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1.
Vaccimonitor (La Habana, Print) ; 30(3)2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1341783

ABSTRACT

Se realizó un estudio retrospectivo y observacional en pacientes con adenocarcinoma pancreático avanzado, tratados con Nimotuzumab combinado con un esquema de quimioterapia GEMOX, atendidos en el Servicio de Oncología Clínica del Hospital Clínico Quirúrgico Hermanos Ameijeiras entre 2013 y 2019 (n=118), cuyo objetivo fue evaluar la respuesta al tratamiento y la supervivencia global según variables clínicas, histopatológicas y tratamiento. Se utilizó método chi-cuadrado para la asociación de variables. Se evaluó la supervivencia global por el método de Kaplan Meier y se utilizó la prueba de Log-Rank y Breslow para la comparación de las curvas, con valor p<0.05. La tasa de control de la enfermedad fue 44,9. La mediana de supervivencia fue de 13,8 meses (IC95 por ciento:11,7-15,8). Las variables estadísticamente significativas asociadas con mayor respuesta al tratamiento y supervivencia fueron: no hábitos tabáquicos; índice plaquetas-linfocitos por debajo de 200; tumores primarios T2-T3, de localización predominantemente en cabeza pancreática; no presencia de metástasis al diagnóstico y más de seis dosis de quimioterapia o Nimotuzumab. Los pacientes con clasificación de bajo peso y albúmina sérica baja tuvieron peor supervivencia (p<0.05). En 42 pacientes se realizó una segunda línea de quimioterapia y se obtuvo supervivencia de 17,4 meses (IC95 por ciento:13,5-21,4). Las toxicidades clasificadas como grado 3-4 se reportaron en 27 pacientes (22,9 por ciento), las más frecuentemente observadas fueron: neuropatía (14,4 por ciento), neutropenia (10,2 por ciento) y trombopenia (9,3 por ciento). En condiciones de práctica clínica, con el Nimotuzumab combinado con quimioterapia GEMOX se obtuvieron óptimas tasas de control de la enfermedad y supervivencia con buen perfil de seguridad(AU)


A retrospective and observational study was carried out in patients with advanced pancreatic adenocarcinoma, treated with Nimotuzumab combined with a GEMOX chemotherapy scheme, in the Clinical Oncology Service at the Ameijeiras Hospital, between 2013 and 2019 (n =118), whose objective was to evaluate the response to the treatment and overall survival according to clinical, histopathological and treatment variables. The chi-square method was used for the association of variables. Overall survival was evaluated by the Kaplan Meier method and the Log-Rank and Breslow test for the comparison of the curves, with p <0.05. The disease control rate was 44.9. The median survival was 13.8 months (95 percent CI: 11.7-15.8). The statistically significant variables associated with greater response to treatment and survival were: no smoking habits; platelet-lymphocyte index below 200; T2-T3 primary tumors, predominantly located in the pancreatic head; no presence of metastases at diagnosis and greater than six doses of chemotherapy and Nimotuzumab. Patients classified as underweight and low serum albumin had worse survival (p <0.05). Second-line chemotherapy was performed in 42 patients and it was obtained SV of 17.4 months (95 percent CI: 13.5-21.4). Toxicities classified as grade 3-4 were reported in 27 patients (22.9 percent); the most frequently observed were: neuropathy (14.4 percent), neutropenia (10.2 perrcent) and thrombopenia (9.3 percent). Under clinical practice conditions, Nimotuzumab combined with GEMOX chemotherapy obtained optimal disease control and survival rates with a good safety profile(AU)


Subject(s)
Humans , Pancreatic Neoplasms/drug therapy , Reference Drugs , Retrospective Studies , Observational Study , Antineoplastic Agents/therapeutic use
3.
Medicina (B.Aires) ; 81(5): 800-807, oct. 2021. graf
Article in Spanish | LILACS | ID: biblio-1351054

ABSTRACT

Resumen El adenocarcinoma ductal de páncreas es una enfermedad agresiva asociada con pobres resultados de supervivencia a largo plazo. La resección quirúrgica y los nuevos tratamientos oncológicos pe rioperatorios han logrado mejorar la supervivencia de estos pacientes en la experiencia internacional. En este estudio retrospectivo se analiza la supervivencia global y la libre de enfermedad de todos los pacientes operados por cáncer de páncreas en el Hospital Italiano de Buenos Aires de enero 2010 a enero 2020. Se identificaron 242 pacientes con resecciones pancreáticas por adenocarcinoma de páncreas o carcinoma indiferenciado. La supervivencia global mediana fue de 22.8 meses (IC 95%: 19.5-29) y la tasa de supervivencia global a 1, 3 y 5 años fue de 72%, 32.5% y 20.8% respectivamente. La supervivencia libre de enfermedad mediana fue de 13.8 meses (IC 95%: 12-17.6) y la tasa de supervivencia libre de enfermedad a 1, 3 y 5 años fueron de 56.1%, 21.8% y 19.4% respectivamente. El grupo de pacientes que logró completar el tratamiento adyuvante mostró una mayor supervivencia global (p<0.0001).


Abstract Pancreatic cancer is an aggressive disease associated with poor results regarding long term survival. Surgical treatment along with new onco logic treatments have improved the survival of these patients in international experience reports. The aim of this study was to describe overall survival and disease-free survival after pancreatectomy for pancreatic ductal adenocarcinoma. A retrospective study of consecutive patients undergoing pancreatic resection due to PDAC or undifferentiated carcinoma from January 2010 to January 2020 in a single tertiary center was performed. Overall, 242 patients underwent complete pancreatic resections for pancreatic ductal adenocarcinoma or undifferentiated carcinoma. Median overall survival was 22.8 months (95% CI: 19.5-29) and survival at 1, 3 and 5 years were 72%, 32.5% and 20.8% respectively. The median disease-free survival was 13.8 months (95% CI: 12-17.6) and 1, 3- and 5-years disease-free survival were 56.1%, 21.8% and 19.4% respectively. The groups of patients that completed adjuvant treatment showed a better overall survival (p < 0.0001).


Subject(s)
Humans , Pancreatic Neoplasms/surgery , Carcinoma, Pancreatic Ductal/surgery , Pancreas , Pancreatectomy , Retrospective Studies
5.
Rev. Soc. Argent. Diabetes ; 55(1): 27-34, ene. - abr. 2021. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1248277

ABSTRACT

Introducción: la diabetes mellitus (DM) se considera un factor de riesgo para el desarrollo de adenocarcinoma ductal de páncreas (ACDP). Objetivos: describir la prevalencia de DM y glucemia en ayuno alterada (GAA) al diagnóstico de ACDP en pacientes asistidos en un centro de referencia gastroenterológico; analizar las diferencias en las características personales y nutricionales en pacientes con ACDP y DM, ACDP y GAA, y ACDP sin DM ni GAA; establecer el tiempo transcurrido desde el diagnóstico de DM hasta diagnosticar ACDP. Materiales y métodos: de octubre de 2019 a marzo de 2020 se revisaron 465 historias clínicas de las Secciones Oncología y Nutrición de pacientes >18 años con diagnóstico de ACDP. Resultados: se registraron 171 historias clínicas (36,7%) con ACDP y DM, y 294 (63,2%) con ACDP sin DM. En el 45,1% de las primeras, el intervalo entre el diagnóstico de DM y el de ACDP fue <1 año, y en el 17,65%, 15,69% y 21,57% los lapsos correspondieron a 1 y 5 años, entre 5 y 10 años y >10 años respectivamente. Conclusiones: la prevalencia de DM en ACDP fue superior a la registrada en la población general (37% vs 12,7%), siendo del 45,10% cuando se presentó dentro del primer año del diagnóstico oncológico. Nuestros resultados concuerdan con la bibliografía internacional que relaciona la DM de reciente diagnóstico como factor asociado a la presencia de ACDP por factores de riesgo compartidos, variables fisiopatológicas de la DM o a consecuencia de la terapéutica farmacológica de la misma.


Introduction: diabetes mellitus (DM) is considered to be a risk factor for the development of pancreatic ductal adenocarcinoma (PDAC). Objectives: describe the prevalence of DM and of impaired fasting glucose (IFG) at the diagnosis of PDAC, among patients assisted in a gastroenterological reference center. Analyze differences in personal and nutritional characteristics in patients with both PDAC and DM; with both PDAC and IFG; and with PDAC but neither DM nor IFG. Determine the time lapse between the diagnosis of DM and the diagnosis of PDAC. Materials and methods: between October 2019 and March 2020, we analyzed 465 clinical records of PDAC-diagnosed patients over 18 years, from Oncology and Nutrition Sections. Results: 171 clinical records (36.7%) showed both PDAC and DM; 294 clinical records (63.2%) showed PDAC but not DM. In 45.1% of the former, the interval between the diagnosis of DM and that of PDAC was <1 year, and in 17.65%, 15.69% and 21.57%, the lapses corresponded to 1 and 5 years, between 5 and 10 years y >10 years, respectively. Conclusions: the prevalence of DM in PDAC patients (37%) is higher than that registered in the overall population (12.7%), reaching a 45.10% when detected during the first year of oncological diagnosis. Our results match the international literature relating recently-diagnosed DM with the presence of PDAC, as effect of shared risk factors between both diseases, or DM pathophysiology factors, or DM pharmacological therapeutic


Subject(s)
Humans , Diabetes Mellitus , Pancreas , Pancreatic Neoplasms , Blood Glucose , Glucose , Medical Oncology
6.
Rev. medica electron ; 43(2)mar.-abr. 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1251944

ABSTRACT

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)


Subject(s)
Humans , Female , Adult , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/etiology , Biopsy , Clinical Diagnosis , Neoplasm Metastasis , Neoplasms/surgery , Neoplasms/diagnosis
7.
Rev. argent. cir ; 113(1): 73-82, abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1288176

ABSTRACT

RESUMEN Antecedentes: Debido a la mejoría de los métodos diagnósticos, la incidencia de la neoplasia papilar mucinosa intraductal del páncreas (NPMI) ha aumentado en los últimos años. Objetivo: Presentar la experiencia en el manejo alejado de pacientes con NPMI en un centro de referencia. Material y métodos : Se realizó análisis retrospectivo de pacientes que consultaron al Servicio de Ci rugía General y HPB del Hospital Universitario Fundación Favaloro, por patología pancreática tumo ral entre enero de 2010 y diciembre de 2019. Los pacientes se clasificaron en 2 grupos: A) aquellos con diagnóstico en consultorio de NPMI y B) aquellos en los que la NPMI fue un hallazgo en la pieza quirúrgica (B). Resultados: Ochenta y seis pacientes fueron analizados: 79 (90%) se incluyeron en el grupo A y 7 en el grupo B. De los pacientes del grupo A, en 57 casos (66%) se decidió conducta expectante y seguimiento (AS). De los 22 pacientes restantes, 18 fueron operados (29%) (AC) y 4 tienen la cirugía pendiente. Para el grupo A, la supervivencia a los 5 años fue de 89% para el grupo AS, de 86% en grupo AC, y del 43% para el grupo B (Breslow 0,001, Log-Rank 0,001 vs. grupo A). Conclusión: El diagnóstico y manejo de la NPMI está hoy estandarizado, en las tipo I y III está indicada cirugía, la tipo II debe seguirse por riesgo de malignización; cuando se le indica cirugía, la supervivencia a largo plazo debe ser similar a la del grupo en seguimiento.


ABSTRACT Background: The incidence of intraductal papillary mucinous neoplasm (IPMN) of the pancreas has increased over the past years along with the development of diagnostic imaging tests. Objective: The aim of this study is to describe our experience on long-term management of patients with IPMNs in a reference center. Material and methods: We conducted a retrospective and descriptive analysis of patients with pancreatic neoplasms followed-up at the Department of General Surgery and Hepato-Biliary Surgery, Hospital Universitario Fundación Favaloro, between January 2010 and December 2019. The patients were classified into 2 groups: group A (diagnosis of IPMN made in the outpatient clinic), and group B (diagnosis of IPMN in the pathological examination). Results: Eighty-six patients were analyzed: 79 (90%) in group A and 7 in group B. In group A, a watchful waiting with monitoring (AM) was decided in 57 cases (66%). Of the remaining 22 patients, 18 (29%) patients underwent surgery (AS) and 4 are waiting for surgery. Survival at 5 years was 89% in group AM, 86% in group AS and 43% in group B (Breslow 0.001, log-rank test 0,001 vs. group A). Conclusion : The diagnosis and management of IPMNs is currently standardized. Surgery is indicated in MD-IPMN and mixed type IPMN. Patients with BD-IPMN type should be monitored due to the risk of malignant transformation. When surgery is indicated, long-term survival should be similar to that of the surveillance group.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Pancreatic Neoplasms , Pancreas , Pancreatic Intraductal Neoplasms , Neoplasms
8.
Rev. medica electron ; 43(2): 3231-3238, mar.-abr. 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1251940

ABSTRACT

RESUMEN El páncreas ectópico es una entidad poco común. Como tumor submucoso de origen congénito, frecuentemente presenta un curso asintomático, aunque con posibles complicaciones. Su diagnóstico de certeza se basa en la endoscopia, el ultrasonido endoscópico y la histología, que permiten adoptar una conducta expectante o quirúrgica. El paciente estudiado presentó un páncreas ectópico localizado en antro gástrico asociado a síntomas de reflujo gastroesofágico rebeldes a tratamiento, los cuales motivaron el estudio endoscópico, con el consecuente hallazgo de dicha entidad (AU).


ABSTRACT Ectopic pancreas is a little common entity. As congenital-originated sub mucous tumor, it frequently presents an asymptomatic course, though with possible complications. Its definitive diagnosis is based in the endoscopy, endoscopic ultrasound and histology, allowing to adopt an expectant or surgical behavior. The current patient presented an unresponsive-to-treatment ectopic pancreas located in the gastric antrum associated to gastro-esophageal reflux symptoms. This motivated the endoscopic study consequently leading to finding this entity (AU).


Subject(s)
Humans , Male , Adult , Pancreatic Neoplasms/diagnosis , Pyloric Antrum/pathology , Gastroesophageal Reflux/complications , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/drug therapy , Signs and Symptoms , Therapeutics/methods , Endoscopy/methods
11.
Rev. medica electron ; 43(1): 2887-2902, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1156782

ABSTRACT

RESUMEN Introducción: los tumores de la encrucijada duodeno-bilio-pancreática o periampulares corresponden a un grupo heterogéneo de tumores. Se originan dentro de los 2 cm de la papila duodenal mayor. En los tumores irresecables, el tratamiento debe estar dirigido a la paliación más efectiva. El tratamiento quirúrgico paliativo va dirigido a resolver la obstrucción biliar, duodenal y el dolor, con el fin de optimizar la calidad de vida de los pacientes. Objetivo: describir el comportamiento del tratamiento quirúrgico paliativo de los tumores periampulares. Materiales y métodos: se realizó una investigación observacional, descriptiva y prospectiva con los pacientes con tumor periampular irresecable tributarios a tratamiento quirúrgico paliativo, en el Servicio de Cirugía General del Hospital Universitario "Comandante Faustino Pérez Hernández", en la ciudad de Matanzas, desde enero del 2010 hasta diciembre del 2019. Resultados: el tumor de páncreas fue el más representado. Todos los pacientes fueron tributarios de derivación biliar quirúrgica paliativa, sin embargo, la derivación gástrica se realizó solo con confirmación endoscópica de infiltración tumoral u obstrucción duodenal y la esplacnicectomía química, siempre que fue factible técnicamente o las condiciones del paciente lo permitieron. La hepaticoyeyunostomía en Y de ROUX fue la derivación biliar de elección. La principal complicación quirúrgica fue la sepsis provocando las muertes. Conclusiones: la paliación quirúrgica es la alternativa de elección con mejores resultados a largo plazo, en los tumores periampulares irresecables con buen estado general, lo que contribuye a una mejor calidad de vida (AU).


ABSTRACT Introduction: the tumors of the duodenal-biliary-pancreatic junction or periampullary tumors correspond to a heterogeneous group of tumor. They originate inside the 2 cm of the major duodenal papilla. In unresectable tumors, the treatment should be intended for the most effective palliation. The surgical palliative treatment is intended for solving biliary, duodenal obstruction, and pain, with the aim of optimizing patients' life quality. Objective: to describe the behavior of the periampullary tumors palliative surgical treatment. Materials and methods: a prospective, descriptive, observational research was carried out in patients with unresectable periampullary tumor tributary to palliative surgical treatment, in the Service of General Surgery of the University Hospital "Comandante Faustino Perez Hernandez", of Matanzas, from January 2010 to December 2019. Results: pancreas tumor was the most represented one. All patients were tributary to biliary palliative surgical derivation, however, gastric derivation was performed only with endoscopic confirmation of tumor infiltration or duodenal obstruction, and chemical splanchnicectomy whenever it was technically feasible and the patient's conditions allowed it. Roux's Y-shaped hepaticojejunostomy was the elective biliary derivation. The main surgical complication was sepsis provoking deaths. Conclusions: surgical palliation is the election alternative with long- term better outcomes, in unresectable periampullary tumors with a good general status, contributing to better life quality (AU).


Subject(s)
Humans , Pancreatic Neoplasms/surgery , Biliopancreatic Diversion , Sepsis/etiology , Duodenal Obstruction , Cancer Pain , Pancreatic Neoplasms/complications , Quality of Life , Epidemiology, Descriptive , Prospective Studies , Observational Study
12.
Repert. med. cir ; 30(1): 59-63, 2021. ilus., tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1292229

ABSTRACT

La hipoglucemia es una urgencia médica frecuente que en la mayoría de los casos es secundaria al uso de fármacos hipoglucemiantes, orales o inyectados, indicados en pacientes con diabetes mellitus. No obstante, puede presentarse en forma espontánea y severa relacionándose con múltiples condiciones clínicas, incluyendo las neoplasias. Ante una hipoglucemia de origen paraneoplásico se deben reconocer los mecanismos fisiopatológicos que la generan y establecer el diagnóstico oportuno y preciso para disminuir las complicaciones propias de este síndrome clínico. Presentamos dos pacientes con cuadro de hipoglucemia refractaria al manejo médico inicial, de aparición similar con patologías diferentes. El primer caso corresponde a un paciente con insulinoma y el segundo con un hemangiopericitoma.


Hypoglycemia is a common medical emergency which is mostly secondary to the use of oral or injected hypoglycemic drugs indicated in patients with diabetes mellitus. However, it can present spontaneously and severely in relation to multiple clinical conditions, including neoplasms. When faced with hypoglycemia associated with paraneoplastic disorders, the pathophysiological mechanisms of hypoglycemia must be recognized and a timely and accurate diagnosis must be established in order to diminish complications inherent to this clinical syndrome. We herein present two patients with hypoglycemia refractory to initial medical management, sharing similar appearance with other pathologies. The first case corresponds to a patient with an insulinoma and the second to a patient with a hemangiopericytoma.


Subject(s)
Humans , Male , Adult , Middle Aged , Pancreatic Neoplasms/complications , Hemangiopericytoma/complications , Hypoglycemia/etiology , Insulinoma/complications , Pancreatic Neoplasms/diagnostic imaging , Hemangiopericytoma/diagnostic imaging , Insulinoma/diagnostic imaging
13.
Clin. biomed. res ; 41(3): 262-263, 20210000. ilus
Article in English | LILACS | ID: biblio-1343186

ABSTRACT

We present a clinical, radiological, surgical, and pathological correlation case of a 49-year-old woman with a prior nephrectomy due to a clear cell renal cell carcinoma, who was then diagnosed with a multilocular cystic lesion in the pancreatic tail after a routine ultrasound. Computed tomography and magnetic resonance cholangiopancreatography showed a multilocular cystic lesion with a hypervascular wall nodule in the pancreas. The patient underwent a distal pancreatectomy and had a final diagnosis of pancreatic mucinous cystadenoma with an associated component of clear cell renal cell carcinoma (collision tumor of the pancreas). (AU)


Subject(s)
Humans , Female , Middle Aged , Carcinoma, Renal Cell , Cystadenoma, Mucinous , Neoplasm Metastasis , Pancreatic Neoplasms , Kidney Neoplasms
14.
Rev. Col. Bras. Cir ; 48: e20202913, 2021. tab, graf
Article in English | LILACS | ID: biblio-1287885

ABSTRACT

ABSTRACT Background and Aims: An association between non-alcoholic fatty liver disease (NAFLD) and pancreatic ductal adenocarcinoma (PDAC) has been previously suggested. This study aims at investigating this association and at identifying potential links between variables of the NAFLD spectrum and PDAC. Methods: A cross-sectional case-matched analytical and comparative study was carried out to analyze patients undergoing surgical resection of PDAC and compare them to a control group of individuals undergoing cholecystectomy at a public tertiary teaching hospital, matched by sex, age and BMI. Hepatic histopathological examinations were compared between cases and controls. Results: Of 56 individuals, 36 were male (64.3%) and the median age was 61.5 years old (interquartile range: 57.5 - 70). The participants' median BMI was 24.3 kg/m2 (interquartile range: 22.1-26.2 kg/m2). Microvesicular steatosis (p=0.04), hepatocellular ballooning (p=0.02), fibrosis (p=0.0003) and steatohepatitis (p=0.03) were significantly more frequent in the group of cases. Odds ratios for hepatocellular ballooning (6.2; 95%CI: 1.2-31.8; p=0.03), fibrosis (9.3; 95%CI: 2.5-34.1; p=0.0008) and steatohepatitis (3.9; 95%CI: 1.1-14.3; p=0.04) were statistically significant in relation to the PDAC prevalence. Conclusions: Significant associations were identified between histopathological aspects of NAFLD (microvesicular steatosis, hepatocellular ballooning, fibrosis, and steatohepatitis) and PDAC.


RESUMO Histórico e objetivos: a associação entre a doença hepática gordurosa não alcoólica (DHGNA) e o adenocarcinoma ductal pancreático (ACDP) foi sugerida anteriormente. Este estudo visa investigar esta associação e identificar possíveis ligações entre as variáveis do espectro da DHGNA e o ACDP. Métodos: foi realizado estudo transversal caso-controle analítico e comparativo para analisar pacientes submetidos a ressecção cirúrgica de ACDP e compará-los a grupo controle de indivíduos submetidos a colecistectomia em hospital público terciário de ensino, pareados por sexo, idade e IMC. Os exames histopatológicos hepáticos foram comparados entre casos e controles. Resultados: dos 56 indivíduos, 36 eram do sexo masculino (64,3%) e a idade mediana era de 61,5 anos de idade (intervalo interquartil 57,5-70). A mediana do IMC dos participantes foi de 24,3 kg/m2 (intervalo interquartil 22,1 26,2). Esteatose microvesicular (p = 0,04), balonização hepatocelular (p = 0,02), fibrose (p = 0,0003) e esteato-hepatite (p = 0,03) foram significativamente mais frequentes no grupo de casos. As razões de chances para balonização hepatocelular (6,2; IC 95%: 1,2 - 31,8; p = 0,03), fibrose (9,3; IC 95%: 2,5 - 34,1; p = 0,0008) e esteato-hepatite (3,9; IC 95%: 1,1 - 14,3; p = 0,04) foram estatisticamente significativas em relação à prevalência de ACDP. Conclusões: houve associações significativas entre aspectos histopatológicos de DHGNA (esteatose microvesicular, balonização hepatocelular, fibrose e esteato-hepatite) e a ocorrência de ACDP.


Subject(s)
Humans , Male , Pancreatic Neoplasms/epidemiology , Non-alcoholic Fatty Liver Disease/complications , Non-alcoholic Fatty Liver Disease/pathology , Non-alcoholic Fatty Liver Disease/epidemiology , Biopsy , Cross-Sectional Studies , Liver , Liver Cirrhosis/pathology , Middle Aged
15.
São Paulo; s.n; 2021. 87 p. tab, ilus.
Thesis in Portuguese | LILACS, Inca | ID: biblio-1348764

ABSTRACT

Um dos principais pontos de controle da tradução de mRNAs ocorre através da fosforilação da subunidade alfa do fator de início de tradução eIF2 (eIF2α), o que leva à inibição da síntese geral de proteínas. GCN2 é uma das quinases de eIF2α que responde à carência de aminoácidos e radiação UV, fosforilando eIF2α e inibindo a tradução geral. Sua atividade depende da união com a proteína GCN1. A proteína IMPACT também interage com GCN1, competindo pela ligação GCN1-GCN2, inibindo a atividade de GCN2 e estimulando a tradução. Através de pesquisas em bancos de dados utilizando o cBioPortal, observamos que em adenocarcinomas de pâncreas, existem alterações nos genes que codificam IMPACT, GCN1 e GCN2 em uma porcentagem significativa de casos. No Brasil, este tumor é responsável por cerca de 2% de todos os tipos de câncer diagnosticados e por 4% do total de mortes por câncer. Devido à natureza agressiva da doença e ao diagnóstico tardio, a maioria dos pacientes apresenta o câncer localmente avançado ou metastático, possuindo uma alta taxa de mortalidade e sobrevida de 5 anos menor que 7%. Portanto, desvendar mecanismos moleculares associados a este tumor é de extrema importância para o desenvolvimento de novas abordagens terapêuticas. Utilizando um modelo celular de adenocarcinoma de pâncreas, nocaute para IMPACT, realizamos ensaios funcionais. eIF2 foi mais fosforilado pelas linhagens nocautes na avaliação por estresse a UV, mas não para privação de leucina. Além disso, células nocautes também apresentaram menor capacidade de formar colônias independentemente de ancoragem, e menos formação tumoral nos ensaios em vivo, além de apresentarem menor capacidade de formar e manter estruturas 3D avaliadas no ensaio de esferoides e adesão. A partir da avaliação dos Tissue Micro Arrays (TMAs), tumores primários apresentaram maior quantidade de IMPACT quando comparados com tumores metastáticos e tecido normal. Interessantemente, tanto no TMA quanto nas linhagens celulares foram observados grânulos de IMPACT tanto no núcleo quanto no citoplasma e associados a proteínas características de grânulos de estresse e proteínas do nucléolo. Diante dos resultados encontrados, podemos concluir que a proteína IMPACT pode ter atuação no ciclo celular além de fazer parte de grânulos de estresse. Além disso, levanta-se a hipótese que pode atuar em dois momentos na progressão tumoral: um primeiro momento onde a superexpressão favoreceria a sobrevivência do tumor e um segundo momento onde a diminuição de IMPACT facilitaria a metástase. Portanto o estudo dessa proteína pode melhorar o entendimento não só dos mecanismos envolvidos no desenvolvimento e progressão do Adenocarcinoma de Pâncreas, mas também de processos biológicos relacionados com outros tumores e até mesmo outras doenças.


Subject(s)
Humans , Male , Female , Aged , Pancreatic Neoplasms , Carcinogenesis , Carcinoma, Pancreatic Ductal
16.
ABCD arq. bras. cir. dig ; 34(4): e1628, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1360014

ABSTRACT

RESUMO -RACIONAL: O adenocarcinoma ductal do pâncreas é a quarta causa de morte associada ao câncer mais comum no mundo ocidental. A presença de células tumorais circulantes (CTCs) pode ser considerada um potencial fator prognóstico, visto que essas células representam a progressão tumoral, permitindo o monitoramento da eficácia terapêutica. OBJETIVOS: explorar as características morfológicas, moleculares e fenotípicas das células tumorais circulantes (CTCs) do sangue de pacientes com carcinoma pancreático e correlacionar os achados com a resposta ao tratamento, sobrevida livre de progressão, sobrevida global (SG) e trombose venosa profunda (TVP). MÉTODOS: o sangue periférico (10mL) foi analisado antes do início do tratamento e após 60 e 120 dias. As CTCs foram detectadas pelo ISET® e caracterizadas por imunocitoquímica. Para análise de miRNAs, leucócitos periféricos dos mesmos pacientes e indivíduos saudáveis foram coletados em paralelo no início do estudo. A expressão de miRNAs foi avaliada usando TaqMan T Array Human MicroRNA Cards v2.0. RESULTADOS: foram incluídos 9 pacientes. As proteínas MMP2 e TGFß-RI foram altamente expressas (77,7%) nas CTCs no início do estudo. No primeiro acompanhamento, MMP2 era predominante (80%) e no segundo acompanhamento, MMP2 e vimentina eram predominantes (50%). Microêmbolos tumorais circulantes (MTC) foram encontrados em dois pacientes e ambos apresentavam TVP. O miR-203a-3p foi altamente expresso em CTCs. miR-203a-3p está envolvido na estimulação da transição epitelio-mesenquima (TEM) e relacionado a pior SG no câncer pancreático (dados TCGA). CONCLUSÃO: Devido ao baixo número de pacientes e curto seguimento, não observamos correlação entre CTCs e resposta ao tratamento. No entanto, houve uma correlação entre MTC e TVP. Além disso, miR-203a-3p foi altamente expresso em CTCs, corroborando os achados de proteínas EMT. Este estudo abre perspectivas sobre a mudança dinâmica no padrão de proteínas expressas ao longo do tratamento e a utilização de miRNAs como novos alvos no carcinoma pancreático.


ABSTRACT - BACKGROUND: Ductal adenocarcinoma of the pancreas is the fourth most common cancer-associated cause of death in the Western world. The presence of circulating tumor cells (CTCs) can be considered a potential prognostic factor, as these cells represent tumor progression, allowing monitoring of therapeutic efficacy. OBJECTIVES: The objectives of this study were to explore the morphological, molecular, and phenotypic characteristics of CTCs from the blood of patients with pancreatic carcinoma and to correlate the findings with response to treatment, progression-free survival, overall survival (OS), and deep vein thrombosis (DVT). METHODS: Peripheral blood (10 mL) was analyzed before the beginning of treatment after 60 and 120 days. CTCs were detected by using ISET® and characterized by immunocytochemistry. For microRNAs (miRNAs) analysis, peripheral leukocytes from the same patients and healthy individuals (controls) were collected in parallel at baseline. The expression of miRNAs was evaluated (in pool) using TaqMan® Array Human MicroRNA Cards v2.0. RESULTS: Only nine patients were included. The proteins, namely, matrix metalloproteinase-2 (MMP2) and TGFβ-RI, were highly expressed (77.7%) in CTCs at baseline; at the first follow-up, MMP2 was predominant (80%) and, at the second follow-up, MMP2 and vimentin were predominant (50%). Circulating tumor microemboli (CTMs) were found in two patients and both presented DVT. The miR-203a-3p was highly expressed in CTCs. The miR-203a-3p is involved in the stimulation of epithelial-to-mesenchymal transition (EMT) and is related to worse OS in pancreatic cancer (TCGA data). CONCLUSION: Due to the low number of patients and short follow-up, we did not observe a correlation between CTCs and response to treatment. However, there was a correlation between CTM and DVT and also miR-203a-3p was highly expressed in CTCs, corroborating the findings of EMT proteins. This study opens the perspectives concerning the dynamic change in the pattern of proteins expressed along with treatment and the use of miRNAs as new targets in pancreatic carcinoma.


Subject(s)
Humans , Pancreatic Neoplasms/genetics , Matrix Metalloproteinase 2/genetics , MicroRNAs/genetics , Neoplastic Cells, Circulating
18.
Rev. chil. endocrinol. diabetes ; 14(1): 17-20, 2021. tab, ilus
Article in Spanish | LILACS | ID: biblio-1146467

ABSTRACT

Insulinoma es un tumor neuroendocrino que surge de las células ß del páncreas y produce hiperinsulinemia endógena. Son neoplasias raras con una incidencia reportada de 4 casos por millón de habitantes por año. La presentación clínica típicamente cursa con síntomas adrenérgicos y neuroglucopénicos secundarios a hipoglicemia. Requiere estudios de niveles séricos de insulina, pro-insulina y péptido C, además de imágenes diagnosticas que confirmen los hallazgos. La mayoría de los insulinomas son benignos, su sitio primario más común es el páncreas y pueden extirparse quirúrgicamente. Se presenta el caso de un hombre de 36 años con déficit cognitivo leve y episodios de diaforesis con deterioro neurológico hasta convulsiones tónico clónicas generalizadas que curiosamente resolvían con uso doméstico de "panela molida". Se ingresó a urgencias por ataques recurrentes de hipoglicemia severa con requerimiento de altas dosis de dextrosa al 50% por acceso central, hasta confirmación diagnóstica, intervención y resección de tumor neuroendocrino pancreático bien diferenciado (G1 según clasificación OMS) tipo insulinoma en la cola del páncreas.


Insulinoma is a neuroendocrine tumor that arises from the ß cells of the pancreas and produces endogenous hyperinsulinemia. They are rare neoplasms with a reported incidence to 4 cases per million inhabitants per year. The clinical presentation typically presents with adrenergic and neuroglycopenic symptoms secondary to hypoglycemia. It requires studies of serum levels of insulin, pro-insulin and C-peptide, in addition to diagnostic images that confirm the findings. Most insulinomas are benign, their most common primary site is the pancreas, and they can be removed surgically. We present the case of a 36-year-old man with mild cognitive deficits and episodes of diaphoresis with neurological deterioration to generalized clonic tonic seizures that curiously resolved with domestic use of "ground brown sugar". He was admitted to the emergency department due to recurrent attacks of severe hypoglycemia with a high-dose requirement for 50% dextrose through central access, until diagnostic confirmation, intervention, and resection of a welldifferentiated pancreatic neuroendocrine tumor (G1 according to WHO classification) insulinoma in the tail of pancreas.


Subject(s)
Humans , Male , Adult , Pancreatic Neoplasms/diagnosis , Insulinoma/diagnosis , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/complications , Magnetic Resonance Imaging , Neuroendocrine Tumors , Diagnosis, Differential , Epilepsy/diagnosis , Glucose/therapeutic use , Hyperinsulinism/etiology , Hypoglycemia/etiology , Hypoglycemia/drug therapy , Insulinoma/surgery , Insulinoma/complications
19.
Autops. Case Rep ; 11: e2020201, 2021. tab, graf
Article in English | LILACS | ID: biblio-1142397

ABSTRACT

Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (UCOGCs) is an extremely rare morphologically and clinically distinct variant of pancreatic ductal adenocarcinoma (PDAC), exhibiting a characteristic component of reactive osteoclast-like giant cells admixed with neoplastic mononuclear cells. Sommers and Meissner first described it in 1954 as an "unusual carcinoma of the pancreas". Later it acquired many different names. In 2010, the WHO classified these tumors as a variant of PDAC under the heading of "undifferentiated carcinoma with osteoclast-like giant cells". Here we describe the first case of pancreatic mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) composed of UCOGC and pancreatic neuroendocrine tumor (NET), which occurred in a 78-year-old man with biliary colic and pancreatitis. The mass did not respond to the chemotherapy, and he soon developed liver metastasis from the NET component, and unfortunately, the patient passed away 10 months later. Since UCOGC is extremely rare, and its association with NET has not been reported yet, our case expands the knowledge regarding its unusual presentation and poor prognosis.


Subject(s)
Humans , Male , Aged , Pancreatic Neoplasms/pathology , Neuroendocrine Tumors , Carcinoma, Pancreatic Ductal/pathology , Giant Cells , Fatal Outcome
20.
Rev. bras. cancerol ; 67(1): e-16967, 2021.
Article in Portuguese | LILACS | ID: biblio-1147265

ABSTRACT

Introdução: A neoplasia maligna de pâncreas configura uma das neoplasias de maior mortalidade em todo o mundo, quase sempre atrelada a um prognóstico sombrio, principalmente quando associada à disseminação linfática e para órgãos distantes. Objetivo: Avaliar a sobrevida global em pacientes com adenocarcinoma de pâncreas atendidos em um centro especializado em oncologia. Método: No período de janeiro de 2011 a dezembro de 2014, foram avaliados retrospectivamente 71 prontuários. Os dados foram analisados pelo software STATA versão 14, utilizando análise de Kaplan-Meier e de regressão de Cox. O intervalo de confiança utilizado foi de 95% e considerado significante p<0,05. Foram preservados os princípios éticos e da confidencialidade. Resultados: Houve predomínio do sexo masculino, raça parda e com idade superior a 61 anos ao diagnóstico. Quanto às características clínicas, 87,8% dos tumores estavam localizados em cabeça de pâncreas. A dor abdominal (92,7%) foi o sintoma mais frequente, seguida de perda progressiva de peso (79,3%) e icterícia (57,3%). A taxa de sobrevida em três meses de acompanhamento foi de 48,4%. Conclusão: O estudo evidencia que o câncer de pâncreas tem uma repercussão extremamente negativa, visto que a maioria dos pacientes recebe o diagnóstico em estágios avançados da doença, dificultando a possibilidade de tratamento curativo.


Introduction: Pancreatic malignant neoplasia represents one of the highest mortality neoplasms worldwide, almost always associated to a dismal prognosis, especially when associated with lymphatic spread and to distant organs. Objective: To assess the global survival in patients with pancreatic adenocarcinoma treated at a specialized oncology center. Method: From January 2011 to December 2014, 71 medical records were retrospectively evaluated. The data were analyzed using the STATA software version 14, using the Kaplan-Meier curve and the Cox regression. The confidence interval used was 95% (p<0.05). Ethical and confidentiality principles have been secured. Results: There was predominance of males, mixed race and over 61 years of age at diagnosis. As for the clinical characteristics, 87.8% of the tumors were located in the head of the pancreas. Abdominal pain (92.7%) was the most frequent symptom, followed by progressive weight loss (79.3%) and jaundice (57.3%). The three-month follow-up survival rate was 48.4%. Conclusion: The study shows that pancreatic cancer has an extremely negative repercussion, since most patients are diagnosed in advanced stages of the disease, hindering the possibility of curative treatment.


Introducción: La neoplasia maligna pancreática representa una de las neoplasias de mortalidad más altas del mundo, casi siempre vinculada a un pronóstico sombrío, especialmente cuando se asocia con diseminación linfática y órganos distantes. Objetivo: Evaluar la supervivencia global en pacientes con adenocarcinoma pancreático tratados en un centro de oncología especializado. Método: Desde enero de 2011 hasta diciembre de 2014, se evaluaron retrospectivamente 71 registros médicos. Los datos se analizaron utilizando el software STATA versión 14, utilizando la curva de Kaplan-Meier y la regresión de Cox. El intervalo de confianza utilizado fue del 95% (p<0,05). Se han preservado los principios éticos y de confidencialidad. Resultados: Predominó el sexo masculino, la raza mixta y los mayores de 61 años en el momento del diagnóstico. En cuanto a las características clínicas, el 87,8% de los tumores se ubicaron en la cabeza del páncreas. El dolor abdominal (92,7%) fue el síntoma más frecuente, seguido de pérdida progresiva de peso (79,3%) e ictericia (57,3%). La tasa de supervivencia de seguimiento a los tres meses fue del 48,4%. Conclusión: El estudio muestra que el cáncer de páncreas tiene un impacto extremadamente negativo, ya que la mayoría de los pacientes reciben el diagnóstico en etapas avanzadas, obstaculizando la posibilidad de tratamiento curativo.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pancreatic Neoplasms/epidemiology , Survival Analysis , Delayed Diagnosis
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