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CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment?

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.

Adult↗

Radiofrequency ablation of 40 lung neoplasms: preliminary results.

OBJECTIVE: Radiofrequency thermal ablation is a minimally invasive treatment widely used for treatment of liver neoplasms and has also been tested on other types of tumor. Few studies have been published regarding the use of radiofrequency thermal ablation in the treatment of lung neoplasms. This study was performed to evaluate the technical feasibility, the safety, and the efficacy of lung radiofrequency thermal ablation. SUBJECTS AND METHODS: Between February 2002 and March 2003, 18 subjects with unresectable lung neoplasms, four of whom had primary neoplasms and 14 of whom had metastatic neoplasms, underwent lung radiofrequency ablation. The technique was performed percutaneously using a monopolar cooled-tip electrode needle under CT guidance with the patient under general anesthesia. Patients had no more than three nodules with a total diameter of 10 cm and no evidence of extrathoracic disease. A total of 40 nodules were treated in 24 therapeutic sessions. After treatment, patients underwent follow-up every 3 months by CT and nuclear MRI with gadolinium for a median time of 8 months (range, 2-14 months). RESULTS: No evidence of local relapse was discovered in 94.4% of subjects. The treatment was safe and well tolerated. Complications encountered included massive pneumothorax, which occurred in one subject, requiring pleural drainage. Other complications were moderate pneumothorax (also requiring pleural drainage), cough, fever, slight dyspnea, and pain, but these complications were short in duration and successfully treated. CONCLUSION: Radiofrequency thermal ablation is a promising technique in the treatment of patients with lung neoplasms and has been found to be both safe and technically feasible.

Adult↗

Deaths from neoplasms and detection of radionuclides in excised human lungs in the Eordea Basin, Greece.

Lignite contains various trace-metal natural radioactive contaminants. In the Eordea Basin, the most important lignite field in Greece, the authors conducted a proportional mortality ratio (PMR) study that compared the mortality rates of individuals who lived in the basin vs. a control group who resided in the city of Kilkis, over a 30-yr period. The following information was used in the study: (a) municipal registrations of deaths from neoplasms during the period from 1971 to 2000, and (b) detection of radioactive substances in samples obtained from excised lungs of individuals living in Eordea Basin who suffered from neoplasm. The corresponding registrations of deaths from neoplasm of the inhabitants of Kilkis, a city located outside the Eordea Basin, formed the control group. A diachronic increase of the PMR was detected as a result of neoplasms and, particularly, as a result of lung cancer in Eordea Basin. However, the above ratio did not exceed the corresponding PMR recorded in Kilkis. In 20 lung samples obtained from patients who had lived in Eordea Basin, and in 19 lung samples from patients in Kilkis, the activity of the radionuclides of uranium and thorium radioactive decay series, potassium-40, and cesium-137 was not higher than expected. No statistically significant difference was found between the inhabitants of the 2 regions, thus it was concluded that the increase in respiratory-system neoplasms was likely associated with the high prevalence of smoking among the regions' inhabitants. In future studies, a longer observation period and examination of more cases will be necessary to further investigate a possible association between radionuclides and lung neoplasms in the Eordea Basin.

Aged↗

Spleen-preserving pancreatectomy for cystic pancreatic neoplasms.

Cystic neoplasms of the pancreas are an uncommon entity comprising fewer than 1 per cent of all pancreatic neoplasms. The guidelines for management of these tumors, specifically, the extent of resection, are unclear. Formerly, a distal pancreatectomy including the spleen was performed for tumors in the tail of the pancreas. The importance of preserving the spleen has been well documented; however, there are few reports of spleen-preserving pancreatectomy for cystic neoplasms of the distal pancreas. We report two patients who underwent spleen-preserving pancreatectomy for mucinous cystic neoplasms in the tail of the pancreas. Both patients were female, ages 39 and 65 years. Preoperative preparation included administration of vaccinations and subcutaneous somatostatin. Operative technique emphasized division of the splenic artery and vein beyond the tip of the distal pancreas without mobilization of the spleen. The pancreas was transected with a vascular stapler. Fibrin glue was applied to the margin of the pancreas. The operative blood loss, duration of operation, and postoperative hospital stay were 150 and 250 mL, 150 and 180 minutes, and 7 and 9 days, respectively. The pathology revealed both lesions to be mucinous cystic neoplasms. The patients recovered and at 6-month follow-up were without complaints and in good health. Spleen-preserving pancreatectomy is rapid and associated with minimal morbidity. This procedure should be considered in the surgical management of cystic neoplasms in the tail of the pancreas.

Adenocarcinoma, Mucinous↗

[Primary nontransitional neoplasms of the bladder].

Revision of all primitive tumours of the bladder diagnosed in our Service between July 1990 and July 1998. Among a total of 703 neoplasms of the bladder only 14 were non-transitional primitive tumours, accounting for just 1.98%. Eleven were malignant neoplasms with a diagnosis of epidermoid carcinoma in nine cases, one adenocarcinoma and one bladder adenocarcinoma. The other three were benign tumours: one haemangioma and two leiomyomas. From a clinical perspective, the predominant symptom was haematuria, followed by irritative symptoms. The two leiomyomas were accidental findings during a gynaecological examination (ultrasound) and a diagnostic examination for a nephritic colic (urography). The diagnostic means used and the extension studies were the same as used for transitional neoplasms. In general, treatment of benign neoplasms was partial cystectomy or transurethral resection while it was radical surgery for the malignant tumours when the existing criteria were an indication for that type of surgery (cystoprostatectomy with bypass), since there are no definite criteria with regards to therapy due to the low incidence of these tumours. Only three of the 11 patients with malignant neoplasms are still alive. All the others died within one year of diagnosis, an evidence of the aggressiveness of these tumours. These cases were considered primitive bladder tumours once it was concluded that there was no relation with any previous or simultaneous transitional neoplasms and that there had been no primitive tumour in a different organ.

Adult↗

Intracranial neoplasms in Ibadan, Nigeria.

OBJECTIVE: To determine the pattern of histopathological variants of intracranial neoplasms, relative distribution of the variants in the age groups and also to determine the gender differences that exist in these tumours. DESIGN: Case control study. SETTING: Department of Pathology, University College Hospital, Ibadan, Nigeria. PATIENTS: Two hundred and ten histologically confirmed cases of intracranial neoplasms seen during eleven-year period (1980 to 1990) were analysed. INTERVENTIONS: Slides of tumours stained with haematoxylin and eosin, reticulin and phosphotungstic acid haematoxylin. RESULTS: Two hundred and ten intracronial neoplasms comprising 172 primary and 48 secondary neoplasms were seen. One hundred and thirty five neoplasms occurred in adults and 75 in children. There was no gender difference, the ratio being 1:1. Gliomas accounted for the largest group of tumours followed by metastases to the brain. Of the gliomas, astrocytoma was the commonest. Craniopharyngiomas were found to be common in children. Germ cell tumours were found to be uncommon. CONCLUSION: Gliomas are the commonest group of intracranial neoplasms in both adults and children. This is followed by metastatic tumours. Tumours of the sella turcica are predominantly found in children. Involvement of the brain in disseminated Burkitt's lymphomas is predominantly found in Africans as the Burkitt's tumour is uncommon in non Africans.

Adolescent↗

Assessment of proliferative activity in ovarian neoplasms by flow and static cytometry. Correlation with prognostic features.

We undertook a prospective flow and static cytometric study of proliferative activity in 74 malignant, borderline and benign ovarian neoplasms. Proliferative activity as assessed by S phase fraction (SPF), and immunostaining of tissue sections with Ki-67 antibody was compared with prognostically important clinicopathologic features. Malignant neoplasms had higher median percentage Ki-67 staining (27.6%) than borderline (12.3%) and benign (2.7%) tumors (P less than 0.05). Percentage Ki-67 staining correlated with SPF, DNA index, architectural grade, nucleolar grade, and mitotic count in malignant tumors; with nucleolar grade in benign tumors and with none of these variables in borderline tumors. Similarly, malignant neoplasms had a higher median SPF (11.5%) than borderline (3.4%) and benign (2.9%) neoplasms (P less than 0.05). In malignant neoplasms, SPF correlated with percentage Ki-67 staining, DNA index, age, and stage, but with none of these in borderline or benign neoplasms.

Aged↗

Orbital neoplasms in cats: 21 cases (1974-1990).

Squamous cell carcinoma was the most common neoplasm found in a review of case records of 21 cats with histopathologically confirmed orbital neoplasms. Other neoplasms found were lymphosarcoma, undifferentiated carcinoma, malignant melanoma, adenocarcinoma, fibrosarcoma, chondroma, and hemangiosarcoma. Three (14%) neoplasms were primary, 15 (71%) were secondary, invading the orbit from adjacent tissues, and 3 (14%) were a manifestation of multicentric disease. The most common clinical sign was exophthalmia, followed by chronic epiphora, enophthalmia, and strabismus. Mean survival time after diagnosis was 1.9 months. Ten cats were euthanatized at the time of diagnosis because of extensive disease. Mean survival time of the other 11 cats was 4.3 months. Skull radiography was helpful in diagnosing orbital neoplasms in 8 of 11 cats that had invasion of the orbit by adjacent neoplasms.

Adenocarcinoma↗

Fine needle aspiration of pancreatic cystic epithelial neoplasms.

Pancreatic cystic epithelial neoplasms present diagnostic challenges in cytology. An accurate diagnosis is important since the prognosis and treatment may vary. We report the cytologic features in fine needle aspirates of four cases of cystic neoplasms of the pancreas (two micro-cystic adenomas, one mucinous cystic neoplasm and one mucinous cystadenocarcinoma). Smears were evaluated as to their cellularity, content and predominant cell type. Aspirates from the microcystic adenomas yielded hypocellular material with rare strips of cuboidal cells having bland nuclei and pale cytoplasm. No mucinous material was identified in the background, but the cells stained positively with periodic acid-Schiff stain. Smears from the mucinous cystic neoplasm were moderately cellular and contained abundant mucinous material. The columnar epithelial cells were arranged in tight sheets, clusters and strips. Most cells had benign nuclear features with focal mild nuclear atypia. Key cytologic findings noted in the mucinous cystadenocarcinoma were moderate cellularity, loose clusters of cells, single cells, overt malignant nuclear features and occasional signet ring cells. Pancreatic pseudocysts can be distinguished from pancreatic cystic epithelial neoplasms by the predominance of histiocytes and inflammatory cells and absence or paucity of epithelial cells. To differentiate microcystic adenomas from mucinous cystic neoplasms, the above criteria coupled with periodic acid-Schiff and mucin staining should effectively differentiate these diagnostic entities.

Aged↗

Hemopoietic neoplasms in lethally irradiated mice repopulated with bone marrow cells carrying the human c-myc oncogene: a repopulation assay.

Bone marrow (BM) cells from two transgenic mice carrying the human c-myc oncogene were separately harvested, and each sample was injected into 25 lethally irradiated mice. We observed the contribution of the myc gene to the occurrence of hemopoietic neoplasms in the BM-repopulated mice, establishing a new experimental system for analyzing oncogene expression in the hemopoietic system in vivo. The hybrid gene that was transferred into the original transgenic mice was a combination of the human c-myc gene with a regulatory unit consisting of a murine immunoglobulin-heavy chain with an SV40 early-T promoter gene (Ig/Tp-myc). Among the transgenic lines, the tested BM cells were chosen from two lines that had been low-prone in leukemia; in these lines hemopoietic neoplasms did not appear for greater than or equal 200 days after birth. Lethally irradiated controls received BM cells from litters of transgenic mice that did not carry c-myc. The lifetime incidence of hemopoietic neoplasms was 94% and 91% in the two groups of mice repopulated with myc+ BM. By contrast, only 15% of control mice with myc- BM developed hemopoietic lesions. The incidence of hemopoietic malignancies combined with nonthymic lymphomas and myeloma cases (88% and 65%) was higher in the repopulated mice than the incidence of pre-B cell lymphomas in the original transgenic lines (56%). Thirty-two of the 40 myc+ mice that were examined showed the presence of the transferred gene in either the normal hemopoietic tissue or in the hemopoietic neoplasm. Furthermore, 18 of 22 hemopoietic neoplasms studied by Northern hybridization expressed mRNA from the transgenic gene; in other four neoplasms, expression was weak or absent.

Animals↗

[CHL prevent colon neoplasms in mice and its selective inhibition on COX-2].

BACKGROUND & OBJECTIVE: Chlorophyllin (CHL) was proved to have strong anti-inducement effect toward many mutagens and epicarcinogens. This study was to explore effect of CHL in preventing colon neoplasms in mice induced by dimethylhydrazine (DMH), and the selective inhibition on cyclooxygenase 2(COX-2). METHODS: The colorectal neoplasms were induced with DMH in mice and the different dose of CHL were administered in different phases, then the prevention of colorectal neoplasms by CHL was examined; The IC50 and growth curve of HT29 cells were measured with MTT method after treated with CHL; The effect of CHL on the expression of COX-1 mRNA and COX-2 mRNA in HT29 cells were measured with RT-PCR method; The effect of CHL on the expression of COX-2 protein and NF-kappaB protein were measured with western blot and immunohistochemistry methods. RESULTS: The incidence of colon cancer, average tumor amount, and percentage of carcinoma in CHL group were significantly lower than those in DMH group (P< .05); CHL could inhibit the growth of HT29 cells. The effects were dose dependent; CHL could selectively inhibit the expression of COX-2mRNA in HT29 cells,the expression of COX-2 protein in colon neoplasms and HT29 cells, and the expression of NF-kappaB protein in colon neoplasms. CONCLUSIONS: CHL could prevent colon neoplasms in mice induced by DMH and the preventive effect related to selective inhibition on COX-2, furthermore, the inhibition of CHL on COX-2 was realized by inhibiting NF-kappaB protein.

Animals↗

Image-directed percutaneous FNAC of ovarian neoplasms.

Fine needle aspiration of ovarian neoplasms is a relatively less frequented area of diagnostic aspiration cytology. Hence, an attempt has been made in the present study to evaluate the current status of Image-directed percutaneous needle aspiration in ovarian neoplasms and to assess its value and limitations in the diagnosis and management of ovarian neoplasms. The present study involves 105 cases of ovarian neoplasms, which were assessed by ultrasound-guided FNAC. Only those cases with adequate material on aspiration and availability of cellblock or biopsy material following FNAC for correlative histopathological study were included in the study. The diagnostic accuracy of ovarian neoplasms in the present study was 89.85%, with a false negative rate of 4.76%. Considering the rapidity and reliability of the procedure with its added advantages like cost-effectiveness and increased patient acceptability, it can be concluded that image-guided FNAC holds a key position in the diagnosis and management of ovarian neoplasms.

Adenocarcinoma↗

Cystic pancreatic neoplasms: 12-year surgical experience.

Cystic pancreatic neoplasms have been increasingly diagnosed in the last years. Resection is recommended in most cases, but their management has not been standardized since an accurate nonoperative differentiation is often difficult. A retrospective review of 30 patients undergoing surgical resection for cystic pancreatic neoplasms between 1993 and 2005 was performed. Median age of the patients was 63 years and 63.5% were female. Twelve patients (40%) were asymptomatic. Twenty-nine had curative resections. Pathologic analysis revealed 13 serous cystadenomas, 9 mucinous cystadenomas, 3 mucinous cystadenocarcinomas, 4 intraductal papillary mucinous neoplasms and 1 solid pseudopapillary neoplasm. Overall mortality was 6.5% (2 patients). Postoperative complications occurred in 12 patients (41%). Pancreatic fistula occurred in 7 cases (24%). Reoperation was required in 2 patients (6.5%). Two patients operated for mucinous cystadenocarcinoma and invasive intraductal papillary mucinous neoplasms died of recurrence at 24 and 7 months postoperatively. Excluding another patient died from other cause, all others are currently alive with no evidence of disease. Diagnostic accuracy for cystic pancreatic neoplasms is still limited. Considering the good prognosis and acceptable morbidity and minimal mortality after surgical treatment in specialized centers, resection seems still justified in most cases.

Adult↗

Neoplasms of the nasopharynx in children.

Neoplasms of the nasopharynx are rare in children, but they threaten the child's life when they do occur. The nasopharynx tends to harbor dysontogenetic neoplasms. After classification into benign and malignant groups, nasopharyngeal neoplasms in children can be further characterized according to the age of the patients in which the clinical manifestations usually appear. Dermoids and teratomas are the most frequently encountered neoplasms of the nasopharynx in infants and may produce airway obstruction and dysphagia. Among the benign tumors of the nasopharynx in children, the juvenile angiofibroma deserves the most attention. With the onset in puberty, these neoplasms may cause recurrent massive bleeding and orbital and intracranial complications. Evaluation of the extent of the neoplasm and the source of the blood supply has been improved with bilateral selective internal and external carotid angiography. Intracranial and orbital invasion is regarded as an indication for radiotherapy. Surgery has been made somewhat safer by preoperative estrogen therapy and angiographic embolization of the major arterial supply. Patients with squamous cell carcinoma of the nasopharynx have immunologic similarities to patients with Burkitt's lymphomia and infectious mononucleosis; The etiologic role of the Epstein-Barr virus is considered. The parts played by radiation therapy, surgery, chemotherapy, and cryosurgery in the treatment of children with carcinoma of the nasopharynx are discussed. The value of radical neck dissection after radiation therapy is critically reviewed. The prognosis in patients with carcinoma of the nasopharynx is better in females than in males and better in children than in adults.

Adolescent↗

[Multiple primary neoplasms].

In the years 1980-1987 in the Department of Internal Diseases, Silesian Medical Academy in Katowice 32 patients were observed with multiple malignant neoplasms of various organs. The time from the diagnosis of the first neoplasm to the appearance of the second one was from 0 to 168 months (mean 61.8 months). The second neoplasm developed in over half the cases (53.1%) after more than 5 years from the first one. The most frequent first neoplasms were: Hodgkin's disease and breast carcinoma, and the most frequent second neoplasm was colonic carcinoma, gastric carcinoma and endometrial carcinoma. The necessity of prolonged observation of patients with malignant neoplasms during many years is stressed.

Adolescent↗

Results of multiparameter studies of T-cell lymphoid neoplasms.

By application of combined structural and functional analyses, most lymphoid neoplasms may be categorized as of T- or B-cell origin. T lymphocyte neoplasms include types of acute and chronic lymphocytic leukemias, certain cutaneous and node-based lymphomas, and lymphomas of thymocytes (convoluted lymphocytic lymphomas). Although much less frequent than B-cell neoplasms, these T-cell neoplasms are important because their recognition has therapeutic and prognostic significance. Relatively specific histopathologic, histochemical, and immunologic criteria have been defined for each neoplasm. These neoplasms are also significant because homogeneous populations of T neoplastic cells have been used successfully in a few cases to study the normal biology of the immune system.

Humans↗

Quantitative relationship between hepatocytic neoplasms and islands of cellular alteration during hepatocarcinogenesis in the male F344 rat.

Hepatocytic neoplasms (nodules and carcinomas) and islands of cellular alteration which display abnormal retention of glycogen on fasting were quantified in F344 male rats at intervals after initiation of hepatocarcinogenesis by the combination of a two-thirds partial hepatectomy with a single treatment with methyl(acetoxymethyl)-nitrosamine during the subsequent peak of DNA synthesis in regenerating livers. In initiated rats fed the liver tumor promoter phenobarbital, yields of neoplasms and islands maintained a constant numerical relationship over time, with one neoplasm emerging for every 1600 islands. Significantly fewer neoplasms developed in rats not fed the phenobarbital, although the numbers of islands observed at 45 and 60 weeks after initiation were not significantly increased by the promoter. The ratio of islands to neoplasms in rats not fed the phenobarbital was about 11,000:1. Dietary phenobarbital appeared to have an effect on initiated hepatocytes (or latent neoplasms) that was not revealed by its effects on the growth and size of the island population.

Animals↗

An ultrastructural cytochemical stain specific for neuroendocrine neoplasms.

Previous work from our laboratory has indicated that the uranaffin reaction, when run under specific conditions, will stain neurosecretory granules. In this ultrastructural cytochemical study, we analyzed the granule-staining properties of 13 normal, 10 abnormal (non-neoplastic), and 138 neoplastic tissues in an attempt to evaluate the specificity of the uranaffin reaction for diagnostic purposes when compared with routinely processed specimens. For the uranaffin reaction, previously fixed tissue stored in buffer was rinsed with 0.9% NaCl and reacted with a 4% aqueous solution of uranyl acetate (pH 3.9) for 48 hours. After three NaCl rinses, the tissue was dehydrated and processed for electron microscopy. The granules of normal or non-neoplastic neuroendocrine cells that stained positively with the uranaffin reaction included pancreatic islet cells, thyroid C cells, adrenal medullary cells, parathyroid chief cells, and the neuroendocrine cells of the intestine. All 42 neuroendocrine neoplasms studied possessed abundant uranaffin-positive granules and included carcinoids, oat cell carcinomas, islet cell neoplasms, medullary carcinomas of the thyroid, pheochromocytomas, carotid body paragangliomas, a pituitary adenoma, Merkel cell carcinomas, parathyroid adenomas, and a neuroblastoma. All 96 control neoplasms that were not classified as neuroendocrine in nature were negative for neurosecretory granules when studied with the uranaffin reaction and included 13 neoplasms derived from endocrine glands, 57 neoplasms from secretory epithelium, 10 of hematopoietic origin, and 16 miscellaneous neoplasms. It was determined that the uranaffin reaction is a useful ultrastructural cytochemical marker for neuroendocrine granules and helped distinguish these cytoplasmic organelles from ultrastructurally similar granules derived from non-neuroendocrine cells.

Adult↗