Tumor sólido pseudopapilar de páncreas: diagnóstico y tratamiento curativo / Solid pseudopapillary tumors of the pancreas: diagnosis andcurative treatment

Objetivos: dar a conocer a través de una serie de casos clínicosuna entidad poco frecuente, con una presentación clínica yunos hallazgos radiológicos concretos, que permiten establecer undiagnóstico y un tratamiento que será en la mayoría de los casoscurativo.Pacientes y métodos: se realizó un estudio descriptivo y retrospectivode los casos diagnosticados y tratados quirúrgicamenteen una Unidad Pancreático-Biliar de un hospital universitario, duranteel periodo comprendo entre marzo de 1999 y septiembrede 2005.Resultados: la incidencia fue de 6 pacientes mujeres, con unaedad media de 33,5 años (rango 11-72). La clínica más comúnfue la de dolor y masa abdominal palpable. La tomografía computerizadafue diagnóstica en tres de las pacientes, en las tres restantesse estableció el diagnóstico diferencial con el tumor neuroendocrino.El tratamiento quirúrgico fue individualizado a cadapaciente según los hallazgos y las imágenes visualizadas en la tomografíacomputerizada. El estudio anatomopatológico confirmóel diagnóstico de presunción, informándose de un caso de carcinomasólido-pseudopapilar de páncreas. La estancia hospitalariafue de 18,16 días (rango 8-30). Mortalidad de 0%. En el seguimientocon una media de 46,3 meses (rango 12-76), no existenrecidivas.Conclusiones: la presencia en una mujer joven de una lesiónvoluminosa en el páncreas, debe hacernos pensar en el tumor sólidopseudopapilar. Debido a su bajo potencial de malignidad y ala existencia de unos patrones radiológicos concretos, su diagnósticodebe ser preciso, ya que el tratamiento quirúrgico radical escurativo

Objectives: to highlight an infrequent occurrence using a seriesof clinical cases with symptoms and signs, and specific radiologicalfindings allowing its diagnosis and treatment, which is inmost cases successful.Patients and methods: a descriptive and retrospective studyof patients diagnosed by computed tomography scanning andthen treated with surgery in the Pancreas and Biliary Unit of aUniversity Hospital from March 1999 to September 2005.Results: there were 6 female patients with a mean age of33.5 years (range 11-72). Most common signs included pain anda palpable mass in the abdomen. Three patients were diagnosedby computed tomography scanning, and a differential diagnosiswith a neuroendocrine tumor was performed for the remainingthree subjects. Surgical treatment was adapted to each patient accordingto the findings and images seen in their computed tomographyscans. Biopsy results confirmed the presumed diagnoses,and showed one case of solid pseudopapillary carcinoma of thepancreas. Average hospital stay was of 18.16 days (range 8-30).Mortality rate was 0%. No recurrences occurred during follow-upfor 46.3 months on average (range 12-76).Conclusions: the presence of a huge mass in the pancreas ofa young female should prompt suspicion for a solid pseudopapillarytumor. Given its low malignant potential, and the presence ofspecific radiographic patterns, its diagnosis should be accurate, asradical surgical treatment is effective

Solid pseudopapillary tumors of the pancreas: diagnosis and curative treatment.

OBJECTIVES: To highlight an infrequent occurrence using a series of clinical cases with symptoms and signs, and specific radiological findings allowing its diagnosis and treatment, which is in most cases successful. PATIENTS AND METHODS: A descriptive and retrospective study of patients diagnosed by computed tomography scanning and then treated with surgery in the Pancreas and Biliary Unit of a University Hospital from March 1999 to September 2005. RESULTS: There were 6 female patients with a mean age of 33.5 years (range 11-72). Most common signs included pain and a palpable mass in the abdomen. Three patients were diagnosed by computed tomography scanning, and a differential diagnosis with a neuroendocrine tumor was performed for the remaining three subjects. Surgical treatment was adapted to each patient according to the findings and images seen in their computed tomography scans. Biopsy results confirmed the presumed diagnoses, and showed one case of solid pseudopapillary carcinoma of the pancreas. Average hospital stay was of 18.16 days (range 8-30). Mortality rate was 0%. No recurrences occurred during follow-up for 46.3 months on average (range 12-76). CONCLUSIONS: The presence of a huge mass in the pancreas of a young female should prompt suspicion for a solid pseudopapillary tumor. Given its low malignant potential, and the presence of specific radiographic patterns, its diagnosis should be accurate, as radical surgical treatment is effective.

Early onset of organ failure is the best predictor of mortality in acute pancreatitis.

BACKGROUND: APACHE II is a multifactorial scoring system for predicting severity in acute pancreatitis (AP). Organ failure (OF) has been correlated with mortality in AP. OBJECTIVE: To evaluate the usefulness of APACHE II as an early predictor of severity in AP, its correlation with OF, and the relevance of an early establishment of OF during the course of AP. PATIENTS AND METHODS: From January 1999 to November 2001, 447 consecutive cases of AP were studied. APACHE II scores and Atlanta criteria were used for defining severity and OF. RESULTS: Twenty-five percent of patients had severe acute pancreatitis (SAP). APACHE II at 24 h after admission showed a sensitivity, specificity, and positive and negative predictive value of 52, 77, 46, and 84%, respectively, for predicting severity. Mortality for SAP was 20.5%. Seventy percent of patients who developed OF did so within the first 24 hours of admission, and their mortality was 52%. Mortality was statistically significant (p< 0.01) if OF was established within the first 24 hours after admission. CONCLUSIONS: APACHE II is not reliable for predicting outcome within the first 24 hours after admission and should therefore be used together with other methods. OF mostly develops within the first days after admission, if ever. The time of onset of OF is the most accurate and reliable method for predicting death risk in AP.

[Results of cephalic pancreaticoduodenectomy in patients with chronic pancreatitis]. / Resultados de la duodenopancreatectomía cefálica en los pacientes con pancreatitis crónica.

OBJECTIVE: To analyse the results obtained after cephalic pancreatoduodenectomy in patients with severe chronic pancreatitis. DESIGN: Retrospective study of indications and results of the intervention.Patients. The inclusion criteria were severe anatomic alteration of the head of the pancreas associated with refractory pain. Pancreatoduodenectomy was performed in 19 patients. RESULTS: Four patients had postoperative morbidity, and the mean hospital stay was 15 days. One patient died in the postoperative period. The pain evolution after surgery was: total control in 72% and satisfactory control in the remaining patients. During follow-up, de novo diabetes was detected in two patients, difficulty in maintaining weight in one patient, and de novo steatorrhea in four patients. CONCLUSIONS: Cephalic pancreatoduodenectomy is a good therapeutic alternative for the treatment of patients with chronic pancreatitis, refractory pain, and severe involvement of the pancreas head. Pain control is excellent and sequelae, such as diabetes or steatorrhea, are easily amenable to medical treatment.

Resultados de la duodenopancreatectomía cefálica en los pacientes con pancreatitis crónica / Results of cephalic pancreatoduodenectomy in patients with chronic pancreatitis

Objetivo. Análisis de los resultados obtenidos tras la realización de una duodenopancreatectomía cefálica en pacientes con pancreatitis crónica grave. Diseño. Estudio retrospectivo de las indicaciones y resultados de la intervención. Pacientes. Los criterios de inclusión fueron la alteración anatómica grave de la cabeza pancreática asociada a dolor intratable. Se efectuó duodenopancreatectomía en 19 pacientes. Resultados. Cuatro pacientes presentaron morbilidad postoperatoria, siendo la estancia postoperatoria media de 15 días. Un paciente falleció en el postoperatorio. La evolución del dolor tras la intervención fue: de control total en el 72 por ciento y satisfactorio en el resto. Durante el seguimiento se detectó diabetes de novo en 2 pacientes, dificultad para mantener el peso en un caso y esteatorrea de novo en 4. Conclusiones. La duodenopancreatectomía cefálica es una buena alternativa terapéutica para el tratamiento de los pacientes con pancreatitis crónica, dolor intratable y afectación grave de la cabeza pancreática. El control del dolor es excelente y las secuelas como la diabetes o la esteatorrea son fácilmente controlables con tratamiento médico. (AU)