National Cancer Institute®
Last Modified: June 1, 2002
UI - 11916627
AU - Lam KY; Leung PS
TI - Regulation and expression of a renin-angiotensin system in human pancreas and pancreatic endocrine tumours.
SO - Eur J Endocrinol 2002 Apr;146(4):567-72
AD - Department of Pathology, School of Medicine, James Cook University, Queensland, Australia.
OBJECTIVE: Evidence exists for the presence of a renin-angiotensin system (RAS) in the pancreas. The aims of this study were to prove the presence of an intrinsic RAS in the human pancreas and to analyse the role of such an RAS in pancreatic endocrine tumours (PETs). METHODS: Gene expression of key RAS components (angiotensinogen and angiotensin II receptors, namely AT1 and AT2) was investigated in human pancreas and in PETs by semi-quantitative RT-PCR and immunohistochemistry. RESULTS: Expression of mRNAs of RAS components was found in human pancreas and in PETs. Data from semi-quantitative RT-PCR analysis demonstrated an increase in the mRNA expression of angiotensinogen and AT2 receptor in PETs when compared with that in normal pancreas. By immunohistochemistry, angiotensinogen protein was predominantly localized in the pancreatic islets while AT1 receptor protein was in the pancreatic ducts. CONCLUSIONS: The data support the notion of the existence of an intrinsic RAS in the human pancreas. It also indicates, for the first time, that such a local pancreatic RAS is subject to regulation by PETs and its significant change may have pathophysiological relevance in patients with PETs.
UI - 11950811
AU - Real FX; Malats N; Lesca G; Porta M; Chopin S; Lenoir GM; Sinilnikova O;
TI - PANKRAS II Study Group Family history of cancer and germline BRCA2 mutations in sporadic exocrine pancreatic cancer.
SO - Gut 2002 May;50(5):653-7
AD - Unitat de Biologia Cellular i Molecular, Institut Municipal d'Investigacio Medica, Universitat Pompeu Fabra, Barcelona, Spain. email@example.com
BACKGROUND: Hereditary factors have been reported in 5-10% of cases with exocrine pancreatic cancer and recent data support a role for BRCA2. AIMS: We have studied the prevalence of germline BRCA2 mutations in two groups of patients with exocrine pancreatic cancer from an unselected series in Spain: group A included 24 cases showing familial aggregation of cancer and group B included 54 age, sex, and hospital matched cases without such evidence. METHODS: Information was obtained by interview of patients and was validated by a telephone interview with a structured questionnaire. In patients from group A, >80% of the coding sequence of BRCA2 was analysed; in patients from group B, the regions in which germline BRCA2 mutations have been described to be associated with pancreatic cancer were screened. RESULTS: Telephone interviews led to reclassification of 7/54 cases (13%). Familial aggregation of cancer was found in 24/165 cases (14.5%); six patients had a first degree relative with pancreatic cancer (3.6%) and nine patients had relatives with breast cancer. Germline BRCA2 mutations were not identified in any patient from group A (0/23). Among group B cases, one germline variant (T5868G>Asn1880Lys) was found in a 59 year old male without a family history of cancer. The 6174delT mutation was not found in any of the 71 cases analysed. CONCLUSIONS: The overall prevalence of BRCA2 mutations among patients with pancreatic cancer in Spain is low and the 6174delT mutation appears to be very infrequent. Our data do not support screening patients with cancer of the pancreas for germline BRCA2 mutations to identify relatives at high risk of developing this tumour.
UI - 11437040
AU - Fritscher-Ravens A; Topalidis T; Bobrowski C; Krause C; Thonke E; Jackle
TI - S; Soehendra N Endoscopic ultrasound-guided fine-needle aspiration in focal pancreatic lesions: a prospective intraindividual comparison of two needle assemblies.
SO - Endoscopy 2001 Jun;33(6):484-90
AD - Dept of Interdisciplinary, Endoscopy, University Hospital Eppendorf Hamburg, Germany. FRI-RAV@t-online.de
BACKGROUND AND STUDY AIMS: The results of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in focal pancreatic lesions are less impressive than those in the mediastinum. The aim of this prospectively randomized study was to compare two commercially available needle assemblies with regard to handling and cytopathological yield. PATIENTS AND METHODS: A total of 30 patients (19 men, 11 women; mean age 61) with focal pancreatic lesions underwent EUS-FNA with each of the two needles (GIP, Wilson-Cook). The sequence was randomized for the examiner and blinded for the cytologist. Three patients had to be excluded because of the impossibility of sample assignment or patient follow-up. EUS-FNA was performed using the standard technique with linear echo endoscopes. RESULTS: None of the characteristics evaluated by the examiner differed significantly between either of the needles. Inadequate results were obtained in 11% using the GIP needle, but in none with the Wilson-Cook needle. GIP needle cytology revealed malignancy in 11 patients (sensitivity, specificity, and accuracy were 55%, 100%, and 65%, respectively, including inadequate results). The aspirates obtained with the Wilson-Cook needle identified malignancy in 16 patients (sensitivity, specificity, and accuracy were 85%, 100%, and 89%, respectively). CONCLUSIONS: No statistically significant differences were detected in the handling of either of the two needle assemblies. No complications were reported using the GIP needles. However, in four procedures breakages of the outer Teflon sheath of the Wilson-Cook needle occurred, and in another four cases re-insertion of the stylet was impossible. Nevertheless, cytopathologic results were significantly better with the Wilson-Cook needle.
UI - 12003425
AU - Arguedas MR; Heudebert GH; Stinnett AA; Wilcox CM
TI - Biliary stents in malignant obstructive jaundice due to pancreatic carcinoma: a cost-effectiveness analysis.
SO - Am J Gastroenterol 2002 Apr;97(4):898-904
AD - Division of Gastroenterology & Hepatology, School of Public Health, University of Alabama at Birmingham, 35294-0007, USA.
OBJECTIVES: Obstructive jaundice frequently complicates pancreatic carcinoma and is associated with complications such as malabsorption, coagulopathy, progressive hepatocellular dysfunction, and cholangitis in addition to disabling pruritus, which greatly interferes with terminal patients' quality of life. Endoscopic placement of biliary stents decreases the risk of these complications and is considered the procedure of choice for palliation for patients with unresectable tumors. We used decision analysis with Markov modeling to compare the cost-effectivenesses of plastic stents and metal stents in patients with unresectable pancreatic carcinoma. METHODS: A model of the natural history of unresectable pancreatic carcinoma was constructed using probabilities derived from the literature. Cost estimates were obtained from Medicare reimbursement rates and supplemented by the literature. Two strategies were evaluated: 1) initial endoscopic plastic stent placement and 2) initial endoscopic metal stent placement. We compared total costs and performed cost-effectiveness analysis in these strategies. The outcome measures were quality-adjusted life months. Sensitivity analyses were performed on selected variables. RESULTS: Our baseline analysis showed that initial plastic stent placement was associated with a total cost of $13,879/patient and 1.799 quality-adjusted life months. Initial placement of a metal stent cost $13,466/patient and conferred 1.832 quality-adjusted life months. Among the variables examined, expected patient survival was demonstrated by sensitivity analyses to have the most influence on the results of the model. CONCLUSION: Initial endoscopic placement of a metal stent is a cost-saving strategy compared to initial plastic stent placement, particularly in patients expected to survive longer than 6 months.
UI - 12000709
AU - Fukushima N; Sato N; Ueki T; Rosty C; Walter KM; Wilentz RE; Yeo CJ;
TI - Hruban RH; Goggins M Aberrant methylation of preproenkephalin and p16 genes in pancreatic intraepithelial neoplasia and pancreatic ductal adenocarcinoma.
SO - Am J Pathol 2002 May;160(5):1573-81
AD - Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21205-2196, USA.
Pancreatic intraductal neoplasia (PanIN) is thought to be the precursor to infiltrating pancreatic ductal adenocarcinoma. We have previously shown that the preproenkephalin (ppENK) and p16 genes are aberrantly methylated in pancreatic adenocarcinoma. In this study we define the methylation status of the ppENK and p16 genes in various grades of PanINs. One hundred seventy-four samples (28 nonneoplastic pancreatic epithelia, 7 reactive epithelia, 29 PanIN-1A, 48 PanIN-1B, 27 PanIN-2, 14 PanIN-3, 15 invasive ductal adenocarcinomas, and 6 miscellaneous pancreatic neoplasms) were microdissected from 29 formalin-fixed paraffin-embedded surgically resected pancreata, and were analyzed by methylation-specific polymerase chain reaction. Fourteen of 15 (93.3%) invasive pancreatic ductal adenocarcinomas showed methylation of the ppENK gene and 4 of 15 (26.7%) showed methylation of the p16 gene. Nonneoplastic pancreatic epithelia did not harbor methylation of either gene. The prevalence of methylation of the ppENK gene increased significantly with increasing PanIN grade. A similar nonsignificant trend was noted for p16 methylation. Aberrant methylation of the ppENK gene was found in 7.7% of PanIN-1A, 7.3% of PanIN-1B, 22.7% of PanIN-2, and 46.2% of PanIN-3. Aberrant methylation of the p16 gene was found in 12% of PanIN-1A, 2.6% of PanIN-1B, 4.5% of PanIN-2, and 21.4% of PanIN-3. All but one of the PanINs from the 14 pancreata without pancreatic carcinoma was unmethylated with respect to either the p16 or ppENK gene. Our results suggest that methylation-related inactivation of the ppENK and p16 genes is an intermediate or late event during pancreatic carcinogenesis. Because aberrant methylation of ppENK or p16 was more often detected in similar grade PanINs from patients with pancreatic carcinoma than in those with other pancreatic diseases, it may be a useful indicator of the potential malignancy of epithelial cells of the pancreas.
UI - 12000726
AU - Terris B; Blaveri E; Crnogorac-Jurcevic T; Jones M; Missiaglia E;
TI - Ruszniewski P; Sauvanet A; Lemoine NR Characterization of gene expression profiles in intraductal papillary-mucinous tumors of the pancreas.
SO - Am J Pathol 2002 May;160(5):1745-54
AD - Cancer Research UK Molecular Oncology Unit, Imperial College School of Medicine at Hammersmith Campus, London, United Kingdom.
The molecular pathology of precursor lesions leading to invasive pancreatic ductal adenocarcinomas remains relatively unknown. We have applied cDNA microarray analysis to characterize gene expression profiles in a series of intraductal papillary-mucinous tumors (IPMTs) of the pancreas, which represents one of the alternative routes of intraepithelial progression to full malignancy in the pancreatic duct system. Using a cDNA microarray containing 4992 human genes, we screened a total of 13 IPMTs including nine noninvasive and four invasive cases. Expression change in more than half of the tumors was observed for 120 genes, ie, 62 up-regulated and 58 down-regulated genes. Some of the up-regulated genes in this study have been previously described in classical pancreatic carcinomas such as lipocalin 2, galectin 3, claudin 4, and cathepsin E. The most highly up-regulated genes in IPMTs corresponded to three members of the trefoil factor family (TFF1, TFF2, and TFF3). Immunohistochemistry performed on five genes found to be differentially expressed at the RNA level (TFF1, TFF2, TFF3, lipocalin 2, and galectin 3) showed a good concordance between transcript level and protein abundance, except for TFF2. Hierarchical clustering organized the cases according to the dysplastic and invasive phenotype of theIPMTs. This analysis has permitted us to implicate several genes (caveolin 1, glypican 1, growth arrest-specific 6 protein, cysteine-rich angiogenic inducer 61) in tumor progression. The observation that several genes are differentially expressed both in IPMTs and pancreatic carcinomas suggests that they may be involved at an early stage of pancreatic carcinogenesis.
UI - 11437039
AU - Mortensen MB; Pless T; Durup J; Ainsworth AP; Plagborg GJ; Hovendal C
TI - Clinical impact of endoscopic ultrasound-guided fine needle aspiration biopsy in patients with upper gastrointestinal tract malignancies. A prospective study.
SO - Endoscopy 2001 Jun;33(6):478-83
AD - Department of Surgical Gastroenterology, Odense University Hospital, Denmark. firstname.lastname@example.org
BACKGROUND AND STUDY AIMS: Several studies have evaluated the accuracy of endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) in the upper gastrointestinal tract, but so far no studies have specifically evaluated the clinical impact of EUS-FNAB in upper gastrointestinal tract cancer patients. In this consecutive and prospective study, EUS-FNAB was only performed if a positive malignant finding would change the therapeutic strategy. PATIENTS AND METHODS: Between 1997 and 1999, 307 consecutive patients were referred for EUS with a diagnosis or strong suspicion of esophageal, gastric or pancreatic cancer; 274 patients were potential candidates for surgical treatment and had EUS. According to predefined impact criteria, 27% (75/274) of the patients had EUS-FNAB for staging or diagnostic reasons. RESULTS: The overall clinical impact of EUS-FNAB was 13%, 14%, and 30% in esophageal, gastric, and pancreatic cancer, respectively. The staging-related clinical impact was similar for all three types of cancer (11-12.5%), whereas the diagnosis-related impact was highest in pancreatic cancer patients (86%). EUS-FNAB was inadequate in 13% and gave false-negative results in 5%. The overall sensitivity, specificity and accuracy for EUS-FNAB were 80%, 78% and 80%, respectively. No complications related to the biopsy procedure were seen. CONCLUSIONS: If EUS-FNAB was performed only in cases where a positive malignant result would change patient management, then approximately one out of four patients with upper gastrointestinal tract cancer would require a biopsy. With this approach the actual clinical impact of EUS-FNAB ranged from 13% in esophageal cancer to 30% in pancreatic cancer. EUS-FNAB plays a limited, but very important clinical role in the assessment of upper gastrointestinal tract cancer.
UI - 11953187
AU - Wu J; Meng X; Li D; Lu H
TI - [Abnormal metabolism of glucose as clue for early diagnosing pancreatic cancer]
SO - Zhonghua Yi Xue Za Zhi 2002 Mar;82(5):312-4
AD - Department of Gastroenterology, Xinhua Hospital, Shanghai Second Medical University, Shanghai 200092, China.
OBJECTIVE: To investigate the incidence, features, and course of abnormal metabolism of glucose in patients with pancreatic cancer and the possibility of using the abnormal metabolism of glucose as early precursory manifestation of pancreatic cancer. METHODS: Fasting plasma-sugar (FPG), plasma insulin and C peptide were examined in 98 patients with pancreatic cancer diagnosed by B mode ultrasonography, CT, endoscopy, and pathological examination. The family history of DM was collected. The body mass index (BMI) was calculated. The relation between abnormal metabolism of glucose and diagnosis of pancreatic cancer was analyzed. One hundred and fifteen patients with advanced gastric cancer (AGC), 87 patients with colon cancer, and 146 patients with type 2 diabetes mellitus (DM) were used as controls. RESULTS: Abnormality of FPG, insulin and C peptide was found in 17 out of the 98 patients with pancreatic cancer, with an incidence rate of 17.4%, significantly higher than that in patients with AGC (1/115, 1.7%, P < 0.05), and patients with colon cancer (5/87, 5.8%, P < 0.025). Thirty eight patients with type 2 DM (39.0%) had their BMI > 24, while no pancreatic cancer patients with abnormality of metabolism of glucose had his BMI > 24 (0/17, 0%, P < 0.05). The duration between the discovery of abnormal metabolism of glucose and the diagnosis of cancer in the 17 patients was 10.8 +/- 7.4 months, and was < 2 years in 15 of them (88.2%), significantly longer than the duration between the appearance of symptoms and the diagnosis in the 146 type 2 DM patients (21/146, 14.4%, P < 0.05). The proportion of positive DM family history was 1/17 in patients with pancreatic cancer, significantly lower than in patients with type 2 DM (97/146, 66.4%, P < 0.05). However, the values of FPG, insulin, and C peptide between the groups with and without pancreatic cancer were not significantly different. CONCLUSION: Clinical manifestations of abnormal metabolism of glucose appear prior to the discovery of space occupying lesions in pancreas in about 17% patients with pancreatic cancer. Newly appearing abnormalities in metabolism of glucose in patients without DM family history and without symptom of obesity should be regarded as important clues for early diagnosing pancreatic cancer.
UI - 12025230
AU - Zhou Y; Wang S; Yue BG; Gobl A; Oberg K
TI - Effects of interferon alpha on the expression of p21cip1/waf1 and cell cycle distribution in carcinoid tumors.
SO - Cancer Invest 2002;20(3):348-56
AD - Department of Medical Sciences, Endocrine Oncology Unit of Internal Medicine, Uppsala University Hospital, S751 85 Uppsala, Sweden.
Interferon alpha (IFN-alpha) has been shown to produce antitumor effects in 50-80% of carcinoid tumor patients and has demonstrated anti-proliferative effects in carcinoid tumor cells, but the mechanism is not well established. This study presents evidence that in a carcinoid tumor cell line, Bon1, IFN-alpha increases the expression of p21 and promotes nuclear translocation of endogenous p21. Furthermore, immunoprecipitation experiments demonstrated that p21 formed immuno-complexes with Stat1 and Stat2 in the nucleus of cells. Interferon alpha can decrease G1- and G2-phase cells, but increase S-phase population. The p21 mRNA expression is inversely correlated to the G1 population (r = -0.933, P < 0.05) and positively correlated to the S-phase population (r = 0.901, P < 0.05). In addition, IFN-alpha inhibited cyclin dependent kinases (CDK), CDK2-, CDK3-, CDK4-, and cyclin E- but not cyclin A-associated kinase activities. Immunodepletion of p21 resulted in a significant enhancement of CDK3 kinase activity (approximately 1.6-fold increase). These results suggest that the mechanism of antitumor and cell cycle regulation of IFN-alpha in carcinoid tumors may, at least in part, be p21-dependent. Based on these results, we conclude that IFN-alpha exerts antitumor effects by increased p21 expression in neuroendocrine tumors.
UI - 11766769
AU - Mirecka J; Libura J; Libura M; Koprowski M; Nowak D; Kedra B; Popiela T
TI - Morphological parameters of the angiogenic response in pancreatic ductal adenocarcinoma--correlation with histological grading and clinical data.
SO - Folia Histochem Cytobiol 2001;39(4):335-40
AD - Department of Histology, Medical College, Jagiellonian University, Cracow, Poland. email@example.com
The aim of this study was to evaluate angiogenesis in tissue of the pancreatic ductal adenocarcinoma and to correlate it with histopathological data such as tumour differentiation, tumour size, lymph node metastasis and patients survival. Tumour samples obtained during surgery from 36 patients were immunostained for the presence of blood vessels with monoclonal antibody against the CD31 molecule. Evaluation of microvasculature was perfomed by counting the microvessel density (MVD) in selected areas under light microscope as well as by computer assisted image analysis (CAIA). In the latter, the following parameters were used for assessment of microvessels: mean number/field, mean area of the vessels, total area/field and total perimeter/field. MVD values obtained under optical microscope and with CAIA were highly correlated. All parameters characterising microvasculature in CAIA also revealed a significant correlation with the histological grading of tumours; generally the less differentiated tumours manifested more extensive vascular network. No significant relationship was found between the tumour size and any of the CAIA parameters. The area of vessels (both total and mean values) revealed a significant, inverse correlation with the incidence of lymph node metastases. The same type of correlation was also found between the mean vessel area and the postoperative survival period. The results show that CAIA of microvessels offers new parameters with some predictive value for the outcome of patients with pancreatic cancer.
UI - 11854622
AU - Nagakawa Y; Aoki T; Kasuya K; Tsuchida A; Koyanagi Y
TI - Histologic features of venous invasion, expression of vascular endothelial growth factor and matrix metalloproteinase-2 and matrix metalloproteinase-9, and the relation with liver metastasis in pancreatic cancer.
SO - Pancreas 2002 Mar;24(2):169-78
AD - Department of Surgery, Tokyo Medical University, 6-7-012 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. firstname.lastname@example.org
INTRODUCTION: Pancreatic cancer frequently is associated with venous invasion and hematogenous metastasis. AIMS: To determine morphologic features of invaded veins, intratumoral vascular composition, the correlation with liver metastasis, and expression of vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-2 and MMP-9, and the mechanism of development of hematogenous metastasis. METHODOLOGY: We examined 32 patients with resected pancreatic cancer: 18 had postoperative liver metastasis, and 14 had no liver metastasis. Specimens were examined to determine the composition of veins and microvessels by staining of victoria-blue and CD34. We also investigated expression of VEGF, MMP-2, and MMP-9 by immunohistochemical staining. RESULTS: Venous invasion was detected in 31 of 32 patients. Invaded venous densities of middle- and large-sized veins were significantly higher in patients with liver metastasis than in those with nonliver metastasis, and they were related to MMP-2 and MMP-9 overexpression. Invaded veins with fragmentation of the lumen through cancer cells were considered to be an intravasation of cancer (destroyed type vein), and their numbers were significantly related to liver metastasis, and MMP-2 and MMP-9 overexpression. CONCLUSION: In conclusion, almost all the patients with pancreatic cancer showed venous invasion, indicating that invasion into large veins and destroyed type veins could be a risk factor for liver metastasis and that increased expression MMP-2 and MMP-9 were related to such invasion.
UI - 11854628
AU - Schramm H; Urban H; Arnold F; Penzlin G; Bosseckert H
TI - Intrasurgical pancreas cytology.
SO - Pancreas 2002 Mar;24(2):210-4
AD - Wald-Klinikum gGmbh, Chirurgisches Zentrum, Departement fur Allgemeine, Viszerale und Kinderchirurgie, Strasse des Friedens 122, D-07548 Gera, Germany.
INTRODUCTION: A differential therapy of chronic pancreatitis and carcinoma calls for evaluation of the validity of findings. Presurgical suspicion of a carcinoma often requires intrasurgical diagnostics such as excisional biopsies, punch biopsies, and fine-needle aspiration cytology (FNAC) for confirmation. AIMS: To evaluate FNAC as an intraoperative diagnostic method of very high probability. METHODOLOGY: Intrasurgical fine-needle aspiration biopsy and cytologic assessment were carried out in 474 patients. The indications for operative therapy and FNAC were suspicion of pancreatic tumor, chronic pancreatitis even without suspicion of tumor, and pathologic alterations found during other surgeries in the upper abdomen. RESULTS: The level of sensitivity was 93.1%, specificity was 99.1%, predictive value of positive results was 99.2% and of negative results was 92.1%. CONCLUSION: FNAC is a suitable method for intrasurgical confirmation of pancreatic carcinoma. It can be performed safely, effectively, and rapidly.
UI - 11986021
AU - Barreiro CJ; Lillemoe KD; Koniaris LG; Sohn TA; Yeo CJ; Coleman J;
TI - Fishman EK; Cameron JL Diagnostic laparoscopy for periampullary and pancreatic cancer: what is the true benefit?
SO - J Gastrointest Surg 2002 Jan-Feb;6(1):75-81
AD - The Johns Hopkins Hospital, Johns Hopkins Medical Institutions, Baltimore, MD 21287-4603, USA.
The role of diagnostic laparoscopy in patients with periampullary and pancreatic malignancies is controversial. A retrospective review was performed including all patients (n = 188) with a periampullary or pancreatic malignancy who underwent both CT and laparotomy at our resectability rate for all periampullary cancers was 67.3% (115 of 171 patients). This compared favorably with the resectability rate for cancers of the pancreatic body and tail (3 of 17 patients, 17.6%; P < 0.01 vs. periampullary cancers). Fifty percent of patients with periampullary cancers were unresectable because of metastatic disease, whereas metastatic disease precluded resection in 64.3% of patients with cancers of the pancreatic body and tail. After patients undergoing operative palliation were eliminated, a nontherapeutic laparotomy would have been precluded by the use of diagnostic laparoscopy in only 2.3% of patients with periampullary cancers (4 of 171 patients). In contrast, 6 (35.3%) of 17 patients with cancers of the pancreatic body and tail underwent a nontherapeutic laparotomy (P < 0.01 vs. periampullary cancers). One hundred fifty-eight (84%) of the 188 CT reports reviewed could be definitively categorized as either "likely to be resectable" or "likely to be unresectable." The remaining 16% were equivocal. Of the 107 patients categorized as likely to be resectable, 89 were actually resected (83.2%). In contrast, only 10 of the 51 patients categorized as likely to be unresectable could be resected (19.6%).
UI - 11907731
AU - Megibow AJ; Lombardo FP; Guarise A; Carbognin G; Scholes J; Rofsky NM;
TI - Macari M; Balthazar EJ; Procacci C Cystic pancreatic masses: cross-sectional imaging observations and serial follow-up.
SO - Abdom Imaging 2001 Nov-Dec;26(6):640-7
AD - Department of Radiology, NYU Medical Center, New York, NY 10016, USA.
BACKGROUND: We retrospectively reviewed the imaging features of a series of patients with cystic pancreatic masses, the majority of whom underwent imaging surveillance. METHODS: Imaging data from 30 patients with known cystic pancreatic masses were reviewed. Nine patients had surgical and/or cytologic classification. Of the 21 who were not operated on, all underwent serial imaging surveillance. Of these, five had corroborative endoscopic retrograde cholangiopancreatography and 16 were followed by only computed tomography and/or magnetic resonance imaging. RESULTS: In the nonoperated group, mean follow-up time was 30 months (3-144 months). Two patients demonstrated growth, and the remainder remain stable. In the patients who underwent surgery, invasive carcinoma was found in those with lesions larger than 4 cm, involvement of the main pancreatic duct, or visible solid components on the imaging study. Smaller lesions were benign. CONCLUSION: In patients with suspected cystic pancreatic neoplasms, surveillance might be possible if lesions are smaller than 2.5 cm, spare the main pancreatic duct, and demonstrate no solid components.
UI - 12015758
AU - Ogawa Y; Tanaka M; Inoue K; Yamaguchi K; Chijiiwa K; Mizumoto K; Tsutsu
TI - N; Nakamura Y A prospective pancreatographic study of the prevalence of pancreatic carcinoma in patients with diabetes mellitus.
SO - Cancer 2002 May 1;94(9):2344-9
AD - Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan.
BACKGROUND: The correlation between diabetes mellitus and pancreatic carcinoma is well documented, but no criteria have been established for the efficient selection of a high-risk group among patients with diabetes mellitus. METHODS: Eighty-seven patients were selected prospectively from outpatients with diabetes and underwent endoscopic retrograde pancreatography (ERP) according to the authors' original criteria, including the onset of diabetes after age 55 years, deterioration of diabetes or loss of body weight despite strict medical control, elevation of serum amylase and/or CA19-9 levels, and pancreatobiliary abnormalities on routine ultrasonography. The patients were divided into two groups according to the time from the onset of diabetes to ERP: Patients in Group A had recent-onset diabetes (within 3 years), and Group B patients had diabetes for > 3 years. RESULTS: A total of 86 patients (excluding 1 patient with unsuccessful ERP who had undergone previous Billroth-2 gastrectomy) were enrolled. There were 33 males and 53 females, age 40-90 years, with a mean age of 65.1 years. ERP demonstrated pancreatic carcinoma, although it was advanced disease in all patients, at an extremely high rate of 7.0% (6 of 86 patients) with no serious complications. The prevalence of pancreatic carcinoma in Group A (13.9%; 5 of 36 patients) was significantly greater compared with Group B (2.0%; 1 of 50 patients; P = 0.0442). ERP with an indwelling balloon catheter and subsequent pancreatic juice sampling was performed in 49 patients, yielding positive cytology in 1 patient with pancreatic tail carcinoma, whereas measurements of carcinoembryonic antigen and CA19-9 levels in pancreatic juice were of no use in the diagnosis of pancreatic carcinoma. CONCLUSIONS: Selective ERP in patients with diabetes who were at high risk did not lead to the early diagnosis of pancreatic carcinoma, although this study showed that the 3-year period after the onset of diabetes was critical. A more aggressive diagnostic approach within this period in diabetic patients with the authors' criteria may contribute to the earlier diagnosis of pancreatic carcinoma. Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10493
UI - 12023573
AU - Zamboni G; Terris B; Scarpa A; Kosmahl M; Capelli P; Klimstra DS; Lam
TI - PW; Kloppel G Acinar cell cystadenoma of the pancreas: a new entity?
SO - Am J Surg Pathol 2002 Jun;26(6):698-704
AD - Department of Pathology, University of Verona, Italy. email@example.com
This report describes a newly observed cystic lesion of the pancreas showing acinar cell differentiation. The patients affected by this lesion included seven women and three men (age range 16-66 years). In six patients, all of whom were female and all but one of whom suffered from abdominal pain, the cystic lesions (diameters, 4-15 cm) were detected by imaging techniques and subsequently removed. In four patients the cystic lesions were incidental findings. Eight lesions occurred as unifocal, unilocular or multilocular cysts in the head (n = 6) or tail (n = 2) of the pancreas. One lesion was bifocal (head and tail) and another involved the entire pancreas. The cysts were only rarely connected with the pancreatic duct system, but with acinar structures. Their lining cells expressed pancreatic enzymes and lacked any cellular atypia or proliferative activity (Ki67 index <1%). For a follow-up period of 6-84 months all patients remained alive and well. Although a nonneoplastic nature cannot be fully excluded, we propose that this lesion, composed of well-differentiated acinar cells, may represent the benign counterpart of the well-recognized acinar cystadenocarcinoma. We therefore suggest the term acinar cell cystadenoma.
UI - 12024726
AU - Babii IaS; Momot NV; Savchenko EA; Ivankov AP; Griazov AB
TI - [Possibilities of magnetic resonance tomography in pancreatic cancer diagnosis]
SO - Klin Khir 2002 Feb;(2):27-9
There was conducted examination of 27 patients with pancreatic cancer using clinico-laboratory and instrumental methods: ultrasonic investigation, computeric tomography (CT), magnetic-resonance tomography (MRT). MRT was uninformative when pancreatic tumor was up to 3 cm in diameter. In diagnosis of cystadenocarcinoma, affection of common biliary duct and vessels and in small focal metastatic hepatic affection the results of MRT showed enhanced precision in comparison with CT. Informativity of MRT and CT in diagnosis of metastases in lymph nodes was equal.
UI - 10787083
AU - Henne-Bruns D; Vogel I; Luttges J; Kloppel G; Kremer B
TI - Surgery for ductal adenocarcinoma of the pancreatic head: staging, complications, and survival after regional versus extended lymphadenectomy.
SO - World J Surg 2000 May;24(5):595-601; discussion 601-2
AD - Department of General and Thoracic Surgery, University of Kiel, Germany.
The purpose of this study was to evaluate the influence of regional versus extended lymphadenectomy on survival after partial 72 patients with histologically proven ductal adenocarcinoma of the pancreatic head were treated. Partial pancreaticoduodenectomy with regional lymphadenectomy was performed in 26 patients. In 46 patients lymphadenectomy was expanded to include extended retroperitoneal lymphatic and connective tissue clearance. Comparing these two groups and including only patients with R0 resections (n = 58) no significant differences in long-term survival could be shown. The following parameters were shown to have a significant or nearly significant influence on long-term survival: (1) stage of the disease: The 5-year survival of patients with stage I/II pancreatic head cancer was 63%, compared to 15% in patients with stage III/IV a + b of the disease (p = 0.0087). (2) Grading: The 1-year survival of patients with well or moderately differentiated tumors was 55%, compared to 0% for patients with poorly differentiated ductal adenocarcinoma (p = 0.0022). (3) N stage: The 5-year survival of patients in N0 stage was 46.9%, compared with 15% for N1 stage patients. The difference was not quite significant (p = 0.081). (4) Portal vein involvement: The 1-year survival was 0% in patients with R0 resections and histologically proven tumor infiltration of the portal vein, compared to 63% for patients with curative resections without portal vein involvement (p = 0.0063). In conclusion our data indicate that extensive retroperitoneal tissue clearance during pancreaticoduodenectomy for ductal pancreatic cancer does not improve survival compared to regional lymphadenectomy restricted to the right side of the mesenteric artery.
UI - 11264079
AU - Grogan JR; Saeian K; Taylor AJ; Quiroz F; Demeure MJ; Komorowski RA
TI - Making sense of mucin-producing pancreatic tumors.
SO - AJR Am J Roentgenol 2001 Apr;176(4):921-9
AD - Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
UI - 11985973
AU - Sohn TA; Yeo CJ; Cameron JL; Nakeeb A; Lillemoe KD
TI - Renal cell carcinoma metastatic to the pancreas: results of surgical management.
SO - J Gastrointest Surg 2001 Jul-Aug;5(4):346-51
AD - Department of Surgery, The Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Baltimore, MD 21287, U.S.A.
Metastatic tumors to the pancreas are uncommon. Renal cell carcinoma is one of the few tumors known to metastasize to the pancreas. The purpose of the current report is to evaluate the surgical management and long-term outcome of patients with metastatic renal cell carcinoma. A retrospective review of patients undergoing pancreatic resection for renal cell carcinomas metastatic to the pancreas or periampullary region initial presentation, other metastatic sites, surgical outcomes, and long-term survival were evaluated. During the 10-year time period, 10 patients underwent pancreatic resection for renal cell carcinoma metastases. Of those, six underwent pancreaticoduodenectomy and two underwent distal pancreatectomy, whereas the two remaining patients underwent total pancreatectomy for extensive tumor involvement throughout the entire gland. The mean time from nephrectomy for resection of the primary tumor to reoperation for periampullary recurrence was 9.8 years (median 8.5 years). The range was 0 to 28 years, with one patient presenting with a synchronous metastasis. The mean age of the patients was 61.2 years with 60% of patients being male and 90% being white. Pathologic findings included histologically negative lymph nodes and negative surgical margins in all patients. One patient had tumor involving the retroperitoneal soft tissue, but final margins were negative. The mean live patient follow-up was 30 months (median = 15 months), with eight patients remaining alive. The Kaplan-Meier actuarial 5-year survival was 75%, with the longest survivor still alive 117 months following resection. The patient with retroperitoneal soft tissue involvement died 4 months after resection. The pancreas is an uncommon site of metastasis for renal cell carcinoma, typically occurring years after treatment of the primary tumor. When the metastatic focus is isolated and the tumor can be resected in its entirety, patients can experience excellent 5-year survival rates. The current report suggests that pancreatic metastases from renal cell carcinoma should be managed aggressively with complete resection when possible.
UI - 12039924
AU - Hochwald SN; Zee S; Conlon KC; Colleoni R; Louie O; Brennan MF; Klimstra
TI - DS Prognostic factors in pancreatic endocrine neoplasms: an analysis of 136 cases with a proposal for low-grade and intermediate-grade groups.
SO - J Clin Oncol 2002 Jun 1;20(11):2633-42
AD - Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
PURPOSE: In some organs (eg, the lung), endocrine tumors are classified on the basis of mitotic rate and necrosis. The purpose of this study was to evaluate prognostic factors in pancreatic endocrine neoplasms recently treated at a single institution. PATIENTS AND METHODS: In 136 patients undergoing surgery from 1979 to 1998, the influence on disease-free survival (DFS) and disease-specific survival (DSS) of tumor size, mitotic rate, vascular invasion, necrosis, metastases, and nuclear grade was determined. Cases were further grouped according to an existing proposed classification system and then regrouped on the basis of mitotic rate (< 2 mitoses per 50 high-power fields v higher) and necrosis (present or absent) into low- and intermediate-grade groups. RESULTS: Correlations with DFS and DSS in univariate analysis included < or = 2 mitoses per 50 high-power fields (P =.001, P =.002), vascular invasion (P =.02, P =.04), size < or = 2 cm (P =.01, P =.05), metastases (P =.0002, P =.07), necrosis (P =.002, P =.16), and nuclear grade (P =.04, P =.33), respectively. By multivariate analysis, for DFS, tumor necrosis and presence of metastases retained significance (P =.01, P =.04, respectively). For DSS, only mitotic rate was a prognostic factor (P =.02). Among the 18 macroadenomas, eight borderline tumors, and 48 low-grade carcinomas, there was no significant difference in DSS between any groups (P =.3). However, in evaluating our newly proposed groups, the differences in DFS and DSS between low- and intermediate-grade groups were highly significant (P =.0007, P =.006, respectively). CONCLUSION: Pancreatic endocrine neoplasms exhibit a spectrum of biologic behavior, and the proposed benign (macroadenoma) and borderline groups contain potentially aggressive tumors. An alternative system based on mitotic rate and necrosis correlates strongly with survival without specifically designating any group as benign.
UI - 11591926
AU - Dahan H; Soyer P; Cochand-Priollet B; Abitbol M; Coumbaras J; Pelage JP;
TI - Boudiaf M; Rymer R [Imaging of primary carcinoid tumor of the pancreas]
SO - J Radiol 2001 Sep;82(9 Pt 1):987-90
AD - Service de Radiologie Viscerale et Vasculaire, Hopital Lariboisiere AP-HP, 2, rue Ambroise Pare, 75475 Paris cedex 10. firstname.lastname@example.org
PURPOSE: To describe the imaging features of primary carcinoid tumors of the pancreas. Materials and Methods. The sonographic and computed tomographic examinations of six patients with pathologically proven primary carcinoid tumor of the pancreas were retrospectively reviewed. RESULTS: In all cases, sonography showed hypoechoic and well circumscribed tumors. CT scan demonstrated hypoattenuating tumors on noncontrast images, with variable enhancement on postcontrast images. Small tumors (less than 2cm in diameter) were homogeneous whereas larger tumors were heterogeneous with areas of cystic necrosis. In two cases, enlarged lymph nodes were found in association with ascitis. In one case, hepatic metastases were present. CONCLUSION: Primary carcinoid tumors of the pancreas display various and non specific imaging features. Small tumors are likely to be homogeneous and hypervascular whereas larger tumors are heterogeneous and hypovascular.
UI - 11976861
AU - Hannesson PH; Lundstedt C; Dawiskiba S; Stridbeck H; Ihse I
TI - Transhepatic intravascular ultrasound for evaluation of portal venous involvement in patients with cancer of the pancreatic head region.
SO - Eur Radiol 2002 May;12(5):1150-4
AD - Department of Radiology, University Hospital, Lund, Sweden. email@example.com
The aim of this study was to evaluate the ability of intravascular ultrasound to diagnose tumor involvement of the portal and the superior mesenteric veins using the preoperative percutaneous, transhepatic approach, and to compare the findings with those made at concomitant direct portography, surgery, and histopathological examination. Ten patients with a preoperative diagnosis of a resectable tumor in the pancreatic head region were examined with percutaneous transhepatic portography (PTP) and intravascular ultrasound (IVUS). The surgeon's intraoperative evaluation and the histopathological examination in combination revealed tumor involvement of the portal or superior mesenteric veins in six of the ten patients. Percutaneous transhepatic portography suggested tumor involvement of the veins in six patients but two of the examinations were false positive and another two were false negative. Intravascular ultrasound showed signs of tumor involvement in eight patients. The examination was, however, false positive in two patients, but there were no false negatives. Complications of the percutaneous transhepatic procedure occurred in six patients including severe pain, bleeding, and related death. Percutaneous transhepatic IVUS of the portal vein may be a useful tool in the preoperative selection of the subgroup of patients with tumor of the pancreatic head region that could benefit from surgery. There is a need for technical improvement as well as studies with larger patient series to definitely decide the role of the technique.
UI - 11401926
AU - Weinberg DS; Heyt GJ; Cavanagh M; Pitchon D; McGlynn KA; London WT
TI - Cholecystokinin and gastrin levels are not elevated in human pancreatic adenocarcinoma.
SO - Cancer Epidemiol Biomarkers Prev 2001 Jun;10(6):721-2
AD - Division of Gastroenterology and Hepatology, Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA. firstname.lastname@example.org
UI - 11837002
AU - Kokhanenko NIu; Amosov VI; Nikonchuk NP; Mosiagina SG; Bryzgalova SV;
TI - Dundukov NN; Kovaleva OV [Significance of ultrasound examination and computed tomography in the diagnosis of pancreatic cancer]
SO - Vestn Khir Im I I Grek 2001;160(5):61-5
The diagnostic sensitivity of USI for localization of a tumor of the pancreatic head was 89.3%, specificity--69.7%, exactness--84.4%. When the tumor was localized in the body-tail these indices were 85.7%, 73.4% and 78.7% respectively. The sensitivity of CT in cases when the localization of the tumor was in the head of the pancreas was 84.9%, specificity--72.2%, exactness--76.5%. When the tumors were localized in the body-tail these indices were 89.5%, 75.4% and 80.9% respectively. An associated analysis of information of the ultrasound and CT concerning the structure of the pancreas made the exactness of the diagnosis of malignization as high as 87.6%, specificity as high as 81.3%, sensitivity as high as 93.7%. The informative value of USI and CT depended on the tumor size, the presence of an inflammatory reaction of the pancreas, the character of a complication, if any, or of their combinations, localization and size of the pathological focus. In the investigation no alterations in the pancreas characteristic only of cancer were found. Thus, a comparison of diagnostic potentials of USI and CT has shown that one method does not exclude, but only supplements the other. CT gives more reliable results in the assessment of the process spread to the surrounding tissues and regional lymph nodes, especially when the tumor is localized in the area of the pancreas tail. USI helps to make more exact assessment of the involvement in the process of the common bile duct, pancreatic duct, and of the visceral vessels by the Doppler examination.
UI - 11893501
AU - Ciccarelli FD; Doerks T; Bork P
TI - AMOP, a protein module alternatively spliced in cancer cells.
SO - Trends Biochem Sci 2002 Mar;27(3):113-5
This article describes a new extracellular domain--AMOP, for adhesion-associated domain in MUC4 and other proteins. This domain occurs in putative cell adhesion molecules and in some splice variants of MUC4. MUC4 splice variants are overexpressed in several tumours; in particular, they are highly expressed in pancreatic carcinomas but not in normal pancreas. The presence of AMOP in cell adhesion molecules could be indicative of a role for this domain in adhesion.