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Pancreatic cancer.

December 2012 - January 2013


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TÍTULO / TITLE:  - HBV infection increases the risk of pancreatic cancer: a meta-analysis.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Cancer Causes Control. 2013 Jan 10.

            ●● Enlace al texto completo (gratuito o de pago) 1007/s10552-012-0144-2

AUTORES / AUTHORS:  - Luo G; Hao NB; Hu CJ; Yong X; Lu MH; Cheng BJ; Zhang Y; Yang SM

INSTITUCIÓN / INSTITUTION:  - Department of Gastroenterology, XinQiao Hospital or Biomedical Analysis Center Third Military Medical University, Chongqing, 400037, People’s Republic of China.

RESUMEN / SUMMARY:  - BACKGROUND: Hepatitis B virus (HBV) infection is reported to be associated with an increased risk of pancreatic cancer (PaC), but it remains controversial whether this is a causal relationship. In addition, it is unclear whether the status of HBV infection also affects PaC risk. Therefore, we conducted a meta-analysis to more closely examine the association between HBV infection and PaC. METHOD: The studies included in the meta-analysis were identified and retrieved from PubMed and several other databases. The literature search was conducted up until August 2012. We adopted the Cochrane Collaboration’s RevMan 5.1 in a combined analysis of pooled relative risk (RR) with their corresponding  95 % confidence intervals (CIs) using a random-effects and a fixed-effects model. RESULTS: Nine studies including 6 case-control and 3 cohort studies met eligibility criteria. The meta-analysis showed that the PaC risk was positively correlated with HBV infection when comparing with ‘never exposed to HBV’ subgroup, the pooled RR was 1.39 (95 % CI 1.22-1.59, p < 0.00001) in chronic HBV  carriers, 1.41 (95 % CI 1.06-1.87, p = 0.02) in past exposure to HBV, and 3.83 (95 % CI 1.76-8.36, p = 0.0007) in active HBV infection. Using a stratified analysis, we also found that the risk of PaC was independent of smoking, alcohol  drinking, and diabetes. CONCLUSION: Findings from this meta-analysis strongly support that HBV infection is associated with an increased risk of PaC.




TÍTULO / TITLE:  - EUS elastography for diagnosis of solid pancreatic masses: a meta-analysis.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Gastrointest Endosc. 2012 Nov 27. pii: S0016-5107(12)02762-9. doi: 10.1016/j.gie.2012.09.035.

            ●● Enlace al texto completo (gratuito o de pago) 1016/j.gie.2012.09.035

AUTORES / AUTHORS:  - Mei M; Ni J; Liu D; Jin P; Sun L

INSTITUCIÓN / INSTITUTION:  - Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University Medical School, Hangzhou, China.

RESUMEN / SUMMARY:  - BACKGROUND: The differential diagnosis of solid pancreatic masses has been a significant challenge up until now. EUS elastography is now used as a new technique to distinguish benign from malignant pancreatic masses. However, the sensitivity, specificity, and accuracy are still questionable. OBJECTIVE: To evaluate the accuracy of EUS elastography for diagnosis of solid pancreatic masses. DESIGN: Thirteen articles for EUS elastography diagnosing solid pancreatic masses were selected. The Mantel-Haenszel and DerSimonian Laird methods were used to analyze pooled results. SETTING: Patients: This study involved 1044 patients. INTERVENTION: EUS elastography. MAIN OUTCOME MEASUREMENTS: The pooled sensitivity, specificity, likelihood ratios, diagnostic  odds ratio, and summary receiver operating characteristic (sROC) curve. RESULTS:  The pooled sensitivity, specificity, and diagnostic odds ratio of EUS elastography distinguishing benign from malignant solid pancreatic masses were 0.95 (95% confidence interval [CI], 0.94-0.97), 0.67 (95% CI, 0.61-0.73), and 42.28 (95% CI, 26.90-66.46), respectively. The sROC area under the curve was 0.9046. The subgroup analysis based on excluding the outliers showed that the heterogeneity was eliminated, and the pooled sensitivity and specificity were 0.95 (95% CI, 0.93-0.97) and 0.7 (95% CI, 0.63-0.76), respectively. The sROC area under the curve was 0.8872. LIMITATIONS: Varied diagnostic standards for EUS elastography were used in the enrolled studies. CONCLUSION: EUS elastography is a reliable technique for the characterization of solid pancreatic masses and may be a useful complementary tool for EUS-guided FNA. However, a more accurate computer-aided diagnosis method for EUS elastography is in demand to reduce various biases and improve the accuracy of EUS elastography for diagnosis of solid pancreatic masses.




TÍTULO / TITLE:  - Changing the Way We Do Business: Recommendations to Accelerate Biomarker Development in Pancreatic Cancer.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Clin Cancer Res. 2013 Jan 23.

            ●● Enlace al texto completo (gratuito o de pago) 1158/1078-0432.CCR-12-2745

AUTORES / AUTHORS:  - Tempero MA; Klimstra D; Berlin J; Hollingsworth T; Kim P; Merchant N; Moore M; Pleskow D; Wang-Gillam A; Lowy AM

INSTITUCIÓN / INSTITUTION:  - Authors’ Affiliations: Pancreas Center, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco; University of California, San Diego, San Diego, California; Memorial Sloan Kettering Cancer Center, New York, New York; Vanderbilt Ingram Cancer Center; Translating Research Across Communities; Vanderbilt University Medical Center, Nashville, Tennessee; University of Nebraska Medical Center, Omaha, Nebraska; Princess Margaret Hospital, Toronto, Ontario, Canada; Harvard University, Cambridge, Massachusetts; and Washington University in St. Louis, St. Louis, Missouri.

RESUMEN / SUMMARY:  - Pancreatic ductal adenocarcinoma is the most aggressive of all epithelial malignancies. In contrast to the favorable trends seen in most other common malignancies, the five-year survival of patients with this disease remains only 6%, a statistic that has changed minimally for decades. Only two drugs have been  approved by the U.S. Food and Drug Administration (FDA) for use in pancreatic cancer in the last 15 years, and there are no established strategies for early detection. Clin Cancer Res; 19(3); 1-3. ©2012 AACR.




TÍTULO / TITLE:  - EUS-guided pancreatic cyst ablation: a critical review (with ).

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Gastrointest Endosc. 2013 Jan 12. pii: S0016-5107(12)02869-6. doi: 10.1016/j.gie.2012.10.033.

            ●● Enlace al texto completo (gratuito o de pago) 1016/j.gie.2012.10.033


INSTITUCIÓN / INSTITUTION:  - Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Korea.




TÍTULO / TITLE:  - Pancreatic retention cyst: multi-modality imaging findings and review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Abdom Imaging. 2013 Jan 6.

            ●● Enlace al texto completo (gratuito o de pago) 1007/s00261-012-9976-1

AUTORES / AUTHORS:  - Ren F; Zuo C; Chen G; Wang J; Lu J; Shao C; Hao X

INSTITUCIÓN / INSTITUTION:  - Department of Radiology, General Hospital of Lanzhou PLA, No. 333 Bin He Road (South), Lanzhou, 730050, Ganshu, People’s Republic of China, renfangyuan@hotmail.com.

RESUMEN / SUMMARY:  - PURPOSE: To investigate the multi-modality imaging presentation of the pancreatic retention cyst (PRC) with pathologic correlation. METHODS: Imaging data including CT, MRI, endoscopic ultrasonography (EUS) and EUS guided fine needle aspiration (EUS-FNA), and endoscopic retrograde cholangiopancreatography (ERCP) in fifteen patients (five males and ten females; mean age, 44.5 years) with pathologically proven PRC were analyzed retrospectively, and imaging features were correlated with pathological findings. RESULTS: Sixteen PRCs of 15 patients were included in this study. The mean size of PRCs was 4.4 x 4.6 cm (range 0.5 x 0.6-8.1 x 10.1 cm). PRC were round (n = 11), oval (n = 2), or lobular (n = 3). Punctiform calcification of the wall on CT (n = 2), thin septa (n = 4), thin wall (n = 3), and dilation of upstream pancreatic duct (n = 6; mean diameter, 4.3 mm) were detected. Dilation of upstream pancreatic duct was smooth in five PRCs and irregular in one PRC with pancreatic duct with punctiform calcification. Communication of PRCs with pancreatic duct was seen in two patients (one on CT, one on ERCP). Pancreatic inflammation and neoplasm were detected in four and two  patients, respectively. CONCLUSIONS: PRC typically presents as a well-defined, round cystic lesion, and different associated pathologic conditions including pancreatic inflammation and neoplasm may be detected in some patients on the multi-modality imaging examinations. Smooth dilation of upstream pancreatic duct  with uncommon communication to the cyst may be helpful for the differentiation. Combination of a variety of imaging modalities could contribute to improve the diagnosis.




TÍTULO / TITLE:  - FOLFIRINOX for locally advanced and metastatic pancreatic cancer: single institution retrospective review of efficacy and toxicity.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Med Oncol. 2013 Mar;30(1):361. doi: 10.1007/s12032-012-0361-2. Epub 2012 Dec 28.

            ●● Enlace al texto completo (gratuito o de pago) 1007/s12032-012-0361-2

AUTORES / AUTHORS:  - Gunturu KS; Yao X; Cong X; Thumar JR; Hochster HS; Stein SM; Lacy J

INSTITUCIÓN / INSTITUTION:  - Section of Medical Oncology, Department of Medicine, Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, PO Box 208032, New Haven, CT, 06520-8032, USA.

RESUMEN / SUMMARY:  - Although FOLFIRINOX significantly increases survival in metastatic pancreatic cancer (MPC) compared to gemcitabine (Conroy et al. N Engl J Med 364:1817-1825, 2011), toxicities have tempered enthusiasm for its use in full doses. To assess the impact of dose attenuations on toxicity and efficacy, we reviewed our institution’s experience with FOLFIRINOX in locally advanced pancreatic cancer (LAPC) and MPC. We performed a retrospective review of dose, toxicity, and efficacy of FOLFIRINOX in all patients with LAPC and MPC treated between June 2010 and July 2011 at Yale. Toxicities in all patients and response rate (RR) and survival in previously untreated MPC were compared to data reported by Conroy. Overall survival (OS) and progression-free survival were estimated by Kaplan-Meier method. Thirty-five patients were treated (16 LAPC; 19 MPC). Twenty-nine patients received dose attenuations with the first cycle. Median relative doses of irinotecan and bolus fluorouracil were less than those reported by Conroy (64 vs. 81 % and 66 vs. 82 %, respectively). RR was 50 % in LAPC and 47 % in MPC, and the latter did not differ significantly from the RR reported by Conroy (p = 0.19). OS at 6 and 12 months in MPC was comparable to OS reported by  Conroy. Grade ¾ toxicities were less than reported by Conroy, including fatigue (p = 0.009) and neutropenia (p < 0.0001). Nine patients experienced transient dysarthria during irinotecan administration. Our findings validate the efficacy and tolerability of FOLFIRINOX in LAPC and MPC and suggest that dose attenuations of irinotecan and bolus fluorouracil improve tolerability without compromising efficacy.




TÍTULO / TITLE:  - Solid-pseudopapillary tumor of pancreas in a young woman: a case report and literature review.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Rev Med Chil. 2012 Sep;140(9):1179-84. doi: 10.1590/S0034-98872012000900012.

            ●● Enlace al texto completo (gratuito o de pago) 1590/S0034-98872012000900012

AUTORES / AUTHORS:  - Oliveira Lima S; Rocha Santana V; Correia Leao S; Faro Santos PS; De Alburquerque-Junior RL

INSTITUCIÓN / INSTITUTION:  - Department of Medicine, University Hospital, Federal University of Sergipe, Aracaju, SE, Brazil.

RESUMEN / SUMMARY:  - Solid-pseudopapillary tumor of pancreas is a rare neoplasm which occurs pre-dominantely in young females. This tumor generally is asymptomatic or minimally symptomatic and some imaging tests are useful for its diagnosis. We report a 17 years-old woman with dyspeptic symptoms submitted to an abdominal ultrasound (US), that revealed a hypoechogenic mass between the liver, right kidney and pancreas. Computer tomography (CT) scan showed a hypodense and heterogeneous mass on pancreas head. The patient underwent elective resection of  the mass and the histopathology was consistent with a solid-pseudopapillary tumor of pancreas. Immunohistochemical positivity for NSE (neuron-specific enolase), progesterone receptor, alfa-1-antitrypsin, vimentin, AE1/AE3, and negativity for  synaptophysin and chromogranin A confirmed the diagnosis. After four years of clinical follow-up, the patient remains in a good general condition without signs of tumor recurrence.




TÍTULO / TITLE:  - Surgical treatment of sporadic pancreatic neuroendocrine tumors: a state of the art review.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - ScientificWorldJournal. 2012;2012:357475. doi: 10.1100/2012/357475. Epub 2012 Dec 10.

            ●● Enlace al texto completo (gratuito o de pago) 1100/2012/357475

AUTORES / AUTHORS:  - Haugvik SP; Labori KJ; Edwin B; Mathisen O; Gladhaug IP

INSTITUCIÓN / INSTITUTION:  - Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway ; Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway.

RESUMEN / SUMMARY:  - Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. They are clinically  diverse and divided into functioning and nonfunctioning disease, depending on their ability to produce symptoms due to hormone production. Surgical resection is the only curative treatment and remains the cornerstone therapy for this patient group, even in patients with advanced disease. Over the last decade there has been a noticeable trend towards more aggressive surgery as well as more minimally invasive surgery in patients with PNETs. This has resulted in improved  long-term survival in patients with locally advanced and metastatic disease treated aggressively, as well as shorter hospital stays and comparable long-term  outcomes in patients with limited disease treated minimally invasively. There are still controversies related to issues of surgical treatment of PNETs, such as to  what extent enucleation, lymph node sampling, and vascular reconstruction are beneficial for the oncologic outcome. Histopathologic tumor classification is of  high clinical importance for treatment planning and prognostic evaluation of patients with PNETs. A constant challenge, which relates to the treatment of PNETs, is the lack of an internationally accepted histopathological classification system. This paper reviews current issues on the surgical treatment of sporadic PNETs with specific focus on surgical approaches and tumor  classification.



TÍTULO / TITLE:  - Pancreatic paraganglioma: A case report of CT manifestations and literature review.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Quant Imaging Med Surg. 2011 Dec;1(1):41-3. doi: 10.3978/j.issn.2223-4292.2011.08.02.

            ●● Enlace al texto completo (gratuito o de pago) 3978/j.issn.2223-4292.2011.08.02

AUTORES / AUTHORS:  - He J; Zhao F; Li H; Zhou K; Zhu B

INSTITUCIÓN / INSTITUTION:  - Department of Radiology, Nanjing Drum Tower Hospital, the Affiliated Hospital of  Nanjing University Medical School, Nanjing, China;

RESUMEN / SUMMARY:  - Paragangliomas are rare tumors arising from paraganglia (or chromaffin bodies) within the ganglia of the sympathetic trunk and the ganglia of the celiac, renal, suprarenal, aortic and hypogastric plexuses. These tumors can be widely distributed from skull base to the bottom of pelvis. Paraganglioma originating from pancreas is extremely rare. Here we report a 40-year-old female patient with paraganglioma located in the pancreatic head as a solid, well-demarcated mass with substantial enhancement on contrast-enhanced CT examination. Relevant literatures are also reviewed.



TÍTULO / TITLE:  - Mucinous cystic neoplasm of the pancreas with severe dysplasia during pregnancy:  Case report and review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Taiwan J Obstet Gynecol. 2012 Dec;51(4):635-8. doi: 10.1016/j.tjog.2012.09.022.

            ●● Enlace al texto completo (gratuito o de pago) 1016/j.tjog.2012.09.022

AUTORES / AUTHORS:  - Tsuda H; Kotani T; Sumigama S; Mano Y; Shimoyama Y; Kikkawa F

INSTITUCIÓN / INSTITUTION:  - Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Nagoya, Japan. Electronic address: hiro-t@med.nagoya-u.ac.jp.

RESUMEN / SUMMARY:  - OBJECTIVE: Mucinous cystic neoplasm (MCN) of the pancreas occurs mainly in women  aged 40-60 years, so it is extremely rare in pregnant woman. CASE REPORT: A 28-year-old woman in the ninth week of pregnancy was referred to our hospital due to a tumor of the abdominal cavity. Abdominal ultrasound demonstrated a huge multicystic lesion in the left upper abdomen. There are mural nodules and hypertrophic septa partially with the presence of blood flow inside the tumor. Endoscopic ultrasonography was performed and a diagnosis of possible pancreatic MCN was made. At the second trimester, distal pancreatectomy with splenectomy was performed. Histopathological analysis of the specimen revealed a pancreatic MCN with severe dysplasia. Immunohistochemically, the tumor was positive for both progesterone and estrogen receptors in the stromal cell nuclei; moreover, MIB-1 stained positive in 10-20% of the nuclei in the epithelium with severe dysplasia. CONCLUSION: MCN carries malignant potential, therefore, early detection and complete surgery is recommended. MCN in pregnancy is rare and the abdomen is distended during pregnancy, so clinicians can easily miss the presence of the tumor. We should recognize the presence of MCN in pregnant woman. We speculate that the presence of blood flow within the tumor and MIB-1-positive cells can be  a predictor for premalignant or malignant MCN.



TÍTULO / TITLE:  - Giant pancreatic insulinoma. The bigger the worse? Report of two cases and literature review.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Int J Surg Case Rep. 2012 Dec 11;4(3):265-268. doi: 10.1016/j.ijscr.2012.11.019.

            ●● Enlace al texto completo (gratuito o de pago) 1016/j.ijscr.2012.11.019

AUTORES / AUTHORS:  - Ielpo B; Caruso R; Ferri V; Quijano Y; Duran H; Diaz E; Fabra I; Puga R; Oliva C; Olivares S; Vicente E

INSTITUCIÓN / INSTITUTION:  - Madrid Sanchinarro University Hospital, General Surgery Department, San Pablo University, CEU, Madrid, España. Electronic address: ielpo.b@gmail.com.

RESUMEN / SUMMARY:  - INTRODUCTION: Giant pancreatic insulinomas are rare endocrine tumors. We describe 2 cases reviewing the current literature. PRESENTATION OF CASE: We report herein  2 female patients affected by giant insulinomas of 14cm and 6cm, respectively. Symptomatic hypoglycemia episodes occurred during 4 months in first case and 3 years in the second one until diagnosis. Both patients were successfully treated  performing a distal pancreatectomy with splenic preservation in the first case and a Whipple’s procedure in the second one. DISCUSSION: Up to now only 7 cases have been reported previously. Insulinomas larger than 3cm accounts for less than 5% of all. This literature review shows that despite the size hypoglycemic symptoms varies from 1 day to 3 years and only 1 out of 9 cases reported presented lymph nodes metastases. No recurrences have been described. CONCLUSION: One of the cases here described (14cm) is the largest presented in the literature. Despite the size, giant insulinoma is related apparently neither to metastases nor to the recurrences.



TÍTULO / TITLE:  - Waldenstrom macroglobulinemia presenting with pancreatic mass: a case report and  review of literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - JOP. 2013 Jan 10;14(1):92-5. doi: 10.6092/1590-8577/1271.

AUTORES / AUTHORS:  - Nayak HK; Kar P; Bagchi A; Kapoor N; Kapahtia S; Sonika U; Kumar N; Kumar S

INSTITUCIÓN / INSTITUTION:  - Department of Medicine, Maulana Azad Medical College, Lok Nayak Hospital. New Delhi, India. drhemantnayak@gmail.com.

RESUMEN / SUMMARY:  - CONTEXT: Waldenstrom macroglobulinemia is a rare lymphoplasmacytic lymphoma characterized by a wide range of clinical presentations related to direct tumor infiltration and the production of IgM. Most commonly it presents with cytopenia, hepatosplenomegaly, lymphadenopathy, constitutional symptoms, and hyperviscosity  syndrome. CASE REPORT: We report a case of Waldenstrom macroglobulinemia in an 60-year-old female who initially presented with intermittent abdominal pain. The  patient had no peripheral lymphadenopathy. On extensive investigation she was found to have pancreatic mass. The diagnosis of Waldenstrom macroglobulinemia was established after cytomorphology and immunohistochemical analysis of the patient’s bone marrow revealed the presence of a lymphoid/lymphoplasmacytoid-like bone marrow infiltrate along with an elevated serum IgM level. The patient responded both clinically and serologically to chemotherapy. This case is unusual because the patient lacked all common clinical features of Waldenstrom macroglobulinemia with exception of anemia. CONCLUSION: To our knowledge this is  the first report of a patient with Waldenstrom macroglobulinemia presenting with  a pancreatic mass adding to the spectrum of clinical presentations seen in this disease. This adds to the wide variety of gastrointestinal related clinical presentations of Waldenstrom macroglobulinemia and points to the need for considering Waldenstrom macroglobulinemia along with other lymphoid neoplasms in  the differential diagnosis of pancreatic lesions.



TÍTULO / TITLE:  - Adenosquamous carcinoma of the uncinate process of the pancreas with synchronous  gastrointestinal stromal tumor of the stomach: Case report and review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Oncol Lett. 2012 Dec;4(6):1191-1194. Epub 2012 Sep 7.

            ●● Enlace al texto completo (gratuito o de pago) 3892/ol.2012.902

AUTORES / AUTHORS:  - He JJ; Ding KF; Zheng L; Xu JH; Li J; Wu YL; Sun LF; Zhou DE; Zheng S

INSTITUCIÓN / INSTITUTION:  - Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China ;

RESUMEN / SUMMARY:  - Recently, the coexistence of gastrointestinal stromal tumors (GISTs) with other neoplasms has been studied with increasing frequency. Coexistence of pancreatic cancer with GISTs remains a rarity; however, here, we report a very rare case of  adenosquamous carcinoma (ASC) of the uncinate process of the pancreas with synchronous GISTs of the stomach in a 62-year-old female. The patient presented with epigastric discomfort and vomiting. Radiographic imaging revealed two masses; one located at the body of the stomach and the other located at the uncinate process of the pancreas. Intraoperatively, a fine needle aspiration biopsy was conducted in the uncinate process of the pancreas, which revealed the  malignancy of the masses. A pancreaticoduodenectomy and partial gastrectomy were  then conducted, and subsequent pathological examinations identified an ASC of the pancreas and a GIST of the stomach. In our case, contrary to the majority of previous cases of synchronous GISTs and other malignancies, GIST was not an incidental finding. The initial suspicion on the GIST as the underlying cause of  clinical symptoms led to the discovery of the ASC of the uncinate process of the  pancreas.



TÍTULO / TITLE:  - Multiple solid pancreatic hamartomas: A case report and review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - World J Gastrointest Oncol. 2012 Sep 15;4(9):202-6. doi: 10.4251/wjgo.v4.i9.202.

            ●● Enlace al texto completo (gratuito o de pago) 4251/wjgo.v4.i9.202

AUTORES / AUTHORS:  - Kawakami F; Shimizu M; Yamaguchi H; Hara S; Matsumoto I; Ku Y; Itoh T

INSTITUCIÓN / INSTITUTION:  - Fumi Kawakami, Shigeo Hara, Tomoo Itoh, Department of Diagnostic Pathology, Kobe  University Hospital, Kobe, Hyogo 6500017, Japan.

RESUMEN / SUMMARY:  - Non-neoplastic tumor-like lesions in the pancreas are uncommon. Here, we present  a case of multiple solid pancreatic hamartomas in a 78-year-old Japanese woman. Her computed tomography revealed a pancreatic mass, measuring 1.8 cm in maximum diameter. However, no symptoms were found. She was not an alcoholic and had no history of pancreatitis. The patient underwent a pancreatoduodenectomy, and three well-demarcated solid nodules measuring 1.7 cm, 0.4 cm, and 0.3 cm in diameter were found in the pancreatic head. Microscopically, the lesions were composed of  non-neoplastic, disarranged acinar cells and ducts embedded in a sclerotic stroma with elongated spindle cells that lacked discrete islets. The stromal spindle cells were immunoreactive for CD34 and CD117. The histological diagnosis was multiple solid hamartomas of the pancreas. There has been no recurrence 30 mo after surgery. So far, 18 cases of pancreatic hamartoma have been reported in the English literature, including our case. Six out of these 18 cases seemed to fit the criteria of solid pancreatic hamartoma. Although the number of cases was limited, solid pancreatic hamartomas seem to be benign tumor-like lesions, which  are found incidentally in healthy middle-aged adults, but occasionally involve the whole pancreas, resulting in a poor prognosis. Solid pancreatic hamartoma was sometimes associated with minor pancreatic abnormality, and multiple small lesions other than the main tumors were detected in a small number of cases. From these findings, one may speculate that solid pancreatic hamartoma could be the result of a malformation during the development of the pancreas.



TÍTULO / TITLE:  - Postpartum hypercalcemia secondary to a neuroendocrine tumor of pancreas; a case  report and review of literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Iran J Med Sci. 2011 Sep;36(3):217-21.

AUTORES / AUTHORS:  - Ghazi AA; Boustani I; Amouzegar A; Attarian H; Pourafkari M; Gashti HN; Sabetian T; Tirgari F; Ghazi S; Kovacs K

INSTITUCIÓN / INSTITUTION:  - Research Institute for Endocrine Sciences, Taleghani General Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

RESUMEN / SUMMARY:  - Parathyroid hormone-related protein producing pancreatic neuroendocrine tumors have been infrequently reported. Herein, we report a case of an Iranian woman who had such a tumor during pregnancy, and gave birth to a female neonate with esophago-tracheal fistula and imperforated anus. Hypercalcemia was diagnosed at postpartum because of elevated serum calcium levels in the neonate and neurologic deterioration of the mother. Extensive literature review revealed 42 cases with pancreatic neuroendocrine tumors and hypercalcaemia. The clinical and laboratory  findings of such patients are reviewed in this manuscript.



TÍTULO / TITLE:  - Nonfunctional neuroendocrine tumor of the pancreas: Case report and review of the literature.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Int J Surg Case Rep. 2013;4(2):225-8. doi: 10.1016/j.ijscr.2012.10.018. Epub 2012 Nov 9.

            ●● Enlace al texto completo (gratuito o de pago) 1016/j.ijscr.2012.10.018

AUTORES / AUTHORS:  - Amador Cano A; Garcia F; Espinoza A; Bezies N; Herrera E; De Leija Portilla J

INSTITUCIÓN / INSTITUTION:  - Digestive and Endocrine Surgery Service, Centro Medico Nacional del Noreste UMAE  25 IMSS, Monterrey, Mexico. Electronic address: ackaos_10@hotmail.com.

RESUMEN / SUMMARY:  - INTRODUCTION: Pancreatic neuroendocrine tumors (PNET) have an incidence of one per 100,000 individuals per year. They represent about 1-2% of all pancreatic tumors. PNETs are a heterogeneous group with various clinical presentations and lineage. Non functional PNET (NF-PNET) are incidentally discovered in most cases. This article presents a review of NF-PNET and the case of a patient with this disease, in addition to its diagnosis, clinical presentation, and treatment. PRESENTATION OF CASE: The patient is a 37-year-old asymptomatic man who was sent  from his reference unit because of a pancreatic tumor that was visualized incidentally during a laparotomy performed three months before due to an acute abdomen secondary to blunt abdominal trauma. A CT scan was requested that showed  a retroperitoneal mass 7.5cmx6.6cmx7cm with infiltration of the duodenal wall. Endoscopy was performed, which reported a duodenal ulcer with nonconclusive histological findings. A percutaneous biopsy was obtained out and a diagnosis of  a neuroendocrine tumor was made. Chemotherapy was started because infiltration of the portomesenteric axis was suspected. The patient presented signs of toxicity during his third cycle and therefore was scheduled for exploratory laparotomy. Pancreatoduodenectomy was performed with a histologic diagnosis of a pancreatic neuroendocrine tumor. DISCUSSION: The presentation of a NF-PNET is nonspecific. They continue to be tumors with a low incidence and few studies directed toward early detection and management have been carried out. Currently, CT scans are the studies most used for detection. CONCLUSION: Surgical treatment is preferred in patients without evidence of unresectability with longer survival. The characteristics of NF-PNETs make their detection difficult and new strategies are needed for early detection and management. New studies in early stages with new cytotoxics or analogs are promising.



TÍTULO / TITLE:  - Super-selective hepatic arterial infusions as established technique (‘ARETAIEION’ Protocol) of [177Lu]DOTA-TATE in inoperable neuroendocrine liver metastases of gastro-entero-pancreatic (GEP) tumors.

RESUMEN / SUMMARY:  - Enlace al Resumen / Link to its Summary

REVISTA / JOURNAL:  - Q J Nucl Med Mol Imaging. 2012 Dec;56(6):551-8.

AUTORES / AUTHORS:  - Limouris GS; Karfis I; Chatzioannou A; Paphiti MI; Lyra M; Gennatas K; Nikou G; Voros D; Pragulidis GP; Polydorou AA; Gouliamos A

INSTITUCIÓN / INSTITUTION:  - Nuclear Medicine Division, Radiology Department I, “Aretaieion” Hospital, Athens  University Medical Faculty, Athens, Greece.

RESUMEN / SUMMARY:  - Aim: Aim of this study was to evaluate the effectiveness of non-carrier added (n. c. a.) [177Lu]DOTA-TATE in inoperable liver metastases, positive for sst2 receptor overexpression (verified by Octreoscan and confirmed by biopsy) due to neuroendocrine gastroenteropancreatic (GEP) tumors. [177Lu]DOTA-TATE has been infused after selective catheterization of the hepatic artery, minimising in parallel the toxicity of non-target tissues. Methods: The dose per session administered to each patient (12 cases in total) was 7400 MBq (200 mCi). Repetitions did not exceed 6-fold with treatment intervals of 5-8 weeks. Response assessment was classified according to the therapeutic benefit. Absorbed doses delivered to metastases, kidneys and red marrow were calculated according to OLINDA 1.1 program and the derived values were correlated to the Response Evaluating Criteria in Solid Tumors (RECIST). CT/MRI scans were performed as baseline before, during and after the end of treatment and monthly ultrasound images for follow-up estimation and measurements. Toxicity (World Health Organization criteria) was measured using blood and urine tests of renal, hepatic and bone marrow function. Results: None of the patients resulted complete response (0.0%); partial response was assessed in 8 (66.7%), disease stabilization in 3 (25%) and progressive disease in 1(8.3%). A 14-month median survival time was estimated for all patients, so far. Eight of 12 (66.7%) showed  a mean target diameter shrinkage ranging from 33% to 45%. The organ average radiation dose estimation was found as follows: a) liver tumor 20.8 mGy/MBq; b) liver 0.14 mGy/MBq; c) kidneys 0.41 mGy/MBq; d) spleen 1.4 mGy/MBq; and f) bone marrow 0.022 mGy/MBq. The average absorbed dose per session to a tumor for a spherical mass of 20 g was estimated to be 20.8 mGy/MBq, depending on the histotype of the tumor. WHO toxicity grade 2 to 3 erythro-, leuko- and thrombo-cytopenia occurred in 9 (75%) cases observed about after the third session. Conclusion: In unresectable metastatic liver lesions positive for somatostatin receptors repeated, trans-hepatic high doses of [177Lu]DOTA-TATE resulted in a more than promising therapeutic outcome with a partial response in  75% of the treated patients. Given the loco-regional modality character of the administration technique, no nephro-toxicity has been so far observed whereas a remarkable myelotoxicity was noticed.