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- Solid pseudopapillary tumor of the pancreas in children: 15-year experience at a single institution with assays using an immunohistochemical panel. [Journal Article]
- Ann Surg Treat Res 2014 Mar; 86(3):130-5.
The aim of this study was to analyze the clinicopathological characteristics of solid pseudopapillary tumor (SPT) of the pancreas and to utilize an immunohistochemical panel to identify specific markers of the disease.Eleven patients diagnosed with and treated for SPT of the pancreas over the past 15 years were retrospectively analyzed.The 11 patients consisted of 8 females and 3 males, of mean age at operation of 13.5 years (range, 10 to 18 years). The most frequent presenting symptom was abdominal pain and/or mass. One patient was referred with hemoperitoneum due to traumatic tumor rupture. The lesions were located in the body, head and tail of the pancreas in four, four, and three patients, respectively. Mean tumor diameter was 7.9 cm (range, 2.5 to 15 cm). Surgical procedures included distal pancreatectomy with splenectomy in four patients, pylorus preserving pancreaticoduodenectomy in four, distal pancreatectomy in two, and subtotal pancreatectomy with splenectomy in one. Mean follow-up was 60.5 months (range, 15 to 126 months). All patients remain alive without tumor recurrence. Immunohistochemical staining showed that all tumors were positive for β-catenin, progesterone receptor (PR), vimentin, and CD99. However, all tumors were negative for E-cadherin and cytokeratin 7 expression.Patients with SPT of the pancreas have an excellent prognosis after surgical excision. Immunohistochemically, E-cadherin/β-catenin, PR, vimentin, and CD99 would help establish the diagnosis of SPT of the pancreas, although the results of immunohistochemical staining were found to have an indistinct complex immunoprofile.
- Which method of pancreatic surgery do medical consumers prefer among open, laparoscopic, or robotic surgery? A survey. [Journal Article]
- Ann Surg Treat Res 2014 Jan; 86(1):7-15.
The consumers' preferences are not considered in developing or implementing new medical technologies. Furthermore, little efforts are made to investigate their demands. Therefore, their preferred surgical method and the factors affecting that preference were investigated in pancreatic surgery.Six-hundred subjects including 100 medical personnel (MP) and 500 lay persons (LP) were surveyed. Questionnaire included basic information on different methods of distal pancreatectomy; open surgery (OS), laparoscopic surgery (LS), and robotic surgery (RS). Assuming they required the operation, participants were told to indicate their preferred method along with a reason and an acceptable cost for both benign and malignant conditions.For benign disease, the most preferred method was LS. Limiting the choice to LS and RS, LS was preferred for cost and well-established safety and efficacy. OS was favored in malignant disease for the concern for radicality. Limiting the choice to LS and RS, LS was favored for its better-established safety and efficacy. The majority thought that LS and RS were both overpriced. Comparing MP and LP responses, both groups preferred LS in benign and OS in malignant conditions. However, LP more than MP tended to prefer RS under both benign and malignant conditions. LP thought that LS was expensive whereas MP thought the cost reasonable. Both groups felt that RS was too expensive.Though efforts for development of novel techniques and broadening indication should be encouraged, still more investments and research should focus on LS and OS to provide optimal management and satisfaction to the patients.
- [Intraductal papillary mucinous neoplasm of the pancreas]. [English Abstract, Journal Article]
- Dtsch Med Wochenschr 2014 Apr; 139(17):894-7.
The diagnosis of cystic pancreatic lesions is raised more often within the last years. This is due to the fact that diagnostic opportunities and modalities such as endosonography (EUS), magnetic resonance imaging (MRI), magnetic resonance cholangio-pancreatography (MRCP), and computertomography (CT) have both improved and are more widely used. As such new recommendations were needed, since the knowledge on cystic pancreatic lesions has increased after the last consensus statement published in 2006. In this review the main aspects of the recent consensus statements for diagnosis and therapy or in some cases the surveillance strategy of intraductal papillary mucinous neoplasm will be summarized. Main duct IPMN will in most cases in surgically "fit" patients be resected, since the risk of malignancy is high in this entity. In patients with branch duct IPMN a careful "watch and wait" strategy can be applied if no "worrisome features" or "high-risk stigmata" can be detected. MRI is the imaging modality of choice, while EUS should be applied in centers with expertise.
- [Retrospective clinical analysis of heterotopic pancreas misdiagnosed as gastrointestinal stromal tumors]. [English Abstract, Journal Article]
- Zhonghua Wei Chang Wai Ke Za Zhi 2014 Apr 25; 17(4):348-51.
To improve the differential diagnosis and treatment between heterotopic pancreas and gastrointestinal stromal tumor.Clinical and follow-up data of 14 cases who were diagnosed preoperatively as gastrointestinal stromal tumor whereas were confirmed as heterotopic pancreas in the gastrointestinal tract by postoperative pathological results in Renji Hospital from January 2007 to June 2013 were analyzed retrospectively.There were 9 males and 5 females, aged ranged from 26 to 69 years old. Eight patients had upper abdominal pain, 2 presented with intestinal obstruction, and 4 were incidentally found on routine health check-up. The lesions located at the stomach in 11 cases, at the duodenum in 1 case, and at the jejunum in 2 cases. All the patients underwent operation. Postoperative pathology confirmed the diagnosis of heterotopic pancreas. Among these lesions, 10 cases presented with co-existence of pancreatic acinus and duct as main component with smooth muscle and few gastric mucosa tissues, 3 cases was mainly the pancreatic acinus and 1 case mainly the pancreatic duct and smooth muscle.Heterotopic pancreas may be misrocognized at gastrointestinal stromal tumors due to non-specific clinical manifestations and effective examination methods. Surgical procedure is the only one and the most effective treatment. Postoperative pathology examination is the most difinitive for differential diagnosis.
- Evaluation of diagnostic utility of multidetector computed tomography and magnetic resonance imaging in blunt pancreatic trauma: a prospective study. [JOURNAL ARTICLE]
- Acta Radiol 2014 Apr 23.
Blunt pancreatic trauma is an uncommon injury with high morbidity and mortality. Retrospective analyses of computed tomography (CT) performance report CT to have variable sensitivity in diagnosing pancreatic injury. Both a prospective analysis of multidetector CT (MDCT) performance and diagnostic utility of magnetic resonance imaging (MRI) in acute blunt pancreatic injury remain unexplored.To prospectively evaluate the utility of MDCT with MRI correlation in patients with blunt pancreatic trauma using intraoperative findings as the gold standard for analysis.The contrast-enhanced CT (CECT) scans of patients admitted with blunt abdominal trauma were prospectively evaluated for CT signs of pancreatic injury. Patients detected to have pancreatic injury on CT were assigned a CT grade of injury according to American Association for Surgery of Trauma classification. MRI was performed in patients not undergoing immediate laparotomy and MRI grade independent of CT grade was assigned. Surgical grade was taken as gold standard and accuracy of CT and MRI for grading pancreatic injury and pancreatic ductal injury (PDI) was calculated. A quantitative and qualitative comparison of MRI was also done with CT to determine the performance of MRI in acute pancreatic injury.Thirty out of 1198 patients with blunt trauma abdomen were detected to have pancreatic injury on CT, which was surgically confirmed in 24 patients. Seventeen underwent MRI and surgical correlation was available in 14 patients. CT and MRI correctly identified the grade of pancreatic injury in 91.7% (22/24) and 92.86% (13/14) patients, respectively. Both CT and MRI correctly identified PDI in 18/19 and 11/12 patients, respectively, with good inter-modality agreement of 88.9% (kappa value of 0.78). MRI also qualitatively added to the information provided by CT and increased diagnostic confidence in 58.8% of patients.MDCT performs well in grading pancreatic injury and evaluating pancreatic ductal injury. MRI is useful in evaluation of acute pancreatic trauma as it can increase diagnostic confidence and provide more qualitative information regarding the extent of injury.
- IL-6-dependent proliferation of alpha cells in mice with partial pancreatic-duct ligation. [JOURNAL ARTICLE]
- Diabetologia 2014 Apr 24.
IL-6 was recently shown to control alpha cell expansion. As beta cells expand following partial pancreatic-duct ligation (PDL) in adult mice, we investigated whether PDL also causes alpha cells to expand and whether IL-6 signalling is involved. As alpha cells can reprogramme to beta cells in a number of beta cell (re)generation models, we examined whether this phenomenon also exists in PDL pancreas.Total alpha cell volume, alpha cell size and total glucagon content were evaluated in equivalent portions of PDL- and sham-operated mouse pancreases. Proliferation of glucagon(+) cells was assessed by expression of the proliferation marker Ki67. Inter-conversions between alpha and beta cells were monitored in transgenic mice with conditional cell-type-specific labelling. The role of IL-6 in regulating alpha cell proliferation was evaluated by in situ delivery of an IL-6-inactivating antibody.In response to PDL surgery, alpha cell volume in the ligated tissue was increased threefold, glucagon content fivefold and alpha cell size by 10%. Activation of alpha cell proliferation in PDL pancreas required IL-6 signalling. A minor fraction of alpha cells derived from beta cells, whereas no evidence for alpha to beta cell conversion was obtained.In PDL-injured adult mouse pancreas, new alpha cells are generated mainly by IL-6-dependent self-duplication and seldom by reprogramming of beta cells.
- Autoimmune pancreatitis. [Journal Article]
- Gastroenterol Rep (Oxf) 2013 Jul; 1(1):27-32.
Autoimmune pancreatitis (AIP) is a rare, heterogeneous, fibroinflammatory disorder of the pancreas. It has gained increasing recognition due to a presentation that can mimic difficult-to-treat disorders such as pancreatic cancer, cholangiocarcinoma and primary sclerosing cholangitis. In contrast, autoimmune pancreatitis is a benign disease that is very responsive to therapy with corticosteroids. There are two types of AIP. Type 1 disease is the most common worldwide and is associated with extrapancreatic manifestations and elevated levels of IgG4-positive cells. Type 2 AIP is characterized by a paucity of IgG4-positive cells and is more difficult to diagnose. This review provides an update on the diagnosis, pathophysiology and treatment of AIP, with special emphasis on the two subtypes.
- Donor Pre-treatment with IL-1 Receptor Antagonist Attenuates Inflammation and Improves Functional Potency in Islets from Brain-Dead Non-human Primates. [JOURNAL ARTICLE]
- Cell Transplant 2014 Apr 22.
Most pancreas and islet grafts are recovered from brain-dead (BD) donors. In this study we characterized the early inflammatory response induced by brain death in pancreata and islets from non-human primate donors and evaluated the effect of targeted antiinflammatory intervention in the protection of pancreatic islets prior to transplantation. Braindead donors were monitored for 6 hours and assigned to three experimental groups. Group 1: BD-untreated donors (BD-UT) (n=7), Group 2: BD + donor pre-treatment with IL-1ra (n=6) and Group 3: Non-BD animals serving as controls (n=7). We observed an IL-1ra dependent reduction in the mobilization and activation of neutrophils from bone marrow and a significantly reduced accumulation of CD68+ leukocytes in the pancreas and islets after brain death induction. Donor treatment with IL-1ra significantly decreased chemokine mRNA expression (MCP-1, IL-8 and MIP-1a) and attenuated the activation of circulating neutrophils and intra-islet macrophages as demonstrated by a reduction in intracellular IL-1β, IL-6, MCP-1 and MIP-1? expression. As a result, IL-1ra dramatically improved viability, mitochondrial membrane polarity and islet engraftment in mice transplanted using a minimal islet mass. These results suggest that early immunomodulation targeting inflammation in the brain-dead donor may represent an effective therapeutic strategy to improve islet quality and function prior to transplantation.
- European cancer mortality predictions for the year 2014. [JOURNAL ARTICLE]
- Ann Oncol 2014 Apr 23.
From most recent available data, we projected cancer mortality statistics for 2014, for the European Union (EU) and its six more populous countries. Specific attention was given to pancreatic cancer, the only major neoplasm showing unfavorable trends in both sexes.Population and death certification data from stomach, colorectum, pancreas, lung, breast, uterus, prostate, leukemias and total cancers were obtained from the World Health Organisation database and Eurostat. Figures were derived for the EU, France, Germany, Italy, Poland, Spain and the UK. Projected 2014 numbers of deaths by age group were obtained by linear regression on estimated numbers of deaths over the most recent time period identified by a joinpoint regression model.In the EU in 2014, 1 323 600 deaths from cancer are predicted (742 500 men and 581 100 women), corresponding to standardized death rates of 138.1/100 000 men and 84.7/100 000 women, falling by 7% and 5%, respectively, since 2009. In men, predicted rates for the three major cancers (lung, colorectum and prostate cancer) are lower than in 2009, falling by 8%, 4% and 10%, respectively. In women, breast and colorectal cancers had favorable trends (-9% and -7%), but female lung cancer rates are predicted to rise 8%. Pancreatic cancer is the only neoplasm with a negative outlook in both sexes. Only in the young (25-49 years), EU trends become more favorable in men, while women keep registering slight predicted rises.Cancer mortality predictions for 2014 confirm the overall favorable cancer mortality trend in the EU, translating to an overall 26% fall in men since its peak in 1988, and 20% in women, and the avoidance of over 250 000 deaths in 2014 compared with the peak rate. Notable exceptions are female lung cancer and pancreatic cancer in both sexes.
- [Clinical features of six patients with pancreas metastasis from renal cell carcinoma]. [English Abstract, Journal Article]
- Hinyokika Kiyo 2014 Mar; 60(3):105-8.
We retrospectively reviewed patients who underwent radical or partial nephrectomy and were followedup in Oji General Hospital from 1992 through 2012. A total of 6 patients had disease recurrence in the pancreas during follow-up. We investigated their clinical features and treatment outcomes. The median age at diagnosis was 75 years. The median interval from nephrectomy to the detection of pancreatic metastasis was 114 months. As local therapy for metastasis, surgical resection was selected for 4 patients. On the other hand, administration of medication, including interferon alpha and sunitinib was selected for 2 patients with other simultaneous metastatic sites. One of the 4 patients with surgical resection had disease recurrence in the residual pancreas and needed additional excision. At the median follow-up of 38 months after treatment of pancreatic metastasis, one patient remained alive without evidence of disease, 3 patients were alive with recurrent disease, and 2 patients had died of the disease.