Peripancreatic Invasion Research Articles

Comparison between pancreatoblastoma (PB) and solid pseudopapillary neoplasm (SPN) in pediatric patients with enhanced CT

Rationale and objectivesTo investigate whether computed tomography features can differentiate pancreatoblastoma (PB) from solid pseudopapillary tumor (SPN) in children. Materials and methodsClinical and imaging data of 18 cases of PB and 61 cases of SPN confirmed by surgery or biopsy were retrospectively analyzed. All enrolled patients underwent 3 phases (non-contrast, arterial, and portal venous phases) of CT scanning. Qualitative CT analysis (location, margin, solid/cystic component proportion, calcification, hemorrhage, peritumoral vascularity, bile duct dilatation, pancreatic duct dilatation, pancreatic atrophy, vascular invasion, peripancreatic invasion, and distant metastases) and quantitative analysis (maximum tumor diameter, interface between tumor and parenchyma [delta], arterial enhancement ratio [AER], and portal enhancement ratio [PER]) were performed. The general CT morphologic features, age and tumor markers were compared also compared between the groups. Univariate analysis and the F test were conducted to identify features of PB. Then logistic Regression classifier was trained using the top five features with the highest F-value. Moreover, we used 5-fold cross-validation techniques for the validation of our model. ResultsPB exhibited a significantly higher frequency of location in the body/tail, larger tumor size, poorly defined margins, calcification, peritumoral vascularity, pancreatic atrophy, and less hemorrhage. In addition, PB had higher AER, PER and lower delta relative to SPN (p < 0.05). PB presented a younger age and higher levels of AFP. Results of the F test indicated that AFP, AER, Age, calcification and pancreatic atrophy were the top five features included in the model that could differentiate pediatric PB from SPN. The combined model of CT and clinical features performed well in differentiating PB from SPN, with an AUC of 0.981 in the training cohort and 0.953 in the validation cohort. ConclusionsAFP, AER, age, calcification and pancreatic atrophy are robust CT and clinical features for differentiating pediatric PB from SPN. A combination of qualitative and quantitative CT features may provide good diagnostic accuracy in differentiating PB from SPN in children.

Comparison between solid pseudopapillary neoplasms of the pancreas and pancreatic ductal adenocarcinoma with cystic changes using computed tomography

BACKGROUND Solid pseudopapillary neoplasms of the pancreas (SPN) share similar imaging findings with pancreatic ductal adenocarcinoma with cystic changes (PDAC with cystic changes), which may result in unnecessary surgery. AIM To investigate the value of computed tomography (CT) in differentiation of SPN from PDAC with cystic changes. METHODS This study retrospectively analyzed the clinical and imaging findings of 32 patients diagnosed with SPN and 14 patients diagnosed with PDAC exhibiting cystic changes, confirmed through pathological diagnosis. Quantitative and qualitative analysis was performed, including assessment of age, sex, tumor size, shape, margin, density, enhancement pattern, CT values of tumors, CT contrast enhancement ratios, “floating cloud sign,” calcification, main pancreatic duct dilatation, pancreatic atrophy, and peripancreatic invasion or distal metastasis. Multivariate logistic regression analysis was used to identify relevant features to differentiate between SPN and PDAC with cystic changes, and receiver operating characteristic curves were obtained to evaluate the diagnostic performance of each variable and their combination. RESULTS When compared to PDAC with cystic changes, SPN had a lower age (32 years vs 64 years, P &lt; 0.05) and a slightly larger size (5.41 cm vs 3.90 cm, P &lt; 0.05). SPN had a higher frequency of “floating cloud sign” and peripancreatic invasion or distal metastasis than PDAC with cystic changes (both P &lt; 0.05). No significant difference was found with respect to sex, tumor location, shape, margin, density, main pancreatic duct dilatation, calcification, pancreatic atrophy, enhancement pattern, CT values of tumors, or CT contrast enhancement ratios between the two groups (all P &gt; 0.05). The area under the receiver operating characteristic curve of the combination was 0.833 (95% confidence interval: 0.708-0.957) with 78.6% sensitivity, 81.3% specificity, and 80.4% accuracy in differentiation of SPN from PDAC with cystic changes. CONCLUSION A larger tumor size, “floating cloud sign,” and peripancreatic invasion or distal metastasis are useful CT imaging features that are more common in SPN and may help discriminate SPN from PDAC with cystic changes.

Proton radiotherapy as a treatment strategy to increase survival in locally advanced pancreatic cancer in the body and tail: a retrospective study

BackgroundLong-term outcomes and prognostic factors of proton radiotherapy for locally advanced pancreatic cancer (LAPC) in the body and tail are still unknown. The aim of this study was to determine the prognostic factors after proton radiotherapy in a large group of patients with LAPC in the body and tail.MethodsThe medical records of 200 patients with LAPC in the body and tail who underwent proton radiotherapy between February 2009 and January 2021 at the Hyogo Ion Beam Medical Center were retrospectively reviewed to identify prognostic factors that contribute to long-term survival.ResultsThe overall survival rate at 1- and 2-year after PT was 69.6% and 35.4% with a median overall survival of 18.4 months. The 1- and 2-year local progression-free, and progression-free survival rates were 84.3% and 68.0%, and 44.3% and 19.4%, respectively. In multivariate analysis, superior mesenteric artery (SMA) invasion (SMA only invasion vs. celiac artery only invasion; P = 0.049: SMA and celiac artery invasion vs. celiac artery only invasion; P = 0.017), carbohydrate antigen 19-9 (CA 19-9) level ≥ 231.9 U/mL (P = 0.001), anterior peripancreatic invasion (P = 0.006), and incomplete scheduled concurrent chemotherapy (P = 0.009) were statistically significant prognostic factors for overall survival. There was no significant difference in local progression-free survival; however, distant metastasis-free survival was statistically worse in patients with prognostic factors than in those without.ConclusionsProton radiotherapy for LAPC in the body and tail may be a valuable multidisciplinary treatment option. Patients with SMA invasion, higher pre-proton radiotherapy serum CA 19-9 level, anterior peripancreatic invasion, or incomplete scheduled concurrent chemotherapy had worse overall survival because of worse distant metastasis-free survival, suggesting that distant metastases have a significant impact on overall survival in such patients.Trial registration: Retrospectively registered.

Intraductal oncocytic papillary neoplasm of the pancreas: clinical and radiological features compared to those of intraductal papillary mucinous neoplasm

PurposeThis study aimed to characterize the clinical and imaging findings of intraductal oncocytic papillary neoplasm of the pancreas (IOPN-P) compared to those of intraductal papillary mucinous adenoma/carcinoma (IPMA/IPMC).MethodsThis multi-institutional retrospective study reviewed the clinical, imaging, and pathological findings of 21 patients with pathologically proven IOPN-P. Twenty-one computed tomography (CT) and magnetic resonance imaging, and seven 18F-fluorodeoxyglucose (FDG)-positron emission tomography were performed before surgery. The following findings were evaluated: preoperative blood test results, lesion size and location, pancreatic duct diameter, contrast-enhancement effect, bile duct and peripancreatic invasion, maximum standardized uptake (SUVmax) value, and pathological stromal invasion.ResultsSerum carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA19-9) levels were significantly higher in the IPMN/IPMC group than in the IOPN-P group. Except in one patient, IOPN-P showed multifocal cystic lesions with solid components or a tumor in the main pancreatic duct (MPD) with dilatation. IOPN-P had a higher frequency of solid parts and a lower frequency of downstream MPD dilatation than IPMA. IPMC showed smaller overall cyst size, more radiological peripancreatic invasion, and worse recurrence-free and overall survival than IOPN-P. The average SUVmax value of IOPN-P was 7.5. Pathologically, 17 of the 21 IOPN-Ps had a malignant component, and six showed stromal invasion.ConclusionIOPN-P shows cystic-solid lesions similar to IPMC but has lower serum CEA and CA19-9 levels, larger overall cyst size, lower frequency of peripancreatic invasion, and more favorable prognosis than IPMC. Moreover, the high FDG uptake by IOPN-Ps may be a characteristic finding of this study.Graphical abstract

Factors associated with long-term survival in gemcitabine-concurrent proton radiotherapy for non-metastatic locally advanced pancreatic cancer: a single-center retrospective study

BackgroundFactors associated with long-term survival in gemcitabine-concurrent proton radiotherapy (GPT) for non-metastatic, locally advanced pancreatic cancer (LAPC) remain unclear. This study aimed to determine the factors associated with long-term survival in GPT for non-metastatic LAPC.MethodsThe medical records of 123 patients with LAPC treated with GPT between February 2009 and December 2019 at Hyogo Ion Beam Medical Center were retrospectively reviewed to assess the factors associated with long-term survival outcomes.ResultsThe median overall survival of the total cohort treated with GPT was 18.7 months. The 1- and 2-year overall, local progression-free, and progression-free survival rates were 70.4% and 35.7%, 78.2% and 59.0%, and 38.6% and 20.8%, respectively. Multivariate analysis revealed that LAPCs at the pancreatic body-tail and those without anterior peripancreatic invasion were independently associated with longer overall survival (P = 0.040 and P = 0.015, respectively). The median overall survival of patients with LAPC at the pancreatic body-tail and those with LAPC without anterior peripancreatic invasion were 24.1 and 28.1 months, respectively. LAPCs at the pancreatic body-tail had a higher volume ratio irradiated over 60 Gy equivalents at gross tumor volume than those at the pancreatic head (P < 0.001). LAPCs with anterior peripancreatic invasion had more peritoneal recurrence within 6 months after GTP than those without anterior peripancreatic invasion (P = 0.039).ConclusionsGPT is a promising treatment option for patients with LAPC at the pancreatic body-tail and those with LAPC without anterior peripancreatic invasion.

Prognosis and survival analysis of patients with pancreatic cancer: retrospective experience of a single institution

BackgroundThe overall survival of patients with pancreatic cancer is extremely low. Despite multiple large-scale studies, identification of predictors of patient survival remains challenging. This study aimed to investigate the prognostic factors for pancreatic cancer.MethodsThe clinical data of 625 patients with pancreatic cancer treated at Shengjing Hospital of China Medical University from January 2013 to December 2017 were collected.ResultsOf 625 patients, 569 were followed from 1 to 75 months. The median overall survival was 9.3 months. The overall 1-, 3-, and 5-year survival rates were 37.8%, 15.1%, and 10.5%, respectively. Cox proportional hazards model indicated that baseline carbohydrate antigen 199 level, neutrophil-lymphocyte ratio, operative procedure, lymph node metastasis, number of distant organ metastasis, and postoperative adjuvant chemotherapy were independent prognostic factors of patients with pancreatic cancer. Baseline carbohydrate antigen 199 level, degree of weight loss, operative procedure, lymph node metastasis, number of distant organ metastasis, and postoperative adjuvant chemotherapy were independent prognostic factors of pancreatic head cancer subgroup. Baseline carbohydrate antigen 199 level, carcinoembryonic antigen level, total bilirubin level, neutrophil-lymphocyte ratio, peripancreatic invasion, number of distant organ metastasis, and postoperative adjuvant chemotherapy were independent prognostic factors of the pancreatic body/tail cancer subgroup.ConclusionsHigher carbohydrate antigen 199 levels, neutrophil-lymphocyte ratio, lymph node metastasis and distant organ metastasis predict a poor prognosis in patients with pancreatic cancer. Early detection, early radical surgery and adjuvant chemotherapy are needed to improve prognosis for this deadly disease.

Common Hepatic Artery Approach in Difficult Laparoscopic Distal Splenopancreatectomy

Introduction: Laparoscopic distal pancreatectomy is the gold standard nowadays. The infiltration of splenic artery near to its origin as well as engagement of splenic vein near to its confluence with superior mesenteric vein could be a reason for technical difficulties. In such cases the most easily accessible major landmark is the common hepatic artery. Transection of the pancreatic neck and splenic vein is essential to reach the dorsal aspect of the splenic artery at the level of the celiac trunk. The aim of this study is to present our approach to retroperitoneal access of the splenic artery. Methods: We present two cases of laparoscopic distal splenopancreatectomy, one of them for cancer of the pancreatic body, and the other one with pseudocyst of the pancreatic body. Mean age of the two patients was 59.5. Results: Totally laparoscopic splenopancreatectomy with hepatoduodenal and celiac lymph node dissection was performed. Peripancreatic invasion near to the origin of the splenic artery was observed. Stepwise pancreatic transection at the neck, followed by transection of splenic vein were done in both cases. In the second one major venous bleeding occured and was managed by clipping and division of the splenic vein. The mean operative time was 240min with insignificant blood loss. The patients had uneventful hospital stay and were discharged on the 7.5th postoperative day. Conclusions: Laparoscopic distal pancreatectomy can be technically difficult and should be performed only by surgeons with sufficient experience in both open pancreatic surgery and advanced laparoscopic gastrointestinal surgery.

Technical aspects in difficult laparoscopic distal splenopancreatectomy

Laparoscopic distal pancreatectomy is the gold standard nowadays. The infiltration of splenic artery near to its origin as well as engagement of splenic vein near to its confluence with superior mesenteric vein could be a reason for technical difficulties. In such cases the most easily accessible major landmark is the common hepatic artery. Transection of the pancreatic neck and splenic vein is essential to reach the dorsal aspect of the splenic artery at the level of the celiac trunk. The aim of this video is to present our approach to retroperitoneal access of the splenic artery. We present two cases of laparoscopic distal splenopancreatectomy, one of them for cancer of the pancreatic body, and the other one with pseudocyst of the pancreatic body. Mean age of the two patients was 59.5. Totally laparoscopic splenopancreatectomy with hepatoduodenal and celiac lymph node dissection was performed. Peripancreatic invasion near to the origin of the splenic artery was observed. Stepwise pancreatic transection at the neck, followed by transection of splenic vein were done in both cases. In the second one major venous bleeding occured and was managed by clipping and division of the splenic vein. The mean operative time was 240 minutes with insignificant blood loss. The patients had uneventful hospital stay and were discharged on the 7.5th postoperative day. Laparoscopic distal pancreatectomy can be technically difficult and should be performed only by surgeons with sufficient experience in both open pancreatic surgery and advanced laparoscopic gastrointestinal surgery.

Prediction of early recurrence of pancreatic ductal adenocarcinoma after resection.

BackgroundEven after curative resection, pancreatic ductal adenocarcinoma (PDAC) patients suffer a high rate of recurrence. There is an unmet need to predict which patients will experience early recurrence after resection in order to adjust treatment strategies.MethodsData of patients with resectable PDAC undergoing surgical resection between January 2005 and September 2018 were reviewed to stratify for early recurrence defined as occurring within 6 months of resection. Preoperative data including demographics, tumor markers, blood immune-inflammatory factors and clinicopathological data were examined. We employed Elastic Net, a sparse modeling method, to construct models predicting early recurrence using these multiple preoperative factors. As a result, seven preoperative factors were selected: age, duke pancreatic monoclonal antigen type 2 value, neutrophil:lymphocyte ratio, systemic immune-inflammation index, tumor size, lymph node metastasis and is peripancreatic invasion. Repeated 10-fold cross-validations were performed, and area under the receiver operating characteristic curve (AUC) and decision curve analysis were used to evaluate the usefulness of the models.ResultsA total of 136 patients was included in the final analysis, of which 35 (34%) experienced early recurrence. Using Elastic Net, we found that 7 of 14 preoperative factors were useful for the predictive model. The mean AUC of all models constructed in the repeated validation was superior to the standard marker CA 19–9 (0.718 vs 0.657), whereas the AUC of the model constructed from the entire patient cohort was 0.767. Decision curve analysis showed that the models had a higher mean net benefit across the majority of the range of reasonable threshold probabilities.ConclusionA model using multiple preoperative factors can improve prediction of early resectable PDAC recurrence.

Development of a radiomics nomogram based on the CE-CT features to predict the survival of upfront resectable patients with pancreatic head cancer and suspected venous invasion.

e15760 Background: Pancreatic head adenocarcinoma is commonly diagnosed at an advanced stage when adjacent vascular invasion is present. This study aimed to establish a radiomics nomogram by integrating radiomics signature and clinical predictors to estimate overall survival(OS) in patients who underwent attempted curative resectional surgery for pancreatic head cancer with suspected peri-pancreatic venous invasion. Methods: Data on patients with pancreatic head adenocarcinoma and suspected peripancreatic invasion who underwent pancreatic resection with venous reconstruction were retrospectively collected from 2012 to 2016 at two academic institutions. A total of 396 radiomics features were extracted from pretreatment CE-CT images of each patient. Least absolute shrinkage and selection operator (LASSO) regression was applied to select optimal features and generate a radiomics signature. The radiomics nomogram was developed by integrating the radiomics signature and clinical predictors. The performance of radiomics nomogram validated in the cohort of patients of second institution. Results: Radiomics signatures were significantly associated with pancreatic head adenocarcinoma patients' survival time. The radiomics nomogram combined with clinical predictors(CA-199 value, Peripancreatic venous abnormalities and Lymph node staging) provided good predictive accuracy of survival on calibration curves. The C-index of the model in predicting overall survival (OS) was 0.836 for the validation cohort. Conclusions: The nomogram accurately predicted OS in patients with pancreatic head cancer with suspected peripancreatic venous invasion after attempted curative pancreatic resectional surgery. These findings might aid clinicians with treatment decision-making and improve precise medicine.

Development of a radiomics nomogram based on the CE-CT features to predict the survival of up front resectable patients with pancreatic head cancer and suspected venous invasion

Introduction: Pancreatic head adenocarcinoma is commonly diagnosed at an advanced stage when adjacent vascular invasion is present. This study aimed to establish a radiomics nomogram by integrating radiomics signature and clinical predictors to estimate overall survival(OS) in patients who underwent attempted curative resectional surgery for pancreatic head cancer with suspected peri-pancreatic venous invasion. Method: Data on patients with pancreatic head adenocarcinoma and suspected peripancreatic invasion who underwent pancreatic resection with venous reconstruction were retrospectively collected from 2012 to 2016 at two academic institutions. A total of 396 radiomics features were extracted from pretreatment CE-CT images of each patient. Least absolute shrinkage and selection operator (LASSO) regression was applied to select optimal features and generate a radiomics signature. The radiomics nomogram was developed by integrating the radiomics signature and clinical predictors. The performance of radiomics nomogram validated in the cohort of patients of second institution. Result: Radiomics signatures were significantly associated with pancreatic head adenocarcinoma patients' survival time. The radiomics nomogram combined with clinical predictors(CA-199 value, Peripancreatic venous abnormalities and Lymph node staging) provided good predictive accuracy of survival on calibration curves. The C-index of the model in predicting overall survival (OS) was 0.836 for the validation cohort. Conclusion: The nomogram accurately predicted OS in patients with pancreatic head cancer with suspected peripancreatic venous invasion after attempted curative pancreatic resectional surgery. These findings might aid clinicians with treatment decision-making and improve precise medicine.

Preoperative prediction of peripancreatic vein invasion by pancreatic head cancer

BackgroundPancreatic adenocarcinoma is often diagnosed at an advanced stage when adjacent vascular invasion is present. Accurate evaluation of presence of vascular invasion can help guide therapy. The aim of this study was to construct a nomogram for preoperative prediction of peripancreatic vein invasion in patients with pancreatic head cancer.Study designData of patients with carcinoma head of pancreas and suspected peripancreatic invasion (n = 247) who underwent pancreatic resection with venous reconstruction between January 2012 and January 2017 at four academic institutions were retrospectively analyzed. Univariate and multivariate analyses were used to identify independent risk factors for vein invasion from among demographic, biological, conditional host-related, and anatomical data. A predictive nomogram was constructed based on the identified independent risk factors.ResultsThe nomogram was constructed using data from 181 patients while the validation cohort consisted of 66 patients. Length of tumor contact (P = 0.031), circumferential vein involvement (P = 0.048), and venous contour abnormalities (P = 0.001) were independent predictors of venous invasion. The C-index of the model in predicting venous invasion was 0.963 for the external validation cohort. Patients could be assigned into low- (< 50%), intermediate- (50–90%), and high-risk (> 90%) groups based on the nomogram to facilitate personalized management.ConclusionsVein invasion by pancreatic head cancer is mainly associated with anatomical factors. The nomogram for prediction of vein invasion was found to be practicable.

Small pancreatic ductal carcinomas on triple-phase contrast-enhanced computed tomography: enhanced rims and the pathologic correlation.

To reveal the prevalence of small (≤ 20mm) pancreatic ductal carcinomas with enhanced rims on triple-phase contrast-enhanced CT and correlate the CT images with the pathologic findings. Between April 2005 and April 2016, 45 patients underwent preoperative triple-phase contrast-enhanced CT and were pathologically diagnosed with small pancreatic ductal carcinoma. CT images were independently reviewed by two radiologists. The attenuation values of the enhanced rims, internal areas of the tumors, and surrounding pancreatic parenchyma were compared using Mann-Whitney U test. These areas were also correlated with the pathologic findings. Tumor invasiveness was compared between the tumors with and without enhanced rims using Fisher's exact test. Enhanced rims were identified in 18 tumors (40%) by consensus between the two reviewers. The enhanced rims showed significantly higher mean attenuation values compared with the internal areas of the tumors (p < 0.001) and surrounding pancreatic parenchyma (p < 0.0086),and were most clearly visualized on equilibrium phase. The enhanced rims pathologically reflected the abundant fibrotic stroma with cancer cells in all tumors. There was no statistically significant difference in tumor invasiveness between the tumors with and without enhanced rims (anterior peripancreatic invasion, p = 0.137; posterior peripancreatic invasion, p = 0.758; portal vein invasion, p = 0.639; and lymph node metastases, p = 0.359). Enhanced rims were detected at a rate of 40% in small pancreatic ductal carcinomas and could be an important finding for diagnosis on CT images, but did not suggest a less aggressive nature.

Predictors of recurrence in patients with solid pseudopapillary neoplasms of the pancreas: a systematic review and meta-analysis of 2579 patients

Background: Recurrence rates and predictors of recurrence for solid pseudopapillary neoplasm of pancreas (SPN) remain unclear, and this makes it challenging to determine the duration of follow up in clinic. Aim of the current study was to perform a systematic review and meta- analysis to determine the recurrence rates, and identify factors associated with recurrence in patients with SPN. Methods: A Pubmed search was conducted to identify studies with SPN published during the last 15 years: 09/2002-09/2017. 877 articles were identified. Studies reporting on case series of patients with SPN with follow up >5 years were included. Isolated case reports, duplicate publications, and patients presenting with metastatic disease were excluded to prevent bias in calculation of recurrence rates. PRISMA 2009 guidelines were followed. STATA 14.2 was used for statistical analysis. Results: 104 studies with 2579 patients were included in the final qualitative analysis. 67 patients developed recurrence during follow up. Pooled estimates from studies with a sample size >20 (N = 33) noted an overall recurrence rate of 2% (95% CI 1 – 3%, Fig. 1). Time to recurrence was available for 48 patients. Median time to recurrence was 41 months (IQR 22 – 72 months, 71% recurred at ≤5years, 25% between >5 and ≤10 years & 4% at >10 years). Factors implicated in tumor recurrence include young age, large tumor size, perineural and lymphovascular invasion, peripancreatic invasion, R1 margin, tumor rupture, and high Ki-67. Conclusion: Our data suggests that 2% of patients with SPN experience recurrence after resection. Majority of recurrence occur at ≤5 years, however 25% experience recurrence between 5 and 10 years. Further comparative analysis of patients who developed recurrence at ≤5 years vs >5years will be performed to identify factors associated with early vs delayed recurrences.

Prognostic significance of epidermal growth factor receptor overexpression in pancreas cancer and nodal metastasis

Identification of molecular markers in pancreatic adenocarcinoma (PA) has the potential to guide targeted therapy. The objective of this study is to determine the prognostic significance of epidermal growth factor receptor (EGFR) expression (membrane and cytoplasmic) in resected PA and its correlation with lymph node metastasis and survival. EGFR overexpression was determined by immunohistochemistry, and the pattern of expression was compared between the primary tumour, adjacent normal pancreas and involved lymph nodes. A total of 88 patients had curative resection. No difference was found in mEGFR overexpression between tumoural and metastatic nodal tissues (P = 0.28). Median overall survival time was 22.9 months. Overall cumulative 1-, 3- and 5-year survival was 48%, 20% and 18%, respectively. In positive mEGFR tumour expression, survival was 46% at 1 year, 8% at 3 years and 0% at 5 years (P < 0.05). Univariate analysis showed that male gender, portal vein (PV) resection, perineural, lymphovascular and peri-pancreatic invasion, positive margins and positive mEGFR expression in tumour tissue had worse survival. Multivariate analysis showed that male gender, PV resection, vascular and perineural invasion remained independent predictors of poor survival. Positive mEGFR overexpression is associated with decreased survival; however, it is not an independent prognostic factor.

The CT findings of pancreatic acinar cell carcinoma in five cases

ObjectivesThe aim of this study is to analyze the computed tomographic (CT) findings of pancreatic acinar cell carcinoma (ACC). Materials and methodsThe CT features and clinical presentations of five patients (four men, one woman; mean age, 52 years) with pathology-proven pancreatic ACC were reviewed. The image characteristics included the lesion location and size, the exophytic nature of the tumor, intratumoral hemorrhage, calcification, the presence of cystic or necrotic components, bile or pancreatic duct dilation, attenuation on the noncontrast image, attenuation on the arterial- and venous-phase images, peripancreatic invasion, peripancreatic lymphadenopathy, and distant metastases. ResultsThe tumors were located at the pancreatic tail in three cases and at the pancreatic head in two cases. The average lesion size was 5.3 cm. Exophytic features and cystic/necrotic components were found in 80% (4/5) and 60% (3/5) of cases, respectively. The ACC showed a mild hypodense appearance on noncontrast CT in 100% (3/3) of cases and a hypodense appearance on arterial-/venous-phase CT in 80% (4/5) of cases. The exception was one lesion that showed a significantly hyperdense appearance and a mildly hyperdense appearance on the arterial- and venous-phase images. None of the CT images showed enhancement of a capsule, calcification, intratumoral hemorrhage, bile or pancreatic duct dilation, vascular encasement, or distant metastatic disease, but three cases showed peripancreatic invasion and lymphadenopathy. ConclusionsWith persistent mild enhancement, the typical ACC appears as an exophytic tumor with a focal cystic/necrotic component and the lack of ductal dilatation. The predilection for older male patients and elevated serum alpha fetoprotein are useful clinical features for confirming an ACC diagnosis.

Lymphangiogenesis and biological behavior in pancreatic carcinoma and other pancreatic tumors

Lymphatic vessels in primary tumor tissue play an important role in lymphatic metastasis. Lymphatic metastasis of malignant neoplasms is significantly related to prognosis, influencing both recurrence and survival. The aim of this study was to investigate the correlation of intra-tumoral lymphatic vessel density (iLVD) and peri-tumoral lymphatic vessel density (pLVD) with biological behavior and prognostic parameters in pancreatic carcinoma (PC) and other pancreatic tumors. Lymphangiogenesis was examined using the D2-40 monoclonal antibody in 33 cases of PC, 7 neuroendocrine tumors of the pancreas (NETP), 7 solid pseudopapillary tumors of the pancreas (SPTP) and 3 cystadenomas of the pancreas (CP). Positively-stained microvessels were counted at magnification ×400 in dense lymphatic vascular foci (hotspots). The LVD of PC was compared to 3 other pancreatic tumors. The relationships among the LVD, the extent of differentiation, lymphatic invasion, lymph node metastasis and other clinicopathological parameters of PC were analyzed. There was no difference in the iLVD among PC, NETP, SPTP and CP. The pLVD of NETP was markedly higher than that of PC, SPTP and CP. The pLVD of PC was significantly higher than that of SPTP and CP, but there was no difference between SPTP and CP. The pLVD of PC was significantly associated with the extent of differentiation, lymphatic invasion and lymph node metastasis, whereas it was not associated with age, gender, tumor size, tumor location and peri-pancreatic invasion. The iLVD of PC was not correlated with these clinicopathological parameters. There was no difference in iLVD and no marked difference in pLVD among the pancreatic tumors. Detection of pLVD is of greater importance than detecting iLVD in these pancreatic tumors, as pLVD can be utilized for the prediction of lymph node metastasis, thus aiding in the evaluation of patient prognosis.

CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (Part I): Anatomy, imaging of the extrapancreatic nerve

Pancreatic carcinoma is an extremely high-grade malignant tumor with fast development and high mortality. The incidence of pancreatic carcinoma continues to increase. Peripancreatic invasion and metastasis are the main characteristics and important prognostic factors in pancreatic carcinoma, especially invasion into the nervous system; pancreatic nerve innervation includes the intrapancreatic and extrapancreatic nerves. A strong grasp of pancreatic nerve innervation may contribute to our understanding of pancreatic pain modalities and the metastatic routes for pancreatic carcinomas. Computed tomography (CT) and magnetic resonance imaging (MRI) are helpful techniques for depicting the anatomy of extrapancreatic nerve innervation. The purpose of the present work is to show and describe the anatomy of the extrapancreatic neural plexus and to elucidate its characteristics using CT and MRI, drawing on our own previous work and the research findings of others.

Clinical significance of PTEN and B7-H1 expressions in pancreatic carcinoma

Objective To investigate the probable correlation between the expressions of phosphatase and tensin homologue deleted on chromosometen (PTEN) and B7-H1 protein in pancreatic carcinoma and the biological behavior characteristics of tumors. Methods Forty-three patients were recruited who had undergone surgical resection for pancreatic carcinoma between 2002 and 2009. The PTEN and B7-H1 protein expressions in the tissue specimens of these 43 patients and 5 non-pancreatic carcinoma people' s pancreatic tissue specimens were evaluated by immunohistochemistry ELPS technique, and the clinical and pathological features of these specimens and the follow-up information were analyzed. Results PTEN expressions were significantly lower in pancreatic carcinoma tissues than in non-pancreatic carcinoma people' s pancreatic tissues but B7-H1 expressions were significantly higher ( P ＜ 0. 01 ). The expression of PTEN was negatively correlated to that of B7-H1 (r = -0.414 ,P ＜0. 01). PTEN and B7-H1 expressions correlated with the pathological grade and tumor-node-metastasis ( TNM ) stage, peripancreatic invasion, regional lymph node involvement,respectively (P＜0. 05). B7-H1 expressions also significantly correlated with the ages (P＜0. 01). Furthermore, PTEN and B7-H1 expressions showed significant prognostic effects (P＜0.01) and there are correlations existed between combined PTEN/B7-H1 expression and prognostic effects (P ＜0. 05). Conclusion The expression of PTEN and B7-H1 may be significantly correlated to the carcinogenesis,development and prognosis of pancreatic carcinoma. Key words: Pancreatic cancer; PTEN; B7-H1; Biological behavior characteristics

Nestin is a novel target for suppressing pancreatic cancer cell migration, invasion and metastasis

Nestin, is a class VI intermediate filament (IF) that is expressed in 30% of pancreatic ductal adenocarcinoma (PDAC) cases, and its expression in PDAC positively correlates with peripancreatic invasion. An expression vector carrying a short hairpin RNA (shRNA) targeting nestin was stably transfected into PANC-1 and PK-45H human pancreatic cancer cells, which express high nestin levels. Alterations in morphology and alignment of actin filaments and α-tubulin were examined by phase-contrast and immunocytochemistry. Effects on cell growth, migration in scratch and Boyden chamber assays, invasion, cell adhesion, and in vivo growth were determined. Differences in mRNA levels were examined by arrays. Nestin shRNA-transfected cells exhibited decreased nestin expression, a sheet-like appearance with tight cell-cell adhesion, increased expression of filamentous F-actin and E-cadherin, and attenuated migration and invasion, both of which were enhanced following nestin re-expression. Expression of α-tubulin, and in vitro cell growth and adhesion were not altered by nestin down-regulation, whereas hepatic metastases were decreased. Thus, nestin plays important roles in pancreatic cancer cell migration, invasion and metastasis by selectively modulating the expression of actin and cell adhesion molecules, and may therefore be a novel therapeutic target in PDAC.</br> See commentary: Pancreatic cancer with Nest-in tendencies