Caracterización clínica y epidemiológica de pacientes operados por câncer de tiroides

RESUMEN Introducción: el carcinoma de tiroides constituye menos del 1% de las neoplasias malignas en la población general y el 0,5% -3% en la edad pediátrica, pero es la neoplasia maligna más frecuente del sistema endocrino siendo responsable del 1% de los fallecimientos por cáncer. Objetivo: caracterizar clínica y epidemiológicamente a los pacientes sometidos a tratamiento quirúrgico por cáncer de tiroides. Métodos: se realizó un estudio observacional descriptivo, retrospectivo, de corte transversal en 45 pacientes sometidos a tratamiento quirúrgico por cáncer de tiroides en el servicio de Cirugía General del Hospital "Carlos Manuel de Céspedes" durante el período comprendido entre enero 2015- diciembre 2018. Resultados: la edad media de los pacientes fue 49.04 años, del sexo femenino (75.56%). El antecedente familiar de primer grado con algún tipo de cáncer de tiroides fue el único factor de riesgo en 4.44%. Predominaron los tumores del tipo histológico papilar (77.78%). La tiroidectomía total fue el proceder quirúrgico más empleado (75.56%). La correlación entre la citología por aspiración con aguja fina y la biopsia por congelación resultó recomendable para la práctica clínica. Conclusiones: la presente investigación concluye con la caracterización de los pacientes con cáncer de tiroides que recibieron tratamiento quirúrgico, mediante tiroidectomía total en casi todos los casos, la mayor parte féminas en edad media de la vida y con ausencia de factores de riesgo para padecer esta enfermedad, la variedad histológica de tipo papilar fue la más frecuente, existiendo correlación entre la citología por aspiración con aguja fina y la biopsia, por lo cual recomendamos tal procedimiento en la práctica clínica diaria.

ABSTRACT Introduction: thyroid carcinoma constitutes less than 1% of malignant neoplasms in the general population and 0.5% -3% in pediatric age, but it is the most frequent malignant neoplasm of the endocrine system, being responsible for 1% of cases. cancer deaths. Objective: to characterize clinically and epidemiologically patients undergoing surgical treatment for thyroid cancer. Methods: a descriptive, retrospective, cross-sectional, observational study was carried out in 45 patients undergoing surgical treatment for thyroid cancer in the General Surgery service of the ``Carlos Manuel de Céspedes´´ Hospital during the period between January 2015-December 2018. Results: the mean age of the patients was 49.04 years, female (75.56%). First-degree family history with some type of thyroid cancer was the only risk factor in 4.44%. Tumors of the papillary histological type predominated (77.78%). Total thyroidectomy was the most used surgical procedure (75.56%). The correlation between fine-needle aspiration cytology and frozen biopsy was recommended for clinical practice. Conclusions: the present investigation concludes with the characterization of patients with thyroid cancer who received surgical treatment, by means of total thyroidectomy in almost all cases, most of them females in middle age of life and with absence of risk factors to suffer from this disease. disease, the histological variety of papillary type was the most frequent, with a correlation between fine-needle aspiration cytology and biopsy, which is why we recommend such a procedure in daily clinical practice.

RESUMO Introdução: o carcinoma da tireoide constitui menos de 1% das neoplasias malignas na população geral e 0,5% -3% em idade pediátrica, mas é a neoplasia maligna mais frequente do sistema endócrino, sendo responsável por 1% dos casos. Objetivo: caracterizar clínica e epidemiologicamente os pacientes submetidos ao tratamento cirúrgico do câncer de tireoide. Métodos: estudo descritivo, retrospectivo, transversal, observacional, realizado em 45 pacientes submetidos a tratamento cirúrgico de câncer de tireoide no Serviço de Cirurgia Geral do Hospital ``Carlos Manuel de Céspedes´´ no período de janeiro de 2015 a dezembro 2018. Resultados: a média de idade dos pacientes foi de 49,04 anos, do sexo feminino (75,56%). História familiar de primeiro grau com algum tipo de câncer de tireoide foi o único fator de risco em 4,44%. Os tumores do tipo histológico papilar predominaram (77,78%). A tireoidectomia total foi o procedimento cirúrgico mais utilizado (75,56%). A correlação entre a citologia aspirativa por agulha fina e a biópsia por congelação foi recomendada para a prática clínica. Conclusões: a presente investigação conclui com a caracterização dos pacientes com câncer de tireoide que receberam tratamento cirúrgico, por meio de tireoidectomia total em quase todos os casos, a maioria deles do sexo feminino na meia-idade de vida e com ausência de fatores de risco para sofrer desta doença. Na doença, a variedade histológica do tipo papilar foi a mais frequente, com correlação entre a citologia aspirativa por agulha fina e a biópsia, razão pela qual recomendamos tal procedimento na prática clínica diária.

Carcinoma pseudopapilar sólido del páncreas / Solid pseudo-papillary carcinoma of the pancreas

El tumor sólido pseudopapilar del páncreas, conocido también como tumor de Frantz, es una enfermedad rara: neoplasia bien delimitada, de lento crecimiento, no agresiva pero maligna, habitualmente con pronóstico favorable. El tratamiento de elección es quirúrgico. Aunque algunos de ellos son agresivos a nivel local, la mayoría de los pacientes se curan con la resección completa del tumor. Se reportó el caso de una mujer de 30 años, ingresada en el Servicio de Cirugía General del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, con diagnóstico presuntivo clínico e imagenológico, de tumor pseudopapilar sólido del páncreas, con confirmación histológica tras la resección quirúrgica. Este infrecuente tumor debe ser considerado en el diagnóstico diferencial de los tumores pancreáticos, fundamentalmente en mujeres jóvenes(AU)

The solid pseudo-papillary carcinoma, also known as Frantz´s tumor, is a rare disease. It is a well-defined neoplasia, of low growth, non-aggressive but malignant, usually with a favorable prognosis. The elective treatment is the surgery. Although some of them are locally aggressive, most patients are healed with the complete tumor resection. The authors reported the case of a woman, aged 30 years who entered the Service of General Surgery of the University Hospital Comandante Faustino Pérez Hernández, with a presumptive clinical and imaging diagnosis of pancreas solid pseudo-papillary tumor, histologically confirmed after surgical resection. This infrequent tumor should be taken into account in the differential diagnosis of pancreatic tumors, mainly in young women(AU)

Papillary Tumor of the Pineal Region:Report of One Case / 中国医学科学院学报

We report a case of papillary tumor in the pineal region.The imaging findings mainly included:(1)slight high density on CT images;(2)short T1 signal,cystic changes,and evident enhancement on magnetic resonance imaging.

Tumor papilar sólido-quístico pancreático / Solid pseudopapillary tumor of the pancreas

RESUMEN Antecedentes: la neoplasia sólida pseudopapilar del páncreas es una entidad rara, que típicamente se presenta en mujeres jóvenes. Suele presentar síntomas abdominales inespecíficos. Es un tumor maligno de bajo grado de malignidad. Objetivos : el objetivo del siguiente informe de serie de casos es presentar 9 casos tratados en un cen tro y realizar una revisión bibliográfica del tema. Material y métodos: estudio retrospectivo descriptivo de los casos con diagnóstico anatomopatoló gico de neoplasia sólida pseudopapilar en el Servicio de Cirugía General, desde febrero de 2013 hasta septiembre de 2019. Se contemplaron como variables: edad, sexo, localización del tumor, tratamiento quirúrgico realizado, tiempo operatorio, complicaciones, estancia hospitalaria y seguimiento alejado. Resultados: fueron 9 casos, todos de sexo femenino con media de edad de 30 años (rango 20 a 70 años). La localización más frecuente fue en cola de páncreas en 4 casos (45%). Todas las pacientes fueron sometidas a cirugía, con abordaje laparoscópico en el 60% de los casos (n = 5); la resección pancreática distal con preservación esplénica fue la conducta más utilizada (n = 6). Se constataron tres complicaciones, de las cuales dos fueron colecciones abdominales como consecuencia de una fístula pancreática que se abordaron por vía percutánea, y la restante fue un retardo del vaciamiento gástrico por lo cual la paciente requirió internación prolongada. Conclusión: la neoplasia sólida pseudopapilar pancreática es una enfermedad poco frecuente, ma ligna pero con bajo riesgo de malignidad. Presenta buena sobrevida cuando se somete a cirugía de carácter curativo; la laparoscopia es la vía de abordaje de elección en centros con experiencia.

ABSTRACT Background: Solid pseudopapillary tumor of the pancreas is a rare condition that affects young women. The most common symptom is unspecific abdominal pain. It is a malignant tumor of low malignant potential. Objective: The aim of this study is to report a case series of patients treated in a single center and perform a bibliographic review. Material and methods: We conducted a retrospective study of the cases with pathological diagnosis of solid pseudopapillary tumor of the pancreas treated in the Department of General Surgery between February 2013 and September 2019. The following variables were analyzed; age, sex, tumor location, surgical treatment, operative time, complications, length of hospital stay and long-term follow-up. Results: Nine patients were included; all of them were women with mean age of 30 years (range: 20 - 70 years). The most common location of the tumor was the tail of the pancreas (n = 4; 45%). Surgery was performed in all the cases; five cases underwent video-assisted laparoscopy and spleen-preserving distal pancreatectomy was the technique more commonly used (n = 6). Three complications were recorded: two abdominal collections due to biliary leaks were trated by percutaneous approach and the other patient presented delayed gastric emptying and required prolonged hospitalization. Conclusion: Solid pseudopapillary tumor pf the pancreas is a rare low-grade malignant neoplasm. The prognosis is favorable after surgery and laparoscopy is the preferred approach in centers with experience.

Papillary tumor in pineal region: Immunohistochemistry meeting the diagnostic challenge

Papillary tumor of pineal region (PTPR) is extremely rare and poses diagnostic challenge with other central nervous system tumors having papillary architecture. Immunohistochemistry is crucial for a definitive diagnosis of PTPR.

Caracterización clínica, patológica y epidemiológica de pacientes con carcinoma diferenciado de tiroides / Clinical, pathological and epidemiological characterization of patients with thyroid differentiated carcinoma

Introducción: El diagnóstico y tratamiento de pacientes con nódulo de tiroides son un desafío clínico, instrumental, imagenológico y patológico, y a pesar de que no representan un problema de salud en Cuba, afecta a un grupo importante de la población, fundamentalmente en edad laboral. Objetivo: Determinar las características clínicas, patológicas y epidemiológicas de pacientes con carcinoma bien diferenciado de tiroides. Métodos: Se realizó un estudio descriptivo y transversal de 30 pacientes con cáncer bien diferenciado de tiroides, operados en el Hospital Oncológico Conrado Benítez García de Santiago de Cuba, desde enero de 2014 hasta julio de 2017 y que recibieron tratamiento oncoespecífico, para lo cual se revisaron las historias clínicas y los informes de biopsia de cada uno. Resultados: En la serie predominaron las mujeres de 40-49 años de edad, los afectados de piel mestiza y negra, el aumento de volumen de la glándula, los nódulos hipoecogénicos, el tumor papilar, además de la infiltración capsular y la permeabilización vascular entre los factores pronósticos histológicos más comunes. Conclusiones: Existen elementos clínicos, epidemiológicos e imagenológicos para diagnosticar un presunto carcinoma bien diferenciado de tiroides.

Introduction: The diagnosis and treatment of patients with thyroid node are a clinical, instrumental, imagenological and pathological challenge, and although they does not represent a health problem in Cuba, they affect an important populational group, fundamentally in working periods. Objective: To determine the clinical, pathological and epidemiological characteristics of patients with well differentiated carcinoma of thyroid. Method: A descriptive and cross-sectional study of 30 patients with well differentiated cancer of thyroid, operated in Conrado Benítez García Oncological Hospital belonging to Santiago de Cuba was carried out from January, 2014 to July, 2017 and who received onchospecific treatment , for which the medical records and the biopsy reports were reviewed from each patient. Results: In the series the 40-49 year-old women , those patients affected of mestizo and black skin, the increase of the gland volume, the hypoechogenic nodules and the papillary tumor prevailed, besides the capsular infiltration and the vascular permeabilization among the most common histological prognosis factors. Conclusions: Clinical, epidemiological and imagenological elements exist to diagnose a presumed well differentiated carcinoma of thyroid.

Surgical treatment of ciliated muconodular papillary tumor of the lung:a report of 11 cases / 中华胸心血管外科杂志

Objective To investigate the clinical features of ciliated muconodular papillary tumor( CMPT) of the lung. Methods We retrospectively reviewed 11 cases with final pathology being diagnosed as CMPT in our department from April 2017 to April 2018. There were 8 males and 3 females with a mean age of(63. 7 ± 5. 6) years. The clinical data, histopatho-logical features, treatment, and prognosis were reviewed. All patients received CT scan before operation. Results The radio-logical features of CMPT include:located peripherally and most in right lower lobe;most CMPT lesions are GGO, some with air spaces in center and few being solid. All patients underwent video-assisted thoracic surgery( VATS) successfully, and there were no severe perioperative complications. The mean operating time was(78. 0 ± 28. 2) min. The mean blood loss was (37. 3 ± 14. 9) ml. The mean postoperative hospital stays were(3. 45 ± 0. 93) days. Pathology examination of all patients were CMPT. Follow-up time ranged from 6 to 18 months and no recurrence was found. Conclusion CMPT is rare tumor, without specific clinical manifestation, but sometimes misdiagnosed as adenocarcinoma in situ or minimally invasive adenocarcinoma. VATS is feasible and safe for CMPT, and the prognosis is good.

A Case of Typical Ciliated Muconodular Papillary Tumor of the Lung: A Clinicopathological Analysis / 中国肺癌杂志

BACKGROUND@#The pathogenesis of a ciliated muconodular papillary tumor (CMPT) of the lung is extremely rare which is difficult to distinguish from other lung lesions and it is easy to cause misdiagnosis and missed diagnosis. By collecting CMPT data, its clinical and pathological features can provide medical treatment ideas for the majority of medical workers and reduce medical errors.@*METHODS@#The clinical data, pathological features, immunophenotype of a typical CMPT patient and related literature were analyzed.@*RESULTS@#The chest computed tomography (CT) showed there was a mixed density nodule in the right lower lung near the pleura with a diameter of about 9 mm. We performed a wedge resection on the patient. The pathological results showed that the nodule was composed of proliferated ciliated cells, mucous cells, and basal-like cells. The ciliated cells were lined on the surface of papillary structures. The basal-like cells were located in the outer layer, while the mucous cells were located between the two. The cell atypia was not obvious. Immunohistochemistry: epithelial cells CEA (+), CK7 (+), CA125 (+), weakly positive for TTF-1, CK20 (-), Ki67 (1%+), CK5/6 (+), and basal cells P63 (+).@*CONCLUSIONS@#CMPT is a rare pulmonary neoplasm. There is no definite conclusion about its biologic nature, but most experts prefer a benign to a malignant tumor. CMPT can show many malignant tumor signs on imaging and is often mistaken for lung adenocarcinoma. According to its typical histopathological characteristics and immunohistochemical phenotype, it can be differentiated from other pulmonary diseases. Whether gene mutation is the driving factor is still unknown. Surgical resection for the tumor reveals a good prognosis.

Surgical treatment of ciliated muconodular papillary tumor of the lung: a report of 11 cases / 中华胸心血管外科杂志

Objective@#To investigate the clinical features of ciliated muconodular papillary tumor(CMPT) of the lung.@*Methods@#We retrospectively reviewed 11 cases with final pathology being diagnosed as CMPT in our department from April 2017 to April 2018. There were 8 males and 3 females with a mean age of(63.7±5.6) years. The clinical data, histopathological features, treatment, and prognosis were reviewed. All patients received CT scan before operation.@*Results@#The radiological features of CMPT include: located peripherally and most in right lower lobe; most CMPT lesions are GGO, some with air spaces in center and few being solid. All patients underwent video-assisted thoracic surgery(VATS) successfully, and there were no severe perioperative complications. The mean operating time was(78.0±28.2) min. The mean blood loss was(37.3±14.9) ml. The mean postoperative hospital stays were(3.45±0.93) days. Pathology examination of all patients were CMPT. Follow-up time ranged from 6 to 18 months and no recurrence was found.@*Conclusion@#CMPT is rare tumor, without specific clinical manifestation, but sometimes misdiagnosed as adenocarcinoma in situ or minimally invasive adenocarcinoma. VATS is feasible and safe for CMPT, and the prognosis is good.

Expression of miR-143 in patients with PTC and its influence on immune function / 中国免疫学杂志

Objective:To investigate the relationship between the expression level of miR 143 and prognosis/cellular biological characteristics in patients with papillary thyroid carcinoma (PTC),and explore the potential mechanisms.Methods:30 PTC patients were admitted and enrolled into the trial from 2013 April to 2016 December.The qPCR was performed to detect the expression of miR143 in cancer tissues and adjacent tissues from 30 PTC patients.The effect of miR143 on overall survival rate and metastasis-free survival rate was assessed with specific analysis .CON and pGenesil1-miR143 vector were transfected into PTC cell line IHH-448h after qPCR.CKK8 and Annexin V/PI flow cytometry were performed to detect cell proliferation ,and apoptosis,respectively.Cell migration was asseessed by transwell experiment .Levels of miR143,IL-10,IFN-γin serum were assessed and calculated with the pearson coeffi-cient.PTC patients were assigned into miR 143 high and low expression group according to miR 143 expression , and IL-10 and IFN-γwere measured with routine protocol.Results:The relative expression of miR143 in paracancerous tissues and tumor tissues was (1.0± 0.15) vs (0.12±0.06).miR143 was significantly associated with the survival rate and metastasis rate of patients (P<0.001).miR143 expression levels in IHH-4 pGenesil1-miR143 and control group were ( 8.63 ±0.71 ) vs ( 1.0 ±0.06 ) , and the proliferative index in pGenesil1-miR143 group was significantly lower than CON group (P<0.01).Percentage of Annexin and V+positive cells in pGenesil1-miR143 and CON group was (40±7.2) vs (2±0.38),and the ratio of the number of migrating cells was (40±7.2) vs (2±0.38) (P<0.001).Analysis showed that r2 were -0.4 and 0.62 for IL-10 and IFN-γ,respectively(P<0.001).In miR143 low group and high ex-pression group,expression levels of IFN-γwas (8±0.23) vs (11.2±0.12),while IL-10 was (12±3.1) vs (8.43±0.44) (P<0.05). Conclusion:miR143 is low expressed in PTC patients and associated with prognosis and survival .Highly expressed miR143 inhibited the proliferation of IHH-4 cell lines,increased apoptosis and decreased migration ,also the expression of miR143 is related to the immune function of the patients .

Analysis of the clinicopathological characteristics and prognosis in 674 cases of breast intraductal papillary tumor / 中华肿瘤杂志

Objective@#Breast intraductal papillary tumors are clinically common diseases derived from the ducts. The aim of this study is to investigate the clinicopathological characteristics of intraductal papillary tumors and risk factors for carcinogenesis.@*Methods@#The clinicopathological data of 674 patients with breast intraductal papillary tumors, who underwent surgery in the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences from January 2010 to July 2015, were retrospectively analyzed.@*Results@#The median follow-up time was 46 months. The 674 cases were classified into 547 intraductal papilloma, 88 cases of intraductal papillary carcinoma, 32 cases of intracystic papillary carcinoma, and 7 cases of solid papillary carcinoma of breast. After a median follow-up time of 46 months, 13 out of 547 (2.4%) intraductal papillomas had local recurrence in the original dissected quadrat, another 10 cases developed breast cancer in the original dissected quadrat. The 3-year recurrence-free survival rates in intraductal papilloma and intraductal papilloma accompanied with atypical ductal hyperplasia were 97.7% and 93.5%, respectively, the recurrence-free survival curves showed a significant difference (P=0.011). Multivariate analysis indicated that atypical ductal hyperplasia was a major prognostic factor affecting the recurrence-free survival of intraductal papilloma (RR=0.183, 95%CI=0.054 to 0.777, P=0.020). Four cases (3.1%) of intraductal papillary carcinoma had local recurrence. The logistic analysis showed that patient aged >45 years, clinical manifestations of a breast lump, maximum tumor diameter greater than 2 cm are possible clinical manifestation of malignant breast intraductal papillary tumors (RR=1.735, 95%CI=1.007-2.990, P=0.047; RR=2.849, 95%CI=1.207-6.711, P=0.017; RR=3.792, 95%CI=2.162-6.653, P<0.001).@*Conclusions@#Intraductal papillary tumors have a certain recurrence rate. Age, clinical features and tumor size may be predictive factors of intraductal papillary carcinoma.

Surgical treatment and prognosis analysis of solid pseudo papillary tumor of the pancreas:a report of 45 cases / 临床外科杂志

Objective To discuss the surgical treatment and prognosis of solid pseudo papillary tumor of the pancreas. Methods The clinical data of 45 patients with solid pseudo papillary tumor of the pancreas were analyzed retrospectively. Surgical treatment was performed in all cases,including 11 cases of local excision of the pancreas,20 cases of resection of the pancreatic body and tail,5 cases of resection of the pancreatic body,tail plus spleen,and 9 cases of pancreaticoduodenectomy. Results A total of 43 ca-ses were followed up for 6 ~ 160 months,with an average of(41. 5 ± 1. 5)months. There were 8 cases of dyspepsia,2 cases of pancreatic fistula,2 cases of pleural effusion,2 cases of incision liquefaction and in-fection,and 1 case of early hemorrhage of the digestive tract. All patients were cured by conservative treat-ment. No metastasis,recurrence or death occurred after the operation. Conclusion The pseudo papillary tumor of the pancreas is a potential low grade malignant tumor which mainly appears in females. Surgery is the only radical treatment and its prognosis is generally good.

Correlación cito-histológica del tumor papilar de la glándula pineal. Presentación de un caso / Papillary pineal tumor: cyto-histological correlation. Case report

En la última revisión de la Organización Mundial de la Salud (OMS) en relación a los tumores del sistema nervioso central (SNC), se describieron nuevas entidades, como el Tumor Papilar de la Glándula Pineal. Esta lesión de rara aparición, se ha identificado en adultos jóvenes. El diagnóstico de estos tumores es complejo ya que depende de su ubicación, edad de aparición y el aspecto histológico; éste último tiene similitudes con otras lesiones como el ependimoma papilar o el papiloma/carcinoma de plexos coroides. Citológicamente presentan características claras que pueden ayudar al diagnóstico a través de la impronta en el estudio intraoperatorio; reconocer ciertos criterios con éste importante y sencillo método diagnóstico ha sido la motivación principal para el estudio de entidades poco frecuentes del SNC, además de corroborar el necesario trabajo de un equipo multidisciplinar.

In the latest revision of the central nervous system tumors (CNS) of the World Health Organization (WHO), new entities has been described, as papillary tumor of the pineal region. This rare lesion has been identified in young adults. The diagnosis of these tumors is complex, depends on the location, age of onset and histological appearance. Histological characteristics have similarities with other lesions such as papillary ependymoma, papiloma / choroid plexus carcinoma. Cytologically have clear characteristics that can aid in the diagnosis through the smears on the intraoperative study. Certain criteria for recognize this important and simple diagnostic method has been the main motivation for the study of CNS rare entities, as our case, in addition to corroborating the necessary work of a multidisciplinary team.

Cirugía preservadora del páncreas, ¿es la fístula pancreática un elemento menor a considerar? / Pancreatic preserving surgery: it is the pancreatic fistula a minor issue to consider?

Objetivo: La insuficiencia pancreática en especial la de carácter endocrino, reviste vital relevancia como complicación tardía de la cirugía pancreática esto debido a la morbilidad asociada y el difícil manejo de la diabetes pancreaticogénica, ante esta situación, se han ideado técnicas quirúrgicas que permitan preservar el mayor tejido pancreático intentando evitar esta temible complicación. Métodos: Se presenta una serie de casos (n=3) con tumores pancreáticos de potencial maligno bajo, a quienes se les practicó una cirugía preservadora del páncreas de los siguientes tipos: pancreatectomía central, pancreatectomía distal de margen mínimo y enucleación de tumor en la cabeza de páncreas, todas las lesiones fueron superiores a los 3 cm de diámetro. Resultados: Dos de los 3 pacientes presentaron fístulas pancreáticas: uno grado A y el otro grado B, con prolongación en su estancia hospitalaria, las cuales fueron manejadas medicamente hasta lograr su resolución. Los pacientes poseen un seguimiento promedio de 31,66 meses, siendo la de mayor seguimiento de 57 meses, actualmente todos se encuentra con eufunción endocrina y exocrina del páncreas, sin recurrencia de la enfermedad neoplásica. Conclusión: La cirugía preservadora ha demostrado ser segura desde el punto de vista oncológico; sin embargo, en lesiones que superen los 3 cm de diámetro hay que sopesar el riesgo dela fístula pancreática asociada(AU)

Objective: The pancreatic insufficiency related to pancreatic resection is one of the most dreaded complications, the difficult management of pancreaticogenic diabetes and the morbidity associated has pushed to create less aggressive surgery in order to preserve more pancreatic tissue. Methods: Case series presentation (n=3) with low malignant pancreatic tumors, were performed three types of surgeries: central resection, distal resection with minimum margin, and enucleation of tumor in the pancreatic head. All of tumors measured above 3 cm.Results:Two of 3 patients developed pancreatic fistulas, one type A and the other type B, the post-operative course was complicated by the fistula, extending the hospital stay, the pancreatic fistulas were management only medically until get resolution. The patients follow up was 31,66 month, with the longest of 57 months. All patients have normal pancreatic function and oncologic disease free. Conclusion: The pancreatic preserving surgery has demonstrated to be saving in terms of oncology, but tumor over 3 cm ithas to be taken in consideration the complication associated to pancreatic fistula(AU)

Endoscopic Papillectomy for Benign Ampullary Neoplasms: How Can Treatment Outcome Be Predicted?

BACKGROUND/AIMS: Endoscopic papillectomy is increasingly performed with curative intent for benign papillary tumors. This study was performed to identify factors that predict the presence of malignancy and affect endoscopic success. METHODS: We retrospectively analyzed the medical records of patients who received an endoscopic papillectomy for papillary adenoma from 2006 to 2009. RESULTS: A total of 43 patients received endoscopic papillectomy. The pathologic results after papillectomy revealed adenocarcinoma in five patients (12%), and the risk of malignancy was high in cases of large lesions, preprocedural pathology of high-grade dysplasia or high serum alkaline phosphatase. Endoscopic success was observed in 37 patients (86%) at the end of follow-up (mean duration, 10.4+/-9.6 months). The factor significantly affecting success was a complete resection at the initial papillectomy (p=0.007). Two patients experienced recurrence 10 and 32 months after the complete resection, but both achieved endoscopic success with repeated endoscopic treatment. Six patients with endoscopic failure received surgical resection. CONCLUSIONS: Endoscopic papillectomy is a safe and effective method for the curative resection of benign papillary tumors, especially when complete resection is achieved at the initial papillectomy. Follow-up with surveillance should be performed for at least 3 years because of the possible recurrence of tumors during these periods.

Clinical feature and differential diagnosis of solid pseudo-papillary tumor of pancreas / 中国医师进修杂志

Objective To summarize the clinical feature and diagnosis experience of sliid pseudopapillary tumor of pancreas (SPT).Methods Clinical manifestations,laboratory examination imageology,operative procedure,pathology of 22 patients from January 2000 to December 2008 were retrospectively analyzed.Results Clinical presentation included a palpable abdominal mass in 3 cases,abdominal pain in 1 cases,abdominal distention in 5 cases,13 cases were asymptomatic.Tumor markers in all patients were negative.Abdominal imaging showed solid and solid cystic masses in pancreas or abdominal cavity.Ten cases located in the head of pancreas,8 cases in the body of pancreas,4 cases in the tail of pancreas.The correct diagnosis proportion of MRI and CT was 33.3％(2/6) and 18.2％(4/22) respectively.Conclusion SPT is one of rare pancreatic neoplasm with low malignant potential,affecting primarily young women.Typital image characteristic contributes to the diagnosis of SPT.

Clinical analysis of 38 cases solid pseudo-papillary tumor of pancreas / 中华内分泌外科杂志

Objective To clarify the clinical features of solid pseudo-papillary tumor of pancreas. Methods Clinical data of 38 patients with solid pseudo-papillary tumor of pancreas were analyzed retrospectively. Results The clinical manifestations included a palpable abdominal mass, abdominal pain and discomfort. Tumor occured in 1 case younger than 10 years old, 11 cases between 11 years old and 20 years old, 7 cases between 21 years old and 30 years old, 9 cases between 31 years old and 40 years old, 5 cases between 41 years old and 50 years old and 1 case older than 50 years. Immunohistochemistry staining showed CgA( + ) in 6 cases,Vim( + )in 29 cases,AAT( + ) in 29 cases,Syn( + ) in 21cases,CD10( + ) in 34 cases,CD56( + ) in 37 cases, Ki-67 ( + ) in 36 cases and PR( + ) in 38 cases. Conclusion Solid pseudo-papillary tumor of pancreas is closely associated with gonadal hormone and reproductive system.

Preoperative predictors for nature of duodenal papillary tumors / 第二军医大学学报

Objective: To establish a preoperative forecasting model for the nature of duodenal papillary tumors and to discuss its main predictors. Methods: A case-control study was conducted; the case group included patients with malignant duodenal papillary tumors and the control group included patients with benign duodenal papillary tumors. All the patients were from Changhai Hospital. Data of patients, including the demographic characteristics, clinical symptoms during onset, laboratory findings, and radiological data, were collected by face-to-face interviews or by reviewing the medical history. Chi-square, t-test or ANOVA were employed to performed univariate analysis. All factors with P values less than or equal to 0.25 in the univariate analysis were used as independent variables for multivariate analysis, and a Logistic regression forecasting model for the nature of duodenal papillary tumors was established. Results: Totally 199 patients with pathologically-confirmed duodenal papillary tumors were included in the present study, with 166 in the case group and 33 in the control group. Multivariate analysis showed that hemoglobin (Hb), total bifirubin (Tbil), direct bilirubin (Dbil), aspartate transferase (AST), alkaline phosphatase(A-KP), gamma glutamyl transpeptidase(GGT), and carcinoembryonic antigen(CEA) were independent predictors for nature of duodenal papillary tumors, with their odds ratios (95% confidence interval) being 0.981 (0.959, 1.003), 0. 867(0.794, 0. 948), 207(1. 075, 1.355), 1. 028(1.008, 1.048) 0. 996(0.992, 1.000), 1.0020(1.000, 1.004), and 0.974(0.953,0.994), respectively. Conclusion: The Logistic regression model, which takes into consideration of Hb, Tbil, Dbil, AST, AKP, GGT, and CEA, can be used to predict the nature of duodenal papillary tumors, and its clinical value need to be further studied.

F-18 FDG PET/CT Finding in Solid Pseudo-papillary Tumor of the Pancreas 6 years After Initial Diagnosis / 핵의학분자영상

Solid pseudo-papillary tumor (SPT) is a rare pancreatic neoplasm with low malignant potential, which tends to occur predominantly in younger females. Only a few cases of SPT seen on F-18 FDG PET scan have been reported, and the findings are not fully evaluated. A 33 year-old woman underwent F-18 FDG PET/CT study for staging of renal cell carcinoma. She was diagnosed with SPT of the pancreas 6 years ago, and has not had any treatment so far. Recent PET/CT showed marked F-18 FDG uptake in the peripheral solid portion and relatively less F-18 FDG uptake to the central calcified portion of SPT. We report one case of SPT of the pancreas on F-18 FDG PET/CT.