Carcinoma pseudopapilar sólido del páncreas / Solid pseudo-papillary carcinoma of the pancreas

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)

Síndrome vascular acral secundária à neoplasia de pâncreas. Relato de caso e revisão de literatura / Acral vascular syndrome secondary to pancreatic cancer: case report and literature review

Paciente do sexo feminino, de 65 anos, foi admitida em nossa instituição com síndrome do dedo azul. Durante a investigação diagnóstica para as principais etiologias possíveis, foi evidenciado adenocarcinoma de cabeça de pâncreas, tendo sido elaborada associação como manifestação paraneoplásica. A investigação da etiologia da síndrome do dedo azul é de suma importância para a conduta terapêutica adequada, já que as causas podem ter evolução extremamente grave na ausência de intervenção, como é o caso dos pacientes que apresentam tal síndrome secundária à neoplasias.(AU)

A 65-year-old female patient was admitted to our institution with the blue toe syndrome. During the diagnostic investigation for possible etiologies, pancreatic head carcinoma was evidenced, and an association as a paraneoplastic manifestation was established. The investigation of the etiology of the blue toe syndrome is very important for the proper treatment, since the causes may have extremely serious development in the absence of intervention, as it is the case of patients with this syndrome secondary to cancer.(AU)

Inflammation and Cancer Development in Pancreatic and Biliary Tract Cancer / 대한소화기학회지

Chronic inflammation has been known to be a risk for many kinds of cancers, including pancreatic and biliary tract cancer. Recently, inflammatory process has emerged as a key mediator of cancer development and progression. Many efforts with experimental results have been given to identify the underlying mechanisms that contribute to inflammation-induced tumorigenesis. Diverse inflammatory pathways have been investigated and inhibitors for inflammation-related signaling pathways have been developed for cancer treatment. This review will summarize recent outcomes about this distinctive process in pancreatic and biliary tract cancer. Taking this evidence into consideration, modulation of inflammatory process will provide useful options for pancreatic and biliary tract cancer treatment.

Adenocarcinoma Arising from Heterotopic Pancreas in Association with a Splenic Cyst.

We report a rare case of adenocarcinoma arising from heterotopic pancreas in splenectomy specimen operated for a Splenic Cyst. This 40 year old female patient presented with vague upper abdominal pain and swelling. USG showed a large cyst within the spleen. The cyst along with the spleen is removed after laparotomy. The pancreas and other abdominal organs were unremarkable on ultrasonography and intraoperative examination. Gross examination showed a cyst with a smooth lining, entirely within the spleen. A small locule, communicating with the main cyst showed small papillary projections. On light microscopy, the cyst wall is lined by single layer of columnar cells. Section from papillary areas showed histological appearance of papillary adenocarcinoma. Remnant of normal pancreatic tissue was discovered at the wall of the cyst. We presume an origin from heterotopic pancreatic tissue in the spleen for this neoplasm and reporting the case for its rarity.

Comment on: Risk of Pancreatic Cancer in Relation to ABO Blood Group and Hepatitis C Virus Infection in Korea: A Case-Control Study

No abstract available.

Obesity and Pancreatic Diseases / 대한소화기학회지

Obesity is defined as BMI (calculated as weight in kg divided by height in m2) more than 30, and overweight is defined as BMI of 25-29.9. Obesity has been considered as a risk factor for pancreatic diseases, including pancreatitis and pancreatic cancer. Severe acute pancreatitis is significantly more frequent in obese patients. Furthermore, obese patients develop systemic and local complications of acute pancreatitis more frequently. The underlying mechanisms are increased inflammation and necrosis from increased amount of intra- and peri-pancreatic fat. In addition, obesity is a poor prognostic factor in acute pancreatitis, and overweight before disease onset appears to be a risk factor for chronic pancreatitis. Overweight and/or obesity are associated with greater risk of pancreatic cancer and younger age of onset. Physical activity appears to decrease the risk of pancreatic cancer, especially among those who are overweight. Long-standing diabetes increases the risk of pancreatic cancer. The pathogenic mechanism is that obesity and physical inactivity increase insulin resistance. In a state of hypersinulinemia, increased circulating level of insulin-like growth factor-1 induces cellular proliferation of pancreatic cancer. Obesity is associated with negative prognostic factor and increased mortality in pancreatic cancer. However, there are controversies regarding the effects of obesity on long-term post-operative results in the patient with pancreatic cancer.

Pancreatic carcinogenesis: The impact of chronic pancreatitis and its clinical relevance.

Pancreatic cancer is a devastating disease with a dismal prognosis and early detection remains a challenge. On the background that inflammation is one of the key steps in the development of cancer, it is natural that chronic pancreatitis is considered as one of the etiological factors for the development of pancreatic cancer. However, the process of pancreatic carcinogenesis is a multifactorial phenomenon rather than a process that evolves solely via inflammation. This review attempts to put into perspective the association between different etiological forms of chronic pancreatitis and pancreatic cancer, and the diverse mechanisms operational in the process of pancreatic carcinogenesis. Furthermore, the clinical relevance of the current understanding of the relationship between chronic pancreatitis and pancreatic cancer, especially with regard to the pancreatic head mass of uncertain etiology, is discussed in this review.

Achados da tomografia computadorizada em metástases pancreáticas do carcinoma de células renais / Computed tomography findings of pancreatic metastases from renal cell carcinoma

OBJETIVO: Apresentar os achados da tomografia computadorizada observados em quatro pacientes submetidos a nefrectomia radical por carcinoma de células renais e que apresentaram metástases pancreáticas. MATERIAIS E MÉTODOS: Os quatro pacientes foram submetidos a nefrectomia radical por carcinoma de células renais, estádios T1 (n=2) e T3a (n=2). O intervalo médio entre a nefrectomia e a detecção das metástases foi de oito anos. Dois pacientes apresentaram metástase pancreática solitária (confinada ao pâncreas) e dois apresentaram metástases pancreáticas única e múltiplas, respectivamente, ambos com recorrência tumoral no rim contralateral. RESULTADOS: As metástases pancreáticas foram visualizadas, na tomografia computadorizada, como lesões hipervascularizadas, solitária (n=2), única (n=1) ou múltiplas (n=1). Foi realizada pancreatectomia parcial em dois pacientes com metástase solitária. Estes pacientes estão livres da doença quatro e dois anos após a cirurgia, respectivamente. CONCLUSÃO: Metástases pancreáticas de carcinoma de células renais são raras, podendo ocorrer muitos anos após a apresentação inicial. Metástases pancreáticas múltiplas e metástases pancreáticas associadas a recorrência tumoral no rim contralateral são incomuns. À tomografia computadorizada, as metástases pancreáticas aparecem como lesões hipervascularizadas e solitárias, simulando tumores das ilhotas celulares. O tratamento cirúrgico das lesões solitárias deve ser considerado.

OBJECTIVE: To present computed tomography findings observed in four patients submitted to radical nephrectomy for renal cell carcinoma who developed pancreatic metastases afterwards. MATERIALS AND METHODS: The four patients underwent radical nephrectomy for stage T1 (n=2) and stage T3a (n=2) renal cell carcinoma. The mean interval between nephrectomy and detection of pancreatic metastases was eight years. Two asymptomatic patients presented with solitary pancreatic metastases (confined to the pancreas). Two symptomatic patients presented with single and multiple pancreatic metastases, both with tumor recurrence in the contralateral kidney. RESULTS: Computed tomography studies demonstrated pancreatic metastases as solitary (n=2), single (n=1) or multiple (n=1) hypervascular lesions. Partial pancreatectomy was performed in two patients with solitary pancreatic metastases and both are free of disease at four and two years after surgery. CONCLUSION: Pancreatic metastases from renal cell carcinoma are rare and can occur many years after the primary tumor presentation. Multiple pancreatic metastases and pancreatic metastases associated with tumor recurrence in the contralateral kidney are uncommon. Usually, on computed tomography images pancreatic metastases are visualized as solitary hypervascular lesions, simulating islet-cell tumors. Surgical management should be considered for patients with solitary pancreatic lesions.

Outcome of surgical management of carcinoma of the pancreas

Majority of the pancreatic tumours arise from ductal epithelium and practically the term pancreatic cancer is reserved for that tumour. Mates are predominantly the victims with male to female ratio of 3:1 in this study. A number of etiological factors have been blamed to be associated but smoking and diabetes mellitus are closely related. Fifty percent patients in this study were found to be either current smokers or have been smoking till last five years. The tumour is notorious for its silent growth and non specific presentation. The most common symptom being jaundice when the tumour arises from head region of the gland, associated with anorexia, vomiting weight loss and malaise. Migrating thrombophlebitis is another unusual feature in some cases. The tumours of body and tail present as mass in the epigastrium. In the present study 90% turnours were arising from the head of the gland and 10% from the body. Cystic neoplasms are common in female patients and arise from the body and tail. Silent spread of the tumour involves the lymph nodes and peripancreatic tissues making it most of the time unresectable at the time of presentation. In the text 10% is the usual resectabte rateIn our study the resectability rate was 25%. Management of the case depends upon the stage of the tumour at time of presentation. Surgical management is the best suitable with chance of curative resection of the tumour. Various modifications in pancreaticoduodenectomy have been done since the Whipples procedure was introduced. Pylorus preserving pancreaticoduodenectomy is one such modification. Pancreatic stump is associated most of the time with complications of leakage. Although the techniques of pancreaticoduodenectomy have been improved with better pre operative evaluation, anaesthetic facilities and post operative care of the patient, the long term five year survival is still not much increased. Moreover, post operative hospital stay and complication rate is still high. Alternatively, bypass procedure especially where the disease i s advanced and the tumour is not resectable, are applied. These palliative procedures are associated with short hospital stay, less post operative complications, early relief of symptoms and better quality of life. Short term survival is rather better in these patients as compared to those undergoing resection. Six months survival in our study was 66.6% as compared to 60% in resected cases. Supportive therapies including chemotherapy, radiotherapy and hormone therapy at present are not of much help

Pancreatic involvement in Von Hippel-Lindau disease.

BACKGROUND: Involvement of the pancreas in Von Hippel-Lindau disease that is a tumor predisposing syndrome mentioned in literature with some morbid and mortal progression. AIMS: For evaluation the faith of the pancreatic involvement in VHL disease we analysed our patient population with VHL disease. MATERIALS AND METHODS: 12 of the 56 patients that were evaluated in our institute with the diagnosis of Von Hippel-Lindau disease had pancreatic involvement. They are periodically examined for 5 years follow up period. Their retrospective analysis was accomplished. RESULTS AND CONCLUSIONS: Pancreatic involvement in our patient population disclosed lesions that were multicysts or serous cystadenomas. During follow up period, we did not observe significant morbidity related to pancreatic involvement. Repeated radiological examination of pancreatic lesions disclosed insignificant modifications such as slight increase or decrease in size. Whereas we considered morbidity and mortality related to renal and central nervous system pathologies in VHL disease. Shortly, even pancreatic involvement in VHL disease requires close clinical follow up, morbidity and mortality in this case is not severe as in renal and the central nervous system involvement.

Dietary habits and cancer mortality among middle aged and older Japanese living in hokkaido, Japan by cancer site and sex.

Dietary factors are thought to be closely associated with the development of human cancers and hence numerous studies in this area have already been conducted in the United States and other Western countries. Comparatively few prospective studies have been published in Japan, especially for Hokkaido people. The present investigation was therefore performed to assess links between four leading cancers and some of the Japanese common dietary factors through a cohort study (1984-2002) in Hokkaido by analyzing 1,524 men and 1,634 women separately aged 40 and over. Adjusted Cox proportional hazard regression was used to calculate the relative risk (RR) for each dietary factor. For men, two dietary factors, miso soup (RR=0.2, 95% confidence interval (95%CI)=0.1-0.8) and pickled vegetables (RR=0.2, 95%CI=0.1-0.8) were associated with lower risk for stomach and colorectal cancer respectively. For women, three factors, namely salty confectionary (RR=3.5, 95%CI=1.1-10.9), black tea (RR=3.8, 95%CI=1.1-13.6), and carbonated drink/juice (RR=3.9, 95% CI=1.4-11.1) appeared related to an elevated risk of stomach cancer. However, further analysis simultaneously with all other adjusted factors indicated only carbonated drink/juice (RR=3.1, 95%CI=1.1-8.9) to present a significant risk factor for stomach cancer. One factor, namely wild edible plants (RR=3.3, 95%CI=1.1-9.8), increased the risk for colorectal cancer in women. None of the dietary components were significantly associated with lung or pancreatic cancers. This study also indicated a wide variation in the impact of dietary factors by sex and cancer site, in line with earlier work, pointing to a necessity for careful interpretation. Further epidemiological investigations by sex with more study subjects and confounding factors will be useful for determining the contribution of individual dietary factors to development of human cancers in Hokkaido, Japan.

Avances en el diagnóstico y tratamiento del cáncer de páncreas / Advances in the diagnosis and treatment of pancreatic carcinoma

Pancreatic carcinoma has a dismal prognosis. In the last years, great efforts have been made to improve diagnosis and preoperative staging of potentially curable carcinomas. Actually, the diagnosis of fairly small tumours is possible. Chemoradiation therapy protocols prior to pancreatectomy, aiming to improve survival, are currently being held. This therapy allows radiation to be distributed into well oxygenated cells before surgical devascularization. This procedure can be done with acceptable morbidity and mortality rates. In selected cases of irresectable carcinoma, surgical palliation allows a better quality of life. Pancreatoduodenal resection, along with other traditional oncological therapies, will continue to be the therapy of choice for patients with carcinoma of the head of the pancreas, without local or regional metastases. However, an intensive search for new therapeutic strategies, specially in the field of molecular biology, is being carried out

Tratamento laparoscopico de obstrucao duodenal em paciente portador de cancer avancado de pancreas / Laparoscopic gastrojejunostomy in a patient with duodenal obstruction from pancreas advanced neoplasm: case report

A incidencia de cancer de pancreas vem aumentando nos paises ocidentais. No entanto, o prognostico ainda e sombrio, apesar das possibilidades terapeuticas hoje disponiveis. O seu diagnostico e, na maioria dos casos, feito tardiamente. A combinacao de avancos nos metodos de imagem e o uso da laparoscopia no estadiamento do cancer do pancreas levou a uma diminuicao do numero de laparotomias exploradoras. No entanto, grande parte destes pacientes ainda podem se beneficiar de um tratamento cirurgico paliativo, seja atraves de derivacao bilio-digestiva ou de gastroenteroanastomose. Apresentamos o relato de um paciente portador de cancer na cauda do pancreas obstruindo a quarta porcao do duodeno associado a metastases hepaticas, tratado por via laparoscopica

Neoplasias periampolares e pancreaticas / Periampullary and pancreatic tumors

Este trabalho visa fazer uma revisao do diagnostico da avaliacao pre-operatoria e tratamento das neoplasias periampolares e pancreaticas. Nos dias atuais e ressaltado que e dificil, e muitas vezes desnecessario, identificar com exatidao a origem das massas periampolares. Assim, e pensamento do autor que na presenca de uma massa pancreatica cefalica que possa ser ressecada, a gastroduopancreatectomia e o procedimento de eleicao, desde que a equipe cirurgica tenha baixa mortalidade operatoria