ABSTRACT
PURPOSE: To evaluate the clinical, pathologic, and imaging findings of solid and papillary epithelial neoplasm (SPEN) of the pancreas and to correlate imaging and gross pathologic features. MATERIALS AND METHODS: A retrospective review was performed in 56 patients (53 female and three male patients aged 10-74 years [mean age at diagnosis, 25 years]) with pathologically proven SPEN of the pancreas. All patients underwent computed tomography (n = 49), ultrasonography (n = 31), or magnetic resonance (MR) imaging (n = 9). Tumor size, location, and imaging features were evaluated and correlated with gross pathologic and histologic features. RESULTS: Mean transverse diameter of these tumors was 9.0 cm (range, 2.5-17.0 cm). They were localized to the tail (n = 30), head (n = 18), and body (n = 8) of the pancreas. All tumors contained some degree of internal hemorrhage or cystic degeneration, and all were well encapsulated. Areas of hemorrhagic degeneration ranged from solid friable tumor to gelatinous or cystic cavities and therefore demonstrated variable imaging features. Calcification was noted in 16 patients. Fluid-debris levels were noted in 10 patients. CONCLUSION: Imaging studies of SPEN of the pancreas consistently demonstrate variable degrees of hemorrhagic degeneration. Calcification is common. Characteristic fluid-debris levels and signal intensities seen with MR imaging indicate blood products. In the appropriate clinical setting, these findings are useful in making a prospective diagnosis.
Subject(s)
Adenocarcinoma/diagnosis , Carcinoma, Papillary/diagnosis , Neoplasms, Glandular and Epithelial/diagnosis , Pancreatic Neoplasms/diagnosis , Adenocarcinoma/pathology , Adolescent , Adult , Aged , Carcinoma, Papillary/pathology , Child , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neoplasms, Glandular and Epithelial/pathology , Pancreas/diagnostic imaging , Pancreas/pathology , Pancreatic Neoplasms/pathology , Retrospective Studies , Tomography, X-Ray Computed , UltrasonographyABSTRACT
BACKGROUND: Blood transfusions are associated with higher postoperative morbidity and tumor recurrence rates in colorectal cancer surgery, To reduce the need for transfusions in patients with tumor-induced anemia who are not suitable for autologous blood donation, it was tested whether perisurgical erythropoietin application would be able to stimulate hematopoiesis adequately. METHODS: In a double-blind randomized study 150 IU/kg body weight erythropoietin was given subcutaneously every 2 days beginning 10 days before operation and continuing until postoperative day 2. Twenty patients were randomized into the erythropoietin group with three observed dropouts and 10 patients into the placebo group. RESULTS: In the erythropoietin group two episodes of hypertension and one deep venous thrombosis were observed. Preoperative hemoglobin response in the erythropoietin group (p = 0.069) was paralleled by a highly significant reticulocyte increase (p = 0.0004). However, frequency of blood transfusion was not different between both study groups (erythropoietin, 1.82 +/- 0.80 units/ patient; placebo, 1.80 +/- 0.97 units/patient). If iron availability was analyzed, a strong correlation between ferritin blood levels and transferrin iron saturation with hemoglobin response was observed in regression analysis (p < 0.001). CONCLUSIONS: These results indicate that hematopoiesis in anemic patients with colorectal cancer can be stimulated by erythropoietin; however, clinical efficacy is to be expected only in selected patients with high iron availability, which calls for further studies combining erythropoietin and parenteral iron application.
