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PubMed2006

The clear cell variant of solid pseudopapillary tumor of the pancreas: a previously unrecognized pancreatic neoplasm.

Solid pseudopapillary tumor is a rare but distinctive pancreatic neoplasm whose cell phenotype remains a mystery. We report 3 cases of a previously undescribed variant of solid pseudopapillary tumor of the pancreas composed almost entirely of multivacuolated clear cells (>90%). The cytoplasmic vacuoles did not contain glycogen, mucin, or lipid but seemed to be formed by dilatation of the endoplasmic reticulum and mitochondria. The tumors displayed prominent trabeculae and a solid growth pattern but lacked the characteristic pseudopapillary pattern of the classical solid pseudopapillary tumor. In contrast, the clinical features, gross characteristics, and immunoprofile were similar to those of classical solid pseudopapillary tumor. Two of the patients were young adult females with well-demarcated tumors involving the body and tail of the pancreas. Tumor cells showed immunoreactivity for vimentin, CD10, CD56, synaptophysin, and nuclear accumulation of beta catenin. In 2 patients, 1 male and 1 female, the tumors were discovered incidentally. Despite vascular invasion in one of the tumors all 3 patients are disease free after distal pancreatectomy. Clues to distinguish the clear cell variant of solid pseudopapillary tumor from endocrine pancreatic tumor composed of clear cells, clear and foamy cell variants of ductal carcinoma, metastatic renal cell carcinoma, serous cystadenoma and ectopic adrenocortical nodules are provided.

Adenocarcinoma, Clear Cell↗
PubMed2005

Fine-needle aspiration cytology of pancreatic somatostatinoma: the importance of immunohistochemistry for the cytologic diagnosis of pancreatic endocrine neoplasms.

Pancreatic somatostatinoma is a rare pancreatic endocrine neoplasm representing as little as 1% of pancreatic endocrine neoplasms (PENs). The histologic features of this tumor are like those of other PENs, except that it commonly forms acinar structures and often has cells with abundant, granular cytoplasm. We have recently encountered two of these neoplasms sampled by endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA). We discuss the cytologic and immunohistochemical findings of these two cases and the cytologic similarities these neoplasms share with pancreatic acinar-cell carcinoma (PACC). We review the cytologic features of PEN and PACC and discuss the importance of cell block immunohistochemistry in the diagnosis of pancreatic neoplasia sampled by EUS-guided FNA.

Aged↗
PubMed1996

The case for parallel classification of biliary tract and pancreatic neoplasms.

Most primary epithelial neoplasms found in the intrahepatic and extrahepatic biliary tracts and the pancreas have similar histologic appearances. The degree of similarity of tumor types is greater than is commonly appreciated and extends to rare neoplasms. It has been suggested that parallel classifications could be used for tumors arising in these sites. However, significant differences in terms used to denote histologically identical neoplasms are found in the current World Health Organization (WHO) classification of biliary tract tumors and the new WHO classification of exocrine pancreatic neoplasms. Mutations of oncogenes and abnormalities of tumor suppressor genes found in ductal adenocarcinomas from the two sites are also similar, although they have somewhat different frequencies. These histologic and molecular similarities provide strong support for the use of parallel descriptive diagnostic terminology for neoplasms arising in the pancreas and the biliary tract. The revised WHO classification of exocrine pancreatic neoplasms accommodates most types of biliary tract neoplasms and provides a new basis for standardization of nomenclature.

Biliary Tract Neoplasms↗
PubMed1975

[Serum lipase activity and endoscopic retrograde pancreatography in chronic pancreatitis and pancreatic neoplasm (author's transl)].

Serum lipase activity was measured in 360 patients with the clinical suspicion of chronic pancreatic disease, 60 of them also having the lipase evocation test (serum lipase activity before and after pancreatic stimulation with secretin and pancreozymin). Of 48 with chronic pancreatitis (40 confirmed at operation) the diagnosis was made by endoscopic retrograde pancretography in all but one. Serum lipase activity was abnormal in 38. Without those cases associated with pancreatic insufficency, serum lipase activity-spontaneously and after the evocation test-was abnormal in 46 patients. Nine of 10 patients with papillary stenosis had the diagnosis confirmed at surgery, the pancretographic findings co-inciding with the surgical ones in all instances. All the five patients with abnormally high serum lipase activity also had chronic pancreatitis on pancreatography. In all of the 18 patients with pancreatic neoplasm pancreatography gave the same results as operation or post-mortem findings. In eight of these serum lipase activity was spontaneously elevated. The lipase evocation test was shown to be most effective if 2 C.H.R.- U/KG-h each of pancreozymin and secretin were administered. Serum lipase results were falsely positive in 17 of 300 patients with clinical suspicion of pancreatic disease but normal pancreatographic findings.

Adult↗
PubMedDate not supplied

Postoperative pancreatic fistula following surgery for gastric and pancreatic neoplasm; is distal pancreaticosplenectomy truly safe?

BACKGROUND/AIMS: A pancreatic fistula is a potentially fatal complication in digestive tract surgery. The aim of this study was to review the prevention and treatment of pancreatic fistula as performed by our department. METHODOLOGY: Three hundred and seventeen patients with gastric neoplasm and 34 patients with pancreatic neoplasm who underwent surgical resection between 1981 and 2001 at Kochi Medical School were studied. Comparative analysis of the incidence of pancreatic fistulae and the mortality rate was carried out according to an operation type and time. RESULTS: Among the 317 patients who underwent total gastrectomy due to gastric neoplasm, 30 (9.5%) showed pancreatic fistulae. The incidence of pancreatic fistulae in patients who underwent distal pancreatectomy for pancreatic neoplasm was 29.4%. The mortality rate of patients who underwent total gastrectomy was 4.4% and there was a tendency for mortality rate to decrease in the second decade compared to the first. The mortality rate of patients who underwent distal pancreatectomy was 5.9%. CONCLUSIONS: Mortality rate tended to decrease with advanced operative procedures, however, the incidence of pancreatic fistulae did not decrease. In pancreatic fistulae, it was found that the type of treatment was important. Intraoperative and postoperative drainage management for pancreaticosplenectomy will likely become much more important.

Adolescent↗
PubMed1998

[Clinical efficacy of MRCP for diagnosis of patients with pancreatic neoplasm].

We examined the usefulness of MRCP in pancreatic cancer compared with ERCP. Moreover, it examined in the same way in focal pancreatitis, too. We compare three findings of 1) main pancreatic duct, 2) branches of the stricture part, 3) side of tail main pancreatic duct about ERCP and MRCP. As for the branches of the stricture part, MRCP was poor compared with ERCP but as for the property of the side of the tail main pancreatic duct, MRCP excelled. The study of mass forming chronic pancreatitis was a similar result and was not the one, which excels ERCP in case of qualitative diagnosis. However, we thought that it was not invasively, suitable behind the digestive operation and digestive passage fault, in case of elapse observation and moreover that MRCP is suitable for pick up the pancreatic cancer in our clinic.

Adenocarcinoma↗
PubMed2003

Vascular involvement in pancreatic neoplasm: a comparison between spiral CT and DSA.

The principal criterion for resectability of pancreatic carcinoma is the assessment of vascular involvement. In a prospective evaluation the ability of Spiral CT Angiography (CTA) to detect vascular involvement in 50 patients with pancreatic carcinoma, was proved; DSA was performed later in all patients. In 20 patients, without vascular involvement, a complete concordance was obtained. Of 30 patients with vascular involvement, there was complete concordance between CTA and angiography in 22 patients and discordance in 8 patients. CTA was superior in 2 cases with periadventitial infiltration and in 5 patients with splenoportal confluence thrombosis. DSA was superior in 1 case with infiltration of the superior mesenteric vein. After surgical evaluation, sensitivity of CTA and DSA was 97% and 77%, respectively, and the negative predictive values were 95% and 74%. As compared to DSA, CTA is more rapid and less invasive and can be considered the modality of choice for preoperative work-up of pancreatic neoplasm.

Adenocarcinoma↗
PubMed1980

The combined use of computed tomography and endoscopic retrograde cholangiopancreatography in the assessment of suspected pancreatic neoplasm: a blind clinical evaluation.

Sixty-one consecutive patients suspected of having pancreatic neoplasms had endoscopic retrograde cholangiopancreatography (ERCP) and computed tomography (CT). The ERCP results were 62% accurate, 8% false negative, and 3% failure. The overall accuracy in cases of successful pancreatic duct cannulation was 88%. The results of CT were 76% correct, 5% false positive, 13% false negative, and 6% indeterminate. Excluding ERCP failure, the CT-ERCP diagnosis was identical in 67%. When findings were identical, the accuracy rate was 93%, high than that of either study alone. The ERCP-CT examinations were often complementary and generally led to a more accurate and specific diagnosis.

Adult↗
PubMed1979

Role of angiography in the diagnosis of pancreatic neoplasms.

The vascular architecture of the pancreas has been described, but few reports indicate preoperative accuracy. During the last 3 years, selective superior mesenteric and celiac angiography was performed in 471 patients. In 35 of these patients, additional selective angiography of the superior pancreaticoduodenal and inferior pancreaticoduodenal arteries was performed to reveal the detailed vascular pattern of the pancreas and its surrounding structures. Exploratory surgery was performed in all patients except the four control subjects. The angiographic findings reflected a poorly vascularized infiltrating lesion with invasion of the blood vessels and serpiginous encasements. Peripancreatic extension of the tumor indicated nonresectability. In early pancreatitis, the pancreas showed increased vascularity and occasional stretched vessels. In more advanced pancreatitis, the arteries were prominent and irregular with increased parenchymal accumulation of contrast medium in the capillary phase. In pseudocysts of the pancreas, the only finding was stretching of the vessels around the lesion. A well circumscribed lesion with increased contrast medium in the capillary and venous phases diagnostic of pancreatic adenoma. Pancreatic angiography is an important diagnostic tool in evaluating and staging pancreatic neoplasms.

Acute Disease↗
PubMed2004

Diagnosis of nonprimary pancreatic neoplasms by endoscopic ultrasound-guided fine-needle aspiration.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a proven modality for the diagnosis of primary pancreatic neoplasms. We describe our experience in diagnosing nonprimary pancreatic tumors by EUS-FNA. Cytology files were searched for all EUS-FNA of the pancreas for the period 2000-2002. All cases diagnosed as neoplasms were selected and those diagnosed as nonprimary pancreatic tumors were reviewed and analyzed. One hundred ninety-one of 468 cases were diagnosed as neoplasms. Eleven of these cases were diagnosed as nonprimary pancreatic tumors (2.4% of all diagnoses and 5.7% of all neoplasms). The diagnoses were supported by clinical history (n = 7), cytological findings (n = 11), cell block histology (n = 11), cell block immunohistochemistry (n = 6), and flow cytometry (n = 1). EUS-FNA is a safe and minimally invasive method for the diagnosis of nonprimary pancreatic neoplasms. Evaluation of clinical history, cytomorphology, and ancillary techniques, especially those applied to cell block material, are essential for accurate diagnoses.

Biopsy, Fine-Needle↗
PubMed2000

Immunohistochemistry in the differential diagnosis of acinar and endocrine pancreatic neoplasms.

Histologic differential diagnosis of acinar cell carcinoma (ACC), mixed acinar-endocrine cell carcinoma (MAEC), and pancreatic endocrine tumors (PET) can be difficult but is important because of differences in their clinical behavior. This study investigates the utility of immunohistochemistry (IHC) in this differential diagnosis using immunohistochemical stains that are available in most laboratories. IHC was performed on paraffin-embedded tissue in ACC (n = 6), MAEC (n = 2), and PET (n = 13), using synaptophysin (SYN), chromogranin (CHR), chymotrypsin (CHY), and alpha-1-antitrypsin (AAT). Electron microscopy (EM) was performed in all cases to confirm the diagnosis. Long-term follow-up and death of disease (DOD) was known in all patients. The ACCs stained as follows: CHY (4/6), AAT (3/6), SYN (4/6); CHR was negative in all cases. Both cases of MAEC stained with CHY, AAT, and SYN (2/2); CHR was negative. PET stained as follows: SYN (13/13), CHR (8/13), CHY (4/13), AAT (5/13). In the ACC/ MAEC group, six of eight patients were DOD at mean follow-up of 11 months. Among the PET, two of 16 patients were DOD at mean follow-up of 37 months. Considerable immunophenotypic overlap exists between ACC, MAEC, and PET. Consequently, one can neither confirm nor rule out a diagnosis of ACC or MAEC using generally available immunohistochemical stains alone. These findings support a role for EM in the evaluation of exocrine and endocrine pancreatic neoplasms.

Adult↗
PubMed1985

Induction of unusual pancreatic neoplasms, with morphologic similarity to human tumors, and evidence for their ductal/ductular cell origin.

A variety of pancreatic neoplasms, including giant cell, poorly differentiated or other unusual types, some morphologically similar to those observed in humans were induced in Syrian hamsters. Unclassified or anaplastic forms were also noted in the hamster. The finding of a blood group A-like antigen, which is produced by normal pancreatic ductal and ductular cells, in all of these induced tumors, but none in acinar, insular, and mesenchymal cells, suggests their ductal/ductular cell origin.

ABO Blood-Group System↗
PubMed1988

Pancreatic neoplasms: how useful is evaluation with US?

The usefulness of ultrasonography (US) in the evaluation of pancreatic neoplasms was assessed in 51 patients. Indications for US included jaundice (n = 19), pain (n = 16), weight loss and anorexia (n = 4), clinically palpable mass (n = 3), bleeding in the upper gastrointestinal tract (n = 1), and gastric outlet obstruction (n = 1). Three patients were investigated because of a previous abnormal US examination; in four the mass was an incidental observation. Sonograms were interpreted without knowledge of results from other procedures. Pancreatic masses were detected in 50 patients. Biliary and pancreatic duct obstructions were seen in 29 and 27 patients, respectively. Liver metastases were identified in 16 patients and missed in three that were not detected with either US or computed tomography. Vascular involvement was predicted in 12 patients and missed in four, while lymphadenopathy was seen in 16 and missed in five. Thirty-one cases of unresectable disease were correctly predicted with US. Resectability was not as accurately determined; only seven of 19 "resectable" lesions were successfully removed. US is an effective tool in the detection and preoperative evaluation of pancreatic malignancy.

Adult↗
PubMed1993

Therapeutic strategies in the surgical management of pancreatic neoplasms in the elderly.

The clinical records of all consecutive patients aged 65 and older undergoing surgical treatment for pancreatic neoplasms between January 1980 and January 1992 were reviewed in order to establish a clinical trial based on the morbidity and mortality rates related to the different surgical procedures. In early diagnosed neoplasms, in patients in good general condition, even in the geriatric age a radical surgical procedure is preferred. In other cases, a palliative surgical procedure has to be performed if possible, namely a bilio-digestive anastomosis, associated if necessary with a gastro-enteric anastomosis.

Aged↗
PubMed2004

Differentiation of cystic pancreatic neoplasms and pseudocysts by conventional and echo-enhanced ultrasound.

BACKGROUND AND AIMS: Echo-enhanced sonography is a non-invasive and increasingly used procedure for the differentiation of pancreatic tumors. However, the diagnostic accuracy of this procedure compared to conventional ultrasound for the differential diagnosis of cystic pancreatic neoplasms from pseudocysts has never been investigated in a prospective study. METHODS: Thirty-one patients with a cystic pancreatic lesion at the conventional ultrasound (mean age 57 years, range 36-82 years) were included in the study. Sonography was performed by an experienced examiner who was unaware of the patients' clinical diagnosis. The exact diagnosis was based on histological evidence from biopsy examination (surgical or transabdominal fine needle biopsy for all cystic neoplasms and five pseudocysts), or a follow-up of at least 18 months (four pseudocysts). RESULTS: Of the 31 patients, 19 had cystadenomas, three had cystadenocarcinomas, and nine had pseudocysts. Only 27% of the cystadenomas and 67% of the pseudocysts could be correctly classified by conventional ultrasound. Conversely, 95% of the cystadenomas (P = 0.0001) and all pseudocysts were diagnosed correctly by echo-enhanced sonography. The sensitivity of echo-enhanced sonography with respect to diagnosing cystadenoma was 95% and its specificity was 92%. The corresponding values for pseudocysts were both 100%. CONCLUSION: Echo-enhanced sonography has a high sensitivity and specificity in the differential diagnosis of cystic pancreatic tumors. With this procedure the differentiation of cystadenomas and pseudocysts can be improved. However, histology is the standard of reference.

Adult↗