National Cancer Institute®
Last Modified: January 1, 2002
UI - 10769297
AU - Ojajarvi IA; Partanen TJ; Ahlbom A; Boffetta P; Hakulinen T; Jourenkova
TI - N; Kauppinen TP; Kogevinas M; Porta M; Vainio HU; Weiderpass E; Wesseling CH Occupational exposures and pancreatic cancer: a meta-analysis.
SO - Occup Environ Med 2000 May;57(5):316-24
AD - Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health, Topeliuksenk 41A, 00250 Helsinki, Finland. firstname.lastname@example.org
OBJECTIVES: Consolidation of epidemiological data on pancreatic cancer and worksite exposures. METHODS: Publications during 1969-98 were surveyed. Studies without verified exposures were excluded. Meta-analyses were conducted on data from 92 studies covering 161 populations, with results for 23 agents or groups of agents. With a standard format, five epidemiologists extracted risk estimates and variables of the structure and quality of each study. The extracted data were centrally checked. Random meta-models were applied. RESULTS: Based on 20 populations, exposure to chlorinated hydrocarbon (CHC) solvents and related compounds was associated with a meta-risk ratio (MRR) of 1.4 (95% confidence interval (95% CI) 1.0 to 1.8). Nickel and nickel compounds were considered in four populations (1.9; 1.2 to 3.2). Excesses were found also for chromium and chromium compounds (1.4; 0.9 to 2.3), polycyclic aromatic hydrocarbons (PAHs) (1.5; 0.9 to 2.5), organochlorine insecticides (1.5; 0.6 to 3.7), silica dust (1.4; 0.9 to 2.0), and aliphatic and alicyclic hydrocarbon solvents (1.3; 0.8 to 2.8). Evidence on pancreatic carcinogenicity was weak or non-positive for the following agents: acrylonitrile (1.1; 0.0 to 6.2); arsenic (1.0; 0.6 to 1.5); asbestos (1.1; 0.9 to 1.5); diesel engine exhaust (1.0; 0.9 to 1.3); electromagnetic fields (1.1; 0.8 to 1.4); formaldehyde (0. 8; 0.5 to 1.0); flour dust (1.1; 0.3 to 3.2); cadmium and cadmium compounds (0.7; 0.4 to 1.4); gasoline (1.0; 0.8 to 1.2); herbicides (1.0; 0.8 to 1.3); iron and iron compounds (1.3; 0.7 to 2.5); lead and lead compounds (1.1; 0.8 to 1.5); man-made vitreous fibres (1.0; 0.6 to 1.6); oil mist (0.9; 0.8 to 1.0); and wood dust (1.1; 0.9 to 2.5). The occupational aetiological fraction of pancreatic cancer was estimated at 12%. In a subpopulation exposed to CHC solvents and related compounds, it was 29%; to chromium and chromium compounds, 23%; to nickel and nickel compounds, 47%; to insecticides, 33%; and to PAHs, 33%. CONCLUSION: Occupational exposures may increase risk of pancreatic cancer. High quality studies are called for on interactions between occupational, environmental, and lifestyle factors as well as interactions between genes and the environment.
UI - 10882255
AU - Curry CA; Eng J; Horton KM; Urban B; Siegelman S; Kuszyk BS; Fishman EK
TI - CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment?
SO - AJR Am J Roentgenol 2000 Jul;175(1):99-103
AD - Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
OBJECTIVE: The purpose of this study was to determine whether CT can be used to distinguish serous cystadenomas from mucinous cystadenomas or cystadenocarcinomas of the pancreas and play an enhanced role in patient triage and treatment. MATERIALS AND METHODS: A blinded retrospective analysis of CT scans from 50 patients with pathologically proven primary cystic pancreatic neoplasms was performed independently by three radiologists. Using classic CT criteria as reported in the literature, each tumor was categorized as definitely serous, mucinous, or indeterminate. Tumor location, size, presence of calcification, and size of largest cyst were recorded. Data for each reviewer were analyzed independently. Consensus data were then subjected to multivariate logistic regression analysis. RESULTS: The ability of our reviewers to diagnose serous neoplasms ranged from 23% to 41%. Eight mucinous neoplasms were mistaken for serous tumors by two of the three reviewers. When consensus between at least two of the three reviewers was used for diagnosis, 27% of serous neoplasms were correctly diagnosed and all of the mucinous tumors were correctly identified as uncertain or mucinous, yielding the same clinical end point. For multivariate logistic regression analysis, a cyst smaller than 2 cm had a statistically significant association (p = 0.005) with serous tumors, and the presence of peripheral tumoral calcification had a statistically significant association (p = 0.01) with mucinous tumors. CONCLUSION: There is significant variability in the CT appearance of serous and mucinous neoplasms of the pancreas, making CT an insensitive tool for differentiating these tumors. All tumors with peripheral calcifications were identified as mucinous neoplasms.
UI - 10963196
AU - Adamek HE; Albert J; Breer H; Weitz M; Schilling D; Riemann JF
TI - Pancreatic cancer detection with magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography: a prospective controlled study.
SO - Lancet 2000 Jul 15;356(9225):190-3
AD - Department of Medicine, Klinikum Ludwigshafen, Academic Hospital of the University of Mainz, Germany.
BACKGROUND: Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive and increasingly used procedure in cases involving biliary and pancreatic diseases. However, the accuracy of MRCP in differential diagnosis between pancreatic cancer and chronic pancreatitis has never been documented in a large prospective controlled study. METHODS: 124 patients were recruited for the study, selected from 141 consecutive patients with an average age of 55 years (range 19-80) who presented to our department between February, 1996, and January, 1998, with a strong clinical suspicion of pancreatic cancer. MRCP images were interpreted by a radiologist and a gastroenterologist who were unaware of the clinical diagnosis of patients. The exact diagnosis was based upon histological evidence from biopsy examination (surgical and fine needle biopsy) or a follow-up of at least 12 months. FINDINGS: Of the 124 patients, 37 (30%) had pancreatic carcinoma; 17 (14%) had other neoplastic pancreatic diseases; 57 (46%) had chronic pancreatitis; 13 (10%) pancreatic ducts were clear. The sensitivity of MRCP with respect to diagnosing pancreatic cancer was 84% and its specificity 97%. The corresponding values for endoscopic retrograde cholangiopancreatography (ERCP) were 70% and 94%, respectively. INTERPRETATION: MRCP is as sensitive as ERCP when detecting pancreatic carcinomas. Furthermore, it is feasible to presume that the use of MRCP may prevent inappropriate explorations of the pancreatic and common bileducts in cases of suspected pancreatic carcinomas, where interventional endoscopic therapy (ie, palliative common-bileduct drainage) is unlikely.
UI - 11248065
AU - Su GH; Bansal R; Murphy KM; Montgomery E; Yeo CJ; Hruban RH; Kern SE
TI - ACVR1B (ALK4, activin receptor type 1B) gene mutations in pancreatic carcinoma.
SO - Proc Natl Acad Sci U S A 2001 Mar 13;98(6):3254-7
AD - Department of Oncology, Pathology, and Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA.
DPC4 is known to mediate signals initiated by type beta transforming growth factor (TGFbeta) as well as by other TGFbeta superfamily ligands such as activin and BMP (bone morphogenic proteins), but mutational surveys of such non-TGFbeta receptors have been negative to date. Here we describe the gene structure and novel somatic mutations of the activin type I receptor, ACVR1B, in pancreatic cancer. ACVR1B has not been described previously as a mutated tumor-suppressor gene.
UI - 11496502
AU - Barsegian AA; Fedenko VV
TI - [Laparoscopic surgery in tumor obstruction of the biliary tract]
SO - Vestn Khir Im I I Grek 2001;160(2):89-94
The article gives a detailed description of the technique of laparoscopic biliodigestive anastomoses in patients with advanced tumors of hepatopancreatoduodenal zone. The authors have an experience with 18 operations. They performed 14 cholecystoenteroanastomoses including 9 total laparoscopic operations and 5 operations through a combined approach--laparoscopy in combination with minilaparotomy. The authors believe that laparoscopic surgery is feasible and safe for treatment of these patients. The combined approach has financial advantages giving the possibility to save the disposable stapling devices.
UI - 11444473
AU - Monstein HJ; Ohlsson B; Axelson J
TI - Differential expression of gastrin, cholecystokinin-A and cholecystokinin-B receptor mRNA in human pancreatic cancer cell lines.
SO - Scand J Gastroenterol 2001 Jul;36(7):738-43
AD - Molecular Biology Laboratory, University Hospital, Linkoping, Sweden.
BACKGROUND: It has been assumed that gastrin stimulates the growth of pancreatic cancer in an autocrine way through co-expression of gastrin and the cholecystokinin-B receptor (CCK-BR). However, pancreatic cancer cell lines established directly from patients have revealed a great heterogeneity in cell proliferation when exposed to CCK, gastrin and their receptor antagonists. The aim of this study was therefore to examine co-expression of CCK-A and CCK-B receptor (CCK-AR and CCK-BR), and gastrin mRNA as well as the secretion of CCK and gastrin peptides in these cell lines. METHODS: Fourteen cell lines were established from primary pancreatic cancers or their metastases. Total RNA was isolated from the cell lines and reverse-transcribed into single-stranded cDNA. A PCR technique based on Taq polymerase-antibody interaction and CCK-AR, CCK-BR and gastrin-specific primers, followed by Southern blot analysis, were the methods used. The incubation mediums were analysed for the presence of secreted CCK/proCCK and gastrin/progastrin peptides by specific radioimmunoassays (RIA). RESULTS: By means of nested Reverse-Transcribed Polymerase Chain Reaction (nested RT-PCR), combined with Southem blot analysis of the PCR amplified products, CCK-AR and gastrin mRNA co-expression was detected in cell lines LPC-6p and LPC-10m, whereas CCK-BR and gastrin mRNA could be detected in cell lines LPC-8p and LPC-12m. A low level of secreted CCK peptides was detected in cell line LPC-6p, which also expressed CCK-AR mRNA. In no other cases were CCK or gastrin peptides detected in the cell culture mediums. CONCLUSION: The lack of CCK-BR and gastrin mRNA co-expression, and not detectable levels of secreted CCK and gastrin in culture media, does not lend support to the hypothesis that concomitant gene-expression of CCK receptors and gastrin or CCK are essential to maintaining pancreatic cancer cell proliferation.
UI - 11464498
AU - Napolitano L; Francomano F; Gargano E; Francione T; Angelucci D;
TI - Napolitano AM [Our experience regarding biologically inactive gastroenteropancreatic neuroendocrine tumors]
SO - Ann Ital Chir 2001 Jan-Feb;72(1):61-4; discussion 65
AD - Dipartimento di Scienze Chirurgiche Universita di Chieti.
The Authors present 9 cases of gastro-enteropancreatic neuro-endocrine biologically inactive tumors. In 5 cases the tumor site was appendicular. In 4 patients an appendectomy was performed, in one patient a right hemicolectomy and the patients after a period of 3-9 years are well and disease free. In a patient with a gastric carcinoid and a single hepatic metastasis a total gastrectomy with an hepatic metastasectomy were performed but the patient died 16 months thereafter. In a case localized to the right colon with a single hepatic metastasis a right hemicolectomy was performed with a metastasectomy but the patient died after 12 months. In a case localized to an ileal loop a segmental resection was performed followed by a medical therapy with octreotide and the patient is well and disease free after 3 years. In a case localized to the pancreas with widespread lymphatic metastasis it was performed a simple biliary diversion (coledocho-duodenostomy) followed by medical therapy with octreotide. Surprisingly after 4 years the patient is alive and a TC control shows a decrease of the pancreatic tumor and of the lympho glandular tumefactions.
UI - 11471608
AU - Procacci C; Carbognin G; Accordini S; Biasiutti C; Bicego E; Romano L;
TI - Guarise A; Minniti S; Pagnotta N; Falconi M Nonfunctioning endocrine tumors of the pancreas: possibilities of spiral CT characterization.
SO - Eur Radiol 2001;11(7):1175-83
AD - Department of Radiology, University of Verona Medical School, Policlinico G.B. Rossi, Italy. email@example.com
The aim of this study was to assess the ability of spiral CT to adequately characterize the nonfunctioning endocrine tumors (NFETs) of the pancreas, distinguishing this lesion from the other pancreatic tumors. The spiral CT examinations of 21 cases of histologically proven NFETs, along with those of 29 cases of other pancreatic tumors and tumor-like lesions, were retrospectively reviewed in a blinded fashion by two radiologists, in order to correctly classify the lesions, highlighting the typical signs reported in the literature. Discordant cases were further analyzed in the presence of a third radiologist. The final diagnosis was acquired by means of a majority or overall consensus. The histopathologic examination was considered the gold standard. The sensitivity, specificity, and positive and negative predictive values of CT were calculated. After the consensus evaluation, the correct diagnosis was reached in 72% of cases, with 10% of nonspecific diagnoses of solid pancreatic tumor and 18% of wrong diagnoses. The sensitivity and specificity of spiral CT in identifying NFETs were 66.6 and 82.7%, respectively. The positive and negative predictive values were 73.7 and 77.4%, respectively. In up to 70% of cases the NFET demonstrates a typical aspect of a mass hyperdense in the arterial contrastographic phase eventually associated with hyperdense hepatic metastases in more than half of the patients. This finding does allow the diagnosis of NFET but without certainty indeed, since other tumors can show a similar densitometric behavior and among them particularly the ductal adenocarcinoma. On the other hand, both the solid, hypovascularized NFETs, and the cystic form, cannot be differentiated from the other solid and cystic tumors of the pancreas.
UI - 11486805
AU - Roebuck DJ; Yuen MK; Wong YC; Shing MK; Lee CW; Li CK
TI - Imaging features of pancreatoblastoma.
SO - Pediatr Radiol 2001 Jul;31(7):501-6
AD - Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong.
BACKGROUND: Pancreatoblastoma is a rare tumour of childhood. Reports of the imaging appearances are limited. OBJECTIVE: To define the imaging features of pancreatoblastoma by analysis of four previously unreported cases and review of the literature. MATERIALS AND METHODS: Findings at CT (n = 4), US (n = 3) and MRI (n = 2) were retrospectively reviewed in four patients with pancreatoblastoma. A Medline search was performed to identify relevant literature. RESULTS: Pancreatoblastoma arises most frequently in the body and/or tail, or involves the entire pancreas. Ultrasonography, CT and MRI show variable imaging features, but should in most cases permit preoperative distinction of pancreatoblastoma from other tumours that occur in this region in infancy and childhood. Detection of metastases in the liver, lymph nodes and peritoneal cavity is not significantly better with any one of these three modalities. CONCLUSION: Preoperative imaging with US, CT and/or MRI will usually suggest a correct diagnosis of pancreatoblastoma. Contrary to previous reports, the tumour arises in the pancreatic head in a minority of cases.
UI - 11490822
AU - Yoshizawa K; Nagai H; Kurihara K; Sata N; Kawai T; Saito K
TI - Long-term survival after surgical resection for pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):1153-6
AD - Department of Surgery, Jichi Medical School, 3311-1 Yakushiji, Minami-Kawachi, Tochigi 329-0498, Japan. firstname.lastname@example.org
BACKGROUND/AIMS: Pancreatic cancer remains one of the most formidable tumors defying early detection and effective treatment. Long-term survivors, however, do exist after resection. We investigated the clinicopathologic features of patients with pancreatic cancer who survived more than 5 years to draw out some suggestions concerning the indication of surgical treatment. METHODOLOGY: We studied the clinicopathologic features of 13 patients with pancreatic cancer who survived more than 5 years after resection. We reviewed their clinical records to investigate preoperative symptoms, serum tumor markers, operative findings, postoperative adjuvant therapy, and modes of recurrence and survival periods. Information on the location, size, histology and spread of the primary tumors were mainly obtained from pathology reports. RESULTS: Histologic types of the long survivors included ductal adenocarcinoma of common type in 4 patients, mucinous noncystic adenocarcinoma in 2, intraductal papillary-mucinous carcinoma (invasive) in 4, undifferentiated carcinoma in 1, endocrine tumor (islet cell carcinoma) in 1 and acinar cell carcinoma in 1. All 4 cases of ductal adenocarcinoma of the common type showed a moderate invasion either to the retroperitoneum, the portal vein or the duodenum. Two patients with mucinous noncystic carcinoma attained a long survival despite extensive invasion of the pancreatic stroma, although one died of peritoneal carcinomatosis. Two of 4 patients with intraductal papillary-mucinous cancer (invasive) died of peritoneal dissemination 6 and 11 years after resection, respectively. Three patients with cancer of other special histologic types, i.e., undifferentiated, well-differentiated endocrine carcinoma and acinar cell carcinoma, showed invasion of the portal vein and splenic artery, involvement of the retroperitoneum and a metastatic tumor in the liver, respectively. CONCLUSIONS: Whereas special histologic types including ductal variants tended to predispose to long-term survival, ductal adenocarcinoma of the common type had some chance of long survival even with invasion of the surrounding tissues.
UI - 11490824
AU - Knoll MR; Rudnitzki D; Sturm J; Manegold BC; Post S; Jaeger TM
TI - Correlation of postoperative survival and angiogenic growth factors in pancreatic carcinoma.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):1162-5
AD - Department of Endoscopic Surgery, University Hospital Mannheim University of Heidelberg, Theodor-Kutzer-Ufer, D-68135 Mannheim, Germany.
BACKGROUND/AIMS: VEGF (vascular endothelial growth factor) and EGF (epidermal growth factor) are promoters of angiogenesis. It was the aim of this study to investigate a possible coexpression of both growth factors in tumor samples of pancreatic cancer patients in relation to survival after resection of the tumor. METHODOLOGY: We investigated the expression of VEGF165 and EGF in tumor specimen from 19 patients that underwent pancreaticoduodenectomy. Growth factor expression was determined using immunohistochemical methods. RESULTS: Coexpression of VEGF165 and EGF was observed in tumor samples of 9 (47%) patients. VEGF165 and EGF expression in the same tumor correlates significantly (P < 0.05, Fisher-test). UICC stage III pancreatic carcinoma patients with VEGF165 negative tumor cells had a significantly better outcome after surgery compared to UICC stage III patients with VEGF165-positive tumor cells (median survival time 19 months vs. 9 months respectively; P < 0.05, Wilcoxon-test). CONCLUSIONS: Antiangiogenic therapy after surgery for pancreatic cancer may be beneficial, especially for UICC III patients.
UI - 11490839
AU - Nakao A
TI - Recent advances in diagnosis and treatment of pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):914-5
UI - 11490840
AU - Hirooka Y; Goto H; Ito A; Hashimoto S; Hirai T; Niwa K; Takeda K;
TI - Hayakawa T Recent advances in US diagnosis of pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):916-22
AD - Second Department of Internal Medicine, Nagoya University School of Medicine, Nagoya, Japan. email@example.com
Recent years have seen dramatic developments in extracorporeal ultrasonography: Color, including-power Doppler ultrasonography, ultrasonography angiography, harmonic imaging (tissue harmonic imaging and contrast harmonic imaging) and 3-dimensional ultrasonography (including virtual endoscopy). In this report, we describe the present situation and the prospective outlook for these new diagnostic modalities mainly on the basis of our own experiences.
UI - 11490841
AU - Ishiguchi T; Ota T; Naganawa S; Fukatsu H; Itoh S; Ishigaki T
TI - CT and MR imaging of pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):923-7
AD - Department of Radiology, Aichi Medical University, 21 Nagakute-cho, Aichi-gun, Aichi-ken, 480-1195, Japan. firstname.lastname@example.org
Recent improvements in imaging techniques have made it possible to improve the diagnostic accuracy for detection, staging, and indicating surgical resectability of pancreatic cancer. The latest advance in the computed tomography technique, is the introduction of subsecond multislice helical scanning that improves z-axis resolution in the reformatted images and three-dimensional rendering with a large volume data. Magnetic resonance imaging provides versatile information including magnetic resonance cholangiopancreatography that allows noninvasive delineation of the pancreatic and biliary duct systems. The presence of pancreatic cancer may best be evaluated by dynamic computed tomography or dynamic magnetic resonance imaging with administration of intravenous contrast material. Both computed tomography and magnetic resonance imaging are valuable for the preoperative assessment of local invasion and vascular involvement. Multislice helical computed tomography is currently considered as the best single modality for the diagnosis of pancreatic cancer as it provides excellent image quality. When advanced magnetic resonance imaging equipment is used as a primary modality, in the future, it may have a possibility to replace other imaging modalities.
UI - 11490842
AU - Itoh A; Goto H; Hirooka Y; Hashimoto S; Hirai T; Niwa K; Takeda K;
TI - Hayakawa T Endoscopic diagnosis of pancreatic cancer using intraductal ultrasonography.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):928-32
AD - Second Department of Internal Medicine, Nagoya University School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan.
BACKGROUND/AIMS: At present developed modalities are not sufficient for detecting early stage pancreatic cancer. We previously reported the clinical usefulness of intraductal ultrasonography in various pancreatobiliary diseases. In the present study we assessed the usefulness of intraductal ultrasonography in diagnosing pancreatic cancer. METHODOLOGY: Thirty-one patients with pancreatic cancer were examined by intraductal ultrasonography. We approached the main pancreatic duct (pancreatic duct-intraductal ultrasonography) in 24 of 31 patients and the bile duct (bile duct-intraductal ultrasonography) in 20 patients with pancreatic cancer. We compared the diagnostic ability of pancreatic duct-intraductal ultrasonography with that of extracorporeal ultrasonography, computed tomography, endoscopic ultrasonography or endoscopic retrograde pancreatography. We examined the usefulness of bile duct-intraductal ultrasonography in diagnosing tumor invasion to the bile duct. RESULTS: Pancreatic duct-intraductal ultrasonography was able to demonstrate a tumor in 22 of 24 patients. Extracorporeal ultrasonography, computed tomography, endoscopic ultrasonography or endoscopic retrograde pancreatography detected tumors in 26, 27, 29, 29 of 31 patients, respectively. In two patients, only intraductal ultrasonography could demonstrate a tumor, which was not detected by any other modalities. We examined bile duct invasion of the tumor according to our grading system. The overall accuracy rate was 90%. No complications were noted in any patients throughout the study period. CONCLUSIONS: Intraductal ultrasonography is useful to diagnose pancreatic cancer, and it is suggested that it should be actively performed after endoscopic retrograde pancreatography.
UI - 11490843
AU - Inoue S; Tezel E; Nakao A
TI - Molecular diagnosis of pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):933-8
AD - Department of Surgery II, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Pancreatic ductal adenocarcinoma is a result of accumulated genetic alterations, including oncogenes such as K-ras, tumor-suppressor genes such as p53, p16 and DPC4 and genome-maintenance genes such as BRCA2, microsatellite instability and telomerase. Recent findings which characterize the molecular genetic profile of the pancreatic cancer have reshaped the nomenclature describing histological progression in pancreatic ductal tumorigenesis. K-ras mutations frequently occur early, whereas changes in the expression and genetic integrity of the p16 gene appear in intermediate lesions, and the inactivation of the p53, DPC4 genes and activation of telomerase occur late in the neoplastic progression. So far K-ras and telomerase activity have been used as molecular markers for the diagnosis of pancreatic carcinoma, whereas p53 and p16 may be a prognostic indicator of pancreatic cancer. Additional tumor-suppressor genes and the related signaling pathway such as ALK-5 are likely to be defined. In addition to the human genome project, these new advances hopefully will accelerate the development of diagnostic and screening techniques for this grave condition.
UI - 11490844
AU - Ichihara T; Nomoto S; Takeda S; Nagura H; Sakamoto J; Kondo K; Horisawa
TI - M; Nakao A Clinical usefulness of the immunostaining of the tumor markers in pancreatic cancer.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):939-43
AD - Department of Surgery, Nagoya National Hospital, 4-1-1 San-no-maru, Naka-ku, Nagoya, Aichi 460-0001, Japan.
The effect of the rapid immunostaining of gastrointestinal cancer-associated antigens, CA19-9, CEA, DUPAN2, and CA50 was discussed for intraoperative pathological diagnosis of pancreatic cancer. The method can be completed in only 13 minutes with microwave irradiation to accelerate the incubation of the primary antibody. Only 3 seconds of irradiation at 500 W for fresh-frozen sections produced specific antigen staining of greater intensity than that obtained with longer incubation by the conventional method. Preservation of the tissue structure was satisfactory with minimal nonspecific background staining enabling us to diagnose the intrapancreatic spread of cancer. This method was also applied to intraoperative peritoneal washing cytology. As with frozen section biopsy, the sensitivity of intraoperative cytology is greater than by the conventional staining method, which is able to achieve more precise staging of pancreatic cancers. Our rapid immunoperoxidase staining method on the cryostat section of pancreatic biopsy specimens and on cytology samples provides important information to determine an appropriate operative approach for pancreatic cancer.
UI - 11490845
AU - Kaneko T; Inoue S; Sugimoto H; Takeda S; Harada A; Nakao A
TI - Intraoperative diagnosis of pancreatic cancer extension using IVUS.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):944-8
AD - Department of Surgery II, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
BACKGROUND/AIMS: Pancreatic cancer easily invades retroperitoneal tissue, especially the portal vein and extrapancreatic nerve plexus. We evaluated the diagnostic accuracy of intraportal endovascular ultrasonography in portal vein and extrapancreatic nerve plexus invasion. METHODOLOGY: Intraportal endovascular ultrasonography was performed in 78 cases of pancreatic cancer (head 67, body 8, total 3). Intraportal endovascular ultrasonography was performed intraoperatively from the superior mesenteric vein with an 8-French, 20-MHz intravascular ultrasound catheter. Three-dimensional intraportal endovascular ultrasonography was constructed by volume rendering. RESULTS: Intraportal endovascular ultrasonography visualized the portal vein as an echogenic band with a thickness of 0.5 mm to 1.0 mm. The diagnostic criterion of portal vein invasion was obliteration of this echogenic band. Intraportal endovascular ultrasonography visualized segment II of the extrapancreatic nerve plexus as the high-echoic area around the inferior pancreaticoduodenal artery. The diagnostic criterion of extrapancreatic nerve plexus invasion was low-echoic infiltration around the inferior pancreaticoduodenal artery. The sensitivity, specificity, and overall accuracy of intraportal endovascular ultrasonography for diagnosis of portal vein invasion was, respectively, 97.4%, 92.5%, and 94.9%. The values for diagnosis of extrapancreatic nerve plexus invasion, respectively, were 94.4%, 97.1%, and 96.2%. Three-dimensional intraportal endovascular ultrasonography depicted the invasion area as a defect of the portal vein wall. CONCLUSIONS: Intraportal endovascular ultrasonography detected subtle portal invasion and provided accurate portal invasion area which was useful for portal vein an reconstruction. Intraportal endovascular ultrasonography could also diagnose the extrapancreatic nerve plexus invasion of segment II.
UI - 11490849
AU - Yamao K; Ohashi K; Nakamura T; Suzuki T; Watanabe Y; Shimizu Y; Nakamura
TI - Y; Ozden I Evaluation of various imaging methods in the differential diagnosis of intraductal papillary-mucinous tumor (IPMT) of the pancreas.
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):962-6
AD - Department of Gastroenterology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan 464. email@example.com
BACKGROUND/AIMS: IPMT (intraductal papillary-mucinous tumor) of the pancreas has unique clinicopathological characteristics. The lesions which show characteristic clinical features of IPMT exhibit a wide spectrum of histological types ranging from atypical hyperplasia to invasive cancer. Therefore, surgical treatment cannot be recommended for all patients with IPMT. It is necessary to assess the malignant potential of IPMT in individual patients in order to select an appropriate approach. The aim of this study was to evaluate the effectiveness of endoscopic ultrasonography and intraductal ultrasonography as compared with ultrasonography and computed tomography for this purpose. METHODOLOGY: Ultrasonography, computed tomography, endoscopic ultrasonography and intraductal ultrasonography were performed in 49 cases of IPMT (atypical hyperplasia 7, adenoma 23, noninvasive 7 and invasive adenocarcinoma 12). On the basis of the histopathological analysis of another 28 cases of resected IPMT specimens, criteria for differential diagnosis by imaging modalities were defined as follows: Nonneoplastic lesion (atypical hyperplasia): no wall thickening or nodule; noninvasive IPMT (adenoma and intraductal carcinoma): a nodule or wall thickening is present; and invasive IPMT with pancreatic parenchymal invasion: a mass with a heterogenous pattern or interruption of the pancreatic duct wall by the mass. RESULTS: The diagnostic accuracy rate for differentiating nonneoplastic lesion noninvasive IPMT, and invasive IPMT was 33% by ultrasonography, 38% by computed tomography, 77% by endoscopic ultrasonography, and 67% by intraductal ultrasonography. Sensitivity, specificity and accuracy rates for differentiating neoplastic and nonneoplastic IPMT by ultrasonography was 33%, 100%, 42%, by computed tomography 36%, 100%, 44%, by endoscopic ultrasonography 90%, 71%, 88%, by intraductal ultrasonography 94%, 29%, 84%, respectively. Sensitivity, specificity and accuracy rates for differentiating invasive and noninvasive IPMT by ultrasonography was 25%, 100%, 80%, by computed tomography 33%, 100%, 83%, by endoscopic ultrasonography 55%, 97%, 88%, by intraductal ultrasonography 56%, 91%, 84%, respectively. Diagnostic accuracy for invasive IPMT except minimally invasive cases by endoscopic ultrasonography and intraductal ultrasonography was 80%, based on the results of the examination which demonstrated a higher grade lesion. CONCLUSIONS: With these criteria, ultrasonography and computed tomography showed high specificity, but low sensitivity for the differential diagnosis of neoplastic/nonneoplastic and invasive/noninvasive IPMT. However, endoscopic ultrasonography and intraductal ultrasonography had high sensitivity and diagnostic accuracy for the differential diagnosis of neoplastic/nonneoplastic lesions. Combination of endoscopic ultrasonography and intraductal ultrasonography showed a high accuracy rate in the diagnosis of invasive IPMT. Thus endoscopic ultrasonography and intraductal ultrasonography contributed significantly to the choice of the treatment for IPMT.
UI - 11490851
AU - Nagasaka T; Nakashima N
TI - Problems in histological diagnosis of intraductal papillary-mucinous tumor (IPMT).
SO - Hepatogastroenterology 2001 Jul-Aug;48(40):972-6
AD - Division of Pathology, Clinical Laboratory Nagoya University Hospital, Tsurumai-Cho 65, Showa-ku, Nagoya 466-8560, Japan. firstname.lastname@example.org
IPMTs (intraductal papillary-mucinous tumors) of the pancreas have been recognized as a distinct clinical entity. WHO used this term in most recent classification (1996). The present report reviews the WHO classification and recent descriptions of IPMT. Problems regarding the histological diagnosis and differential diagnosis are also discussed. In the WHO classification, IPMTs are classified into three categories: intraductal papillary-mucinous adenoma, intraductal papillary-mucinous tumor with moderate dysplasia and intraductal papillary-mucinous carcinoma. The classification is based on the tissue morphology, such as degree of dysplasia and pattern of proliferation. Some immunohistochemical and molecular markers have been reported for differential diagnosis and estimating the prognosis of IPMT. MUC1, Dpc-4, p53 and Ki-67. In making a differential diagnosis, mucinous cystic tumors are the most problematic. Communication with the pancreatic ducts, the presence of ovarian type stroma and capsular formation are key histological factors for a differential diagnosis between IPMTs and mucinous cystic tumors. The prognosis of IPMTs is favorable in general. However, once massive invasion has occurred, the prognosis is very poor, as in cases of ductal carcinoma. For further studies of IPMT, pathologists and clinicians involved in the diagnosis and treatment of IPMTs need to understand the concept of IPMTs and use the WHO classification.
UI - 11504292
AU - Mullan MH; Gauger PG; Thompson NW
TI - Endocrine tumours of the pancreas: review and recent advances.
SO - ANZ J Surg 2001 Aug;71(8):475-82
AD - Department of Surgery, Division of Endocrine Surgery, University of Michigan Hospital, Ann Arbor 48109-0331, USA.
Pancreatic endocrine tumours (PET) are rare but nonetheless important to recognize and treat in a timely fashion. Significant morbidity occurs due to excess secretion of hormones, with all of the PET having some degree of malignant potential. Surgeons must plan directed operative strategies to deal with these tumours and be prepared to undertake aggressive palliative debulking resections if indicated. Somatostatin receptor scintigraphy and endoscopic ultrasound have been particularly helpful in both localizing and staging patients with PET. Other important advances in management include the use of long-acting somatostatin analogues to inhibit hormonal secretion and tumour growth. The possibility of multiple endocrine neoplasia type 1 (MEN-1) should be considered in any patient with a PET. The present article will review the various classes of PET, describe MEN-1 in relation to PET and examine advances in imaging and localization. The role of surgery for PET is also discussed in the present review.
UI - 11520088
AU - van Geenen RC; van Gulik TM; Offerhaus GJ; de Wit LT; Busch OR; Obertop
TI - H; Gouma DJ Survival after pancreaticoduodenectomy for periampullary adenocarcinoma: an update.
SO - Eur J Surg Oncol 2001 Sep;27(6):549-57
AD - Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
AIM: Survival after pancreaticoduodenectomy for periampullary tumours is limited. Over the last decade peri-operative management has improved and morbidity and mortality decreased. The aim of the study was to analyse recent survival data after pancreaticoduodenectomy and to determine 1998, 204 patients with a ductal adenocarcinoma in the pancreatic head (108), distal bile duct (32), and ampulla (64) who underwent standard pancreaticoduodenectomy, were analysed with regard to histology and tumour status. Survival was calculated by using the Kaplan-Meier method. Risk factors were identified in a univariate and multivariate analysis. RESULTS: Median survival after resection for carcinoma of the pancreatic head, distal bile duct, and ampulla were 16, 25 and 24 months, respectively (P=0.008). In the univariate analysis vein resection, blood transfusion of more than four packed red cells, the presence of tumour positive resection margins, lymph-node metastases and poor tumour differentiation significantly decreased survival. In the multivariate analysis positive resection margins, lymph-node metastases, and poor tumour differentiation independently influenced survival. CONCLUSIONS: Resection margins, lymph-node status and tumour differentiation are independent prognostic factors. Survival after standard pancreaticoduodenectomy for periampullary tumours has not improved. Copyright 2001 Harcourt Publishers Limited.
UI - 11550286
AU - Moore PS; Missiaglia E; Antonello D; Zamo A; Zamboni G; Corleto V;
TI - Falconi M; Scarpa A Role of disease-causing genes in sporadic pancreatic endocrine tumors: MEN1 and VHL.
SO - Genes Chromosomes Cancer 2001 Oct;32(2):177-81
AD - Department of Pathology, Universita di Verona, Strada le Grazie 8, I-37134 Verona, Italy.
Pancreatic endocrine tumors (PETs) occur in association with multiple endocrine neoplasia type 1 (MEN1) and von Hippel-Lindau (VHL) syndromes caused by germline alterations in MEN1 and VHL, respectively. It is thus expected that these genes will also be altered in a proportion of sporadic PETs. Indeed, MEN1 is altered in about 25% of nonfamilial PETs, although no mutations have been found in VHL. For all clinical subtypes, the frequency of allelic loss on chromosome arm 11q mirrors observed mutational frequencies, with the exception of nonfunctional tumors (NF-PETs), in which mutations have been reported in only 8% of cases. As allelic loss on 11q is the most frequent event found in these neoplasms, this low frequency is somewhat puzzling, particularly in light of the fact that most MEN1-associated PETs are nonfunctioning. To clarify the role of these genes in sporadic PETs, we analyzed 31 sporadic NF-PETs, nine insulinomas, and one VIPoma for alterations in MEN1 and VHL. As somatic mutations were observed in eight (26%) of the NF tumors and in one insulinoma, it would therefore appear unlikely that an additional tumor suppressor gene related to sporadic PET pathogenesis is located on 11q. One insulinoma also had a somatic mutation in VHL, and thus this gene may also be altered in these neoplasms, albeit in a small proportion of cases. Copyright 2001 Wiley-Liss, Inc.