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1.
Medicine (Baltimore) ; 100(22): e26167, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087876

RESUMO

ABSTRACT: The embryonic development of the pancreas originates from dorsal and ventral anlagen, and the pancreatic cancer arising from dorsal or ventral pancreas may have different clinical pathology features. This study aims to explore whether there are differences in clinicopathological features and prognosis of pancreatic head carcinoma arising from dorsal or ventral pancreas.Between January 2014 and February 2018, 101 patients with resectable pancreatic head cancer who underwent pancreaticoduodenectomy in our institution were retrospectively reviewed. The patients were assigned into 2 groups according to tumor location on preoperative imaging materials (computed tomography/magnetic resonance imaging [CT/MRI]), and the clinicopathological features and prognosis were retrospectively analyzed in view of the embryonic development of the pancreas.Among these patients with pancreatic head cancer, 42 patients had tumors arising from dorsal pancreas (D group) and 59 patients had tumors arising from ventral pancreas (V group). The frequency of lymph node (LN) metastasis around the common hepatic artery (CHA) and hepatoduodenal ligament lymph nodes in the D group was higher than that in the V group (45.2% vs 10.2%, P = .001). And the rate of LN metastasis in the superior mesenteric artery (SMA) region in the V group is higher than that in the D group (32.2% vs 4.8%, P = .002). The D group was more likely to invade the common bile duct (78.6% vs 59.3%, P = .042) and duodenum (71.4% vs 44.1%, P = .006) than the V group. In addition, the survival outcome of V group was better than D group (median overall survival [OS], 15.37 months vs 10.53 months, P = .048, median DFS 9.73 months vs 5.93 months, P = .046).The clinicopathological features of pancreatic head carcinoma arising from dorsal or ventral pancreas are different, and the pancreatic head carcinoma arising from ventral pancreas has a better survival outcome.


Assuntos
Neoplasias Pancreáticas/patologia , Adulto , Idoso , Comorbidade , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/mortalidade
2.
Ann Palliat Med ; 10(5): 5902-5907, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34107726

RESUMO

We report an extremely rare case of primary gastric melanoma with pancreatic metastasis. As far as we know, the concept of primary gastrointestinal melanoma is currently controversial, because there are very few reports of primary gastrointestinal melanoma. At the same time, isolated pancreatic metastases are also very rare. The patient was admitted to the hospital with a main complaint of decreased appetite, and then underwent gastroscopy and found a mass in the stomach. The mass was initially diagnosed as poorly differentiated adenocarcinoma following a gastroscopic biopsy. The patient underwent radical total gastrectomy, pancreatic body and tail resection, splenectomy, and Roux-en-Y esophagojejunostomy. After further immunohistochemical examination of the surgically removed tissue, malignant melanoma was diagnosed. The tumor cells were arranged in sheets or nests with infiltrating growth, the cell sizes were inconsistent, nucleoli were obvious, and melanin particles were seen in the cytoplasm of some cells. The tumor cells were positive for MITF and S-100. Detailed systemic and imaging examinations did not find any other primary lesions. The patient denied any melanoma and skin lesion history. We believe this is a manifestation of primary gastric melanoma. We report this rare case of gastric melanoma with the aim of increasing clinicians' awareness of non-cutaneous melanoma and its treatment methods.


Assuntos
Melanoma , Neoplasias Pancreáticas , Neoplasias Gástricas , Gastrectomia , Humanos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Gástricas/diagnóstico por imagem
3.
BMJ Case Rep ; 14(6)2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34088689

RESUMO

A 67-year-old woman underwent a medical check-up by her general practitioner after complaining of atypical pain in the shoulder girdle. Due to the important inflammatory syndrome noticed on blood testing, a polymyalgia rheumatica was suspected and she was started on corticosteroid treatment with good clinical response, but no impact on inflammation. She underwent extensive imaging with a thoraco-abdominal CT scanner that demonstrated a pancreatic mass, then later a PET-CT showed 3 different hyperactive lesions. Biopsies then revealed simultaneous diffuse large B-cell lymphoma (DLBCL), colorectal adenocarcinoma and pancreatic neuroendocrine tumour. She benefited from low rectal endoscopic excision of the colorectal tumour, R-CHOP chemotherapy for DLBCL and laparoscopic left pancreatectomy. Successful treatment required a good multidisciplinary collaboration between the different specialists. The patient made a good recovery and achieved complete remission at 1 year. This an unusual presentation of multiple primary malignancies.


Assuntos
Neoplasias Colorretais , Linfoma Difuso de Grandes Células B , Neoplasias Primárias Múltiplas , Neoplasias Pancreáticas , Idoso , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/tratamento farmacológico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
4.
World J Gastroenterol ; 27(17): 1936-1942, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-34007131

RESUMO

Progress in the fight against pancreatic cancer has been hampered by many factors. One of them is the inability to detect the disease early in overwhelming majority of patients. The present paper outlines a novel way in which progress could be accelerated. This includes a focus on two harbingers-post-pancreatitis diabetes mellitus and excess intra-pancreatic fat deposition-that converge at affecting the tumor macroenvironment and microenvironment specifically in the pancreas, not other organs. The two entities have the potential to be incorporated into future screening strategies with a view to early detecting of pancreatic cancer.


Assuntos
Diabetes Mellitus , Hipercolesterolemia , Neoplasias Pancreáticas , Pancreatite , Humanos , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico por imagem , Pancreatite/diagnóstico por imagem , Pancreatite/etiologia , Microambiente Tumoral
5.
Nihon Shokakibyo Gakkai Zasshi ; 118(5): 480-489, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33967133

RESUMO

A 66-year-old man was admitted to our department with hypercalcemia, pancreatic and liver tumors, and periportal lymph node enlargement. Contrast-enhanced computed tomography revealed a tumor in the pancreatic tail and the right hepatic lobe along with periportal lymphadenopathy. Laboratory data revealed hypercalcemia and high serum parathyroid hormone-related protein (PTHrP) levels. Using a 22-gauge Franseen needle, we performed endoscopic ultrasonography-guided fine-needle biopsy of the pancreatic mass and an enlarged lymph node. Histopathological examination of the biopsy specimen revealed moderately to well-differentiated pancreatic adenocarcinoma with poorly differentiated squamous cell elements, as well as squamous cell carcinoma of the lymph node. Immunohistochemical examination showed that the pancreatic tissue was weakly immunopositive and the lymph node was strongly immunopositive for anti-PTHrP antibody. We diagnosed the patient with pancreatic adenosquamous carcinoma with liver and lymph node metastasis, associated with hypercalcemia of malignancy secondary to PTHrP secretion. We administered systemic chemotherapy comprising gemcitabine and nab-paclitaxel. Unfortunately, the patient died 8 months after being diagnosed with this malignancy. PTHrP-producing adenosquamous carcinoma of the pancreas is rare;only 14 cases are reported in the literature. Based on immunohistochemical evaluation, this case report suggests that metastatic lymph nodes may lead to the overproduction of PTHrP in such cases.


Assuntos
Adenocarcinoma , Neoplasias Pancreáticas , Idoso , Biópsia por Agulha Fina , Humanos , Masculino , Neoplasias Pancreáticas/diagnóstico por imagem , Proteína Relacionada ao Hormônio Paratireóideo , Ultrassonografia de Intervenção
6.
World J Gastroenterol ; 27(15): 1569-1577, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33958844

RESUMO

Bile duct epithelial tumours showing papillary neoplasm in the bile duct lumen are present in the intrahepatic and extrahepatic bile ducts. Clinicopathological images of these tumours are distinctive and diverse, including histological images with a low to high grade dysplasia, infiltrating and noninfiltrating characteristics, excessive mucus production, and similarity to intraductal papillary mucinous neoplasm (IPMN) of the pancreas. The World Health Organization Classification of Tumours of the Digestive System in 2010 named these features, intraductal papillary neoplasm of the bile duct (IPNB), as precancerous lesion of biliary carcinoma. IPNB is currently classified into type 1 that is similar to IPMN, and type 2 that is not similar to IPMN. Many of IPNB spreads superficially, and diagnosis with cholangioscopy is considered mandatory to identify accurate localization and progression. Prognosis of IPNB is said to be better than normal bile duct cancer.


Assuntos
Neoplasias dos Ductos Biliares , Ductos Biliares Extra-Hepáticos , Colangiocarcinoma , Neoplasias Pancreáticas , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/terapia , Humanos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/terapia
7.
World J Gastroenterol ; 27(15): 1630-1642, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33958848

RESUMO

BACKGROUND: Recurrent acute pancreatitis (RAP) may be a presenting feature of and an indication for resection of pancreatic cysts, including intra-ductal papillary mucinous neoplasm (IPMN). Few data are available regarding the prevalence of malignancy and post-operative RAP in this population. AIM: To study the role of resection to help prevent RAP and analyze if presentation as RAP would be a predictor for malignancy. METHODS: This retrospective study assessed 172 patients who underwent surgical resection of pancreatic cystic neoplasms at a university hospital between 2002 and 2016. The prevalence of preoperative high-risk cyst features, and of neoplasia was compared between patients with and without RAP. To identify the cause of pancreatitis, all the patients had a detailed history of alcohol, smoking, medications obtained, and had cross-sectional imaging (contrast-enhanced computed tomography/magnetic resonance imaging) and endoscopic ultrasound to look for gallstone etiology and other structural causes for pancreatitis. The incidence of RAP post-resection was the primary outcome. RESULTS: IPMN accounted for 101 cases (58.7%) {[branch duct (BD) 59 (34.3%), main duct (MD) 42] (24.4%)}. Twenty-nine (16.9%) presented with RAP (mean 2.2 episodes): 15 had BD-IPMN, 8 MD-IPMN, 5 mucinous cystic neoplasm and 1 serous cystic neoplasm. Malignancy was similar among those with vs without RAP for all patients [6/29 (20.7%) vs 24/143 (16.8%)] and IPMN patients [6/23 (26.1%) vs 23/78 (29.5%)], although tended to be higher with RAP in BD-IPMN, [5/15 (33.3%) vs 3/44 (6.8%), P = 0.04]. At mean follow-up of 7.2 years, 1 (3.4%) RAP patient had post-resection RAP. The mean episodes of acute pancreatitis before vs after surgery were 3.4 vs 0.02 (P < 0.0001). CONCLUSION: Malignancy was not increased in patients with pancreatic cystic neoplasms who have RAP compared to those without RAP. In addition, specific cyst charac-teristics were not clearly associated with RAP. The incidence of RAP was markedly decreased in almost all patients following cyst resection.


Assuntos
Adenocarcinoma Mucinoso , Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Pancreatite , Doença Aguda , Humanos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/cirurgia , Pancreatite/diagnóstico por imagem , Pancreatite/epidemiologia , Pancreatite/etiologia , Estudos Retrospectivos
8.
BMJ Case Rep ; 14(5)2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34031062

RESUMO

A 59-year-old woman presented with abdominal pain associated with nausea and night sweats. A large mass was found in the pancreatic tail and innumerable liver lesions were identified. Ultrasound-guided biopsy of a liver nodule confirmed moderately differentiated adenocarcinoma consistent with a pancreatobiliary primary. On FOLFIRINOX chemotherapy, subsequent CT scans showed shrinkage of the pancreatic mass and liver metastases. Her cancer antigen 19-9 (CA 19-9) normalised after 11 months. Oxaliplatin was discontinued due to peripheral neuropathy but she completed 37 cycles of FOLFIRI during which her pancreatic mass disappeared, liver lesions decreased in size and were subsequently deemed to be scar tissue by the radiologist. After 4 years of treatment, the patient agreed to a break from chemotherapy. Eighteen months afterwards, an MRI abdomen continues to demonstrate no visible pancreatic mass and the two remaining liver lesions, believed to be scar tissue, remain stable. Her CA 19-9 level remains normal. This appears to be a complete response to FOLFIRINOX/FOLFIRI chemotherapy in a patient with metastatic pancreatic cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Pancreáticas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Feminino , Fluoruracila/uso terapêutico , Humanos , Irinotecano , Leucovorina/uso terapêutico , Pessoa de Meia-Idade , Oxaliplatina/uso terapêutico , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/tratamento farmacológico
9.
Br J Radiol ; 94(1122): 20210315, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33956484

RESUMO

OBJECTIVES: To determine the optimal scan delay corresponding to individual hemodynamic status for pancreatic parenchymal phase in dynamic contrast-enhanced CT of the abdomen. METHODS: One hundred and fourteen patients were included in this retrospective study (69 males and 45 females; mean age, 67.9 ± 12.1 years; range, 39-87 years). These patients underwent abdominal dynamic contrast-enhanced CT between November 2019 and May 2020. We calculated and recorded the time from contrast material injection to the bolus-tracking trigger of 100 Hounsfield unit (HU) at the abdominal aorta (s) (TimeTRIG) and scan delay from the bolus-tracking trigger to the initiation of pancreatic parenchymal phase scanning (s) (TimeSD). The scan delay ratio (SDR) was defined by dividing the TimeSD by TimeTRIG. Non-linear regression analysis was conducted to assess the association between CT number of the pancreas and SDR and to reveal the optimal SDR, which was ≥120 HU in pancreatic parenchyma. RESULTS: The non-linear regression analysis showed a significant association between CT number of the pancreas and the SDR (p < 0.001). The mean TimeTRIG and TimeSD were 16.1 s and 16.8 s, respectively. The SDR to peak enhancement of the pancreas (123.5 HU) was 1.00. An SDR between 0.89 and 1.18 shows an appropriate enhancement of the pancreas (≥120 HU). CONCLUSION: The CT number of the pancreas peaked at an SDR of 1.00, which means TimeSD should be approximately the same as TimeTRIG to obtain appropriate pancreatic parenchymal phase images in dynamic contrast-enhanced CT with bolus-tracking method. ADVANCES IN KNOWLEDGE: The hemodynamic state is different in each patient; therefore, scan delay from the bolus-tracking trigger should also vary based on the time from contrast material injection to the bolus-tracking trigger. This is necessary to obtain appropriate late hepatic arterial or pancreatic parenchymal phase images in dynamic contrast-enhanced CT of the abdomen.


Assuntos
Meios de Contraste/farmacocinética , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
BMJ Case Rep ; 14(5)2021 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011656

RESUMO

A 55-year-old patient had spent 12 years with unexplained seizures, initially diagnosed as epilepsy and then as a psychiatric disorder. When she was admitted with hypoglycaemia, a fasting test was performed showing blood sugar levels as low as 1 mmol/L with symptoms of neuroglycopenia. Insulinoma was suspected and an MRI showed a large tumour in the tail region of the pancreas. A Dodecanetetraacetic acid-Tyr3-octreotate (DOTATATE) positron emission tomography CT indicated no malignancy and showed no signs of metastasis. The patient underwent surgery, leaving her asymptomatic.


Assuntos
Epilepsia , Insulinoma , Neoplasias Pancreáticas , Erros de Diagnóstico , Feminino , Humanos , Insulinoma/diagnóstico por imagem , Insulinoma/cirurgia , Pessoa de Meia-Idade , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X
11.
Radiologe ; 61(6): 563-571, 2021 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-34002282

RESUMO

CLINICAL/METHODOLOGICAL ISSUE: Chronic pancreatitis (CP) is a long-lasting inflammation of the pancreas that changes the normal structure and function of the organ. There are a wide range of inflammatory pancreatic diseases, of which some entities, such as focal pancreatitis (FP) or "mass-forming pancreatitis," can mimic pancreatic ductal adenocarcinoma (PDAC). As a consequence, a misdiagnosis can lead to avoidable and unnecessary surgery or delay of therapy. STANDARD RADIOLOGICAL METHODS: The initial imaging method used in pancreatic diseases is ultrasound due to its availability and low cost, followed by contrast-enhanced computed tomography (CE-CT), which is considered a workhorse in the diagnostic work-up of diseases of the pancreas. Magnetic resonance imaging (MRI) and/or MR cholangiopancreatography (MRCP) can be used as a problem-solving tool to distinguish between solid and cystic lesions, and to rule out abnormalities in the pancreatic ducts, such as those associated with recurrent acute pancreatitis (AP) or to show early signs of CP. MRCP has essentially replaced diagnostic endoscopic retrograde cholangiopancreatography (ERCP) in the initial assessment before any therapeutic intervention. PRACTICAL RECOMMENDATION: The following review article summarizes the relevant features of CT and MRI that can help to make the diagnosis of CP and to aid in the differentiation between focal pancreatitis and PDAC, even in difficult cases.


Assuntos
Neoplasias Pancreáticas , Pancreatite Crônica , Doença Aguda , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Imageamento por Ressonância Magnética , Neoplasias Pancreáticas/diagnóstico por imagem , Pancreatite Crônica/diagnóstico por imagem
12.
Nihon Shokakibyo Gakkai Zasshi ; 118(4): 340-347, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33840715

RESUMO

A 57-year-old woman presented with multilocular cysts like a bunch of grapes, 30mm in diameter, in the tail of the pancreas. The number of cysts has increased, and each one had grown. Eventually, they turned into a unilocular cyst with a cyst in the cyst structure of about 50mm in diameter. Laparoscopic distal pancreatectomy was performed, and the resected specimen was diagnosed with mucinous cystadenoma. We report the rare morphological change in this case and consider the mechanism of its occurrence based on pathological considerations.


Assuntos
Cistadenoma Mucinoso , Cistos , Neoplasias Pancreáticas , Cistadenoma Mucinoso/diagnóstico por imagem , Cistadenoma Mucinoso/cirurgia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Pâncreas , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia
13.
Nihon Shokakibyo Gakkai Zasshi ; 118(4): 358-365, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33840717

RESUMO

A 66-year-old man with epigastric pain was admitted to our hospital for further evaluation of a pancreatic mass, as indicated on transabdominal ultrasonography performed by his family doctor. Using various imaging modalities, the 22-mm tumor was diagnosed as a cystic tumor with hemorrhagic necrosis. The tumor diameter reduced to 11mm over the course of 1 month. However, the tumor margin was irregular than that at the initial diagnosis, and circumferential rim enhancement was observed in equilibrium phase computed tomography images. Therefore, we diagnosed the patient with pancreatic ductal adenocarcinoma with a necrotic component. Distal pancreatectomy with splenectomy was performed, and the subsequent histological diagnosis was poorly differentiated adenocarcinoma. This case had an interesting course as described by the diagnostic images.


Assuntos
Adenocarcinoma , Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Carcinoma Ductal Pancreático/cirurgia , Humanos , Masculino , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Estudos Retrospectivos
14.
J Int Med Res ; 49(4): 3000605211003759, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33840245

RESUMO

Pancreatic cancer with gastrointestinal tract metastasis is a fairly rare occurrence, and gastric metastasis in such cases has been seldom reported. We herein present a case of gastric involvement secondary to pancreatic cancer in a 74-year-old woman in whom the metastatic lesion only presented as mucosal erosion in the stomach. The patient had a 1-month history of progressive right upper quadrant pain before admission. Computed tomography and endoscopic examinations revealed a solid and hypo-enhancing mass in the head of the pancreas. The patient underwent conventional upper endoscopy before pancreatic biopsy, and mucosal erosion was observed in the gastric pylorus. We obtained gastric and pancreatic biopsies by gastroscopy and endoscopic ultrasound-guided fine needle aspiration, respectively. Pathologically, the biopsies taken from the area of gastric erosion showed poorly differentiated invasive adenocarcinoma that was morphologically consistent with the pancreatic specimens. Moreover, the gastric section showed tumor thrombi within the vessels. Hence, the suspected diagnosis was unresectable pancreatic cancer with gastric metastasis. The patient immediately underwent two courses of chemotherapy, but her condition rapidly deteriorated and she died 2 months later.


Assuntos
Neoplasias Pancreáticas , Idoso , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Humanos , Pâncreas/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Estômago
15.
BMC Gastroenterol ; 21(1): 162, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849435

RESUMO

BACKGROUND: Intraductal tubulopapillary neoplasm (ITPN) of the pancreas is a new disease concept defined by the World Health Organization in 2010. ITPN progresses with tubulopapillary growth in the pancreatic duct and is known to have a fair prognosis. Localization in the main pancreatic duct (MPD) is one characteristic. There are few case reports of ITPN in a branch of the pancreatic duct (BD). CASE PRESENTATION: We encountered a case of ITPN localized in BD. An 85-year-old man was followed after colonic surgery for rectal carcinoma. An abdominal computed tomography scan revealed a cystic mass in the pancreatic head and further examination was done. A T2 weighted intension picture in magnetic resonance imaging showed a 20 mm cystic lesion with an internal mass of 15 mm. Duodenal papilla were slightly open and endoscopic retrograde pancreatography revealed mild and diffuse dilatation of the main pancreatic duct and mucin in the MPD. In consideration with the image examinations, we diagnosed the tumor as an intraductal papillary mucinous neoplasm with carcinoma because of its large mural nodule (> 10 mm in size) in a cyst. Consequently, a pancreaticoduodenectomy was performed. Macroscopically, a white solid tumor sized 2.5 × 1.8 × 1.0 was identified in the head of the pancreas. The cut surface of the resected pancreas showed a side-branch type intraductal tumor with tubulopapillary architecture without mucin secretion. Immunohistochemical staining was positive for MUC1, and negative for MUC2 and MUC5AC. The final diagnosis was determined to be pancreatic ITPN from BD. At the time of this report (48 months post-surgery), the patient remains disease-free without evidence of recurrence. CONCLUSION: ITPNs localized in BD are rare and diagnosis prior to surgery is difficult. In our case, the shape was round, not papillary, and with little fluid. These characteristics are different from a branch duct type IPMN and can be a clue to suspect ITPN in BD.


Assuntos
Carcinoma Ductal Pancreático , Carcinoma Papilar , Neoplasias Pancreáticas , Idoso de 80 Anos ou mais , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/cirurgia , Carcinoma Papilar/cirurgia , Humanos , Masculino , Recidiva Local de Neoplasia , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia
16.
Eur J Radiol ; 139: 109685, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33819805

RESUMO

OBJECTIVES: To evaluate the utility of MDCT criteria for the determination of resectability and tumor response in borderline resectable pancreatic cancer (BRPC) following neoadjuvant therapy (NAT). METHODS: This prospective study includes 90 consecutive BRPC patients who underwent surgery following NAT. Two radiologists assessed baseline and pre-surgical CTs for (largest tumor axis, size, attenuation, and vascular criteria). Logistic regression was used to determine which CT criteria independently associated with R0 resection and pathologic major response (pMR). Median survival and overall survival (OS) were calculated. RESULTS: Seventy-three/90 (81.1 %) patients had R0 resection, and 11/90 (12.2 %) had pMR. After NAT, there were significant interval changes in the largest tumor axis, size, attenuation, and venous burden index (VBI) (P < 0.02). On the multivariable analysis, regression of the VBI and low VBI at the pre-surgical CT were independently associated with an increased likelihood of R0 resection (OR 1.82; 95 % CI 1.44-5.33) (OR 1.91; 95 % CI 1.83-6.14). The assessment of VBI at the pre-surgical CT showed moderate reproducibility (k-value, 0.56 - 0.60). On the multivariable analysis, partial response (PR) was found to be independently associated with an increased likelihood of pMR (OR 1.71; 95 % CI 1.31-3.45). The median survival was longer in patients who had R0 (P = 0.01). The overall survival was longer in patients who had pMR compared to those who did not (P = 0.02). CONCLUSION: Surgical exploration could be indicated in patients who had regression of the VBI and low VBI at the pre-surgical CT. PR response is associated with pMR.


Assuntos
Terapia Neoadjuvante , Neoplasias Pancreáticas , Humanos , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Estudos Prospectivos , Reprodutibilidade dos Testes
17.
Eur J Radiol ; 139: 109672, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33819806

RESUMO

PURPOSE: To assess the diagnostic performance of intravoxel incoherent motion (IVIM) and diffusion-weighted imaging (DWI) for characterising pancreatic ductal adenocarcinoma (PDAC). METHOD: A literature search was performed through PubMed, Web of Science, the Cochrane Library, and Embase databases. The search date was updated to extend until 28 October 2020, with no starting time limitation. The pooled sensitivity and specificity were calculated using a bivariate random effects model. Summary receiver operating characteristic curves were constructed, and area under the curve (AUC) of each diffusion parameter was calculated. Subgroup and meta-regression analyses were performed to assess for heterogeneity. Study quality was assessed. RESULTS: Twenty-nine studies involving 1579 participants were included, of which 26 evaluated the apparent diffusion coefficient (ADC) and eight evaluated IVIM, with five evaluating both ADC and IVIM. Pooled sensitivity and specificity of ADC were 83 % (95 % CI, 76 %-88 %, I2 = 86 %) and 85 % (95 % CI, 79 %-90 %, I2 = 77 %), respectively, and AUC was 0.91 (95 % CI, 0.88-0.93). The perfusion fraction had the highest diagnostic accuracy in the IVIM model; the pooled sensitivity, specificity, and AUC were 87 % (95 % CI, 81 %-92 %, I2 = 45 %), 88 % (95 % CI, 77 %-94 %, I2 = 57 %), and 0.93 (95 % CI, 0.91-0.95), respectively. The pooled sensitivity, specificity and AUC for the tissue diffusion coefficient were 74 % (95 % CI, 55 %-87 %, I2 = 87 %), 69 % (95 % CI, 52 %-82 %, I2 = 73 %), and 0.77 (95 % CI, 0.73-0.81), respectively. And the pooled sensitivity, specificity, and AUC for the pseudodiffusion coefficient were 89 % (95 % CI, 77 %-96 %, I2 = 79 %), 74 % (95 % CI, 60 %-84 %, I2 = 78 %), and 0.88(95 %CI,0.85-0.91), respectively. Meta-regression analyses revealed that study design (specificity, P<0.01), region-of-interest delineation (sensitivity, P = 0.02;specificity, P = 0.03), field strength (sensitivity, P<0.01), and thickness (sensitivity, P<0.01; specificity, P = 0.01) were sources of ADC heterogeneity. CONCLUSIONS: DWI and IVIM have comparable diagnostic power and good diagnostic performance for characterising PDAC.


Assuntos
Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Carcinoma Ductal Pancreático/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Humanos , Movimento (Física) , Neoplasias Pancreáticas/diagnóstico por imagem , Sensibilidade e Especificidade
18.
J Surg Oncol ; 123(6): 1449-1459, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33831249

RESUMO

Despite overall advances in cancer therapy, patients with pancreatic ductal adenocarcinoma continue to have a poor prognosis. While adjuvant therapy is still considered standard, there is mounting evidence that neoadjuvant therapy confers similar benefits in patients with locally advanced disease. The primary measures of response are radiographic, biochemical, margin status, and pathologic. Given overall low response rates and the need for new treatment strategies, standard metrics remain important to the investigation of new systemic agents.


Assuntos
Carcinoma Ductal Pancreático/terapia , Neoplasias Pancreáticas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/cirurgia , Fluoruracila/administração & dosagem , Humanos , Irinotecano/administração & dosagem , Leucovorina/administração & dosagem , Terapia Neoadjuvante , Oxaliplatina/administração & dosagem , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia
19.
Magy Onkol ; 65(1): 6-13, 2021 Mar 17.
Artigo em Húngaro | MEDLINE | ID: mdl-33730111

RESUMO

Our aim was to present different treatment strategies (non-gated [NG], respiratory-gated [RG] and deep inspiration breath-hold [DIBH] technique) of linac-based stereotaxic ablative radiotherapy (SABR) for pancreatic cancer in terms of use of marker, abdominal compression, image quality, and time efficiency. From October 2016 to October 2020 14 patients were treated with VMAT-based SABR (NG: 6/14, 8/14 RG RT including 3/8 DIBH SABR). Treatment verification consisted of 3D/4D CBCTs. For intrafractional tumor visualization (11/14) different type of fiducials were used. The average treatment time was the shortest with NG RT, followed by DIBH and RG RT. However, the best image quality was achieved with DIBH technique. The Krippendorff's agreement test among three independent RTTs showed that DIBH CBCT (Cone Beam CT) can produce sufficient image quality for OARs and can be used to reliably determine OARs position related to safety zone (PRV). Overall, marker-based DIBH SABR with intrafractional tumor visualization appears to be the best technique on linac at present.


Assuntos
Neoplasias Pancreáticas , Radiocirurgia , Suspensão da Respiração , Humanos , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/cirurgia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador
20.
Medicine (Baltimore) ; 100(13): e25076, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787590

RESUMO

RATIONALE: Ectopic insulinomas are extremely rare and challenging to diagnose for clinicians. Precise preoperative localization is essential to successful treatment. PATIENT CONCERNS: A 23-year-old man presented with a 1-year history of recurrent hypoglycemia. DIAGNOSIS: Examinations in the local hospital did not reveal any pancreatic lesion. After admission, a fasting test and a 5-hour oral glucose tolerance test (OGTT) suggested a diagnosis of endogenous hyperinsulinemic hypoglycemia. Enhanced volume perfusion computed tomography (VPCT) revealed 2 nodules in the tail of the pancreas, a nodule in the gastric antrum, and a nodule in the hilum of the spleen. To differentiate which nodule was responsible for hypoglycemia, we performed 68Ga-Exendin-4 PET/CT and 68Ga-DOTATATE PET/CT which helped to make a conclusive diagnosis that the lesion in the gastric antrum was an ectopic insulinoma. INTERVENTIONS: The patient was cured with minimally invasive laparoscopic resection of the tumor. OUTCOMES: The symptoms were relieved and the blood glucose level remained normal after surgery. CONCLUSIONS: This case shows that 68Gallium-exendin-4 PET/CT is useful for precise localization and thereby successful treatment of insulinoma, especially for occult insulinomas and those derived from an ectopic pancreas.


Assuntos
Coristoma/diagnóstico por imagem , Insulinoma/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Gástricas/diagnóstico por imagem , Coristoma/complicações , Exenatida , Radioisótopos de Gálio , Teste de Tolerância a Glucose , Humanos , Hipoglicemia/diagnóstico por imagem , Hipoglicemia/etiologia , Insulinoma/complicações , Masculino , Compostos Organometálicos , Pâncreas , Antro Pilórico/diagnóstico por imagem , Compostos Radiofarmacêuticos , Recidiva , Adulto Jovem
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