Validation of Group B Borderline Resectable Pancreatic Cancer: Retrospective Analysis

BACKGROUND/AIMS: Among borderline resectable pancreatic cancer (BRPC), group B BRPC patients have findings that are suggestive but not diagnostic of metastasis. In this study, we attempted to validate whether group B could truly be categorized as a borderline resectable group. METHODS: We placed the BRPC patients into group A or group B. The survival outcomes were compared between the groups. RESULTS: A total of 53 patients with pancreatic adenocarcinoma was classified as either group A or B borderline resectable. In group A, 23 (60.5%) of 38 patients underwent pancreatectomy after concurrent chemoradiotherapy or chemotherapy, but in group B, only five (33.3%) of 15 patients underwent pancreatectomy, mainly because of the progression of suspected distant metastasis. There was a significant difference in overall survival (OS) between group A and B patients (median OS, 21.2 months vs 10.2 months, respectively; p=0.007). Of the patients who underwent pancreatectomy, group B had a higher recurrence rate compared to group A (recurrence rate: 11 of 23 patients [47.8%] vs five of five patients [100%], respectively; p=0.033). CONCLUSIONS: This report is the first to validate the definition of BPRC. Group B had much worse outcomes, and whether group B BRPC can be categorized as BRPC together with group A is questionable.

Pancreatic cancer in Saudi patients treated at tertiary institution. Ten years retrospective study

To describe presentation, management, and outcome, and determine prognostic factors for pancreatic cancer patients. A retrospective review of patients diagnosed with pancreatic cancer at King Abdulaziz Medical City, Riyadh, Saudi Arabia during the period from January 2000 to December 2010. Descriptive statistics were conducted on the collected data and survival was estimated using the Kaplan Meier estimate. Univariate and multiple regression analyses were carried out. The medical records of 179 patients were reviewed. The patients' median age was 63 years ranging from 15-96 years, and 116 [64.8%] of them were male. The one-year survival rate was 39% and the 5-year survival was 10%. The median overall survival [OS] was 6.9 months. Age at diagnosis, grade, T stage, N stage, M stage, TNM stage group, and the combined stage group [stage III/IV versus others], site of distant metastasis, carcinoembryonic antigen [CEA], carbohydrate antigen 19-9, surgery and chemotherapy were significant predictors for OS on an univariate Cox proportional hazards regression analysis. A multiple regression model including all the significant predictors was conducted. Age at the time of diagnosis and M stage were significant variables. Our patients present at a younger age and have better 5-year survival compared with the United States Surveillance Epidemiology and End Results data, which deserves further evaluation. Age and disease stage were identified as independent prognostic factors for survival in this patient population

Pancreatic Tumors: Emphasis on CT Findings and Pathologic Classification

Pancreatic tumors can be classified by their morphologic features on CT. The subtypes include solid tumors, mixed cystic and solid lesions, unilocular cysts, multilocular cystic lesions, and microcystic lesions. Endoscopic US and MRI can provide detailed information for classifying pancreatic lesions. Each subtype has different kinds of tumors and malignant potential, thus the classification can be useful for a better differential diagnosis and treatment planning. For this purpose, we suggest an appropriate modified classification system by using the imaging features of pancreatic tumors with an emphasis on CT findings and illustrate various findings of typical and atypical manifestations.

Primary Pancreatic Lymphoma in Korea-A Single Center Experience

The aim of this study was to report a single center experience of primary pancreatic lymphoma (PPL) in Korea. We analyzed the clinicopathological data from four PPL patients (three male, median age 36 yr) diagnosed from 1997 to 2007 at Seoul National University Hospital. The diagnoses were: diffuse large B cell lymphoma (n=2), Ki-1 (+) anaplastic large cell lymphoma (n=1), and Burkitt lymphoma (n=1). Presenting symptoms and signs were: abdominal pain (n=4), pancreatitis (n=2), weight loss (n=2) and abdominal mass (n=1). No patient underwent surgery. The Ann Arbor stages of the patients were: IEA (n=1), IIEA (n=1), and IVEB (n=2). Two patients underwent treatment. The stage IEA patient underwent chemotherapy and radiation therapy that resulted in a complete remission. The stage IVEB patient who underwent chemotherapy relapsed. This patient underwent subsequent peripheral blood stem cell transplantation and is alive at 30 months. Two patients (stages IVEB and IIEA) without treatment died at 0.8 and 7.0 months, respectively. For PPL patients, chemotherapy-based treatment, and addition of radiation therapy, if possible, may offer good prognosis.

Tumores endócrinos del páncreas / Endocrine tumors of the pancreas

Multiple endocrine neoplasia (MEN) is a rare familial disorder that affects multiple endocrine organs. it is inherited in an autosomal dominant pattern with variable penetrance. There are two distinct types of MEN. Dominantly inherited neoplasia are believed to occur from the recessive loss of tumor suppressor gene function. The first mutational event affects the germ cell, is hereditary, and predisposes to neoplasia. Because tumors occur in multiple organs in MEN, the second mutational evento probably occurs in common precursor cells, such as the amine precursor uptake and decarboxylation cells (APUD). The gene locus for tupe 1 MEN has been mapped to cromosome 11q. Type 1 organs affected: parathyroids, pancreas and pituitary. The gene locus for type 2 MEN is thought to be located for chromosome 10, (other organs). Fifty to 60 % of patients with type 1 MEN have pancreaticislet cell tumors. Insulinomas are tumors that originate in the beta cells of the islets of Langerhans, which compose the APUD system, the meaning of which is: A=Amino, P=Precursor, U=Uptake, D=Decarboxylation. The cells fo the APUD system have common cytochemical characteristics with the ability to secret polypeptides and amines. Symptoms are related to the peptide secreted by the tumor, and some tumors can produce multiple peptides. Gastrinomas comprise about 60 % of type 1 MEN-associated islet cell tumors. Gastric acid hypersecretion results from excess gstrin secretion and causes multiple gastric and duodenal ulcers (Zollinger-Ellison syndrome). The author describe an experience with this pathology with special reference to diagnostic methods, treatment, follow-up, laboratory studies and localization of the tumor.

Neoplasias císticas do pâncreas / Cystic neoplasms of the pancreas

Os autores fazem uma revisão sobre neoplasias císticas do pâncreas , abrangendo sua classificação aspectos clinico- cirúrgicos diagnostico , assim como algoritmos de tratamento, seguimento e prognóstico

[Endoscopic ultrasonography versus helical CT in diagnosis and staging of pancreatic cancer]

Compare the performances of EUS to helical CT in the diagnosis and staging of pancreatic adenocarcinoma. Forty two consecutive patients [mean age 63 years; 25 men, 17 women] who had surgical exploration and histologically proved pancreatic cancer were retrospectively included. All our patients underwent with endoscopic ultrasonography [EUS] and helical computed tomography [helical CT]. Data analysis compared helical CT, EUS with the surgical data with or without histological study in diagnosis, staging and resectability of pancreatic cancer. Surgical findings were used as gold standard. For positive diagnosis EUS was more sensitive 100% [CI:93-100] than helical CT 88% [CI:77-95]. But helical CT was more specific 89% [CI:64-98] than EUS 83% [CI:58-96] for small tumors whose diameter is below 2,5 cm in which EUS was more sensitive in their detection [100% versus 83%]. In evaluating venous involvement EUS was more sensitive than helical CT [96% versus 50%; p<0.05], while CT was more specific [81% versus 75%; p<0.05]. Regarding lymph nodes invasion, the two imaging technique had the same sensibility [56%] with better specificity for helical CT [83% versus 75%; p<0.05]. The accuracy of EUS in identifying the T and N stages were 80% and 67% respectively, while helical CT have an accuracy of 50% and 71% respectively. EUS and helical CT correctly identified all resectable tumors while EUS was more accurate than helical CT in detecting non resectable tumors 94% versus 69%.EUS remains superior to helical CT in positive diagnosis of pancreatic adenocarcinoma especially for small tumors and also for the diagnosis of venous invasion and in identifying non resectable tumors. The two techniques have the same accuracy in the detection of lymph node involvement

Etiological spectrum of obstructive Jaundice

The objective of this study was to determine the etiological spectrum of obstructive jaundice in this part of the world. This prospective study was carried out at Liaquat National Hospital, Karachi from March 1997 to February 2001 and later at Isra University Hospital, Hyderabad from January 2003 to December 2006. Sixty five patients with obstructive jaundice were included in this study. The data was collected with respect to patient's identity, age, gender and cause of the obstructive jaundice. Fifty seven percent of patient had malignant obstructive jaundice and carcinoma of head of pancreas being the leading cause of malignant obstructive jaundice. Forty three percent patients had benign causes of obstructive jaundice, choledocholithiasis being the most common benign cause. Choledocholithiasis and malignancy are the two major causes of obstructive jaundice

Doença arterial obstrutiva periférica agravada pela utilização de gemcitabina para tratamento de neoplasia pancreática: relato de caso e revisão da literatura / Peripheral obstructive arterial disease worsened by use of gemcitabine for the treatment of pancreatic cancer: case report and review of the literature / Peripheral obstructive arterial disease worsened by use of gemcitabine for the treatment of pancreatic cancer: case report and review of the literature

Este estudo tem por objetivo relatar um caso de isquemia crítica de membro inferior associada a quimioterapia com gemcitabina. O relato descreve o caso de um paciente de 68 anos submetido a duodenopancreatectomia devido a tumor no pâncreas. Um mês depois da operação, o paciente realizou quatro sessões de quimioterapia com gemcitabina, durante um mês. Após 30 dias, o paciente desenvolveu sintomas de doença arterial obstrutiva periférica, e duas semanas depois, isquemia crítica do membro inferior direito. O exame por imagem demonstrou doença arterial difusa associada à oclusão femoropoplítea com reenchimento distal precário. O paciente foi submetido a uma tentativa de revascularização que, devido às condições locais, foi malsucedida, resultando na amputação do membro no nível da coxa.

We report a case of lower limb critical ischemia associated with chemotherapy with gemcitabine. This report presents a case of a 68-year-old man who underwent pancreatoduodenectomy due to pancreas tumor. One month later, the patient was submitted to four chemotherapy sessions with gemcitabine for 1 month. In addition, 30 days later he developed symptoms of peripheral arterial obstructive disease, and critical ischemia of the right lower limb 2 weeks later. An imaging study showed diffuse arterial disease associated with femoropopliteal occlusion and poor distal bed. The patient was submitted to a revascularization procedure, which was unsuccessful due to local conditions, resulting in above-knee amputation.

Tumores neuroendocrinos no funcionantes de páncreas / Pancreatic islet cell tumors

Antecedentes: Dentro del capítulo de las neoplasias de páncreas, los tumores insulares no funcionantes son los menos frecuentes. Generalmente son de diagnóstico tardío, de comportamiento biológico maligno en un 80 por ciento de los casos y presentan una tasa de sobrevida a los 5 años de 40 a 60 por ciento. Objetivo: Analizar la experiencia en este tipo de tumores en los últimos 10 años. Material y métodos: Desde enero de 1987 a enero de 1997 se operaron 23 pacientes con tumores insulares de páncreas, de los cuales 10 casos eran no funcionantes, 8 mujeres y 2 varones con una edad promedio de 49,5 años. El tiempo promedio transcurrido entre el comienzo de los síntomas y el diagnóstico fue de 1.5 años. El síntoma más frecuente fue el dolor abdominal. Todos fueron evaluados por ecografía y TAC. Ecoendoscopía en 5 casos, ecografía intraoperatoria en 5, RNM en 3 y angioresonancia en 1. En un caso localmente avanzado se realizó punción diagnóstica preoperatoria. Resultados: Nueve pacientes fueron resecados con criterio curativo, siendo un caso irresecable. Se realizaron una duodenopancreatectomía y 8 esplenopancreatectomías corporocaudales. El promedio de internación fue de 13 días. No se registró mortalidad perioperatoria. La tasa de morbilidad fue del 20 por ciento. El diagnóstico histológico fue tumor insular en los 10 casos, 8 de los cuales fue carcinoma insular. Al momento del análisis 4 pacientes se encontraban vivos y libres de enfermedad, 4 murieron a los 49, 50, 60 y 62 meses y dos fueron perdidos del seguimiento a los 18 y 24 meses. Conclusiones: Debido al comportamiento biológico maligno de estos tumores, la resección es la mejor opción independientemente del tamaño tumoral. Sin embargo, debido a que poseen mejor pronóstico que el adenocarcinoma, siempre se debe realizar diagnóstico histológico en los tumores considerados irresecables

Cáncer de páncreas / Cancer of the pancreas

Objetivo: Revisar y actualizar información epidemiológica, clínica histopatológica, de diagnóstico, etapificación y tratamiento del cáncer de páncreas. Antecedentes: El cáncer de páncreas en México y en el mundo ha mostrado incremento en su frecuencia. Es una enfermedad de diagnóstico temprano difícil y pronóstico generalmente malo, que produce elevada mortalidad. Método: Se hizo una recopilación de la información contenida en artículos clásicos y de informes recientes de la literatura de acuerdo con los objetivos planteados. Resultados: La ingesta de café y bebidas alcohólicas además del tabaquismo con los aspectos epidemiológicos más frecuentemente relacionados con la enfermedad. Los síntomas son inespecíficos y cuando ya son evidentes normalmente la enfermedad ya está avanzada. El adenocarcinoma intraductal es la variedad histológica más frecuente. La sospecha clínica apoyada de la tomografía Axial Computarizada (TAC) son elementos importantes en el diagnóstico. Existen otros novedosos como los anticuerpos monoclonales y la determinación de oncogenes. La etapificación es importante para conocer el tipo de tratamiento apropiado en cada caso. La operación clásica sigue siendo la duodenopancreatectomía la cual ha sufrido algunas modificaciones que no inciden grandemente en los resultados a largo plazo. Conclusiones: En la actualidad se tiene un mejor conocimiento de la enfermedad lo cual ha redituado en diagnósticos más tempranos y en un incremento en la sobrevida

Tumores quísticos del páncreas: diagnóstico y tratamiento a propósito de 24 casos: Tercer premio en el xiii Congreso Argentino de Radiología / Cystic tumors of the pancreas: Third price at the xiii th Argentine Congress of Radiology

Se evaluó el impacto de los nuevos métodos diagnósticos por imágenes y el resultado de las intervenciones quirúrgicas en los pacientes con tumores quísticos del páncreas. Se estudiaron 24 pacientes, 3 hombres y 21 mujeres, con una edad promedio de 45 años (rango 16-81), tratados desde 1980 a 1992. Dentro de los tumores quísticos se presentaron 16 cistadenomas mucinosos de los cuales 8 fueron benignos y 8 presentaron degeneración maligna; 5 cistoadenomas serosos, 2 neoplasias quísticas papilares y un cistoadenoma mucinoso ducto-ectático. Los 24 pacientes tuvieron cirugía y confirmación anatomopatológica. En un caso se realizó punción biopsia percutánea. A todos los pacientes se les realizó ecografía (US) y tomografía axial computada (TAC). A tres pacientes se les realizó estudios angiográficos, a uno colangipancreatografía retrógrada por vía endoscópica y a cuatro resonancia magnética por imágenes (RM). El estudio de CPER contribuyó en el diagnóstico de cistoadenoma ductoectático el cual comprometía la región del proceso uncinado del páncreas. todos los pacientes fueron sometidos a intervenciones quirúrgicas. Se realizó técnica de Whipple en 6 pacientes (3 con preservación pilórica). En 17 pacientes se efectuó pancreatectomía distal o izquierda y en un caso se realizó resección local. No hubo mortalidad postoperatoria. Nuestra experiencia sugiere que los métodos diagnósticos actuales, en particular la US,TC y la RM, ayudan a diferenciar las neoplasias quísticas de los tumores sólidos, pseudoquistes y quistes de retención. Además estos estudios muestran características que distinguen los tumores mucinosos de los serosos y ocasionalmente sugieren la presencia de malignidad. La aspiración citológica y la biopsia parcial de la pared no son suficientes para establecer el diagnóstico en los tumores mucinosos ya que la degeneración maligna puede ser pequeña y no detectable por los métodos de imágenes. La resección es la terapia de elección que puede realizarse con una morbi-mortalidad mínima y la mayor probabilidad de cura

Carcinoma del páncreas: utilidad de la clasificación histológica y frecuencia de coagulación intravascular diseminada / Carcinoma of the pancreas. Relevance of the histologic classification and frecuency of diseminated intravascular coagulation

Se revisaron 96 casos de autopsia de carcinoma de páncreas con objeto de determinar la relación entre el tipo histológico y el pronóstico. Se estudió además la frecuencia de la coagulación intravascular ddiseminada en este grupo de casos y se comparó con la de un grupo testigo de noplasmas malignas no pancreáticas apareado por edad y sexo. La mayoría de los casos (86.4%) correspondió a adenocarcionomas de los conductos. El tiempo promedio de evoluación fue de 2.8 meses. Con excepción de algunos tumores raros, como el cistadenocarcinoma mucinoso, la clasificación histológica tiene poco valor poruqe el pronóstico es semejante en las distintas variedades. La coagulación intravascular diseminada y las tromboembolias nenosas y de arterias pulmonares fueron más comunes en casos de carcinoma de páncreas que en otras neoplasias malignas (p<0.035 y p>0.001 respectivamente). Esta diferencia se debe problablemente a la mayor producción de substancias tromboplásticas por el carcinoma de páncreas.