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Background: The Gustave Roussy immune score (GRIm score) is a laboratory index developed to predict survival in nonsmall cell lung cancer patients undergoing immunotherapy and has shown that the pretreatment value is an independent prognostic factor for survival. In this study, we aimed to determine prognostic significance of GRIm score for pancreatic adenocarcinoma that have not been determined in the literature for pancreatic cancer before. The reason for choosing this scoring is to show that the immune scoring system works as a prognostic marker in pancreatic cancer known as immune?desert tumor via immune properties of microenvironment. Methods: Medical records of patients with histologically confirmed pancreatic ductal adenocarcinoma, who were treated and followed up between December 2007 and July 2019 at our clinic, were reviewed retrospectively. GRIm scores of each patient were calculated at the time of diagnosis. Survival analysis were performed according to risk groups. Results: A total of 138 patients were included in the study. While 111 (80.4%) patients were in the low?risk group; 27 (19.6%) were in high?risk group according to GRIm score. Median OS was 36.9 months (95% Confidence interval (CI): 25.42�.56) in lower GRIm scores, and it was 11.1 months (95% CI: 6.83�.44) in higher GRIm scores (P = 0.002). One?two?three?year OS rates were 85% versus 47%, 64% versus 39%, 53% versus 27% for low versus high GRIm scores, respectively. The multivariate analysis revealed that high GRIm score was an independent poor prognostic factor. Conclusion: GRIm can be used as a noninvasive, easily applicable, practical prognostic factor in pancreatic cancer patients
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O Carcinoma de Células Acinares (CCA) é uma neoplasia epitelial maligna, composta por células com semelhança morfológica com células acinares e com evidências de produção de enzimas exócrinas pelas células neoplásicas. CCA é um tumor extremamente raro e agressivo: representa cerca de 1% de todas as neoplasias pancreáticas, e a taxa de sobrevida global de 5 anos encontra-se inferior a 10%. Esse relato justifica-se não só pela rara ocorrência da doença, mas também pela escassa literatura acerca dos conhecimentos da patologia estudada. Além disso, o CCA é um tumor com difícil diagnóstico e extremamente agressivo; o tratamento dessa doença continua sendo aprofundado, uma vez que novos estudos sugerem a presença de micrometástases indetectáveis em exames de imagem em pacientes submetidos à ressecção cirúrgica total com margens negativas. Dessa forma, há a necessidade de incrementar relatos de caso à bibliografia existente. O presente trabalho trata-se de um relato de caso de Carcinoma de Células Acinares no pâncreas de paciente do sexo masculino de 9 anos diagnosticado no Hospital da Criança Santo Antônio do Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre.
Acinar Cell Carcinoma (ACC) is an epithelial malignant neoplasm composed of cells with morphological similarity to acinar cells and with evidence of exocrine enzyme production by the neoplastic cells. ACC is extremely rare and an aggressive tumor: it represents about 1% of all pancreatic neoplasms, and the overall 5-year survival rate is less than 10%. This report justifies itself by the rare occurrence of the disease and by the scarce literature concerning the pathology studied. Moreover, ACC is a tumor that is difficult to diagnose and extremely aggressive; the treatment of this disease continues under investigation since new studies suggest the presence of micrometastases - undetectable in imaging studies - in patients undergoing total surgical resection with negative margins. Thus, there is a need to add case reports to the existing bibliography. The present study is a case report of Acinar Cell Carcinoma of the pancreas in a 9-year-old male patient diagnosed at Santo Antônio Children's Hospital, Hospital Complex Santa Casa in Porto Alegre (Hospital da Criança Santo Antônio do Complexo Hospitalar Santa Casa de Misericórdia).
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Carcinoma, Acinar CellABSTRACT
Pancreatic cancer (PC) is a highly malignant tumor of the digestive system. Due to the lack of sensitive and effective detection markers, the tumor is usually at a relatively advanced stage in initial diagnosis. Therefore, early detection of PC is crucial for timely treatment and better prognosis. Exosomes are extracellular vesicles secreted by cells. They have a lipid bimolecular membrane structure to ensure the stable existence of a large number of biologically active substances contained therein. So they can accurately reflect the characteristics of parental cells. Exosomes are widely present in various body fluids and can non-invasively, conveniently and real-timely extracted, with the potential to become a marker for early tumor diagnosis. Previous studies have shown that compared with traditional diagnostic methods, exosomes showed higher sensitivity and specificity in the early diagnosis of various cancers. This article reviews the research progress of exosomes in the early diagnosis of pancreatic cancer.
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Context: The safety and efficacy of irreversible electroporation (IRE) for locally advanced pancreatic carcinoma (LAPC) are well established. However, whether adjuvant chemoradiotherapy after IRE increases, the survival rate remains unknown. Therefore, this study evaluated the effect of chemoradiotherapy combined with IRE in patients with LAPC. Subjects and Methods: We retrospectively analyzed 42 patients with LAPC between July 2015 and December 2016 at PLA General Hospital treated with IRE or IRE combined with radiation and/or chemotherapy. These patients were divided into the IRE group and the combined-therapy group. All patients underwent computed tomography (CT), magnetic resonance imaging, and positron-emission tomography-CT and no signs of metastases were found. The prognosis of these patients was observed. Results: The times after operation and after diagnosis in the combined-therapy group (304.20 ± 118.54) and (334.40 ± 114.07) days, respectively, were better those than in the IRE group (214.36 ± 95.68) and (244.68 ± 110.61) days, respectively. Moreover, patients in the combined-therapy group had a significantly better survival rate than the IRE group (80 vs. 45.45%, P < 0.05). Conclusions: IRE combined with radiotherapy or chemotherapy was superior to IRE alone for the treatment of LAPC, as it prolonged the survival time and improved the survival rate, making it worthy of wide dissemination and clinical application
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Objective To study the component ratios of pancreatic carcinoma,and prognosis of patients with the different pathological types.Methods The data of 92 011 pancreatic carcinoma patients who were diagnosed by the definite pathological method from 2004 to 2014 were extracted from the US SEER database.The life table was used to calculate the 1-,3-and 5-year survival rates.The Kaplan-Meier was used to construct the survival curves of the patients.The Cox univariate analysis was applied to evaluate the HR of the different pathological types,and the x2 test and independent sample t-test were used to evaluate the base line data.Results The overall 5-year survival of 92 011 pancreatic carcinoma patients was 7.6％.The median survival time was 8.8 months and the component ratios of the pancreatic ductal adenocarcinoma (PDAC),pancreatic epithelium cancer bedside the PDAC,neuroendocrine tumors,undifferentiated carcinoma,mesenchymal carcinoma and rare cancer unclassified were 85.78％,6.40％,6.67％,0.97％,0.10％ and 0.08％,respectively.The differences were statistically significant between the baseline data such as age,gender,race and position (P ＜ 0.05).The overall 5-year survivals of the PDAC,pancreaticepithelium cancer beside the PDAC,neuroendocrine tumors,undifferentiated carcinoma,mesenchymal carcinoma and rare cancer unclassified were 4.2％,13.4％,49.2％,5.0％,29.2％ and 24.5％,respectively,and the median survival times were 5 months,7 months,58 months,2 months,26 months and 7 months respectively.The distant metastasis rate of neuroendocrine carcinoma was the lowest (35.0％).The undifferentiated carcinoma was the most prone to distant metastases (65.2％).Basically,half of the other types of pancreatic cancer had metastasis at the time of diagnosis.In pancreatic epithelium cancer beside the PDAC,the high to low 5-year survival rates were solid pseudopapillary carcinoma (87.3％),cystadenocarcinoma (36.8％),intraductal papillary mucinous neoplasm (36.5％),acinar cell carcinoma (20.0％),and pancreatic adenocarcinoma mixed with other subtypes (19.7％).The incidence of the other types of pancreatic carcinoma was less than 8％,such as mucinous carcinoma,squamous cell carcinoma,adenosquamous carcinoma and signet ring cell carcinoma.In neuroendocrine tumor,the 5-year survival rate of insulinoma (77.1％) was higher than those of neuroendocrine tumor (malignant) (NET,62.0％) and neuroendocrine carcinoma (NEC,46.5％).Conclusion The prognosis of pancreatic carcinoma was poor,and the pathological types had a significant impact on the prognosis of the patients.
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Pancreatic carcinoma remains one of the most challenging malignant tumor with an increasing morbidity in China.The significance of multidisciplinary and comprehensive treatment of pancreatic cancer has been recognized in recent years.Moreover,several novel clinical staging standards of pancreatic cancer have emerged to help optimize the treatment strategies and improve patients' prognosis in precise treatment era.Currently,in addition to the traditional TNM stage,usage of histologic grade (G),resection marginstatus (M),lymphatic invasion status (L),vascular invasion status (V),perineurial invasion status (P) and combination of these stages recommended by NCCN guideline as GTNMLVP stage have emerged.Other novel staging standards include respectability status,standardized pancreatic surgery classification,genetics classification,etc.This review summarized the characteristics and clinical significance of these novel established methods for pancreatic cancer precise staging.
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Objective To evaluate the therapeutic effect of chemotherapeutic drugs on pancreatic carcinoma based on patient-derived xenograft(PDX)models,and to screen an individualized treatment strategy. Methods Fresh human pancreatic carcinoma tissues were subcutaneously transplanted into nude mice to establish PDX models which could be stab-ly passaged. The traceability of PDX models was determined by STR analysis. The PDX models were treated with three dif-ferent clinical chemotherapeutic drugs oxaliplatin, gemcitabine and irinotecan, respectively, and the tumor volumes were measured at different times. The therapeutic effect of those drugs was assessed by TGD mathematical model and plasma CA19-9 test. Results The traceability of patient-derived xenograft samples was up to 99.99%. Compared with the con-trol group,the treatment with irinotecan and gemcitabine inhibited tumor growth significantly(P=0.001), and gemcit-abine had even better result. The minimum toxic effect in the mice was induced by irinotecan treatment,followed by gem-citabine treatment. Conclusions Pancreatic carcinoma PDX models are successfully established and can be stably pas-saged. Gemcitabine shows the most inhibitory effect on tumor growth based on TGD mathematical model assessment, and deserves to be recommended as the preferred drug for individual treatment of pancreatic carcinoma.
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Objective To investigate the diagnostic value of contrast-enhanced CT and MR diffusion-weighted imaging (DWI) in differentiating autoimmune pancreatitis (AIP) from pancreatic carcinoma (PC).Methods Twelve patients with AIP (AIP groups) and 15 patients with PC (PC groups) were included in this study.Contrast-enhanced CT and DWI were performed in all patients.The manifestations of the pancreatic lesions,pancreatic duct and bile duct were observed.The CT attenuation values and the apparent diffusion coefficient (ADC) values of the lesions were calculated.Frequencies of the CT manifestations,and the mean CT attenuation values,and the ADC values were compared between the two groups.Results Most of the AIP showed diffuse enlargement,sausage shape,peripancreatic capsule,penetrating sign of pancreatic duct and thickness of the bile duct.The frequencies of the findings mentioned above were significantly different between AIP and PC (P＜0.05).The CT attenuation values of the lesions,and the rate of lesions' CT attenuation values to livers' in 3 phases of contrast enhanced CT were significantly different between AIP and PC (P＜0.05).The ADC values of AIP were significantly lower than that of PC (P＜0.05).Conclusion The changes of morphology of pancreas,pancreatic and bile duct may facilitate in differentiating AIP from PC.Quantitative analysis of CT attenuation values and ADC values measured on MR images may be helpful in differentiating AIP from PC.
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Objective To detect the serum levels of calpainin (S100A11) using nanomagicbeabs sorting-time resolved fluoroimmuno assay (NMBS-TRFIA) and evaluate its diagnostic value in pancreatic carcinoma.Methods 88 patients with pancreatic carcinoma,50 patients with acute pancreatitis,10 patients with pancreatic cyst and 20 healthy controls were selected as the study subjects.The human peripheral serum blood was sorted with S100A11 antibody coupled nanomagicbeabs,and the concentration of S100A11 was detected by TRFIA method.The area under the receiver operating characteristic (ROC) curve (AUC) was used to determine the cut-off level for diagnosis of pancreatic carcinoma,in order to evaluate the sensitivity and specificity for diagnosis of pancreatic carcinoma.Results S100A11 showed a linear relationship within the range of 6.08～ 500 ng/ml using NMBS-TRFIA method,intraassay CV≤6.35％,inter-assay CV≤7.12％,and the average recovery rate was 104.7％.The serum levels of S100A11 in patients with pancreatic carcinoma,patients with acute pancreatitis and patients with pancreatic cyst were 185.53 ± 161.19,106.06±113.83 and 68.99± 47.83 ng/ml respectively.Compared with the normal control group (37.98±25.14 ng/ml),the differences were statistically significant (t=-8.065,-3.375,-2.266,all P ＜0.01).The serum levels of S100A11 in patients with pancreatic carcinoma was significantly higher than those in patients with acute pancreatitis and patients with pancreatic cyst (all P＜0.05).According to the ROC curve,ROCAUC=0.985 (95％ CI:0.972 ～ 0.997),the best cut-off level for the diagnosis of pancreatic carcinoma was 89.5 ng/ml (sensitivity 81.8 ％,specificity 67.5 ％).Conclusion NMBS-TRFIA can enrich S100A11 in serum and improve the detection sensitivity of serum S100A11,and the method is simple and easy to be popularized.Serum S100A11 has a high sensitivity and specificity in the diagnosis of pancreatic carcinoma,and is a new serum marker for the diagnosis of early pancreatic carcinoma.
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Objective: To investigate the characteristics and clinical value of lymph node metastasis according to the clinical data of re-gional lymph node resection in pancreatic head carcinoma. Methods: We summarized and statistically analyzed the lymph node num-bers in lymph node dissection specimens of 160 cases of pancreatic duct adenocarcinoma from February 2010 to October 2013 in Fu-dan University, Shanghai Cancer Center retrospectively and explored the relationship between various clinical factors and lymph node metastasis; and summarized the clinical data in group 16 lymph node metastasis of the patients and investigated the clinical signifi-cance of lymph node dissection in these patients. Results: After the pathological diagnosis of pancreatic adenocarcinoma, 72.5% of all the 160 patients had lymph node metastasis (116 cases of 656 lymph node metastases). Among them, 26 patients had group 16 lymph node metastasis. Lymph node metastasis was not related to gender, age, tumor size, or differentiation, but related to tumor clinical staging. In this study, we found that the lymph node metastasis in group 16 was in subgroup 16b1. patients without lymph nodes me-tastasis, patients with lymph nodes metastasis while without group 16 lymph nodes metastasis and patients with both lymph nodes metastasis and group 16 lymph nodes metastasis, the postoperative median survival time was 25.6 months, 17.25 months and 10.95 months, respectively (P<0.001). Patients with lymph node metastasis in subgroup 16b1 and cancer antigen 19-9>370 U/mL had a shorter survival period. Conclusions: Proper subgroup 16b1 lymph node resection is necessary for radical pancreaticoduodenectomy.
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Objective To investigate the effect of cetuximab on the proliferation of pancreatic carcinoma cell lines SW1990 and PANC-1.Methods 100.0 μg/mL cetuximab added DMEM medium(cetuximab group), simple DEME medium as the control group, two groups of the pancreatic carcinoma cell lines SW1990 and PANC-1 were cultured, the SW1990 and PANC-1 were detected by MTT after cultured 12, 24, 48 h, the expression of epidermal growth factor receptor gene(EGFR-mRNA)and protein in two groups were detected by RT-PCR and Western-blot after 24 h;the cell cycle was detected by flow cytometry after 24 h, the activity of Wnt/ beta-catenin pathway was detected by double luciferase assay after 24 h.Results The OD of the cetuximab group of the SW1990 and PANC-1 cell lines proliferation were lower than the control group after 12, 24, 48 h (P<0.05);the OD of the cetuximab group of the SW1990 and PANC-1 cell lines proliferation in 24, 48 h was significantly decreased than 12 h (P<0.05);the proportion of G1 phase cells of the SW1990 and PANC-1 of the cetuximab group increased significantly than the control group (P<0.05), the proportion of S and G2 phase cells decreased significantly than the control group (P<0.05), the expression of the EGFR-mRNA and protein of the cetuximab group were lower than the control group (P<0.05),the TOP/FOP of the Wnt/beta-catenin pathways' activity of the cetuximab group was lower than that of the control group (P<0.05).Conclusion The proliferation of pancreatic carcinoma cell lines SW1990 and PANC-1 was significantly inhibited by cetuximab, which was mainly achieved by decreasing the activity of Wnt/beta-catenin pathway and the expression of EGFR-mRNA and protein.
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Objective:The aim of this study was to detect the P2X7 receptor (P2X7R) protein expression in pancreatic carcinoma and to analyze its association with clinicopathology features of pancreatic carcinoma.And furtherly to explore the effects and underlying mechanisms of P2X7R on invasion and migration of PANC-1 cell line.Methods:P2X7R expression was determined by immunohistochemistry in specimens of primary cancer and adjacent noncancerous tissues respectively,and analyzed the relationship between P2X7R expression and clinicopathology features of pancreatic carcinoma.The transwell assay and wound healing assay were used for investigating cell invasion and migration ability of PANC-1,and western blotting was performed to measure the expresions of MMP2 and MMP9.Results:P2X7R protein was highly expressed in both PANC-1 cell line and tumor tissue,and associated positively with the histological differentiation and lymph node staging.The active P2X7R could increase the cell migration and invasion ability of PANC-1 cell line through up-regulated MMP2 and MMP9.Conclusions:The overexpression of P2X7R plays crucial roles in the migration and invasion of pancreatic carcinoma,and may represent a novel molecular target in pancreatic carcinoma therapy.
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Objective To discuss the clinical value of magnetic resonance diffusion-weighted imaging (MR-DWI) in distinguishing tumor remnants from tumor necrosis of pancreatic carcinoma after cryoablation treatment.Methods Conventional MRI T1WI,T2WI scan,DWI sequence and dynamic enhanced MRI scan were performed in 26 patients with pancreatic carcinoma who were received cryoablation treatment.The changes in MRI signals after cryoablation treatment were recorded.The apparent diffusion coefficient (ADC) values of the normal pancreas,preoperative tumor tissue,postoperative remnants and necrosis tissue were calculated,and the results were compared.The correlation between the ADC values and the size of the tumor was evaluated,and the differences in ADC values among the tumors that had different diameter,location and staging were statistically analyzed.Results Of the 26 patients,complete necrosis of tumor was obtained in 16.The necrotic tumor tissue displayed low-signal on T1WI,high-signal on T2WI and low-signal on DWI,with no enhancement on dynamic enhanced imaging.Active residual tumor tissue was detected in 9 patients,among them the residual tumor diameter ＞5 cm was seen in 7 patients;the residual rate was 34.6％.ADC values of the following tissue,from low to high in order,were preoperative pancreatic tumor tissue (1.022± 0.126)x10-3 mm2/s,postoperative residual tumor tissue (1.130±0.155)x10-3 mm2/s,normal pancreatic tissue (1.924±-0.124)×10-3 mm2/s and postoperative necrosis tissue (2.312-±0.214)×10-3 mm2/s.No statistically significant difference in ADC values existed between preoperative pancreatic tumor tissue and postoperative residual tumor tissue (P=0.452),while statistically significant difference in ADC values existed between normal pancreatic tissue and postoperative necrosis tissue (P＜0.001).The ADC values of pancreatic tumor tissue bore a negative correlation with the tumor size (R=-0.43,P=0.027 2),while the ADC values lacked the relationship to the tumor location as well as to the tumor staging (P=0.738 8 and P=0.089 5 respectively).Conclusion MR-DWI can effectively distinguish the residual tumor tissue from the necrotic tumor tissue of pancreatic carcinoma after cryoablation treatment,which provides reliable basis for further clinical diagnosis and treatment.
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Early detection of pancreatic cancer is difficult and most of patients with pancreatic cancer present with locally advanced stage disease or distant metastasis on diagnosis. Micrometastasis occurs in the majority of pancreatic cancers larger than 2 cm in diameter and making early diagnosis and treatment essential to improve the prognosis. Small pancreatic tumors less than 2 cm in diameter can be missed on transcutaneous ultrasound, CT and MRI. Endoscopic ultrasound (EUS) has been considered the most sensitive modality in evaluation of pancreatic lesions. It can be placed in close proximity to the pancreas and provide real-time, high resolution imaging using a high frequency ultrasound probe to find lesions as small as 5 mm. Recently, small pancreatic tumors have been increasingly detected with the widely used EUS. The development of new techniques such as EUS elastography, contrast-enhanced harmonic EUS (CEH-EUS) and fine needle aspiration biopsy (EUS-FNAB) have enhanced the ability of EUS in detection of small solid pancreatic tumors as well as in differentiation of malignancies from benign tumors.
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Objective To investigate the effects of semaphorin 4D(Sema4D) on the proliferation,migration and angiogenic of human pancreatic carcinoma cells.Methods Sema4D-siRNA was designed and synthesized and transfected into human pancreatic carcinoma cells.After 48 hours of transient infection,the changes of expression of Sema4D mRNA before and after transfection were detected by reverse transcription-polymeruse chain reaction method.And after 72 hours of transient infection,the changes of expression of Sema4D protein before and after transfection were detected by Western blot method.The changes of growth of the transfected cells were observed by methyl thiazolyl terazolium assay.Using transwell migration test and scratch repair test to detect the changes of migration ability of human pancreatic carcinoma cells after transfection.Using tubule formation assay to observe the effect of supernatant of pancreatic carcinoma cell cultures on angiogenesis after transfection.Results Compared with the negative control group and blank control group,the expression of Sema4D mRNA and Sema4D protein and the growth rate of pancreatic carcinoma cells decreased significantly (P ＜ 0.05).In transwell migration test and scratch repair test,it was observed that Pancreatic cancer cells penetrating cell number and scratch repair rate were significantly lower than that in negative control group and blank control group (P ＜ 0.05).Tubule formation assay showed that there were significant differences in angiogenesis numbers among siRNA transfection group(0.5 ± 0.02),negative control group(1.45 ± 0.60) and blank control group (1.37 ± 0.52) (P ＜ 0.05).Conclusion Sema4D-siRNA can induce RNA interference in pancreatic carcinoma cells and down-regulate the expression of Sema4D gene,which can inhibit the proliferation of pancreatic carcinoma cells,significantly reduce the migration ability of pancreatic carcinoma ceils and inhibit angiogenesis.
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Objective To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in predicting peripancreatic vascular invasion in pancreatic carcinoma through comparison with the findings on surgical exploration. Methods A total of 94 pancreatic cancer patients (confirmed by pathological examination) were included in this study. The CEUS data were analyzed retrospectively. The enhancement characteristics of lesions were documented. And the peripancreatic vascular invasion were analyzed. The main features of peripancreatic vascular invasion on CEUS were as followings: 1) peripancreatic arteries to be embedded, trapped in the tumor or surrounded by tumor, or to have intraluminal infiltration or luminal stenosis. 2)superior mesenteric vein, portal vein to be surrounded by tumor or to be narrow, distorted or occluded. The CEUS findings were compared with postoperative pathological results. Results 94 patients were diagnosed with pancreatic cancer by pathological examination, including 62 cases of pancreatic head carcinoma, 32 cases of pancreatic tail carcinoma. The imaging of contrast-enhanced ultrasound showed 6 cases (6.4%) of high uneven enhancement, 78 cases (83%) of low uneven enhancement, and 10 cases (10.6%) of heterogeneous enhancement in parenchyma phase, respectively. Twenty-five cases (26.6%) of CA invasion were detected by CEUS, while no invasion was observed in 69 cases (73.4%). Compared with pathological findings, the predictive sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS were 63.6%, 79.7%, 84.7%, 56.0%, 88.0%, respectively. Twenty-seven cases (28.7%) of SMA invasion were detected by CEUS, while no invasion were observed in 67 cases (71.3%). Compared with pathological findings, the predictive sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS were 66.6%, 77.6%, 80.2%, 44.0%, 91.0%, respectively. Besides, PV invasion features were found in 27 cases (28.7%), while 67(71.3%) cases were detected without invasion features. Compared with pathological findings, sensitivity, accuracy, specificity, positive predictive value, negative predictive value of CEUS in predicting PV invasion were 86.6%, 94.6%, 98.4%, 96.2%, 94.0%, respectively. Furthermore, CEUS detected SMV invasion in 26 cases (27.6%), while no invasion features in 68 (72.4%) cases. The sensitivity, accuracy, specificity, positive predictive value, negative predictive value for CEUS were 75.0%, 87.2%, 92.4%, 80.7%, 89.7%, respectively. Conclusion Due to its good diagnostic and predictive performance in detecting malignant pancreatic tumors and peripancreatic vascular invasion, CEUS could be served as an effective predictive modality in assessing the resectability of pancreatic carcinoma.
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Objective To investigate the value of multiple sequential MRI in the differential diagnosis of vater ampulla carcinoma (VPC).Methods MRI data of 53 patients with VPC confirmed by surgery and pathology were analyzed retrospectively,which included 17ampullary carcinomas,15 pancreatic head carcinomas,10 duodenal papillary carcinomas and 11 distal common bile duct carcinomas.All patients underwent routine MRI plain scan,MRCP and multi-phase dynamic enhancement scan for the upper abdomen.The morphological characteristics and model of multi-phase dynamic enhancement of the tumor,and the morphological changes of pancreaticobiliary duct were focused,and relevant data were also measured.Results The differences of tumor size,central location,and signal homogeneity among the four different histological types showed statistical significance(P＜0.05),and their patterns of multi-phase dynamic enhancement also had differences.Double-segment sign was most found in VPC (26/53),four-segment sign was easy showed in pancreatic head carcinoma (8/15)and three-segment sign in distal common bile duct carcinoma (8/11).Beak sign was common seen in ampullary carcinoma(10/17),rat-tail sign was easy discovered in pancreatic head carcinoma (7/15) and truncated sign in distal common bile duct carcinoma(10/11).Diameter of major pancreatic duct in pancreatic head carcinoma was maximum and minimum in distal common bile duct carcinoma,and their difference had statistical significance(P＜0.05).Distance between obstructive end of bile common duct and major papilla of duodenum,and between obstructive end of major pancreatic duct and major papilla of duodenum as well as the pancreaticobiliary conjunction angle in pancreatic head carcinoma and distal common bile duct carcinoma were greater than that in ampullary carcinoma and duodenal papillary carcinoma.Conclusion MRI can prominently demonstrate various imaging characteristics of VPC with different histological origins.It is very valuable in the differential diagnosis of VPC with different histological types by comprehensive analysis of these findings.
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Objective To study the clinical efficacies of different surgical palliative treatments for patients with advanced pancreatic carcinoma.Methods A retrospective analysis was conducted on the clinical data of 119 patients with advanced pancreatic carcinoma who were treated in the department of General Surgery of Linyi's Central Hospital from January 2010 to January 2016.According to the different surgical methods the patients received,they were divided into the seed group (n =38),the radiofrequency ablation (RF) group (n =52) and the control group (n =29).Patients' general data,operation data,postoperative complications and follow-up profiles were analyzed.Results There was no significant difference in the patients'general data among the three groups of patients (P ＞ 0.05).The incidences of postoperative complication in the seed group,the RF group and the control group were 55.3％,38.5％ and 20.7％,respectively.There was significant differences between the incidences of postoperative complications between the seed group and the control group (P ＜ 0.05).There was no perioperative death.The postoperative follow-up rate was 91.6％.Pain in the seed group and the RF group significantly improved,while it was not significantly improved in the control group.There were significant differences in the postoperative pain scores (P ＜0.05).The 6 months,1-year and 2-year overall survival rates were 61.3％,25.9％,8.6％ respectively.The median survival was 8 months.In the seed group,the 6 months,1-year and 2-year survival rates were 75.2％,37.8％,18.9％ respectively.The median survival was 9 months.In the RF group,the 6 months,1-year and 2-year survival rates were 60.4％,25％,6.3％ respectively.The median survival was 8 months.In the control group,the 6 months,1-year and 2-year survival rates were 53.4％,15.3％,3.8％ respectively.The median survival was 6.5 months.On log-rank test,there was no significant difference in survival rates among the three groups (P =0.145).Conclusions Patients with advanced pancreatic carcinoma had poor prognosis.I125 radioactive particles implantation and radiofrequency ablation were useful to improve patients'quality of life and prolonged their survival.
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Objective To investigate the safety and efficacy of stent insertion combined with high-intensity focused ultrasound(HIFU) ablation for malignant obstructive jaundice caused by pancreatic carcinoma.Methods From January 2013 to February 2017,a total of 80 patients with malignant obstructive jaundice caused by pancreatic carcinoma underwent biliary stent insertion in our center,who were divided into combined treatment(stent insertion with HIFU ablation) group(n=38) and solitary stent insertion group(n=42).The stent patency time and survival time were compared between the two groups.Results Relief of jaundice were archived in all patients in both groups.Cholangitis was observed in 7 cases in both two groups.Reobstruction of stent was observed in 15 patients in both two groups.The median stent patency time was 179 days in combined treatment group and 119 days in solitary stent insertion group(P<0.01);the median survival time was 209 days in combined treatment group and 145 days in solitary stent insertion group,the differences were significant(P<0.01).Based on the univariate and multivariate Cox regression analyses,the predictors of prolonging survival included subsequent HIFU ablation after stent insertion and earlier tumor stage(P<0.05).Conclusion Combined biliary stent insertion and HIFU ablation is a safe and effective method for malignant obstructive jaundice caused by pancreatic carcinoma,and seems to extend stent patency time and survival when compared with biliary stent only.
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Las metástasis oculares constituyen el tumor maligno intraocular más frecuente en la población adulta. Estas tienen en su mayoría un compromiso coroideo. Se describe el caso de una paciente que presentó disminución de la agudeza visual rápidamente progresiva en el ojo derecho. Sin antecedentes personales relevantes, durante la evaluación oftalmológica se observa una lesión coroidea, la cual clínica y radiológicamente sugería una metástasis coroidea como primera impresión diagnóstica. Posterior a la realización de estudios de extensión se confirmó histopatológicamente un tumor pancreático como origen de la metástasis. Las metástasis oculares ocasionadas por el páncreas son extremadamente raras, lo cual se confirma en la revisión de la literatura realizada.
The ocular metastases are the most common intraocular malignant tumor in the adult population. These have mostly a choroid commitment. This case report describes a female patient who presented with a rapidly progressive decrease in visual acuity in the right eye, no other symptoms were referred and her medical history was no relevant. A choroidal lesion was found, which clinically and radiologically suggested a choroid metastasis as the diagnosis. With extension studies was confi rmed histopathologically a pancreatic tumor as the primary tumor. The ocular metastases that are originated for the pancreas are extremely rare; this is confirmed by the review of the literature.