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Results for “PANCREATIC NEOPLASMS”

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At least 19 recordsLinked to original sources
PubMed2001

Imaging features of pancreatic neoplasms.

Pancreatic masses are common in daily imaging practice. The advent of helical CT and breathold MRI has provided a new impetus to the study of the pancreas not only for the potential of characterizing pancreatic masses and pancreatitis but also because of the more accurate staging of pancreatic neoplasms using this technique. Pancreatic tumors are classified according to its histologic origin. Ductal adenocarcinoma is the most common. Regarding ductal adenocarcinoma, despite the fast evolving imaging techniques promising an earlier diagnosis and an accurate staging, still the prognosis is extremely poor. However, new surgical data indicate that long-term survival although rare, occurs on resected tumors less than 2 cm, without vascular encasement or adenopathy. Logically, early detection and accurate staging of tumors has become the main focussing in pancreatic imaging since it may result in an increase in the survival of these patients. In this context, the role of imaging to identify, characterize and stage pancreatic neoplasms will be described. Furthermore, the key radiological features of a gamut of more uncommon pancreatic neoplasms will be illustrated. These include other exocrine epithelial tumors (anaplastic carcinoma, pancreatoblastoma, acinar cell carcinoma serous cystic pancreatic adenoma, mucinous cystic tumors, intraductal mucinous papillary tumor, and solid pseudopapillary neoplasm), endocrine tumors or islet cell tumors (insulinoma, gastrinoma, gluconoma, vipoma, non-functioning tumors), rare non-epithelial tumors (lymphoma, teratoma) and metastases to the pancreas.

Diagnostic Imaging↗
PubMed2007

Expression of extracellular matrix metalloproteinase inducer (EMMPRIN/CD147) in pancreatic neoplasm and pancreatic stellate cells.

EMMPRIN (extracellular matrix metalloproteinase inducer, CD147) participates in the progression of various malignancies by stimulating the synthesis of specific matrix metalloproteinases (MMP) from peritumoral fibroblasts. In the present study, the expression and functional role of EMMPRIN was investigated in pancreatic neoplasm. QRT-PCR, immunohistochemistry, immunoblot, and ELISA analyses were used to analyze the expression, localization, and release of EMMRPIN. Silencing of EMMPRIN was performed using siRNA oligonucleotides, and functional consequences were assessed using growth assays, invasion assays, as well as MMP1/MMP2 and VEGF ELISA. EMMPRIN mRNA levels were 2.2-fold increased in pancreatic cancer (n = 52) and 2.0-3.5-fold increased in other pancreatic neoplasm (n = 105), but unchanged in chronic pancreatitis (n = 10) compared to normal pancreatic tissues (n = 9). Strong and predominantly membranous immunostaining was observed in the cancer cells and surrounding stromal cells. EMMPRIN serum levels were also significantly increased in pancreatic cancer patients (n = 44) (4.13 +/- 0.28 ng/ml) with an AUC of 0.97 compared to healthy volunteers (n = 29) (0.95 +/- 0.16 ng/ml; p < 0.0001) and with an AUC of 0.74 compared to chronic pancreatitis patients (n = 20) (2.98 +/- 0.5 ng/ml; p = 0.0021). EMMPRIN silencing did not significantly affect anchorage-dependent or -independent growth of pancreatic cancer cells. In contrast, EMMPRIN silencing in pancreatic stellate cells slightly repressed VEGF and MMP2 levels but strongly increased pro-MMP1 expression under coculture conditions. In conclusion, Increased EMMPRIN expression is present in different pancreatic neoplasm, likely representing a tumor-specific reaction with the potential to modulate the tumor microenvironment rather than a mere reflection of an activated stroma.

Animals↗
PubMedDate not supplied

Postoperative pancreatic fistula following distal pancreatectomy for pancreatic neoplasm; can pancreatic fistula be prevented?

BACKGROUND/AIMS: Pancreatic fistula is a potentially fatal complication in pancreatic surgery. The objective of this study was to analyze the incidence of pancreatic fistula in patients who underwent distal pancreatectomy for pancreatic neoplasm. METHODOLOGY: Forty-seven patients who underwent distal pancreatectomy for neoplasm of the pancreas at Kochi Medical School between October 1981 and December 2002 were studied. Comparative analysis was carried out to identify the correlations between the incidence of pancreatic fistula and parameters of preoperative evaluation, intraoperative procedure, and postoperative laboratory investigation. RESULTS: The incidence of pancreatic fistula in patients who underwent distal pancreatectomy for pancreatic neoplasm was 27.7%. Intraoperatively, the frequency of pancreatic fistula was significantly high in patients who underwent distal pancreatectomy without lymph node dissection and ligation of the splenic artery. No significant difference was recognized between the conventional surgical division and auto suture staple groups, however, in the ultrasonically activated scalpel (USAS) group, no pancreatic fistula was observed. A multivariate analysis revealed that independent high incidence of pancreatic fistula were 1) the situation of the tumor at pancreatic body, 2) the procedure of D2 lymph node dissection, and 3) the ligation of the root of splenic artery. In the group with the presence of pancreatic fistula, the serum amylase level on the first postoperative day was significantly higher than that in the group without fistula. CONCLUSIONS: Our findings supported that pancreatic fistula may be preventable by use of the USAS and treatment of acute pancreatitis in the early postoperative stage.

Adult↗
PubMed2003

State-of-the-art imaging of pancreatic neoplasms.

Pancreatic imaging with multidetector CT allows multiphase acquisition of thin slices in a single breath-hold and is especially valuable in obtaining isotropic three-dimensional reformations that improves our ability to provide accurate pre-operative vascular mapping. Advanced MR technology allows faster imaging of pancreas, thus facilitating MR cholangiopancreatography. Use of tissue-specific MR contrast agents, endoscopic ultrasound and PET in pancreatic imaging has evolved considerably. This review article discusses the role of CT, MR, endoscopic ultrasound and PET imaging in pancreas.

Adenocarcinoma↗
PubMedDate not supplied

[Ultrasonography of pancreatic neoplasms].

Pancreatic tumors are the fourth cause of death in Occident: the 5-year-survival rate is less than 5% because of diagnostic difficulties, low clinical expression at early stage, and complexity of the surgical treatment. The role of ultrasound (US) is in early diagnosis, because also in early cancer there could be lymphatic spread or peritoneal involvement. There are multiple modalities to study the pancreas with US: abdominal US, "contact" US (endosonography and intra-operative or laparoscopic US). The first is not invasive, cheap but limited by extrinsic and intrinsic factors, the latter are respectively characterized by high cost, and need of endoscopic specialists for endosonography, the complementarity to laparoscopy or surgery for the laparoscopic/intraoperative US. Abdominal US is the first diagnostic step for the pancreas, but it is not affordable in 15-25% of patients, because of meteorism. In all the other cases, it represents the pancreas with a good contrast between the normal parenchyma and tumoral tissues. Abdominal US, together with biopsy, can define the resectability. Ecoendoscopy is actually dedicated to small tumors staging, but recent studies demonstrate the same results achieved by spiral TC. Laparoscopic US is a second step imaging in patients already selected for surgery. The first finality in US evaluation of tumor masses is early diagnosis of pancreatic cancer; it can give to some of these patients the opportunity of undergoing to surgical treatment. This could be achieved by a proper use of the moititude of ultrasonic abdominal explorations that are requested in daily practice. US, together with CT and MR, can define the resectability of the tumor, with further supplementar evaluation by mean of laparoscopic US. Intraoperative US is now indicated for planning and guiding the surgeon in resection of the pancreatic cancer.

Humans↗
PubMed2004

Palliation of pancreatic neoplasms.

Pancreatic adenocarcinoma accounts for 80% of pancreatic tumours. The majority are unresectable at diagnosis and only 10% of patients survive to 1 year. Therefore, selection of appropriate palliative procedures for jaundice, gastric outlet obstruction or pain is a vitally important aspect of the management of these patients. Overall survival is equivalent following surgical or non-surgical palliation of biliary obstruction. Operative biliary bypass is a more major intervention but is associated with longer relief of symptoms and fewer readmissions compared to non-operative procedures. Prognostic factors such as histopathology, presence of metastatic disease and C reactive protein levels may allow better prediction of survival, therefore aiding selection of the most appropriate palliative techniques.

Abdominal Pain↗
PubMed1994

Embolization in the palliation of complications of inoperable primary pancreatic neoplasms.

Primary pancreatic neoplasm typically presents at an advanced stage where surgical management may not be feasible. These patients are often symptomatic due to biliary obstruction but problems may also include gastrointestinal bleeding and endocrinological complications. We describe two cases illustrating the use of palliative embolization in the control of biochemical and haemorrhagic complications of primary pancreatic neoplasm. In one case, massive gastrointestinal bleeding from an inoperable primary pancreatic carcinoma was controlled by two embolization procedures to produce devascularization of the primary lesion. In a second case, life-threatening hypercalcaemia was thought to be due to secretion of a parathormone-like material from an inoperable islet cell tumour. There was no evidence of liver metastases and the pancreatic mass was embolized, following which serum calcium was reduced to near normal levels with considerable clinical improvement. We conclude that there is a role for embolization of inoperable primary pancreatic neoplasm in the palliation of biochemical or haemorrhagic complications of these tumours.

Adenocarcinoma↗
PubMed1999

Cystic pancreatic neoplasms.

Cystic pancreatic neoplasms comprise a heterogeneous group of pathologic entities. Mucinous cystic tumors and serous cystadenomas account for more than 75% of reported cases. While serous cystadenomas are almost uniformly benign, mucinous cystic tumors all have malignant potential and must be treated as such. While both clinical and biochemical features can distinguish among the various cystic pancreatic lesions, surgical resection is often required for both definitive diagnosis and treatment. When surgery is performed, benign lesions should be treated with pancreatic parenchymal sparing procedures if anatomy permits. Standard surgical oncologic principles should be employed when treating indeterminate or malignant lesions.

Cystadenocarcinoma, Mucinous↗
PubMed2004

Diagnostic imaging of cystic pancreatic neoplasms.

Cystic pancreatic neoplasms are being diagnosed with growing frequency due to improving imaging technologies and increasing clinician awareness. Distinguishing cystic neoplasms from pseudocysts and discriminating among the various cystic neoplasms is essential to appropriate management. The backbone of diagnosis of these tumors continues to be cross-sectional imaging by CT and MRI. Despite refinements in technology and significant progress in characterizing these lesions, the overall accuracy of CT and MR is limited. EUS, especially as means of FNA, will have an increasing role in the evaluation of selected cases as experience grows. No radiologic investigation can reliably distinguish cystic neoplasms from pseudocysts nor differentiate among cystic neoplasms in all cases. For uncertain lesions, surgeons should favor either careful observation with serial imaging or surgical resection.

Cystadenoma↗
PubMed2000

Eosinophilic pancreatitis: a rare entity that can mimic a pancreatic neoplasm.

Eosinophilic pancreatitis is a rare disorder that is frequently diagnosed only after pancreatic resection for suspected pancreatic tumor. It typically occurs in the setting of either eosinophilic gastroenteritis or the hypereosinophilic syndrome. Isolated eosinophilic infiltration of the pancreas is less common. We describe a case of a 36-year-old man who presented with the clinical symptoms of acute pancreatitis. Radiologic evaluation revealed an obstructive pancreatic lesion suspicious for carcinoma. Pathologic examination of the resection specimen revealed a dense infiltrate of eosinophils in the pancreas. Although an uncommon condition, eosinophilic pancreatitis is a syndrome lacking well-defined causes that can be associated with eosinophilic gastroenteritis, a treatable condition, or the potentially fatal hypereosinophilic syndrome. While the radiographic features of this condition can vary widely, eosinophilic infiltration of the pancreas with or without involvement of the gastrointestinal tract is the pathologic feature common to all of the previously reported cases.

Adult↗
PubMed1984

Expression of laminin in pancreatic neoplasms and in chronic pancreatitis.

The distribution of laminin, a basement membrane glycoprotein, was studied by immunohistological techniques in 10 samples of normal pancreatic tissue, in 15 samples of chronic pancreatitis, and in 33 pancreatic neoplasms. Sections of formalin-fixed, paraffin-embedded specimens were pretreated with pepsin and immunostained for laminin. As judged by the expression of laminin, normal pancreatic glands were surrounded by a continuous, intact basement membrane. In chronic pancreatitis the basement membrane was also mainly continuous, but focally weaker and thinner than around normal glands. In pancreatic adenocarcinomas laminin was irregularly distributed and in large areas totally absent. In anaplastic carcinomas no extracellular laminin was seen, but two cases showed some intracellular laminin in a punctate pattern. The findings suggest that these cancers have defects in the deposition of a basement membrane or that it is degraded. Our data suggest that the integrity of the basement membrane correlates with the degree of malignancy in ductal adenocarcinomas, but this is not the case for mucinous cystic neoplasms or for islet cell tumors. In these neoplasms a nearly intact basement membrane was seen both in malignant tumors and in their benign counterparts.

Adenocarcinoma↗
PubMed2001

Endoscopic ultrasonography in the diagnosis and staging of pancreatic neoplasms.

BACKGROUND: Pancreatic cancer is the fourth leading cause of death among Americans. Twenty-eight thousand cases of pancreatic cancer are diagnosed annually and about the same number of patients die of pancreatic cancer every year. Most patients with pancreatic cancer are diagnosed when the tumor is 3 cm or more in diameter. Most pancreatic cancers are metastatic at the time of diagnosis and the median survival is only 18-20 mo. Overall, actual 5-yr survival is about 10% and has not changed much over several decades. Curative surgical resection is currently believed to offer the only chance of long-term survival in these patients. Difficulty in the early diagnosis of pancreatic cancer remains a major obstacle in improving outcomes in these patients. Screening for pancreatic cancer is currently not recommended. However, recent developments in endoscopic ultrasound (EUS) and cytological EUS-guided fine-needle aspiration (FNA) allow early diagnosis of pancreatic cancer with histological confirmation. EUS-FNA in conjunction with helical CT also provides reliable preoperative staging of pancreatic tumors. EUS with FNA therefore appears to be a promising tool in the fight against pancreatic cancer.

Biopsy, Needle↗