there was no evidence of luminal narrowing or obstruction. The CT scan showed diffuse enlargement of the pancreas and the bulging contoured mass at the pancreatic head and tail with inhomogeneous enhancement, including multiple hypodense areas. It also showed the patent peripancreatic vessels and multiple LN enlargements around the pancreas.

Application study of malignant pancreas tumor treatment with embedment of ~(125)I by CT guide / 肿瘤研究与临床

Objective To discuss the method,safety and effect of malignant pancreas tumor treated by CT guided percutaneous embedding of~(125)I. Methods 32 cases of malignant pancreas tumor with CT scan and contrast enhancement were retrospectively analysed.All the cases had been confirmed pathologically be- fore CT guided therapy.The number of~(125)I particle was 12～46,The distance between particles was 0.～1.2 cm. The number of puncture point was 1～2.The number of puncture direction was 2-5 times.Results Regarding 32 cases for 1 month,the size of the tumor reduced in 11 cases,no change in 20 cases,and increased in 1 case.As for 31 cases for 2 months,the size reduced in 16 cases,no change in 13 cases,and enlarged in 3 cases.Regarding 30 cases for 3 months,the size reduced in 18 cases,no change in 11 cases,and increased in 3 cases. Regarding 28 cases for 6 months, he size reduced in 10 cases, no change in 5 cases, and in- creased in 13 cases.Regarding 22 cases for 1 year,12 cases had been done the second therapy,the size of the tumor reduced in 16 cases,no change in 3 cases,and increased in 3 cases.Conclusion The size of pancreas tumors were reduced obviously,the symptoms were relieved after the treatment.The method turned out to be safe and accurate.

A Case of Osteoclast-like Giant Cell Tumor of the Pancreas with Ductal Adenocarcinoma: Histopathological, Immunohistochemical, Ultrastructural and Molecular Biological Studies

Osteoclast-like giant cell tumor of the pancreas is a very rare neoplasm, of which the histiogenesis remains controversial. A 63-yr-old woman was hospitalized for evaluation of epigastric pain. An abdominal computerized tomography revealed the presence of a large cystic mass, arising from the tail of pancreas. A distal pancreatectomy with splenectomy was performed. Histologically, the tumor was composed of mononuclear stromal cells intermingled with osteclast-like giant cells. In addition, there was a small area of moderately to well differentiated ductal adenocarcinoma. The final pathologic diagnosis was osteoclast-like giant cell tumor of the pancreas with ductal adenocarcinoma. Here, we describe the histopathological, immunohistochemical, ultrastructural and molecular biological findings of this tumor with review of the literature pertaining to this condition.

Selective Intra-Arterial Calcium Stimulation with Hepatic Venous Sampling for Preoperative Localization of Insulinomas

OBJECTIVE: To determine the value of selective intra-arterial calcium stimulation with hepatic venous sampling using serum insulin and C-peptide gradients for the preoperative localization of insulinomas. MATERIALS AND METHODS: Seven consecutive patients [three men and four women aged 15-77 (mean, 42.7) years] with hypoglycemia underwent selective intra-arterial calcium stimulation in conjunction with hepatic venous sampling. Insulin gradients were calculated by an individual blinded to all other preoperative imaging studies and operative findings. In all patients except one, C-peptide gradients were also analyzed. The results were compared with the preoperative findings of ultrasonography, computed tomography, arteriography and endoscopic ultrasonography, as well as with the intraoperative findings of ultrasonography and palpation at surgery. RESULTS: Eight insulinomas (mean diameter, 12.5 mm) were diagnosed after surgery. In six patients, the calcium stimulation test with insulin gradients allowed accurate localization of the pathologic source of insulin secretion. Both C-peptide and insulin gradients substantially increased diagnostic accuracy. In one patient, C-peptide gradients were more helpful than insulin gradients for tumor localization. CONCLUSION: Selective intra-arterial calcium stimulation with hepatic venous sampling is a highly accurate and safe method for the preoperative localization of insulinomas. Additional C-peptide gradients seem to be helpful in assessing tumor location, but further study is needed.