Experiencia en el manejo del tumor sólido pseudopapilar de pancreas en un centro de referencia / Experience in the management of the solid pseudopapillary tumor of the pancreas in a reference center

El tumor sólido pseudopapilar de páncreas tiene una incidencia de 0,13-2,7%, afectando preferentemente a mujeres jóvenes. Presentamos la experiencia en el manejo de tumores sólidos pseudopapilares de páncreas durante 10 años en el Hospital Coromoto de Maracaibo. Métodos: Estudio retrospectivo realizado en el Hospital Coromoto de Maracaibo desde enero 2010 hasta diciembre 2019. Se analizaron las variables edad, sexo, ubicación del tumor, procedimiento quirúrgico, tamaño del tumor, tiempo quirúrgico, tiempo de hospitalización y complicaciones. Resultados: De 183 casos totales de cirugía pancreática,15 casos presentaron diagnóstico anatomopatológico de tumor sólido pseudopapilar, representando un 8,20% del total de las cirugías pancreáticas; con edades comprendidas entre 15 a 56 años, con una media de 27,93 de los cuales el 93,33% fueron del género femenino. La ubicación más frecuente fue el cuerpo y la cola del páncreas con un 53,33%. El procedimiento quirúrgico más empleado fue la pancreatectomía distal en 8 casos. El tamaño promedio de los tumores fue de 6,47cm y el tiempo quirúrgico empleado fue de 254 minutos para las pancreatectomías distales y 412 minutos para los procedimientos de Whipple, con una media de hospitalización de 4,6 y 7,2 días respectivamente. Presentaron complicaciones 2 pacientes y sin decesos. Conclusiones: El tumor sólido pseudopapilar es una neoplasia pancreática de comportamiento incierto, con una baja incidencia entre todos los tumores de páncreas, donde la laparoscopia es un método de abordaje seguro en las pancreatectomías distales, sin diferencias en estancia hospitalaria y tiempo quirúrgico. La resección quirúrgica con márgenes libres es curativa(AU)

The solid pseudopapillary tumor of the pancreas has an incidence of 0.13-2.7%, preferentially affecting young women. We present the experience in the management of solid pseudopapillary tumors of the pancreas for 10 years at the Coromoto Hospital in Maracaibo. Methods: Retrospective study carried out at the Coromoto Hospital in Maracaibo from January 2010 to December 2019. The variables age, sex, tumor location, surgical procedure, tumor size, surgical time, hospitalization time and complications were analyzed. Results: Of 183 total cases of pancreatic surgery, 15 cases had a pathological diagnosis of a solid pseudopapillary tumor, representing 8.20% of the total of pancreatic surgeries; with ages ranging from 15 to 56 years, with an average of 27.93 of which 93.33% were female. The most frequent location was the body and tail of the pancreas with 53.33%. The most used surgical procedure was distal pancreatectomy in 8 cases. The average size of the tumors was 6.47cm and the surgical time used was 254 minutes for distal pancreatectomies and 412 minutes for Whipple procedures, with a mean hospital stay of 4.6 and 7.2 days, respectively. Two patients presented complications and no deaths. Conclusions: The solid pseudopapillary tumor is a pancreatic neoplasm of uncertain behavior, with a low incidence among all pancreatic tumors, where laparoscopy is a safe approach to distal pancreatectomies, without differences in hospital stay and surgical time. Surgical resection with free margins is curative(AU)

Value of endoscopic ultrasound in distinguishing ectopic pancrease and stromal tumor in stomach / 中华超声影像学杂志

Objective To explore the value of endoscopic ultrasound (EUS) in differential diagnosis of ectopic pancreas and stromal tumor in stomach.Methods The clinical data and endoscopic ultrasound findings of 40 patients with ectopic pancrea and 141 patients with stromal tumor were retrospectively analyzed,including the location,size,growth pattern,layer of origin,internal echo pattern and so on.All patients were diagnosed pathologically.Results Ectopic pancreas were predominantly located in the antrum (92.5％) and stromal tumor were mainly located in the gastric body (45.4％),the antrum (23.4％) and the fundus (22.0％),there was a significant difference in lesion' s location between two diseases (P ＜0.001).There was no statistical difference in the ratio of longest/shortest diameter of the lesion size(P =0.057).But there was statistical difference in lesion size between ectopic pancrease and stromal tumor [(19.98 ± 12.80)mm vs (11.25 ± 3.61)mm].Mural growth pattern was most common in ectopic pancrease (82.5％) and mural growth pattern (37.6％),extraluminal growth pattern (24.8％) and intraluminal growth pattern (22.7％) in stromal tumor (P ＜0.001).The third layer (75.0％) was predominant in ectopic pancrease while the fourth (54.6％) and the second layers (34.0％) in stromal tumor (P ＜0.001).With regard to internal echo pattern,hypoechoic (32.5％),intermediate (27.5％) and heterogeneous (27.5％) was predominant in ectopic pancrease and homogeneous hypoechoic lesion (72.3％) in the stromal tumor (P ＜ 0.001).Conclusions There were statistical differences between ectopic pancrease and stromal tumor in the location,size,layer of origin,growth pattern and internal echo pattern under EUS.EUS plays an important role in identification of ectopic pancrease and stromal tumor.

Opinions on several issues concerning radical pancreaticoduodenectomy for pancreatic head carcinoma / 中华肝胆外科杂志

According our practice of raical pancreaticoduodenectomy for pancretic head carcinoma and combined with these reviews, we suggested the active and palliative pancreaticoduodenectomy should be aviod. Skeletonization of hepatoduodenal ligament and the retroperitoneal resection should be the routine procedure in pancreticoduodenectomy, and at least invovle two regional lymph nodes. In addition, regardless of the metastase of No 13 lymph node, ristricted retroperitoneal resection for resectable pancretic carcinoma was needed. Exposured the superior mesenteric artery and distinguished inferior of uncinate process of pancrease with the artery, were the key point of the uncinate process of pancrease resection. Preoperative evaluation of angiography and other images, the ratio of activeness and combination with vessel resection would be improved. The style of pancreaticojejunostomy could be selected by the experience of the operator, we are apt to the double-deck invaginated pancreaticojejunostomy. Additionally, utilization of the electronic surgical workstation, should be careful and also need to accumulate more experience.

Expression of livin and caspase-3 and their clinical significance in pancreatic carcinoma / 临床与实验病理学杂志

Purpose To study the expression of livin and caspase-3 protein in pancreatic carcinoma and their correlation with clinicopathologic features and survivial time.Methods High-throughput tissue microarray technique and immunohistochemistry were used to detect the expression of livin and caspase-3 protein in 88 pancreatic carcinoma specimens without a history of chemo-radiation therapy and 11 non tumorous pancreatic tissues,and the relationship of these subjects was analyzed with Spearman rank correlation. Among these 88 cases, 54 cases were followed-up for 2 months to 6 years, whom were used for the prognosis analysis.Results In the 88 cases, the positive rate of livin was 76.1% (67/88); however, the positive expression of caspase-3 was 90.9%(10/11) in non-tumorous pancreatic tissue, which was much higher than that in the cancer (40.9%,36/88), with statistically significant differences(P＜0.01). There were significant relationships of livin protein expression with sex, TNM stage and lymph node metastasis (P＜0.05); the expression of caspase-3 protein expression was significantly related to sex, histological grade, TNM stage and lymph node metastasis (P＜0.01). Spearman rank correlation showed a significant correlation between livin and caspase-3 protein (P＜0.01). In 54 cases with followed-up data, univariant analysis revealed that both of livin protein expression and lymph node metastasis were related to the survival rate (P＜0.05), but caspase-3 protein expression, sex, age, tumor location, size, histological grade and TNM stage were unrelated to prognosis (P＞0.05). Furthermore,COX stepwise proportional hazards analysis showed that only livin status retained independent significance in prospecting prognosis of pancreatic carcinoma.Conclusions The expression of livin is associated with clinicopathologic features and prognosis in pancreatic carcinoma. High expression of livin protein indicates poor prognosis, which could become an independent index for the evaluation of prognosis.caspase-3 protein may be involved in the regulation of apoptosis and the progression of pancreatic carcinoma.

Small cell carcinoma of pancrease

Small cell cancer commonly occurs in the lungs, but it is rarely found in other organs. Small cell cancer that occurs in the pancreas is rare and its progress very rapid, and most patoents' tumor has already spread by metastasis when it is discovered. Although this cancer has a poor prognosis, we report here on treating case with combined curative resection and chemotherapy and showed a good prognosis.

Pancreatic Tuberculosis with Microcystic Adenoma

Tuberculosis of the pancreas is a rare disorder. The clinical presentation of pancreatic tuberculosis include nonspecific symptoms such as fever, fatigue and weight loss. The radiological features mimic pancreatic malignancy or pancreatitis. So, the diagnosis of pancreatic tuberculosis is very difficult. A 62-year-old man was referred for pancreatic mass. Findings on preoperative imaging modalities were consistent with pancreatic carcinoma, and fine needle aspiration test indicated microcystic adenoma or carcinoma. Pylorus-preserving pancreaticoduodenectomy was done. Final diagnosis was pancreatic tuberculosis combined with microcystic adenoma. We conclude in that patients who have a mass in the pancreas, pancreatic tuberculosis should be considered, particularly in the developing country and immunosuppressed individuals.

Laparoscopic Enucleation of a Pancreatic Mucinous Cystadenoma

We report a case of a 52-year-old man in whom a cystic pancreatic tumor was successfully removed by laparoscopic enucleation. The patient had a followup CAT-scan for a resolving right upper lobe pneumonia which demonstrated a unilocular hypodense 3.9x2.2 cm sized cyst in the uncinate process of the pancreas. He had a laparoscopic biliopancreatic diversion with duodenal switch in July 2002, and also had laparoscopic cholecystectomy for cholelithiasis in December 2003. Laparoscopic intraoperative ultrasonography revealed a solitary cystic tumor in the inferior portion of pancreatic head. Laparoscopic enucleation of the tumor was performed using Ultracision(R) between the cyst outer wall and the normal pancreatic parenchyma. The operative time was 160 minutes, the estimated blood loss was 20 ml, and there were no perioperative complications. The patient's postoperative course was uneventful, and he was discharged on the first postoperative day. The histopathologic diagnosis showed a mucinous cystadenoma. We reported a new technique for safe management of small cystic tumors located on surface of the pancreas.

Roles of nuclear factor-?B in the development of rat pancreatic fibrosis mediated by angiotensin II / 中国病理生理杂志

AIM: To determine the effects of NF-?B on the development of rat pancreatic fibrosis mediated by angiotensin II. METHODS: Spraque-Dawley rats (200-300g) were randomly divided into normal group, control group and losartan-treatment group. Pancreatic fibrosis was induced by injection of 2% TNBS into biliopancreatic duct. Rats in losartan-treatment group and control group were respectively treated with losartan (10 mg?kg~(-1)?d~(-1)) by gavage and the same volume of saline vehicle. The expression, distribution, and activation of NF-?B were studied by Western blot, immunohistochemistry and TransAM~(TM). Toluidine blue staining and transmission electron microscopy were also used to observe the number, distribution and degranulation of mast cells. In addition, RT-PCR was performed to detect the intrapancreatic ICAM-1 mRNA expression. RESULTS: The expression and activity of intrapancreatic NF-?B p65 protein were significantly increased on day 3 after operation, reaching peak on day 7 [(0.406?0.086) mg/g total protein]. Mast cell activation was observed and ICAM-1 mRNA levels on day 3 and 7 were up-regulated in control group. Losartan treatment inhibited NF-?B expression and activation, reduced mast cell infiltration and degranulation and decreased ICAM-1 mRNA expression compared with control rats. CONCLUSION: It might be associated with the expression and activation of NF-?B that angiotensin II mediates inflammation and fibrosis in the early stage of pancreatic fibrosis. [

Nine Case of Congenital Variants of the Pancreatic Duct Diagnosed by ERCP / 대한소화기내시경학회지

Although variation is the rule with pancreatic duct morphology, certain variants occur as a result of altered embroological development. These ductal configurations, most striking deviations from the normal configuration, may be classfied according to alterations of embryological development. These congenital variants of pancreatic duct may be important for several reasons. First, the pseudomass effect of ductal anomalies can be mistaken for carcinoma by the inexperienced radiologists. Second, whether or not the anomaly is important, it is present in many patients with recurrent pacreatitis. Original descriptions were based on small sampling of postmortem studies and surgical specimen, but more recently the advent of endoscopic retrograde cholangiopancreatography(ERCP) has confirmed of the work of early anastomists and increased awareness of these variants. To evalute of frequency, characteristics of associated disease and clinical significance of pancreatic anomalies, we have reviewed of 5330 case of ERCP filmes which were undertaken between July, 1973 and August, 1993. Having reviewed of ERCP filmes, we found out 9 case of pancreatic duct variants. Among them, 7 cases were classified as ductal duplication anomalies, 4 cases of number variation, most, bifuricaiton and 3 cases of form variation, which were composed of loop, spiral and terminal N. Three cases of fusion anomalies were also noted, which were 2 cases of panceratic divisum and 1 case of incomplete pancreatic divisum. The associated diseases were 6 cases of bile duct and galbladder stones and 3 cases of pancreatic cancer. We could not find out the case of congenital anomalies as cause of obstructive pain and pseudomass effect.