Exocrine Pancreatic Carcinoma Research Articles

Computed tomographic features of exocrine pancreatic carcinomas in dogs and cats.

Exocrine pancreatic carcinomas are uncommon in dogs and cats, and diagnosis with diagnostic imaging can be challenging. This retrospective, multi-institutional, descriptive study was performed to evaluate the CT features of exocrine pancreatic carcinomas. The CT examinations of 18 dogs and 12 cats with exocrine pancreatic carcinomas diagnosed by cytology or histopathology were reviewed. The CT features of exocrine pancreatic carcinomas included a well-defined mass in 28/30 (93%) with contrast enhancement in 27/30 (90%), commonly heterogeneous 22/30 (73%); often with a nonenhancing fluid to soft tissue attenuating center 12/30 (40%). The right lobe of the pancreas was the most common location, 14/30 (47%), then the left lobe, 10/30 (33%), and the body, 6/30 (20%). Extrahepatic biliary duct dilation was present in six animals; 5/6 (83%) of the masses were located in the right pancreatic lobe. Additional findings included peripancreatic fat-stranding 17/30 (57%), lymphadenopathy 16/30 (57%), peripancreatic soft tissue nodules 12/30 (40%), and free fluid 10/30 (33%). When comparing the imaging features of dogs and cats, there was a large overlap in imaging characteristics. There was a significant difference between the height of the masses, with dogs having larger masses (P-value.0028). Lymphadenopathy was more likely in larger masses [increased height (P-value.029)]. Cats were significantly older than dogs (P-value.0355). Pancreatic carcinomas were commonly identified as masses with heterogeneous contrast enhancement and a nonenhancing fluid to soft tissue attenuating center with concurrent peripancreatic changes (fat-stranding and/or soft tissue nodules) and lymphadenopathy.

Pancreatic adenocarcinoma treated with surgical resection, toceranib phosphate and firocoxib in a dog: a case report.

Exocrine pancreatic carcinomas are rarely reported in dogs. A ductal pancreatic adenocarcinoma in a 10-year-old intact beagle is described in this report. The diagnosis was made based on clinical signs, imaging (abdominal ultrasound and CT scan) and histopathology. Treatment consisted of partial right lobe pancreatectomy followed by adjuvant therapy with toceranib phosphate (Palladia®) and firocoxib (Previcox®) for six months. The treatment was well tolerated, and the survival time was 445 days. To our knowledge, this is the longest survival reported in the literature for a dog diagnosed with exocrine pancreatic adenocarcinoma. The results described here may contribute to provide a better understanding about this neoplasia and potential treatment options.

Surgical treatment of resectable and borderline resectable pancreatic cancer in tertiary cancer center: the 6-year experience

Objective: The aim of the study is to analyze the short and long-term results of surgical treatment of resectable and borderline-resectable patients during 2015-2017 (1st period) and 2018-2021 (2nd period). Material and Methods: A retrospective analysis of patients treated with pancreatic resection with (VR) and without portal or mesenteric vein resection (standard resection, SR) for exocrine pancreatic carcinoma in National Cancer Institute, Kyiv, Ukraine in 2015-2021. Results: 188 patients underwent surgical treatment, among which 67 received concomitant portal/mesenteric vein resection. Postoperative mortality was 10.04% (14.93% and 6.61% in VR and SR group, respectively, p=0.11). Textbook outcome rate was 67.3% vs 72.7% in VR and SR groups, respectively (p=0.57). Comparing 2015-2017 and 2018-2021 time periods, TO rate did not change for VR – 67.9% vs 66.8% (p>0.99), but tended to increase in SR group – 62.2% vs 80.4% (p=0.089).  Median overall survival was 17.03 month and did not differ between VR and SR. OS of all patients differed significantly between 2015-2017 and 2018-2021 – 13.8 vs 22.5 month (p=0.013). In multivariative analysis pancreatic head resection and lower tumor grade were positive prognostic factors, while age >65 and first study period – negative for OS. Conclusion: Extended due to venous resection pancreatectomies lead to comparable with standard procedures short-term and long-term results. The tumor grade G1-2, patient age less than 65, pancreaticoduodenal resection, and treatment period 2018-2021 were independent factors for better prognosis. Further prospective data is necessary to obtain representative results

Comprehensive cancer-oriented biobanking resource of human samples for studies of post-zygotic genetic variation involved in cancer predisposition.

The progress in translational cancer research relies on access to well-characterized samples from a representative number of patients and controls. The rationale behind our biobanking are explorations of post-zygotic pathogenic gene variants, especially in non-tumoral tissue, which might predispose to cancers. The targeted diagnoses are carcinomas of the breast (via mastectomy or breast conserving surgery), colon and rectum, prostate, and urinary bladder (via cystectomy or transurethral resection), exocrine pancreatic carcinoma as well as metastases of colorectal cancer to the liver. The choice was based on the high incidence of these cancers and/or frequent fatal outcome. We also collect age-matched normal controls. Our still ongoing collection originates from five clinical centers and after nearly 2-year cooperation reached 1711 patients and controls, yielding a total of 23226 independent samples, with an average of 74 donors and 1010 samples collected per month. The predominant diagnosis is breast carcinoma, with 933 donors, followed by colorectal carcinoma (383 donors), prostate carcinoma (221 donors), bladder carcinoma (81 donors), exocrine pancreatic carcinoma (15 donors) and metachronous colorectal cancer metastases to liver (14 donors). Forty percent of the total sample count originates from macroscopically healthy cancer-neighboring tissue, while contribution from tumors is 12%, which adds to the uniqueness of our collection for cancer predisposition studies. Moreover, we developed two program packages, enabling registration of patients, clinical data and samples at the participating hospitals as well as the central system of sample/data management at coordinating center. The approach used by us may serve as a model for dispersed biobanking from multiple satellite hospitals. Our biobanking resource ought to stimulate research into genetic mechanisms underlying the development of common cancers. It will allow all available "-omics" approaches on DNA-, RNA-, protein- and tissue levels to be applied. The collected samples can be made available to other research groups.

Pancreatic neuroendocrine neoplasms: Clinicopathological features and pathological staging.

The nomenclature and classification of pancreatic neuroendocrine neoplasms has evolved in the last 15 years based on the advances in knowledge of the genomics, clinical behaviour and response to therapies. The current 2019 World Health Organization classification of pancreatic neuroendocrine neoplasms categorises them into three groups; pancreatic neuroendocrine tumours (PanNETs)(grade 1 grade 2, grade 3), pancreatic neuroendocrine carcinomas and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) based on the mitotic rate, Ki-67 index, morphological differentiation and/or co-existing tissue subtype. PanNETs are also classified into non-functional NET, insulinoma, gastrinoma, VIPoma, glucagonoma, somatostatinoma, ACTH-producing NET and serotonin producing NET based on hormone production and clinical manifestations. A portion of the cases were associated with genetic syndromes such as multiple neuroendocrine neoplasia 1 (MEN 1), neurofibromatosis and Von Hippel-Lindau syndrome. In view of the distinctive pathology and clinical behaviour of PanNENs, the current 8th AJCC/UICC staging system has separated prognostic staging grouping for PanNETs from the pancreatic neuroendocrine carcinomas or MiNENs. Pancreatic neuroendocrine carcinomas and MiNENs are staged according to the prognostic stage grouping for exocrine pancreatic carcinoma. The new stage grouping of PanNETs was validated to have survival curves separated between different prognostic groups. This refined histological and staging would lead to appropriate selections of treatment strategies for the patients with pancreatic neuroendocrine neoplasms.

Clinical outcome in 23 dogs with exocrine pancreatic carcinoma.

Exocrine pancreatic carcinoma is uncommon in the dog and the veterinary literature surrounding the disease is minimal. Twenty-three cases of canine exocrine pancreatic carcinoma were reviewed in a retrospective manner to obtain information on clinical presentation, behaviour and survival associated with the disease. Presenting clinical signs were nonspecific and included anorexia, lethargy, vomiting and abdominal pain. The overall median survival time was only 1 day but was confounded by the large number of dogs that were euthanized shortly after diagnosis. Metastatic disease was detected in 78% of cases at the time of diagnosis, attesting to the aggressive nature of the disease. Neither lymph node metastasis, tumour size nor tumour location had an impact on overall survival. Only one patient was a previous diabetic who is contrary to reports of the disease in people and felines. This retrospective study reaffirms the need for early detection measures to optimize disease control. However, the benefits of therapy with surgery or radiation and adjuvant chemotherapy remain to be elucidated in dogs with exocrine pancreatic carcinoma.

Spontaneous neoplasia in captive syngnathid species: A retrospective case series (2003-2014) and literature review.

Syngnathidae (seahorses, pipefish and seadragons) are charismatic species commonly kept in commercial aquaria, but published literature on syngnathid diseases is limited and immunohistochemical techniques not routinely employed. A retrospective review of 2,541 syngnathid submissions received between March 2003 and October 2016 identified 18 neoplasms including germ cell tumours, exocrine pancreatic and intestinal carcinomas, chromatophoromas, and single cases of lymphoma, thyroid and renal carcinoma, swim bladder and pituitary adenoma. Big-bellied seahorses accounted for 19% of submissions, but 50% of neoplasms were diagnosed in this species. This study includes the first reported cases of germ cell tumours, chromatophoroma, thyroid carcinoma and pituitary adenoma in Syngnathidae and the first reports of neoplasia in pipefish species. Out of nine commercial antibodies trialled for immunohistochemical characterization of neoplastic tissue, only pan-cytokeratin proved cross-reactive. Electron microscopy was performed in four cases. Tumours should be considered as differential diagnosis in cases with buoyancy issues, debilitated or emaciated animals, and may predispose to secondary infections. This study highlights the value of histopathological disease surveillance for commercial aquarium settings.

Prognostic Assessment of Non-functioning Neuroendocrine Pancreatic Neoplasms as a Basis for Risk-Adapted Resection Strategies.

In contrast to exocrine pancreatic carcinomas, prognosis and treatment of pancreatic neuroendocrine neoplasms (PNEN) are significantly different. The variable growth pattern and associated clinical situation of functioning and non-functioning PNEN demand an individualized surgical approach. However, due to the scarce evidence associated with the rare disease, guidelines lack detailed recommendations for indication and for the required extent of surgical resection. In a retrospective single-center study from 1990 to 2018, 239 patients with PNEN were identified. Clinical data were collected in the MaDoc database of the University Medical Center Mainz. A total of 155 non-functional PNEN were selected for further analysis. According to the classification of NET by the WHO in 2017, 28.8% (n = 40) of the tumors were G1, 61.9% (n = 86) G2, and 9.4% (n = 13) G3. In 73 patients, hepatic metastases were present. Sixty patients had lymph node metastasis. An R0 resection was achieved in 98 cases, an R1 situation in 10 cases. Five times, a tumor debulking was carried out (R2) and 5 times the operation was aborted without any resection because of the advanced tumor stage. A relapse occurred in 29 patients. Different prognostic factors (grade, tumor size, age) were analyzed. Grade-dependent 10-year overall survival rates were 79.5% (grade 1) and 60.1% (grade 2), respectively. The survival rate of grade 3 patients was limited to 66.7% after 13months. In our study, patients with non-functioning PNEN had a longer overall survival after successful R0 resection. The risk analysis confirmed a Ki-67 cutoff value of 5%, which divided a high- and low-risk group. Patients with a PNEC G3 (Ki-67 index > 50%) had a very poor prognosis.

Diagnosis and long-term management of blastomycosis in two ferrets (Mustela putorius furo)

Abstract Background - Blastomycosis is an uncommon fungal infection endemic to certain parts of Eastern North America. Blastomycosis has been reported twice before in ferrets, but both cases died shortly after diagnosis. Case description - Two male neutered ferrets ( Mustela putorius furo ) from the same household, 4 and 1½-years of age, presented for respiratory signs. The diagnostic work-up included thoracic radiographs and ultrasound, advanced imaging, and cytology of a pulmonary mass, which led to a diagnosis of pulmonary blastomycosis in both cases. Both ferrets developed central nervous system (CNS) clinical signs. Ferret 1 developed signs referable to CNS lesions 3 months after initial presentation, and the second ferret 27 months after initial presentation. An MRI study and CSF analysis were performed on the first case. Both ferrets were treated with combinations of antifungal therapy and short-term prednisolone with a total follow-up period of 35 and 31 months respectively. Both cases responded favorably to antifungal therapy and supportive care. Response to therapy and the dynamics of infection were monitored with serial urinary Blastomyces antigen assays, thoracic radiographs, and routine bloodwork. The first ferret was euthanized three years after diagnosis due to an abdominal neoplasia. An exocrine pancreatic carcinoma, a cervical chordoma, and pulmonary blastomycosis were diagnosed on histopathology. Conclusions and case relevance - This report constitutes the first to document CNS blastomycosis in ferrets, long-term medical management of both pulmonary and suspected CNS blastomycosis in ferrets, and the use of serial urinary Blastomyces antigen assays to monitor disease progression in this species.

SUN-385 A Rare Case of Ectopic ACTH Secretion by Pancreatic Adenocarcinoma

Background Ectopic ACTH secretion caused by pancreatic neuroendocrine tumor is rare, but is responsible for 15% of ectopic Cushing syndrome. Their presentation and treatment are challenging because their preoperatory diagnosis and treatment are difficult due to its divergent and heterogeneous nature. CaseThe patient is a 65year old male with recent diagnosis of pancreatic cancer with liver metastases opting for naturopathic treatment, history of excessive alcohol use, gout, and biliary stent placement, presented to the ED with abnormal labs. On admission he was noted to be bradycardic with heart rate in 50s, WBC slightly elevated at 12.3, potassium 1.6, bicarbonate 50, calcium 6.5, bilirubin 8.8, ALT 79, AST 63, TSH undetectable, and T3-T4 extremely low. Patient also had lower extremity edema, lethargy, and confusion. Initial presentation was concerning for myxedema coma. Ultrasound for DVT was negative.Twelve-lead EKG demonstrated a ventricular rate of 58, sinus bradycardia with second degree AV block . IV Synthroid and replacement protocol was initiated. MRI of the brain was unremarkable. Patient noted to have upper extremity contractures. 24 hour urine free cortisol was 12,000 (normal 7.2-60 pg/mL ); ACTH 719 pg/mL (normal 4.5 - 20 pmol/L); CEA 10.3 (normal <3 ng/mL, CA19-9 762.0 (normal <40 U/mL). Continued hypokalemia as well as tetany and hypocalcemia secondary to metabolic alkalosis over the next few days were largely due to multifactorial reasons, including Keto-alkalione diet, profound weight loss, chronic stooling and recent development of ectopic Cushing’s with mineralocorticoid excess and hyperaldosteronism resulting in increased tubular wasting of potassium. Patient was continued on PO + IV repletion. Hydrocortisone and Synthroid were discontinued. Patient was started on amiloride PO and clindamycin and Bactrim due to intrinsic immunosuppression. No Ketoconazol was given because of transaminitis. The patient and his family opted for hospice care as he was not a candidate for oral chemotherapy or bilateral adrenalectomy for elevated cortisol levels and for his prognosis of <2 months. Conclusion; Exocrine pancreatic tumors are the most common type of pancreatic neoplasm and commonly consist of purely exocrine characteristics. The significance of this case lies in the extreme rarity of pancreatic adenocarcinoma exhibiting endocrine traits with only one previous case in the literature. This case suggests that exocrine pancreatic cancer with endocrine features is a distinct condition and that certain guidelines and protocols may be necessary for this entity. Resources 1. Gullo, L., et al. “Pancreatic Exocrine Carcinoma Producing Adrenocorticotropic Hormone.” Pancreas, vol. 7, no. 2, 1992, pp. 172-176., doi:10.1097/00006676-199203000-00007.

Partial Pancreatectomy Using Ultrasonic Scalpel for Exocrine Pancreatic Ductal Papillary Carcinoma in a Cat

Partial Pancreatectomy Using Ultrasonic Scalpel for Exocrine Pancreatic Ductal Papillary Carcinoma in a Cat

Postsurgical Outcome in Cats with Exocrine Pancreatic Carcinoma: Nine Cases (2007-2016).

Feline exocrine pancreatic carcinoma has been reported to be an aggressive tumor with a high metastatic rate and poor prognosis. Studies reporting long-term outcome of cats after surgical removal of solitary pancreatic carcinomas are rare, due to the uncommon diagnosis and paucity of cats who undergo treatment. In this study, nine cases of feline exocrine pancreatic carcinoma from seven academic and private practice veterinary hospitals were reviewed to examine the outcome in cats undergoing surgical removal of the mass. The median postsurgical survival time for the nine cats was 316.5 days (range, 25-964 days), with three cats alive at a median follow-up time of 309 days. This study demonstrates that surgical removal of pancreatic exocrine tumors in cats with localized disease can result in survival times of over 300 days.

Assessment of the American Joint Commission on Cancer 8th Edition Staging System for Patients with Pancreatic Neuroendocrine Tumors: A Surveillance, Epidemiology, and End Results analysis.

Although several staging systems have been proposed for pancreatic neuroendocrine tumors (pNETs), the optimal staging system remains unclear. Here, we aimed to assess the application of the newly revised 8th edition American Joint Committee on Cancer (AJCC) staging system for exocrine pancreatic carcinoma (EPC) to pNETs, in comparison with that of other staging systems. We identified pNETs patients from the Surveillance, Epidemiology, and End Results (SEER) database (2004–2014). Overall survival was analyzed using Kaplan–Meier curves with the log‐rank test. The predictive accuracy of each staging system was assessed by the concordance index (c‐index). Cox proportional hazards regression was conducted to calculate the impact of different stages. In total, 2424 patients with pNETs, including 2350 who underwent resection, were identified using SEER data. Patients with different stages were evenly stratified based on the 8th edition AJCC staging system for EPC. Kaplan–Meier curves were well separated in all patients and patients with resection using the 8th edition AJCC staging system for EPC. Moreover, the hazard ratio increased with worsening disease stage. The c‐index of the 8th edition AJCC staging system for EPC was similar to that of the other systems. For pNETs patients, the 8th edition AJCC staging system for EPC exhibits good prognostic discrimination among different stages in both all patients and those with resection.

Chinese expert consensus on radioactive 125I seeds interstitial implantation brachytherapy for pancreatic cancer.

Pancreatic cancer, also known as exocrine pancreatic carcinoma or pancreatic ductal adenocarcinoma, is one of the most challenging tumor entities worldwide, which is characterized as a highly aggressive disease with dismal overall prognosis. Treatment options for patients with locally advanced pancreatic cancer include surgery, chemotherapy, and radiotherapy. In many cases, surgical resection is not possible due to the advanced stage at diagnosis and poor responses to current treatments, therefore, treatment alternatives have to be performed. However, brachytherapy through radioactive 125I seeds (RIS) implantation into pancreatic cancer has been first applied in unresectable carcinoma and made accuracy curative effects. Therapeutic procedures of RIS implantation for pancreatic carcinoma were not identical in domestic medical centers, making it hard to achieve homogeneity and affecting the efficacy seriously at last. To maximize the benefits of RIS for patients with pancreatic cancer, Chinese Medical Doctor Association of Radioactive Seed Implantation Technology Expert Committee and Committee of Minimally Invasive Therapy in Oncology, Chinese Anti-Cancer Association, Radioactive Seed Therapy Branch organized and helped establish China expert consensus on RIS implantation for the treatment of pancreatic cancer, to provide a reference for clinical practices.

Clinical Outcome of Exocrine Pancreatic Adenocarcinoma: A Single Center Experience

Background: Pancreatic carcinoma is an uncommon tumor with a high mortality rate. Because of the late presentation ofthe disease, only a small percent of patients are candidate for surgery. Aim: To assess the epidemiology and the clinical outcome of patients diagnosed with pancreatic adenocarcinoma presented to the Clinical Oncology Department at Menoufia University. Methods: All patients presenting with exocrine pancreatic carcinoma from January 2007 to December 2011 were included. Epidemiological features of patients and their treatment details and outcome were collected retrospectively from the medical records. An equal number of matched controls were interviewed and filled a  uestionnaire to identify possible risk factors. Results: Exocrine pancreatic adenocarcinoma represented 1.4 % of all cancer patients treated at our institution. The study included 76 patients and 76 controls. Pancreatic cancer patients were significantly more likely to be overweight when compared to controls (OR= 2.51, 95%CI: 1.04-6.06). Diabetes mellitus and smoking were significantly more prevalent among patients (OR= 2.36, 95%CI: 1.23-4.54; OR= 2, 95%CI: 1.05-3.81; respectively). The median time to progression was 12 weeks (95%CI: 9.46-14.53) and the median overall survival was 16 weeks (95%CI: 12.22-19.78). Patients with earlier tumor stage and those who underwent surgery followed by adjuvant chemotherapy had significantly better overall survival (p=0.02 and <0.001, respectively).Conclusion: Exocrine pancreatic adenocarcinoma is an uncommon tumor among cancer patients treated at the ClinicalOncology Department of Menoufia University. Diabetes mellitus, higher body mass index and smoking are significantlymore prevalent in pancreatic carcinoma patients. Earlier tumor stage and undergoing surgery followed by chemotherapy are associated with statistically significant better overall survival.

Insurance Status Is Related to Receipt of Therapy and Survival in Patients with Early-Stage Pancreatic Exocrine Carcinoma.

Objectives. The study objective was to determine how insurance status relates to treatment receipt and overall survival for patients with early-stage pancreatic exocrine carcinoma. Methods. SEER data were evaluated for 17,234 patients diagnosed with Stage I/II pancreatic exocrine carcinoma. Multivariate regression models controlled for personal characteristics to determine whether insurance status was independently associated with overall survival and receipt of radiation/surgery. Results. Odds of receiving radiation were 1.50 and 1.75 times higher for insured patients compared to Medicaid and uninsured patients, respectively (p < 0.01). Insured patients had 1.68 and 1.57 times increased odds of receiving surgery compared to Medicaid and uninsured patients (p < 0.01). Risk of death was 1.33 times greater (p < 0.01) in Medicaid patients compared to insured patients; when further adjusted for treatment, the risk of death was attenuated but remained significant (HR = 1.16, p < 0.01). Risk of death was 1.16 times higher for uninsured patients compared to insured patients (p = 0.02); when further adjusted for treatment, the risk of death was no longer significant (HR = 1.01, p = 0.83). Conclusions. Uninsured and Medicaid-insured patients experience lower treatment rates compared to patients who have other insurances. The increased likelihood of treatment appears to explain the insured group's survival advantage.

Exocrine Pancreatic Carcinoma with Hypoglycemia in a Dog

Background: Primary pancreas neoplasms are rare, representing less than 0.5% of all veterinary tumors. They are highly aggressive, and most of the patients have unspecifc clinical signs until diagnosis. Although the treatment of choice is surgical resection, only 15 to 20% of the patients may undergo surgery and be cured. Survival is variable after diagnosis,ranging from 4 to 10 months. Prognosis is poor due to the aggressiveness and advanced stage of the disease at the moment of diagnosis, and the weak response to all existing treatments. The objective of this study was to report a case of exocrine pancreatic carcinoma in a dog with hypoglycemia.Case: The present study describes a clinical case of exocrine pancreatic carcinoma in the Clínica Escola de Veterinária (CEVET) at UNICENTRO-PR. The patient was taken to the CEVET and the main complaint of the owner was a volume increase in the ventral thoracic region. During the physical examination, it was observed that this increased volume was a mammary tumor in the third gland of the right side of the body. The animal showed no other symptoms and the diagnosis of exocrine pancreatic cancer was only possible because glucose levels in routine examination were below the normal reference value for the species (47 mg/dL). After the glycemic curve was determined, it was observed that glucose levels were below reference values, even after feeding (at 8 am and 7 pm). Suspicion of a metastasis of mammary tumor in the pancreas, or even a pancreatic tumor, was then raised. Blood insulin was performed and a 42.3 µUI/mL increase was observed. Insulin reference values range from 5 to 20 µUI/mL. Based on these results, and after the owner signed an informed consent form, exploratory celiotomy was carried out in order to assess pancreatic changes and, if possible, to excise any nodule that was found. However, instead of a single nodule, as expected, diffuse lesions with several whitish micronodules that showed frm consistency were observed. As it was not possible to excise all the nodules, the option was to carry out pancreas biopsy and mastectomy.Discussion: The absence of characteristic clinical signs or radiological changes suggestive of a tumor in this clinical case is supported by data in the literature as, most of the times, conclusive diagnosis is carried by histopathological analysis of the structure resected in the surgery. The pancreas is made up of ductal, acinar, and endocrine/neuroendocrine cells supported by conjunctive and endothelial tissue and lymphocytes. Malignant neoplasms may originate from any of these types of cells.However, the literature describes that most human and animal patients with pancreatic tumors present late and unspecifc clinical signs, whereas in this report the animal did not show any clinical signs. The treatment of choice is surgical resection, and total or partial pancreatectomy or pancreatoduodenectomy have been used in humans and dogs. Because of that, support therapy is highly important for improved quality of life. In this case, the presence of hypoglycemia, different from most reports, which describe hyperglycemia, led to further laboratory analysis. The presence of hyperinsulinemia and, later on, the fndings of the pancreas biopsy, led to the diagnosis of exocrine pancreatic cancer. It was concluded that this typeof tumor needs to be further analyzed and studied in dogs, as case reports such as this one are not common in veterinary.Keywords: neoplasia, celiotomy, hyperinsulinemia.

Ductal pancreatic adenocarcinoma.

Ductal adenocarcinoma of the pancreas is the fourth most common cause of death from cancer in men and women in Germany: about 15 000 persons die of this disease each year. The S3 guideline on exocrine pancreatic carcinoma was updated with the aid of systematic literature reviews on the surgical, neoadjuvant, and adjuvant treatment of ductal pancreatic carcinoma, and on treatment in the metastatic stage. These reviews covered the periods 2002 to February 2012 (for radiotherapy) and 2006 to August 2011 (for all other topics). The criteria for borderline resectable pancreatic tumors are the same as those of the guidelines of the National Comprehensive Cancer Network. Preoperative biliary drainage with a stent is recommended only if cholangitis is present or if a planned operation cannot be performed soon after the diagnosis is made. When a pancreatic carcinoma is resected, at least 10 regional lymph nodes should be excised, and the ratio of affected to excised nodes should be documented in the pathology report. Gemcitabine and 5-fluorouracil are recommended for adjuvant therapy. Neither of these drugs is preferred over the other; if the one initially given is poorly tolerated, the other one should be given instead. When gemcitabine and erlotinib are given for palliative treatment, erlotinib should be given for no longer than 8 weeks if no skin rash develops. In selected patients, the folfirinox protocol yields markedly better results than gemcitabin. Moreover, the new combination of nab-paclitaxel and gemcitabine can be used as first-line treatment. In the event of disease progression under first-line treatment, second-line treatment should be initiated. In recent years, new chemotherapeutic protocols have brought about marked improvement in palliative care. Further trials are needed to determine whether the perioperative or adjuvant use of these protocols might also improve the outcome of surgical treatment with curative intent.

Pituitary Metastasis of Pancreatic Origin in a Dog Presenting with Acute-Onset Blindness

Pituitary metastases have rarely been recorded in dogs, and to date, none of those reported have been of pancreatic origin. MRI findings are available for only one of those cases. Herein the authors present an 11 yr old English springer spaniel diagnosed with pituitary metastasis of pancreatic origin with a 24 hr history of blindness and only a single lesion on MRI. Neurologic and ophthalmologic examinations localized the lesion to the optic nerves, optic tracts, or optic chiasm. MRI showed a single lesion characterized by a well-circumscribed pituitary mass with extrasellar extension, causing compression of the optic chiasm. Signal intensity was unusual as enhancement could not be appreciated after contrast administration. The dog was euthanized without further diagnostic tests. Histopathologic examination revealed a poorly differentiated exocrine pancreatic carcinoma with widespread metastasis involving the pituitary gland. To the authors' knowledge, this is the first such case reported in a dog. Pituitary metastases should be included as a differential diagnosis for dogs presenting with acute-onset blindness and for single brain masses affecting the pituitary gland.

Cost–Utility Estimations of Palliative Care in Patients With Pancreatic Adenocarcinoma: A Retrospective Analysis

We earlier reported cost-utility estimates in patients who undergo resection aimed at cure for pancreatic carcinoma. The present study describes similar information on patients with unresectable tumors who experienced palliative care only. A population-based cohort of patients with exocrine pancreatic adenocarcinoma during 1998-2005 was evaluated retrospectively (n = 444). Total direct health care costs at departments of surgery and oncology, for primary health care, and at hospice were achieved. Self-estimated health-related quality of life (HRQL) was assessed by the SF-36. A single preference-based utility index, SF-6D, was derived from SF-36 items to estimate quality-adjusted life years (QALYs). Results were compared to similar findings in a previously reported group of patients with pancreatic carcinoma resected for cure (n = 31). Palliative care patients (n = 305) had impaired HRQL particularly related to physical domains. The mean preference-based health utility index at diagnosis was 0.65 ± 0.02 [95 % confidence interval (CI) 0.61-0.69] compared to 0.77 ± 0.02 (95 % CI 0.75-0.79) in healthy reference individuals. Total direct health care costs were 50 % in patients on palliative care compared to costs for surgical R0 resections (23,701 and 50,950<euro>, respectively). QALYs for 1 year from diagnosis were 0.2 (95 % CI 0.17-0.23) in patients on palliative care and 0.48 (95 % CI 0.44-0.54) in resection patients. Costs per QALY were 118,418<euro> and 106,146<euro>, respectively (95 % CI 103,048-139,418<euro> and 94,352-115,795<euro>). Optimized palliative care of patients with exocrine pancreatic carcinoma had costs per achieved utility similar to those for surgical resections aimed at cure.