Mucin-producing Tumors Research Articles

Peroral pancreatoscopy in the diagnosis of mucin-producing tumors of the pancreas

Background: Mucin-producing tumor of the pancreas is an increasingly recognized clinical entity. However, the differentiation of benign from malignant mucin-producing tumors of the pancreas is challenging. Peroral pancreatoscopy as recently developed may have potential for the diagnosis of mucin-producing tumors of the pancreas. Methods: The subjects were 41 patients with clinically diagnosed mucin-producing tumors of the pancreas, 40 of whom underwent surgical resection. Autopsy findings were available in another patient with unresectable disease. Histologically, hyperplasia was identified in 3 patients, mildly atypical adenoma in 11, severely atypical adenoma in 16, and adenocarcinoma in 11. Peroral pancreatoscopy was performed before surgery or pathologic examination. The findings were retrospectively evaluated and compared with the histopathologic diagnosis. Results: Pancreatoscopic observation was successful in 30 patients (73.2%). Elevated lesions were identified in 22 (73.3%). Villous or vegetative elevations and red color markings were frequently found in severely atypical adenoma or adenocarcinoma. Tumor location (main or branch duct type) did not correlate with survival after resection. Partial resection was performed in 7 of 30 patients with nonmalignant tumors and resulted in favorable outcomes. Conclusion: Peroral pancreatoscopy can be used to differentiate benign mucin-producing tumors of the pancreas (hyperplasia and mildly atypical adenoma) from the more dysplastic lesions (severely atypical adenoma and adenocarcinoma) and may provide useful information for determining the type of surgery to be performed. (Gastrointest Endosc 2000;52:67-73.)

Mucinous cystadenomas and intraductal papillary mucinous tumors of the pancreas in magnetic resonance cholangiopancreatography.

In mucin-producing tumors of the pancreas, diagnosis using endoscopic retrograde cholangiopancreatography (ERCP) is limited to cystic formations that communicate with the main pancreatic duct. Magnetic resonance cholangiopancreatography (MRCP) is a new, sophisticated method which is currently under evaluation. The authors describe the usefulness of MRCP in diagnosis of mucin-producing tumors. Six patients with mucin-producing tumors were investigated using MRCP and ERCP. Imaging was compared with surgery and histopathological examinations. Three patients were found to have mucinous cystadenomas (MC), two patients had intraductal papillary mucinous tumors (IPMT) and one patient had a cystadenocarcinoma. MRCP demonstrated the cystic formations in all patients. Magnetic resonance imaging (MRI) showed contrast-mediated enhancement of the cystic wall in patients with MC, and visualized the pancreatic ducts completely in patients with IPMT. ERCP failed to visualize the cystic lesion in one patient with MC of the pancreatic tail. Furthermore, ERCP showed evidence of IPMT in dilated main ducts with multiple filling defects but did not visualize the ducts completely. MRCP provides visualization of pancreatic ducts, extraductal variations, and cystic formations more completely than ERCP does. It avoids complications seen in ERCP. MRCP may replace ERCP in the evaluation of mucin-producing tumors of the pancreas.

A Case of Small Pancreatic Ductal Carcinoma Accompanied by Intraductal Mucin-Producing Pancreatic Tumors

A Case of Small Pancreatic Ductal Carcinoma Accompanied by Intraductal Mucin-Producing Pancreatic Tumors

MR Cholangiopancreatographic Differentiation of Benign and Malignant Intraductal Mucin- Producing Tumors of the Pancreas

The purpose of this study was to establish MR cholangiopancreatographic criteria for discriminating benign from malignant intraductal mucin-producing tumors of the pancreas. Thirty-one patients with 34 intraductal mucin-producing tumors underwent MR cholangiopancreatography. Tumors were classified as either main duct type (n = 10) or branch duct type (n = 24). In patients with the main duct type, the maximum diameter and the location of the main pancreatic duct, the extent of main pancreatic duct dilatation, and the presence of a filling defect were evaluated. For branch duct type, the location and maximum diameter of the cystic lesion, the presence of a filling defect, and the presence of associated main pancreatic duct dilatation were evaluated. In patients with the main duct type, the main pancreatic duct was significantly narrower when associated with benign rather than malignant tumors. All malignant tumors showed diffuse main pancreatic duct dilatation, whereas all benign tumors showed segmental dilatation. Among patients with branch duct type, the cyst was smaller when it was a benign rather than malignant tumor. All but one malignant tumor showed mild associated main pancreatic duct dilatation, whereas benign tumors were not associated with main pancreatic duct dilatation. Filling defects suggested malignancy, although half of the malignant tumors had no filling defects. In patients with intraductal mucin-producing tumors of the pancreas, filling defects are indicative of malignancy. Diffuse main pancreatic duct dilatation greater than 15 mm (main duct type), or any main pancreatic duct dilatation (branch duct type), is strongly associated with malignancy.

7099 Wire guided endoscopic balloon dilation through the working channel of the scope in a case of a tortuous stenosis at the duodenal second portion.

The endoscopic balloon dilation has been widely applied for the stenotic lesions of gastrointestinal tract either by "through-the-scope (TTS)" or "over-the-wire (OTW) " dilator.We present here a case of tortuous stenosis at the duodenal second portion, which failed to be dilated with either type but dilated successfully with a new type having both TTS and OTW function. A 74-year-old man who had had duodenum-preserving pancreas head resection for mucin-producing tumor was admitted to our hospital because of almost complete stenosis with ulcer scar at the duodenal second portion. Since surgical intervention seemed to be difficult, the endoscopic balloon dilation was first chosen for this stenosis with conventional TTS balloon dilator. However, the stenotic portion was too tortuous to pass the balloon even with the aid of endoscopic manipulation. Next, the guide wire was inserted through the channel of the scope into the stenotic portion with fluoroscopy. The endoscope was removed, leaving the guide wire at the stenotic portion. OTW balloon dilator was tried over this guide wire but the balloon catheter could not be inserted through the stenotic lesion due to bend of the guide wire in the stomach. After these failures, we determined to use the new type balloon dilator with TTS and OTW function one week later. GIF-2T200 (Olympus, Tokyo) was inserted to the oral side of the stenosis. CRETM Wire-Guided Balloon Dilatation Catheter (inflated diameter 18-20 mm) (Boston Scientific,Watertown, MA) was introduced through the working channel (3.7mm) of the scope. Since the stenosis was not clearly visualized in the endoscopic view, the guide wire, which was preloaded in the guide wire lumen of the balloon, was inserted through the stenosis with fluoroscopy verification. Then the balloon catheter was advanced over the guide wire in the scope channel to pass the balloon through the stenosis. After the positioning the balloon with fluoroscopy, the balloon was inflated with mixture of contrast medium and saline at controlled pressure of 3, 4.5, 6 ATM (18, 19, 20 mm of the estimated inflated balloon diameter, respectively ) for 2 minutes with keeping the wire at the duodenal third portion. The dilation was repeated twice at 6 ATM for 2 minutes to facilitate the effect of dilation. The guide wire was helpful to keep the balloon in the appropriate position both at the inflation and deflation of the balloon. After the dilation procedure, the successful dilation of the stenosis was confirmed by the contrast medium injected through the scope channel with fluoroscopy, although the stenosis was not well visualized in the endoscopic view. The patient could take soft food and gruel easily without complication one week after the procedure. We conclude CRETM Wire-Guided Balloon Dilatation Catheter is a very useful device to facilitate the endoscopic procedure even for a tortuous stenosis at the duodenum.

Differential expression of human spasmolytic polypeptide (trefoil factor family-2) in pancreatic carcinomas, ampullary carcinomas, and mucin-producing tumors of the pancreas.

Human spasmolytic polypeptide (hSP) is a member of the trefoil peptide group, thought to be involved in mucin production and cell growth. It has been reported that hSP protein is expressed in digestive cancers but not in normal pancreas. The expression of hSP in pancreatic neoplasms has not been investigated in detail. The immunohistochemical expression of hSP protein was investigated in pancreatic carcinomas, ampullary carcinomas, mucin-producing tumors, serous cystadenomas and islet cell tumors of the pancreas. hSP was expressed in 23% of pancreatic duct cell carcinomas, and hSP protein was more frequently detected in cases of early-stage or histologically low-grade duct cell carcinomas than in cases of late-stage or histologically high-grade carcinomas. Patients with hSP protein expression showed a better prognosis than did those with negative hSP expression. hSP expression was detected in 92% of mucin-producing tumors, but was not detected in serous cystadenoma or islet cell tumors. Immunohistochemical hSP expression is related to differentiation and a better prognosis in pancreatic duct cell carcinomas. Furthermore, hSP protein is related to the pathogenesis and clinical characteristics of mucin-producing tumors of the pancreas.

Heterotopic Bone Formation in Two Cases of Colon Carcinoma

Heterotopic bone formation is rare in the gastrointestinal tract. We here present the clinical and pathologic details of a 56-year-old male patient with mucinous adenocarcinoma of the colon and a 70-year-old male patient with colon metastasis previously operated on for signet-ring-cell carcinoma of the stomach who was treated with radiotherapy postoperatively. Both of them showed diffuse bone metaplasia. Heterotopic bone formation is usually present with mucin-producing benign or malignant tumors. The pathogenesis of osseous metaplasia is not well known; however, it is speculated that the extravasation of mucin may have a stimulatory role.

Intraductal oncocytic papillary carcinoma with invasion arising from the accessory pancreatic duct

Mucin-producing tumors of the pancreas were first reported by Ohhashi and Takagi in 1980.1 Since then, many cases of intraductal papillarymucinous tumors (IMPTs) of the pancreas, which are similar to mucin-producing tumors of the pancreas, have been reported.2 IMPTs are generally regarded as tumors with a favorable prognosis. However, those with associated infiltration, noted in up to 25% of cases, are often mucinous and clinically indolent.3 Furthermore, some IMPTs exhibit ductal type infiltration and these are always associated with a poor prognosis.4 Intraductal oncocytic papillary neoplasms (IOPNs) of the pancreas have also been reported; these have the potential to develop into invasive carcinoma.5 Most IMPTs arise from the main pancreatic duct and IMPTs arising from the accessory pancreatic duct are relatively rare, there being only 6 reported cases.2,6-10 We present a case of invasive IPON arising from the accessory pancreatic duct.

Cell localization of mucin-type receptors assayed with novel GalNac/Gal-specific lectin from sea musselCrenomytilus grayanus in human colon tumors

Cell localization of mucin type receptors in low-differentiated human colon adenocarcinoma was studied. Several types of receptor localization were identified. It was shown that lectin CGL most intensively binds to intracellular membranes, cytoplasm, and secrete of mucin-producing tumor cells.

Mucin-producing tumors of the pancreas: clinicopathological features, surgical treatment, and outcome.

Mucin-producing tumors (MPTs) of the pancreas are increasingly being recognized. To evaluate the appropriate surgical treatment and predict the prognosis of MPTs, we performed a retrospective clinicopathological study in 51 patients, 27 with benign tumors and 24 with borderline/malignant tumors. Three of the malignant tumors showed stromal invasion and lymph node metastasis on histological examination. Of the 24 patients with borderline/malignant tumors, 2 died of MPTs and 4 died of other diseases. At the last follow-up, 35 patients were alive and well. The 5-year postoperative survival rate was 90% for patients with benign tumors, and 78% of these with borderline/malignant tumors. Five of the patients with borderline/malignant tumors had multicentric tumors. Three of these patients underwent resection of the rest of the pancreas, 5, 6, and 8 years, respectively, after the first operation. Extended radical resection is required for malignant MPT with invasion of the pancreatic stroma. We prefer to perform pancreatogastrostomy or Imanaga's procedure to allow examination of the body and tail of the pancreas by endoscopic retrograde pancreatography after resection of the pancreatic head. Careful follow-up for a long period may be the most prudent approach for detecting multiple MPTs in the residual pancreas after surgical treatment.

Morphological-Histochemical Study of Intestinal Carcinoids and K-ras Mutation Analysis in Appendiceal Carcinoids

Intestinal carcinoids are potentially malignant neoplasms. Their histogenesis and pathogenesis are currently uncertain. The morphological and histochemical characteristics of twenty intestinal carcinoids are studied. The primary sites of three mucin-producing tumors were examined by electron microscope. Furthermore 11 appendiceal carcinoids were analysed by the polymerase chain reaction (PCR) for the detection of ras and p53 point mutations. Microscopically all carcinoids were of mixed type. Focal mucin production was evident in three carcinoids that metastasised to regional lymph nodes. HID-Alcian blue staining proved that mucin in both primary and secondary foci did not belong to the sulphated group. The secretory granules and mucin droplets found in a single neoplastic cell suggest that carcinoids of the small intestine and some of the appendix arise from the endoderm. Neither ras nor p53 mutations were detected. It seems that ras oncogenes are probably not involved in the pathogenesis of appendiceal carcinoids. Copyright 1999 W.B. Saunders Company Ltd on behalf of the Arányi Lajos Foundation

Overexpression of C-NEU and C-MET during rat liver cholangiocarcinogenesis: A link between biliary intestinal metaplasia and mucin-producing cholangiocarcinoma.

Based on limited but compelling immunohistochemical data demonstrating individual overexpression of the tyrosine kinase growth factor receptors, c-erbB-2 and c-met, in significant percentages of human cholangiocarcinoma (ChC), we investigated if combined overexpression of both c-neu, the rat homologue of c-erbB-2, and c-met, the receptor for hepatocyte growth factor/scatter factor (HGF/SF), might represent a characteristic, early event associated with furan-induced cholangiocarcinogenesis in rat liver. Specifically, through the use of immunohistochemistry, in situ hybridization (ISH), and Western and Northern blotting, we found that both c-neu and c-met are prominently overexpressed in intestinal metaplastic lesions in early putative precancerous cholangiofibrotic tissue formed in the livers of rats after 6 weeks of furan treatment when compared with normal and hyperplastic intrahepatic biliary epithelia. We further demonstrated that c-neu and c-met are concordantly overexpressed in neoplastic glandular epithelia in later-developed primary "intestinal-type" of ChC formed in the livers of furan-treated rats, as well as in subsequently derived transplantable mucin-producing tumors. Overexpression of c-neu and c-met correlated with increased proliferating cell nuclear antigen (PCNA)-labeling indices, which were determined to be three to four times higher in intestinal metaplastic glands in precancerous cholangiofibrotic tissue and in neoplastic glands in the primary "intestinal type" of ChC than in hyperplastic bile ductular structures within either cholangiofibrotic or bile duct-ligated (BDL) livers. The c-neu and c-met receptor proteins overexpressed in different in vivo passages of a transplantable ChC each contained immunoreactive phosphotyrosines, indicating an activated state. However, we did not detect evidence of either gene amplification of c-neu or c-met or of a common transmembrane-activating mutation in c-neu expressed in transplantable ChC. Our findings indicate that altered expression of c-neu and c-met occurs relatively early in the process of furan-induced cholangiocarcinogenesis in rat liver and may play a potentially important role in its pathogenesis. They further indicate a common alteration in tyrosine kinase growth factor receptor expression linking early putative precancerous intestinal metaplastic lesions in liver to later-developed mucin-producing biliary cancer.

Loss of p27 Kip1 expression independently predicts poor prognosis for patients with resectable pancreatic adenocarcinoma

As a universal inhibitor of cyclin-dependent kinases in mammalian cells, p27Kip1 expression has been implicated in tumor progression and has proved to be a prognostic predictor for several human cancers. In this study, the authors investigated the expression of p27Kip1 and its potential prognostic significance in patients with resectable pancreatic adenocarcinoma. The correlation between p27Kip1 expression and prognosis was investigated retrospectively in 38 patients who had undergone resection of pancreatic adenocarcinoma including 2 cystadenocarcinomas and 4 mucin-producing tumors. Immunohistochemical staining using an anti-p27Kip1 antibody, along with an assessment of tumor cell Ki-67 labeling index, was performed on resected specimens. p27Kip1 expression in pancreatic adenocarcinoma was decreased dramatically when compared with that in normal pancreatic tissue. Based on 35 cases available for survival analysis, loss of p27Kip1 expression in 16 cases defined as having no or <1% p27Kip1 positive tumor cells showed 1-, 1.5-, and 2-year survival rates of 37.5%, 15.6%, and 0%, respectively, in comparison with 1-, 2-, and 3-year survival rates of 68.4%, 62.2%, and 49.8%, respectively, in the other cases (P = 0.001). After excluding cases of cystadenocarcinoma and mucin-producing tumors, the survival advantage for patients with p27Kip1 positive tumors remained apparent (P = 0.024). In each Cox regression model, both those including cystadenocarcinoma and mucin-producing tumors and those that did not, p27Kip1 expression proved to be an independent predictor for overall survival by multivariate analysis. These results reveal the significance of p27Kip1 immunostaining in predicting the outcome of patients with resectable pancreatic adenocarcinoma, adding a novel predictor in the evaluation of prognosis for this lethal disease.

Prognostic Factors Affecting Survival in Patients with Colorectal Carcinomatosis

This study evaluates prognostic factors that may influence survival in patients who present with carcinomatosis from colorectal cancer. Patients may present with curcinomatosis as the pattern of metastases at the initial diagnosis of colorectal cancer. Little is known about the natural history of carcinomatosis and the prognostic factors affecting outcome. All patients treated at Roswell Park Cancer Institute from 1988 to 1994 who presented with carcinomatosis at the initial diagnosis of colorectal cancer were identified. A retrospective review of the medical records for patient and tumor demographics was performed. Estimated survival distributions were calculated by the method of Kaplan and Meier. Tests of significance with respect to survival distribution were based on the log-rank test. Cox proportional hazards model was used for the multivariate analysis. There were 31 males and 38 females. The median age was 61 years (range, 26–80). The primary cancers were in the sigmoid with 24 patients (35%), cecum with 14 patients (20%), and transverse colon with 11 patients (16%). The remainder were distributed throughout the colon and rectum. The most common presentation was large bowel obstruction in 29 patients (42%). T3 and T4 cancers were present in 39 (57%) and 13 patients (19%), respectively. Lymph nodes were positive in 39 patients (57%), and mucin-producing tumors were also present in 39 patients (57%). Twelve patients (17%) had one site of disease, 17 patients (25%) had two sites of disease, and 37 (54%) patients had three or more sites of disease. Ascites was present in 29 patients (42%). Residual disease was present at the completion of surgery in 45 patients, absent in 13 patients, and status unknown in 11. The presence of residual disease (p = 0.0001), presence of ascites (p = 0.02), stage greater than T3 (p = 0.02), and increasing number of carcinomatosis sites (p = 0.006) were found to have a negative impact on survival on univariate analysis. On multivariate analysis, only the presence of residual disease at the completion of surgery was found to be an independent predictor of survival (p = 0.04). Overall median survival was 14 months with a 26% estimated 2-year survival. The presence of gross residual disease at the completion of surgery was shown to be the only independent factor negatively affecting survival. This has potential implications for the operative management of patients presenting with colorectal carcinomatosis.

Mucin-producing tumor of the pancreas: diagnostic value of diffusion-weighted echo-planar MR imaging.

To determine whether diffusion-weighted echo-planar magnetic resonance (MR) imaging can help differentiate mucin-producing tumors of the pancreas from other cystic lesions. Diffusion-weighted echo-planar 1.5-T MR imaging was performed in patients with mucin-producing tumor (n = 15), pseudocyst (n = 15), or serous microcystic tumor (n = 2). Images were obtained with diffusion-sensitizing gradients of 30 and 300 sec/mm2. The apparent diffusion coefficient (ADC) was calculated. At 30 sec/mm2, all cystic lesions had very high signal intensity. The dilated main pancreatic duct was depicted in eight patients with mucin-producing tumor and in six with pseudocyst. The mean (+/- standard deviation) ADCs of mucin-producing tumors (2.7 x 10(-3) mm2/sec +/- 0.9 x 10(-3)) and pseudocysts (3.2 x 10(-3) mm2/sec +/- 1.0 x 10(-3) were significantly lower (P < .01) than those of serous cysts or cerebrospinal fluid (5.8 x 10(-3) mm2/sec +/- 2.0 x 10(-3)). At 300 sec/mm2, cysts and the main pancreatic ducts had high signal intensity in cases of mucin-producing tumor, indicative of the presence of mucinous products in both the cystic cavity and the main pancreatic duct. The signal intensity of cystic fluid in pseudocysts was high on diffusion-weighted images, but that of the pancreatic duct was decreased (ADC = 5.1 x 10(-3) mm2/sec +/- 1.7 x 10(-3)). Diffusion-weighted MR imaging can help characterize cystic lesions of the pancreas. Findings-suggestive of viscous fluid in mucin-producing tumors are present on such images.

Differential diagnosis of mucin-producing tumors of the pancreas by intraductal ultrasonography and peroral pancreatoscopy.

Although mucin producing tumors of the pancreas have been recently recognized as premalignant or malignant neoplasms, their diagnosis and management have been undetermined as yet. The aim of this study was to evaluate the capability of intraductal ultrasonography (IDUS) and peroral pancreatoscopy (PPS) in the differential diagnosis of mucin-producing tumors compared to that of other diagnostic tools. From 1986 to 1997, 31 patients with mucin-producing tumors of the pancreas underwent surgery. Histologically, in patients with adenocarcinoma, papillary tumorous lesions within the pancreatic ducts were 3 mm or more in maximum height. The detection rates for such lesions were 29% with US, 21% with CT, 86% with EUS, 100% with IDUS and 83% with PPS. In patients with adenocarcinoma, PPS revealed taller papillary lesions with redness and/or capillary vessels. Biopsy and cytology during ERCP and under PPS direct vision had a sensitivity of about 60 % in the differential diagnosis between malignancy and benign diseases. Mucin-producing tumors of the pancreas with papillary tumorous lesions of 3 mm or more in maximum height should be considered as adenocarcinomas. The combined use of IDUS and PPS with biopsy and cytology is now considered the best for the differential diagnosis of mucin-producing tumors of the pancreas.

The Rocky liver: radiologic-pathologic correlation of calcified hepatic masses.

Although relatively uncommon in daily clinical practice, calcification may be found in inflammatory hepatic lesions and in benign and malignant liver neoplasms. The most common source of calcified hepatic lesions is inflammatory conditions such as granulomatous diseases (e.g., tuberculosis). The calcification typically involves the entire lesion and appears as a dense mass that can produce artifacts on computed tomographic (CT) scans. Echinococcus cysts have curvilinear or ring calcification. Hemangiomas, especially large ones, may contain large, coarse calcifications that are centrally located in areas of fibrosis; these may be seen at CT (20% of cases) or radiography (10%). In hepatocellular adenoma, calcifications may be solitary or multiple and are usually located eccentrically within a complex heterogeneous mass. Calcifications in fibrolamellar carcinoma have been reported in 15%-25% of cases at CT and occur in a wide variety of patterns. Calcifications in intrahepatic cholangiocarcinoma are typically accompanied by a desmoplastic reaction and are visible at CT in about 18% of cases. Calcified hepatic metastases are most frequently associated with mucin-producing neoplasms such as colon carcinoma. Knowledge of the pathologic features of each entity helps radiologists to better recognize the shape, size, density, number, location, and distribution of hepatic calcifications seen on images and to narrow the differential diagnosis.

Contrast-Enhanced Endoscopic Ultrasonography in Pancreatic Diseases: A Preliminary Study

Objective: The purpose of this study was to clarify the usefulness of contrast-enhanced endoscopic ultrasonography in pancreatic diseases. Methods: The subjects comprised 37 patients with pancreatic diseases: 11 with ductal cell carcinoma, 10 with mucin-producing tumor, five with pseudo-cyst, four with islet cell tumor, four with chronic pancreatitis, and three with serous cystadenoma. After endoscopic ultrasonography, Albunex (0.22 ml/kg) was injected intravenously at a rate of 1 ml/s into the right median vein, and observation was continued for 10 min. The presence or absence of enhancement of the lesion was determined in each disease. Because all the patients with ductal cell carcinoma, islet cell tumor, chronic pancreatitis, and serous cystadenoma, as well as five with mucin-producing tumor and three with pseudo-cyst, underwent angiography, vascularity was compared between angiographic images and those of contrast-enhanced ultrasonography. Results: Enhancement of the lesion was observed in all patients with islet cell tumor and serous cystadenoma, in eight with mucin-producing tumor, and in three with chronic pancreatitis. However, no enhancement effect was observed in the patients with ductal cell carcinoma and those with pseudo-cyst. Comparison between the images of contrast-enhanced endoscopic ultrasonography and angiographic images showed three patients in whom angiograms were hypovascular, but enhancement effect was observed on ultrasonographic images. Conclusion: The combined evaluation of plain and enhanced images of endoscopic ultrasonography may be useful for the diagnosis of pancreatic diseases.

Contrast-enhanced endoscopic ultrasonography in pancreatic diseases: a preliminary study.

The purpose of this study was to clarify the usefulness of contrast-enhanced endoscopic ultrasonography in pancreatic diseases. The subjects comprised 37 patients with pancreatic diseases: 11 with ductal cell carcinoma, 10 with mucin-producing tumor, five with pseudo-cyst, four with islet cell tumor, four with chronic pancreatitis, and three with serous cystadenoma. After endoscopic ultrasonography, Albunex (0.22 ml/kg) was injected intravenously at a rate of 1 ml/s into the right median vein, and observation was continued for 10 min. The presence or absence of enhancement of the lesion was determined in each disease. Because all the patients with ductal cell carcinoma, islet cell tumor, chronic pancreatitis, and serous cystadenoma, as well as five with mucin-producing tumor and three with pseudo-cyst, underwent angiography, vascularity was compared between angiographic images and those of contrast-enhanced ultrasonography. Enhancement of the lesion was observed in all patients with islet cell tumor and serous cystadenoma, in eight with mucin-producing tumor, and in three with chronic pancreatitis. However, no enhancement effect was observed in the patients with ductal cell carcinoma and those with pseudo-cyst. Comparison between the images of contrast-enhanced endoscopic ultrasonography and angiographic images showed three patients in whom angiograms were hypovascular, but enhancement effect was observed on ultrasonographic images. The combined evaluation of plain and enhanced images of endoscopic ultrasonography may be useful for the diagnosis of pancreatic diseases.

Mucin-producing tumors of the pancreas: A longterm follow-up study in 22 patients

Mucin-producing tumors of the pancreas: A longterm follow-up study in 22 patients