scholarly journals Triple metachronous primary pancreatic and gallbladder cancer associated with pancreaticobiliary maljunction: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuta Kuhara ◽  
Yasushi Hashimoto ◽  
Satoshi Hirahara ◽  
Haruna Kubota ◽  
Kenji Shirakawa ◽  
...  
Keyword(s):  
Lymph Node ◽  
Gallbladder Cancer ◽  
Histological Examination ◽  
Lymph Node Metastases ◽  
Pancreatic Head ◽  
Pancreaticobiliary Maljunction ◽  
Curative Surgery ◽  
Initial Surgery ◽  
Node Metastases

Abstract Background Metachronous pancreatic and gallbladder cancer is a rare condition and has a dismal prognosis. Herein, we present a patient with triple metachronous primary pancreatic and gallbladder cancer associated with pancreaticobiliary maljunction who achieved long-term survival after undergoing repeat curative surgery. Case presentation A 65-year-old female patient with advanced gallbladder cancer associated with pancreaticobiliary maljunction underwent extended cholecystectomy with extrahepatic bile duct resection. The pathological diagnosis was T3N0M0 stage III A papillary adenocarcinoma with hepatic invasion. During a monthly follow-up, a diffuse hypovascular 2.0 × 1.5-cm mass was detected in the pancreatic head 6.2 years after the initial surgery. Hence, the patient underwent pancreaticoduodenectomy. Histological examination revealed T3N0M0 stage IIA well-differentiated adenocarcinoma without lymph node metastases. Marked inflammatory reaction was observed in the non-cancerous lesions of the proximal pancreatic head parenchyma containing bile pigment within ductular lumens. After 12.5 years from the initial surgery, total pancreatectomy for a 4.0 × 3.0-cm mass in the remnant pancreas was performed. Histological examination revealed T3N1M0 stage IIB moderately differentiated adenocarcinoma with lymph node metastases. Hence, surgical curative resection was achieved. Based on the pathological findings, a definitive diagnosis of triple metachronous pancreatic and gallbladder cancer was made. The pathology suggests no precursor lesions such as pancreatic intraepithelial neoplasia (PanIN) and atypical flat lesions, but marked inflammations in the non-cancerous lesions, strengthening our hypothesis that chronic inflammation induced by the pancreaticobiliary maljunction is related to carcinogenesis of the pancreas. Despite further adjuvant chemotherapy, the patient’s general condition worsened; however, she remained alive 15.2 years after the initial surgery while receiving the best supportive care. Conclusions Repeat curative surgery for triple metachronous cancer was associated with a favorable prognosis. Both the biliary tract and the pancreas should be closely monitored during follow-up among patients with pancreaticobiliary maljunction, which can be managed with curative surgery.

scholarly journals Residual disease in lymph nodes has no influence on survival in patients with incidental gallbladder cancer – institution experience with literature review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Mihajlo Đokic ◽  
Urban Stupan ◽  
Sabina Licen ◽  
Blaz Trotovsek
Keyword(s):  
Lymph Node ◽  
Survival Rate ◽  
Lymph Nodes ◽  
Gallbladder Cancer ◽  
Lymph Node Metastases ◽  
Residual Disease ◽  
Treatment Strategies ◽  
Node Metastases ◽  
Incidental Gallbladder Cancer

Abstract Background A better appreciation of the course and factors that influence incidental gallbladder cancer (iGBC) is needed to develop treatment strategies aimed to improve outcomes. The purpose of the study was to determine the influence of residual disease in the liver and lymph nodes on overall survival in re-resected patients with iGBC. Patients and methods Patients undergoing radical re-resection for iGBC from January 2012 to December 2018 were retrospectively identified. Patients with a 5-year follow-up and submitted to complete resection with stage I, II and III disease were analysed. The influence of residual disease (RD) in liver and lymph nodes on survival was assessed using the Kaplan-Meier curves. In addition, the rest of the group was assessed based on type of primary/secondary procedure, number of harvested lymph nodes and RD in liver and/or lymph nodes. Results In this retrospective study 48 out of 58 (83%) patients underwent re-resection. Among the group with a 5-year follow-up (re-operation between 2012–2014), 22 patients out of 28 (79%) were re-resected. Survival analysis showed that patients with no RD in the liver and lymph nodes had statistically significant better 5-year survival than those with RD. Comparing 5-year survival rate in patients with RD in the liver or lymph nodes against no RD group, patients with RD in the liver had statistically significantly worse 5-year survival, while lymph node metastases did not show any statistically significant different in 5-year survival. Besides, a statistically significant better prognosis was found in stage II disease compared to stage III, as expected. Conclusions The most important predictors of a 5-year survival in our study were RD in liver and stage of the disease. Lymph node metastases did not have any impact on the overall 5-year survival rate.

Prospective Study of Fluorodeoxyglucose–Positron Emission Tomography Imaging of Lymph Node Basins in Melanoma Patients Undergoing Sentinel Node Biopsy

1999 ◽  
Vol 17 (5) ◽  
pp. 1508-1508 ◽  
Author(s):  
Jeffrey D. Wagner ◽  
Donald Schauwecker ◽  
Darrell Davidson ◽  
John J. Coleman III ◽  
Scott Saxman ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Node ◽  
Lymph Node Metastases ◽  
Fdg Pet ◽  
Regional Lymph Node ◽  
Emission Tomography ◽  
Node Biopsy ◽  
Positron Emission ◽  
Node Metastases

PURPOSE: To prospectively compare positron emission tomography (PET) imaging of regional lymph node basins to sentinel node biopsy (SNB) in patients with American Joint Committee on Cancer (AJCC) stage I, II, and III melanoma localized to the skin. METHODS: Patients with cutaneous melanoma with Breslow's depth greater than 1 mm (AJCC T2-4N0M0) or localized regional cutaneous recurrence (TxN2bM0) underwent whole-body imaging of glucose metabolism with fluorodeoxyglucose (FDG) PET followed by SNB. PET scans were interpreted in a blinded fashion and compared with histologic analyses of SNB specimens and clinical follow-up examination. Nodal tumor volumes were estimated. RESULTS: Eighty-nine lymph node basins were evaluated by FDG-PET and SNB in 70 assessable patients. Eighteen patients (25.7%) had lymph node metastases at the time of FDG-PET imaging: 17 proved by SNB (24.3%) and one by follow-up examination (1.4%). Median tumor volume in positive sentinel node basins was 4.3 mm3 (range, 0.07 to 523 mm3). Sensitivity of SNB for detection of occult regional lymph node metastases was 94.4%, specificity was 100%, positive predictive value (PPV) was 100%, and negative predictive value (NPV) was 98.6%. Sensitivity of FDG-PET was 16.7%, specificity was 95.8%, PPV was 50%, and NPV was 81.9%. At a median follow-up duration of 16.6 months, seven patients (10%) developed recurrent disease. PET predicted one recurrence (14.3%) in a node basin missed by SNB. CONCLUSION: FDG-PET is an insensitive indicator of occult regional lymph node metastases in patients with melanoma because of the minute tumor volumes in this population. FDG-PET does not have a primary role for staging regional nodes in patients with clinically localized melanoma.

Stromal Distribution of CA 19-9 as a Predictor of Lymph Node Metastases in Gallbladder Cancer without Serosal Invasion

Oncology ◽  
1994 ◽  
Vol 51 (3) ◽  
pp. 238-243 ◽  
Author(s):  
Tetsuo Ohta ◽  
Takukazu Nagakawa ◽  
Luis Fonseca ◽  
Yutaka Yoshimitsu ◽  
Itsuo Miyazaki ◽  
...  
Keyword(s):  
Lymph Node ◽  
Gallbladder Cancer ◽  
Lymph Node Metastases ◽  
Serosal Invasion ◽  
Node Metastases

Sensitivity rate of ultrasound (US)-guided fine-needle aspiration cytology (FNAC) using the Berlin morphology criteria for lymph node metastases to reduce the need for surgical sentinel node (SN) staging in melanoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8535-8535 ◽  
Author(s):  
Christiane A. Voit ◽  
Alexander Christopher Jonathan Van Akkooi ◽  
Saskia Gooskens ◽  
Petra Siegel ◽  
Gregor Schaefer-Hesterberg ◽  
...  
Keyword(s):  
Lymph Node ◽  
Clin Oncol ◽  
Lymph Node Metastases ◽  
High Sensitivity ◽  
Needle Aspiration ◽  
Tumor Burden ◽  
Maximum Diameter ◽  
Node Metastases ◽  
Rotterdam Criteria

8535 Background: US-guided-FNAC prior to surgical SN staging is emerging as a possible cost-effective addition to the staging of melanoma patients (pts). Formerly, sensitivity (sens) rates of lymph node US in melanoma were disappointing (20–40%). The introduction of the Berlin Morphology Criteria has significantly improved sens rates for US-FNAC (J Clin Oncol 2010;28(5):847-52). The aim of the current study was to report on 1000 patients the sens, specificity (spec), positive (PPV) and negative (NPV) predictive value rates of US-FNAC from our prospective database with prolonged follow-up. Methods: Since 2001, >1000 stage I / II consecutive melanoma pts have undergone US-FNAC prior to SN. All patients underwent lymphoscintigraphy. Peripheral Perfusion (PP), Loss of Central Echoes (LCE), Balloon Shaped (BS) were the Berlin Morphology Criteria which were registered. FNAC was performed in case of presence of any of these factors. SN tumor burden was measured according to the Rotterdam Criteria. All patients underwent SN or LND in case of positive FNAC. Results: Mean/median Breslow thickness was 2.56 / 1.57 mm (0.2 – 44 mm).Mean/median follow-up was 39 / 32 months (0 – 115). Ulceration was present in 24 %. SN positivity rates were 20 % (202 / 1000). Sens was 51 %. Spec, PPV and NPV were 99%, 91% and 89%. Sensitivity was highest for T4 tumors (77%). PP, LCE, BS had sens of 69%, 24%, 25%. SN tumor burden > 1 mm in largest diameter according to the Rotterdam Criteria was identified by US-FNAC in 86%. Threshold for positive FNAC was 0.4 mm in maximum diameter. Conclusions: The new criterion of Periferal Perfusion is of key importance to achieve the high sensitivity of US-FNAC according to the Berlin Morphology Criteria (J Clin Oncol 2010; 28:847-852) to identify lymph node metastases. Especially for T4 patients and in patients with advanced SN tumor burden it can reduce significantly the need for surgical SN staging. The EORTC Melanoma Group will launch the prospective validation study, USE FNAC, in 2012.

Incidence, significance, and follow-up of para-aortic lymph node metastases in late invasive carcinoma of the cervix

1977 ◽  
Vol 128 (3) ◽  
pp. 336-340 ◽  
Author(s):  
James H. Nelson ◽  
John Boyce ◽  
Milagros Macasaet ◽  
Therese Lu ◽  
Joseph F. Bohorquez ◽  
...  
Keyword(s):  
Lymph Node ◽  
Lymph Node Metastases ◽  
Invasive Carcinoma ◽  
Aortic Lymph Node ◽  
Node Metastases

scholarly journals Malignant Paragangliomas Associated with Mutations in the Succinate Dehydrogenase D Gene

2007 ◽  
Vol 92 (4) ◽  
pp. 1245-1248 ◽  
Author(s):  
B. Havekes ◽  
E. P. M. Corssmit ◽  
J. C. Jansen ◽  
A. G. L. van der Mey ◽  
A. H. J. T. Vriends ◽  
...  
Keyword(s):  
Lymph Node ◽  
Succinate Dehydrogenase ◽  
Lymph Node Metastases ◽  
Expression Patterns ◽  
Interindividual Variations ◽  
Subclinical Disease ◽  
Catecholamine Excess ◽  
Node Metastases ◽  
Head And Neck Paraganglioma

Abstract Introduction: Malignant paragangliomas have been well described in carriers of mutations of the succinate dehydrogenase B (SDHB) gene, but have rarely been associated with mutations in the succinate dehydrogenase D (SDHD) gene. Aim: The aim of the study was to report the different clinical expression patterns of malignant paragangliomas in five patients with SDHD (D92Y) mutations observed in approximately 200 SDHD (D92Y) mutation carriers followed in our institution. Results: Metastasis and/or local tumor invasion was documented 0 (n = 2), 1, 18, and 30 yr after the initial diagnosis of paraganglioma. Malignancy was proven by paraganglioma bone metastases (n = 2), intrathoracic paraganglioma with lymph node metastases, locally invasive head-and-neck paraganglioma with destruction of the petrosal bone, and locally invasive paraganglioma of the bladder with lymph node metastases. Four of the five patients developed catecholamine excess during follow-up due to intraadrenal paraganglioma (pheochromocytoma) (n = 1), extra adrenal paraganglioma (n = 2), and presumed subclinical disease (n = 1). Conclusion: SDHD mutations (D92Y) are associated with malignant paragangliomas and catecholamine excess with remarkable interindividual variations despite the same mutation. We estimate that the prevalence of malignancy in carriers of D92Y mutations is at least 2.5%.

scholarly journals Sonic hedgehog and pancreatic-duodenal homeobox 1 expression distinguish between duodenal and pancreatic gastrinomas

2009 ◽  
Vol 16 (2) ◽  
pp. 613-622 ◽  
Author(s):  
Volker Fendrich ◽  
Ricarda Ramerth ◽  
Jens Waldmann ◽  
Katja Maschuw ◽  
Peter Langer ◽  
...  
Keyword(s):  
Lymph Node ◽  
Expression Pattern ◽  
Sonic Hedgehog ◽  
Lymph Node Metastases ◽  
Pancreatic Head ◽  
Endocrine Tumors ◽  
Pancreatic Endocrine Tumors ◽  
Node Metastases ◽  
Different Genetic Background ◽  
Pdx1 Expression

Some 80–90% of gastrinomas are located in the gastrinoma triangle, which includes the duodenum, the pancreatic head, and the hepatoduodenal ligament. The natural history of the tumors depends on their origin. Duodenal gastrinomas are much less aggressive than pancreatic primaries and infrequently develop liver metastases. The reason therefore is unclear. The transcription factor pancreatic-duodenal homeobox 1 (Pdx1) is important in differentiation and development of the pancreas and duodenum. In embryonic development, Sonic hedgehog (Shh) expression establishes a sharp molecular boundary, which allows for the proper patterning of the duodenal and pancreatic epithelium. Pancreatic polypeptide (PP) is expressed in pancreatic islets and is known to be expressed in pancreatic endocrine tumors. This study aims to clarify the expression pattern of Pdx1, Shh, and PP in duodenal and pancreatic gastrinomas. Tissue from 15 patients with duodenal and from 11 patients with pancreatic gastrinomas that underwent surgery between 1987 and 2007 at our institution because of a gastrinoma were evaluated by immunohistochemistry (IHC). Furthermore, tissue from lymph node metastases from two patients with a so far undetected primary gastrinoma was analyzed. IHC revealed strong Pdx1 expression in pancreatic gastrinomas, but not in duodenal gastrinomas. By contrast, there was no Shh expression detectable in pancreatic gastrinomas, but found in all duodenal gastrinomas. This pattern was also true for associated metastases. Shh expression combined with absence of Pdx1 expression in lymph node metastases from patients with an unknown location of the primary suggests a so far undetected duodenal gastrinoma. We show for the first time that only pancreatic, but not duodenal gastrinomas express Pdx1. Moreover, only duodenal gastrinomas express Shh, suggesting a different genetic background of these two tumors. Whereas the expression of Pdx1 in pancreatic gastrinomas might suggest their endocrine origin from islets, duodenal gastrinomas develop from a Pdx1 negative cell cluster. The expression pattern of Pdx1, Shh, and PP in resected metastases can help to locate an otherwise undetected primary gastrinoma.

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