Efficacy of endoscopic ultrasound fine needle aspiration in diagnosing the rare (non-adenocarcinoma) tumors of pancreas.

BACKGROUND: Five percent of pancreatic neoplasms are non- adenocarcinoma tumors. Clinical presentation and imaging characteristics of these tumors are similar to adenocarcinoma. This study aims at evaluating the results and efficacy of Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in diagnosing the pancreatic non-adenocarcinoma tumor in patients with solid pancreatic mass. METHODOLOGY: The present study which is of a descriptive, prospective and case series nature, has been studying the diagnostic value of EUS-FNA in pancreatic non-adenocarcinoma tumor in 60 patients with pancreatic solid neoplasm. Cytopathologic diagnosis founded on EUS-FNA accepted as final diagnosis in unresectable ones. But the reference standard for the final diagnosis in patients with resectable tumor was surgical pathology. In patients with non diagnostic EUS-FNA specimen, final diagnosis achieved by re-FNA, Computerized Tomography (CT) guided biopsy, or surgery. RESULTS: Ten patients (17%) found to have non-adenocarcinoma tumor. Half of them were male. EUS-FNA was diagnostic in 8 cases (80%) including the 4 neuroendocrine tumors, one gastrointestinal stromal tumor, one mucinous neoplasm, one pseudopapillary tumor, and one geant cell tumor. Surgical pathology confirmed the EUS-FNA diagnosis in five patients that had resectable tumor. However EUS-FNA recognition accepted as final diagnosis in three patients that had unresectable tumor. EUS-FNA was non-diagnostic in one patient with pancreatic lymphoma and another patient with colon cancer metastasis. CONCLUSION: EUS FNA is a safe and effective for diagnosing the solid non-adenocarcinoma tumors as well as adenocarcinomas of pancreas.

Resectability of the pancreatic adenocarcinoma: A study from Iran.

BACKGROUND: Definite treatment of pancreatic adenocarcinoma is surgical resection. Absence of early symptoms in most patients leads to late diagnosis and treatment. This study aims to evaluate resectability of the pancreatic adenocarcinoma at the time of the diagnosis in Iran. MATERIALS AND METHODS: The present study which is of a descriptive, prospective and case series nature, has been studying the resectability of the pancreatic adenocarcinoma by multi-detector computerized tomography, endoscopic ultrasonography, laparoscopy and/or laparotomy in 157 patients for the duration of 2 years since November 2009. RESULTS: A total of 157 patients were enrolled in this study. Majority of them (68%) were male. The mean age was 67 years. Final diagnosis obtained 1-12 (2.7 ± 1.6) months after beginning of the symptoms. The lesion situated in the head of the pancreas in 127 cases (81%). Vascular invasion, lymphadenopathy, liver metastasis and peritoneal involvement were seen in 88%, 57%, 43% and 19% of the patients, respectively. According to imaging, tumor was resectable in 10 (6%) patients but laparoscopy and/or laparotomy revealed that only five cases (3%) were actually resectable. After 24 months, only 8 patients were alive; 5 cases of them had been treated by Whipple surgery and other 3 cases were under the chemotherapy. At 1 and 2 year survival rate of the patients was 11% and 5%, respectively. CONCLUSION: Majority (97%) of the pancreatic adenocarcinomas are unresectable at the time of diagnosis. Thus, meticulous preoperative assessment of patients is essential in patients to avoid major surgery in unresectable cases.

Efficacy of multi-detector computerized tomography scan, endoscopic ultrasound, and laparoscopy for predicting tumor resectability in pancreatic adenocarcinoma.

BACKGROUND: Definitive treatment for pancreatic adenocarcinoma is surgical resection. Endoscopic ultrasound (EUS), multi-detector computerized tomography scan (MDCT), and laparoscopy are current preoperative methods for assessing the resectability in this malignancy. This study compared the efficacy of these methods in predicting the resectability of pancreatic adenocarcinoma. METHODOLOGY: One hundred and fifty-seven patients considered for resection of pancreatic adenocarcinoma in two centers in Iran were evaluated. All of the patients were evaluated by MDCT and/or EUS; ones that had resectable tumor in imaging were assessed by laparoscopy/laparotomy. Patients undergoing pancreaticoduodenectomy were followed for 2 years. RESULTS: The majority (67%) were male. The mean age was 66 years. The lesion was situated in the head of pancreas in 127 cases (81%). Tumor resectability rate according to the MDCT scan/EUS, laparoscopy, and laparotomy was 6%, 5%, and 3%, respectively. Only 3% of the pancreatic adenocarcinoma cases were resectable at the time of diagnosis. Fifty percent of patients predicted to have resectable tumor according to MDCT/EUS and 37.5% of cases that had resectable disease in laparoscopy were found to have unresectable lesions at laparotomy and or postsurgical follow up. CONCLUSIONS: Prognosis continues to be dismal for pancreatic adenocarcinoma, and better methods to assess tumor resectability are needed.

Serum CA19-9 in patients with solid pancreatic mass.

AIM: This study evaluated the results and efficacy of serum CA 19-9 in determining the nature of a pancreatic solid mass in patients referred for investigation of possible malignancy. BACKGROUND: A wide variety of tumor markers have been proposed for pancreatic cancer but currently the only one with any practical usefulness for diagnosis, prognosis, and monitoring of treatment is "CA 19-9". PATIENTS AND METHODS: This present study is a single center 2 year descriptive, prospective and case series studying patients with a pancreatic solid mass. RESULTS: Serum CA 19-9 was checked in 159 patients. The majority of patients were male (68%) and 81% had mass in the head of pancreas. Pathologic assessment revealed 131 adenocarcinomas (82%), 10 other malignancies (6%), 7 benign lesion (4%) and was non-diagnostic in 11 cases (7%). Mean level of this tumor marker in patients with adenocarcinoma, non-adenocarcinoma malignancy, benign and non-diagnostic pathology was 1094, 1004, 120, 259 U/ML respectively. With regarding 58 U/ML as a cutoff point; sensitivity, specificity, positive predictive value, negative predictive value and accuracy of this tumor marker for diagnosing the adenocarcinoma were 85%, 67%, 88%, 60% and 81% respectively. CONCLUSION: There was no significant relationship between Serum CA 19-9 value and histopathology of solid pancreatic mass. This marker has limited sensitivity and specificity and cannot be used as a definite diagnostic test. So the use of CA 19-9 for the differentiation of pancreatic cancer should be applied on an individual case basis, depending on the clinical situation and imaging findings.

A 63 years old woman with progressive mechanical dysphagia and weight loss: a case presentation.

When considering a patient with dysphagia, an attempt should be made to determine whether the patient has difficulty only with solid boluses (suggestive of mechanical dysphagia) or with liquids and solids (suggestive of a motility dysphagia). Lesions such as an oesophageal tumor and external pressure effect from a lung tumor or aberrant vessel can lead to mechanical dysphagia. Endoscopy and / or a barium swallow are helpful in identifying the anatomical disarrangement. In this study a patient with progressive mechanical dysphagia is presented that finally diagnosed by as Lung Squamous Cell Carcinoma. There were no respiratory symptoms. Diagnosis was made by a computerized tomography scan of the thorax, bronchoscopy and bronchial biopsy.

Cholangiocarcinoma or Caroli disease: a case presentation.

Early diagnosis and appropriate treatment of cholangiocarcinoma is problematic. Cross sectional imaging and tumor marker CA 19-9 are not absolutely reliable and tissue sampling is difficult. We present a patient with cholangitis and cystic dilation of intra-hepatic bile ducts that primarily diagnosed as Caroli's disease in imaging and needle biopsy but laparotomy and surgical biopsy revealed cholangiocarcinoma.

The relationship between type D personality and perceived social support in myocardial infarction patients.

BACKGROUND: Type D personality is based on two global and stable personality traits, including negative affectivity (NA) and social inhibition (SI). The aim of this study was to examine the relationship between type D personality and perceived social support in post myocardial infarction (MI) patients. METHODS: One hundred seventy six consecutive patients following MI admitted to the cardiac care unit (CCU) of nine hospitals in Isfahan, Iran from April to September 2006 were selected based on the inclusive and exclusive criteria. The patients completed the Persian version of type D personality scale and the Persian version of multidimensional scale of perceived social support (MSPSS). Also, demographic and medical questionnaire was completed for each patient. Chi-squared test, t-test and MANOVA were used to analyze the data. RESULTS: The findings indicated that 35.8% patients (35.8 %) were classified as type D. The results of MANOVA showed that type D patients were significantly different from non-type D patients (F = 8.72, p = 0.0001) on MSPSS scores and on all dimensions including family subscale (F = 11.52, p = 0.001), friends subscale (F= 16.16, p = 0.0001) and significant others subscale (F = 5.04, p = 0.026). CONCLUSIONS: Type D personality substantially affects the way MI patients perceive availability of social support from different sources including family, friends, and significant others. One implication of this finding may be to develop tailor-made interventions for MI patients with type D.