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BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is associated with a very poor prognosis, with near-identical incidence and mortality. According to the World Health Organization Globocan Database, the estimated number of new cases worldwide will rise by 70% between 2020 and 2040. There are no effective screening methods available so far, even for high-risk individuals. The prognosis of PDAC, even at its early stages, is still mostly unsatisfactory. Impaired glucose metabolism is present in about 3/4 of PDAC cases. METHODS: Available literature on pancreatic cancer and diabetes mellitus was reviewed using a PubMed database. Data from a national oncology registry (on PDAC) and information from a registry of healthcare providers (on diabetes mellitus and a number of abdominal ultrasound investigations) were obtained. RESULTS: New-onset diabetes mellitus in subjects older than 60 years should be an incentive for a prompt and detailed investigation to exclude PDAC. Type 2 diabetes mellitus, diabetes mellitus associated with chronic non-malignant diseases of the exocrine pancreas, and PDAC-associated type 3c diabetes mellitus are the most frequent types. Proper differentiation of particular types of new-onset diabetes mellitus is a starting point for a population-based program. An algorithm for subsequent steps of the workup was proposed. CONCLUSIONS: The structured, well-differentiated, and elaborately designed approach to the elderly with a new onset of diabetes mellitus could improve the current situation in diagnostics and subsequent poor outcomes of therapy of PDAC.
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Nuclear magnetic resonance (NMR) metabolomics was used for identification of metabolic changes in pancreatic cancer (PC) blood plasma samples when compared to healthy controls or diabetes mellitus patients. An increased number of PC samples enabled a subdivision of the group according to individual PC stages and the construction of predictive models for finer classification of at-risk individuals recruited from patients with recently diagnosed diabetes mellitus. High-performance values of orthogonal partial least squares (OPLS) discriminant analysis were found for discrimination between individual PC stages and both control groups. The discrimination between early and metastatic stages was achieved with only 71.5% accuracy. A predictive model based on discriminant analyses between individual PC stages and the diabetes mellitus group identified 12 individuals out of 59 as at-risk of development of pathological changes in the pancreas, and four of them were classified as at moderate risk.
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Diabetes Mellitus , Metabolómica , Humanos , Espectroscopía de Resonancia Magnética , Páncreas , Análisis Discriminante , Neoplasias PancreáticasRESUMEN
OBJECTIVES: Acute biliary pancreatitis is the most common form of acute pancreatitis worldwide. Endoscopic ultrasound (EUS) may be helpful in detecting common bile duct stones and in indicating more invasive endoscopic retrograde cholangiopancreatography (ERCP) examinations or determining rarer aetiologies of acute pancreatitis. METHODS: Over a period of six years, we prospectively collected 131 patients with acute biliary pancreatitis and observed the need for endoscopic examination alongside with a decrease in the number of necessary ERCP examinations as a result of negative EUS results (no bile duct stones detected). We compared groups of patients given different endoscopic treatments in relation to their hospital mortality relative to the incidence of severe acute pancreatitis. RESULTS: As many as 68 % of primarily indicated EUS examinations had a negative result (no common bile duct stones detected) and this result saved the patients from needing to undergo an invasive ERCP procedure. Both the incidence of the severe form of acute pancreatitis and the hospital mortality rate were lower among patients who underwent only EUS or ERCP after EUS as compared to patients who underwent ERCP straight away. CONCLUSION: The use of EUS in patients with acute pancreatitis is very helpful in determining the treatment strategy (ERCP indication) and may reduce hospital mortality (Tab. 2, Ref. 14).
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Cálculos Biliares , Pancreatitis , Humanos , Pancreatitis/diagnóstico por imagen , Enfermedad Aguda , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Endosonografía/efectos adversos , Endosonografía/métodos , Cálculos Biliares/complicaciones , Cálculos Biliares/diagnóstico por imagenRESUMEN
The association of pancreatic cancer with type 2 diabetes mellitus was investigated by 1H NMR metabolomic analysis of blood plasma. Concentration data of 58 metabolites enabled discrimination of pancreatic cancer (PC) patients from healthy controls (HC) and long-term type 2 diabetes mellitus (T2DM) patients. A panel of eight metabolites was proposed and successfully tested for group discrimination. Furthermore, a prediction model for the identification of at-risk individuals for future development of pancreatic cancer was built and tested on recent-onset diabetes mellitus (RODM) patients. Six of 59 RODM samples were assessed as PC with an accuracy of more than 80%. The health condition of these individuals was re-examined, and in four cases, a correlation to the prediction was found. The current health condition can be retrospectively attributed to misdiagnosed pancreatogenic diabetes or to early-stage pancreatic cancer.
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Diabetes Mellitus Tipo 2 , Diabetes Mellitus , Neoplasias Pancreáticas , Diabetes Mellitus Tipo 2/diagnóstico , Detección Precoz del Cáncer , Humanos , Metabolómica , Neoplasias Pancreáticas/diagnóstico , Espectroscopía de Protones por Resonancia Magnética , Estudios RetrospectivosRESUMEN
We compare two types of pancreatic carcinoma samples obtained by EUS-guided fine needle biopsy (EUS-FNB) in terms of the success rates and clinical validity of analysis of two most commonly investigated DNA/RNA pancreatic cancer markers, KRAS mutations and miR-21 expression. 118 patients with pancreatic ductal adenocarcinoma underwent EUS-FNB. The collected sample was divided, one part was stored in a stabilizing solution as native aspirate (EUS-FNA) and second part was processed into the cytological smear (EUS-FNC). DNA/RNA extraction was followed by analysis of KRAS mutations and miR-21 expression. For both sample types, the yields of DNA/RNA extraction and success rates of KRAS mutation and miRNA expression were evaluated. Finally, the resulting KRAS mutation frequency and miR-21 prognostic role were compared to literature data from tissue resections. The overall amount of isolated DNA/RNA from EUS-FNC was lower compared to the EUS-FNA, average yield 10 ng vs 147 ng for DNA and average yield 164 vs. 642 ng for RNA, but the success rates for KRAS and miR-21 analysis was 100% for both sample types. The KRAS-mutant detection frequency in EUS-FNC was 12% higher than in EUS-FNA (90 vs 78%). The prognostic role of miR-21 was confirmed in EUS-FNC (p = 0.02), but did not reach statistical significance in EUS-FNA (p = 0.06). Although both types of EUS-FNB samples are suitable for DNA/RNA extraction and subsequent DNA mutation and miRNA expression analysis, reliable results with clinical validity were only obtained for EUS-FNC.
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Biomarcadores de Tumor/análisis , Carcinoma Ductal Pancreático/diagnóstico , Citodiagnóstico/métodos , Neoplasias Pancreáticas/diagnóstico , Manejo de Especímenes/métodos , Anciano , ADN/análisis , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Femenino , Humanos , Masculino , MicroARNs/análisis , Persona de Mediana Edad , Mutación , Proteínas Proto-Oncogénicas p21(ras)/genética , Fijación del Tejido/métodos , Neoplasias PancreáticasAsunto(s)
Hipertensión Portal/etiología , Neoplasias Pancreáticas/diagnóstico , Plasmacitoma/diagnóstico , Choque Hemorrágico/etiología , Endosonografía , Resultado Fatal , Humanos , Hipertensión Portal/diagnóstico , Persona de Mediana Edad , Páncreas/diagnóstico por imagen , Páncreas/patología , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/patología , Plasmacitoma/complicaciones , Plasmacitoma/patología , Choque Hemorrágico/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
To enable the early diagnosis of pancreatic cancer, the search for and definition of reliable biomarkers remain a subject of great interest, with the specificity and sensitivity of the currently used biomarkers being below the required values. We tested a novel diagnostic approach for pancreatic cancer based on the specific molecular signature of blood plasma components. To acquire more detailed structural information, structure-sensitive chiroptical methods (electronic circular dichroism and Raman optical activity) were supplemented by conventional Raman and infrared spectroscopies. The obtained spectra were subsequently processed by linear discriminant analysis yielding high values of specificity and sensitivity. In addition, to monitor not only large biomolecules as potential biomarkers but also those of low molecular weight, we conducted an analysis of blood plasma samples by using metabolomics. The achieved results suggest a panel of promising biomarkers for a reliable detection of pancreatic cancer.
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Dicroismo Circular/métodos , Metabolómica/métodos , Neoplasias Pancreáticas/sangre , Espectroscopía Infrarroja por Transformada de Fourier/métodos , Espectrometría Raman/métodos , Anciano , Biomarcadores de Tumor/sangre , Carnitina/análogos & derivados , Carnitina/sangre , Estudios de Casos y Controles , Análisis Discriminante , Humanos , Lisofosfatidilcolinas/sangre , Persona de Mediana Edad , Proyectos PilotoRESUMEN
BACKGROUND: Novel, less invasive approaches such as single-incision laparoscopic cholecystectomy or natural orifice transluminal endoscopic surgery require preclinical evaluation and training. Therefore, there is a need for an experimental model closely mimicking the clinical situation. The aim of our study was to create an experimental model of calculous cholecystitis in a large laboratory animal and test its feasibility for the evaluation of different techniques of cholecystectomy. METHODS: In 11 laboratory pigs, gallstones were placed inside the gallbladder laparoscopically. Levels of inflammatory markers-leucocytes (WBC), C-reactive protein (CRP) and interleukin 6 (IL-6)-were monitored on the postoperative days (POD) 1, 2, 3, 7 and 30. Abdominal ultrasound was performed 2 and 4 weeks after the operation. Four weeks after the lithiasis induction, laparoscopic cholecystectomy was performed. The control group consisted of ten healthy animals in which a cholecystectomy was performed. The pigs were monitored for 30 days after surgery. All removed gallbladders were assessed histologically. RESULTS: The induction of lithiasis took 42 (35-52) min with no morbidity and mortality. The values of WBC, CRP and IL-6 increased significantly (vs. baseline) on POD 1, 2 and 3 (p < 0.05) and then normalised. Ultrasonography confirmed the presence of chronic calculous cholecystitis in all cases after 4 weeks. Laparoscopic cholecystectomy was significantly longer in animals with lithiasis, 63 (42-91) versus 46 (31-62) min (p = 0.018). Perioperative gallbladder wall perforation was significantly more frequent in the model group (8/11 vs. 1/10; p = 0.04). In contrast to healthy animals, all gallbladders with stones showed histological signs of chronic inflammation. CONCLUSIONS: A new animal model of calculous cholecystitis was created. Laparoscopic cholecystectomy was more technically difficult compared to operating on a healthy gallbladder. This model may be a suitable tool for effective preclinical training and also for the evaluation of different techniques of cholecystectomy.
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Colecistectomía Laparoscópica/educación , Colecistolitiasis/cirugía , Cirugía Endoscópica por Orificios Naturales/educación , Animales , Colecistectomía Laparoscópica/métodos , Modelos Animales de Enfermedad , Procedimientos Quirúrgicos Mínimamente Invasivos , Cirugía Endoscópica por Orificios Naturales/métodos , Porcinos , Resultado del TratamientoRESUMEN
Pancreatic cancer (PC) behaves very differently in comparison with other malignancies. Its incidence has been increasing continuously; mortality has not decreased, the diagnosis is frequently late, radical surgery is performed only in 15-20% of patients, and chemotherapy is only palliative. PC occurs in three different forms. Sporadic PC accounts for 90% of all PCs. Its most frequent form is the pancreatic ductal adenocarcinoma. The remaining 10% constitute two minority groups: familial PC (7%) and PC as a manifestation of a genetic cancer syndrome (3%). PCs are preceded by a precancerous lesion (precursor). At present, six different precursors are known. They have different histomorphological characteristics and malignant potential. The recognition and correct interpretation of individual precursors influences adequate clinical decision-making. The publication surveys the present knowledge of individual precursors and their role in the early pancreatic carcinogenesis.
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Carcinoma Ductal Pancreático/patología , Transformación Celular Neoplásica/patología , Neoplasias Pancreáticas/patología , Lesiones Precancerosas/patología , Anciano , Animales , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/metabolismo , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/metabolismo , Carcinoma Ductal Pancreático/terapia , Transformación Celular Neoplásica/genética , Transformación Celular Neoplásica/metabolismo , Detección Precoz del Cáncer , Epigénesis Genética , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/terapia , Lesiones Precancerosas/genética , Lesiones Precancerosas/metabolismo , Lesiones Precancerosas/terapia , Pronóstico , Factores de Riesgo , Transducción de SeñalRESUMEN
BACKGROUND: The changes in gastrointestinal hormones associated with pancreatic ductal adenocarcinoma (PDAC) in patients with impaired glucoregulation have yet to be evaluated. The aim of this study was to determine plasma concentrations of selected gastrointestinal hormones in PDAC patients with and without diabetes and to compare them with levels found in Type 2 diabetic patients without cancer. METHODS: In this study we examined plasma concentrations of glucose-dependent insulinotropic peptide (GIP), glucagon-like peptide 1 (GLP-1), pancreatic polypeptide (PP), peptide YY (PYY) and neuropeptide Y (NPY), and cytokines leptin and adiponectin in 94 patients with histologically confirmed PDAC. Thirty-nine patients with Type 2 diabetes without PDAC and 29 healthy individuals with no evidence of acute or chronic diseases were examined as controls. RESULTS: Significantly lower plasma concentrations of GIP were found in PDAC patients with new-onset diabetes/prediabetes (n = 76), or in those with normal glucose regulation (n = 18), compared to patients with Type 2 diabetes without PDAC and controls (15.5 (3.7-64.5) or 6.5 (1.7-24.5) vs. 39.8 (15.1-104.7) and 28.8 (7.4-112.2) ng/L, p < 0.001); the same relationship was observed for PP (38.9 (10.2-147.9) or 28.1 (7.9-100.0) vs 89.1 (38.0-208.9) and 75.8 (30.1-190.6) ng/L, p < 0.01), respectively. The lowest levels of GIP and PP concentrations were found in PDAC patients with new-onset diabetes/prediabetes and weight loss > 2 kg (p < 0.001). CONCLUSIONS: We conclude that GIP and PP plasma concentrations are lower in pancreatic cancer irrespective of the degree of glucose intolerance as compared to Type 2 diabetic patients and healthy controls. In new onset diabetes especially if associated with weight loss, these changes may represent a new clue for the diagnosis of PDAC.
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Glucemia/metabolismo , Carcinoma Ductal Pancreático/sangre , Diabetes Mellitus Tipo 2/complicaciones , Polipéptido Inhibidor Gástrico/sangre , Neoplasias Pancreáticas/sangre , Polipéptido Pancreático/sangre , Pérdida de Peso , Adulto , Anciano , Biomarcadores/sangre , Carcinoma Ductal Pancreático/complicaciones , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/fisiopatología , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Péptido 1 Similar al Glucagón/sangre , Intolerancia a la Glucosa/sangre , Intolerancia a la Glucosa/complicaciones , Intolerancia a la Glucosa/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Neuropéptido Y/sangre , Neoplasias Pancreáticas/complicaciones , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/fisiopatología , Péptido YY/sangreRESUMEN
The incidence and prevalence of metabolic syndrome (MS) and colorectal cancer (CRC) has been rising in developed countries. The association between these two diseases has been widely studied and reported. Less evidence is available about the relationship between MS and CRC precancerous lesions (adenomatous polyps, adenomas). The aim of this paper is to present an overview of our scientific understanding of that topic and its implication in clinical practice. One of the principal goals of current CRC secondary prevention efforts is to detect and remove the precancerous lesions in individuals with an average CRC risk to prevent the development of invasive cancer. MS is not currently considered a high-risk CRC factor and is therefore not included in the guidelines of organized screening programs. However, in light of growing scientific evidence, the approach to patients with MS should be changed. Metabolic risk factors for the development of adenomas and cancers are the same - obesity, impaired glucose tolerance, dyslipidemia, hypertension, cardiovascular diseases and diabetes mellitus type 2. Therefore, the key issue in the near future is the development of a simple scoring system, easy to use in clinical practice, which would identify individuals with high metabolic risk of colorectal neoplasia and would be used for individual CRC secondary prevention strategies. Currently, such scoring systems have been published based on Asian (Asia-Pacific Colorectal Screening Score; APCS) and Polish populations.
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Adenoma/complicaciones , Adenoma/diagnóstico , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/diagnóstico , Síndrome Metabólico/complicaciones , Adenoma/epidemiología , Colonoscopía , Neoplasias Colorrectales/epidemiología , República Checa , Prueba de Tolerancia a la Glucosa , Humanos , Tamizaje Masivo , Síndrome Metabólico/epidemiología , Isquemia Miocárdica/complicaciones , Invasividad Neoplásica , Obesidad/complicaciones , Obesidad/epidemiología , Prevalencia , Factores de Riesgo , Prevención Secundaria , Índice de Severidad de la EnfermedadRESUMEN
High-resolution imaging methods (HRIMs) and biomarkers present the second step of pancreatic cancer (PC) diagnostics in at-risk individuals. These include patients with positive risk factors, early symptoms, nonresponders to the initial antidiabetic therapy, patients older than 50 years of age with new-onset unstable diabetes requiring insulin as well as patients with long-term insulin-non-dependent diabetes and recent (up to 6 months) failure of antidiabetic therapy. The procedures should be started without delay and the co-operation between the primary and tertiary medical centers is highly desirable. An early indication of HRIMs and biomarkers is a prerequisite for the diagnosis of a resectable PC. This publication reviews the recent contribution of HRIMs and biomarkers toward an early diagnosis of PC.
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Adenoma/diagnóstico por imagen , Carcinoma in Situ/diagnóstico por imagen , Carcinoma Ductal Pancreático/diagnóstico por imagen , Detección Precoz del Cáncer/métodos , MicroARNs/genética , Neoplasias Quísticas, Mucinosas y Serosas/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Adenoma/genética , Adenoma/metabolismo , Anticuerpos/metabolismo , Biomarcadores , Carcinoma in Situ/genética , Carcinoma in Situ/metabolismo , Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/metabolismo , Colangiopancreatografia Retrógrada Endoscópica , Pancreatocolangiografía por Resonancia Magnética , Diagnóstico por Imagen de Elasticidad , Endosonografía , Humanos , Imagen por Resonancia Magnética , Tomografía Computarizada Multidetector , Neoplasias Quísticas, Mucinosas y Serosas/genética , Neoplasias Quísticas, Mucinosas y Serosas/metabolismo , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/metabolismo , Plectina/metabolismo , Tomografía Computarizada por Tomografía de Emisión de Positrones , UltrasonografíaRESUMEN
BACKGROUND/OBJECTIVES: Pancreatic ductal adenocarcinoma (PDAC) is frequently heralded by an impairment of glucose homeostasis. Dipeptidyl peptidase-IV (DPP-IV) and fibroblast activation protein alpha (FAP) are aminopeptidases that regulate several bioactive peptides involved in glucoregulation, and are frequently dysregulated in cancer. The present study analyzes blood plasma levels and the quantity and localization of DPP-IV and FAP in PDAC tissues. METHODS: DPP-IV and FAP concentration and enzymatic activity were evaluated in the plasma from 93 PDAC, 39 type 2 diabetes mellitus (T2DM) and 29 control subjects, and in matched paired non-tumorous and tumor tissues from 48 PDAC patients. The localization of DPP-IV and FAP was determined using immunohistochemistry and catalytic histochemistry. RESULTS: The enzymatic activity and concentration of DPP-IV was higher in PDAC tumor tissues compared to non-tumorous pancreas. DPP-IV was expressed in cancer cells and in the fibrotic stroma by activated (myo)fibroblasts including DPP-IV(+)FAP(+) cells. FAP was expressed in stromal cells and in some cancer cells and its expression was increased in the tumors. Plasmatic DPP-IV enzymatic activity, and in particular the ratio between DPP-IV enzymatic activity and concentration in PDAC with recent onset DM was higher compared to T2DM. In contrast, the plasmatic FAP enzymatic activity was lower in PDAC compared to T2DM and controls and rose after tumor removal. CONCLUSIONS: DPP-IV-like enzymatic activity is upregulated in PDAC tissues. PDAC patients with recent onset diabetes or prediabetes have increased plasmatic DPP-IV enzymatic activity. These changes may contribute to the frequently observed association of PDAC and recent onset impairment of glucoregulation.
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Adenocarcinoma/enzimología , Carcinoma Ductal Pancreático/enzimología , Dipeptidil Peptidasa 4/metabolismo , Neoplasias Pancreáticas/enzimología , Adulto , Anciano , Anciano de 80 o más Años , Diabetes Mellitus Tipo 2/enzimología , Dipeptidil Peptidasa 4/sangre , Endopeptidasas , Femenino , Fibrosis , Gelatinasas/metabolismo , Humanos , Masculino , Proteínas de la Membrana/metabolismo , Persona de Mediana Edad , Miofibroblastos/enzimología , Páncreas/enzimología , Serina Endopeptidasas/metabolismo , Células del Estroma/enzimología , Adulto JovenRESUMEN
Risk factors (long-term diabetes, obesity) and early symptoms (new-onset diabetes, loss of weight, or persistent low body mass) are the initial symptoms of pancreatic carcinogenesis. They may be influenced by antidiabetic drugs and their correct evaluation is a prerequisite for early diagnosis of pancreatic cancer (PC). We review the risk factors, early symptoms, and the impact of antidiabetic drugs on early pancreatic carcinogenesis. The main source of data was the database Medline/PubMed and abstracts of international congresses (DDW, UEGW). The risk factors and early symptoms are integral components of the familial PC surveillance and sporadic PC screening. Preventive programs should always be include multistep and multidisciplinary procedures. The correct evaluation of antidiabetic drugs and their interactions with other components of pancreatic carcinogenesis may influence the early diagnosis of PC.
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Hipoglucemiantes/efectos adversos , Neoplasias Pancreáticas/etiología , Transformación Celular Neoplásica/efectos de los fármacos , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/etiología , Detección Precoz del Cáncer/métodos , Humanos , Obesidad/complicaciones , Neoplasias Pancreáticas/diagnóstico , Factores de RiesgoRESUMEN
Leylls syndrome (syndrome of toxic epidermal necrolysis) is a rare disease, firstly described by Scottish doctor of medicine Allan Lyell in 1956. It is characterized by huge skin and mucosa necrolysis, which affects at least 30 % of body surface, and systemic symptoms. According to the frequency of the occurrence it is an extremely rare condition, with an incidence of 0.5-2 cases per million residents per year. Leylls syndrome is considered as a toxoallergic reaction, triggered mostly by some medication and it is associated with a very high mortality rate (in the literature reported between 30 to 90 %). Adequate and timely local and systemic treatment at the Intensive Care Unit or at the specialized clinic can improve the overall poor prognosis of the patients. In our case report we describe a very rare case of the Lyells syndrome after exposure to the antifungal organosulfur compound, which is widely used by the homegardners and farmers.
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Fungicidas Industriales/efectos adversos , Síndrome de Stevens-Johnson/etiología , Tiocarbamatos/efectos adversos , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Pancreatic cancer (PC) behaves very differently in comparison with other malignancies. Its prevalence continuously increases, mortality does not decrease, diagnosis is frequently late, radical surgery is limited to 15-20 % of patients, postoperative relapses are frequent, and chemotherapy has a palliative character. Preventive programs are the only possibility of improvement. In familial pancreatic cancer (FPC) the knowledge of the genetic mutation enables earlier entry of specialists into the surveillance program. The repeated use of high resolution imaging methods (including endoscopy and pancreatic cytology) may be followed by more frequent detection of the precursors and earlier stages of FPC. The identification of sporadic pancreatic cancer (SPC) depends fully on the construction of a multi-step and multi-disciplinary preventive program.
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Carcinoma/diagnóstico , Carcinoma/genética , Detección Precoz del Cáncer , Predisposición Genética a la Enfermedad , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/genética , Carcinoma/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Mutación , Neoplasias Pancreáticas/prevención & control , Medición de Riesgo , Factores de RiesgoRESUMEN
Differential diagnosis of solid pancreatic masses using EUS FNA is in 1015 % of cases still challenging. Promising method, which helps to distinguish between chronic pancreatitis and cancer, is point mutations of the proto-oncogene KRAS test. This method is not established in routine clinical practice yet.Objectives were the determination of the sensitivity of the KRAS assay using various kinds of samples of patients with pancreatic mass and testing the effect of the presence of KRAS mutations on the prognosis of survival. 147 patients underwent EUS-FNA examination of pancreatic mass, accompanied by blood sampling with subsequent separation of plasma for the detection of circulating tumor DNA. Part of biopsy sample was left native in a stabilizing solution and part as cytological smear. Samples (native aspirates, cytological smears, plasma) were examined for the presence of KRAS mutation by heteroduplex analysis, denaturing capillary electrophoresis.Among 147 patients with pancreatic masses, 118 were diagnosed as a cancer, 26 chronic pancreatitis, 3 neuroendocrine tumor. In total 147 native aspirates, 118 cytological smears and 94 plasma samples were examined. The highest sensitivity of KRAS mutation was reached in the group of pancreatic cancer patients using cytology, in which 90 % of KRAS mutation was detected (106/118 of the samples). When using the native cellular aspirates, mutation was detected in 78 % (92/118 samples), and examination of plasma was positive in 27 % (24/90 samples). In four patients with chronic pancreatitis KRAS mutations was detected, although none has been cytologically confirmed as a cancer. Two of these four patients were confirmed in the course of the disease as a cancer, one patient died because of alcoholic delirium and the last one was indicated for surgery recently.Examination of KRAS mutations can be performed in all patients undergoing EUS-FNA, with the cytology being the most reliable type of sample for genetic tests. KRAS examination would be reasonable to introduce into routine clinical practice in a group of patients with unclear differential diagnosis of chronic pancreatitis, especially in those with suspicion of cancer in inflammatory terrain.Kexwords: pancreatic cancer, chronic pancreatitis, KRAS mutation , EUS-FNA.
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Carcinoma Ductal Pancreático/genética , Carcinoma Ductal Pancreático/patología , Biopsia por Aspiración con Aguja Fina Guiada por Ultrasonido Endoscópico , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/patología , Proteínas Proto-Oncogénicas p21(ras)/genética , Anciano , Análisis Mutacional de ADN/métodos , Diagnóstico Diferencial , Endosonografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mutación , Pancreatitis Crónica/genética , Pancreatitis Crónica/patología , Pronóstico , Proto-Oncogenes MasRESUMEN
Raman optical activity (ROA) is inherently sensitive to the secondary structure of biomolecules, which makes it a method of interest for finding new approaches to clinical applications based on blood plasma analysis, for instance the diagnostics of several protein-misfolding diseases. Unfortunately, real blood plasma exhibits strong background fluorescence when excited at 532 nm; hence, measuring the ROA spectra appears to be impossible. Therefore, we established a suitable method using a combination of kinetic quenchers, filtering, photobleaching, and a mathematical correction of residual fluorescence. Our method reduced the background fluorescence approximately by 90%, which allowed speedup for each measurement by an average of 50%. In addition, the signal-to-noise ratio was significantly increased, while the baseline distortion remained low. We assume that our method is suitable for the investigation of human blood plasma by ROA and may lead to the development of a new tool for clinical diagnostics.
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Plasma/química , Espectrometría Raman/métodos , Fluorescencia , Humanos , Rotación Óptica , Espectrometría Raman/instrumentaciónRESUMEN
Pancreatic adenocarcinoma is a dismal disease with a very serious prognosis and a very low 5-year survival. Local symptoms are present at a late stage of the disease and in the majority of cases do not enable radical surgery. Intervention is possible only in locally restricted tumor and remains the only chance of significant survival. At present, two early symptoms of this growth are known. They include impaired glucose tolerance or diabetes similar to but not identical with diabetes type 2, and a decrease of the body mass. They precede by a period of 2-3 years local symptoms that are late and cause the bad prognosis. The earlier diagnosis of pancreatic adenocarcinoma represents an urgent and serious task. The project of a screening program based on the use of the early symptoms may move the diagnosis of pancreatic adenocarcinoma to the earlier stage of the disease. The key-players for the most important first step of this program are general practitioners and ambulatory diabetologists.