Morphologic Changes in the Body of the Pancreas Secondary to a Mass in the Pancreatic Head

Retropancreatic retroperitoneal tumors (RRTs) are seldom encountered in clinical practice. The lack of characteristics on clinical presentation and imaging make preoperative diagnosis difficult and surgical management remains a challenge. This retrospective report surveys the presenting diagnosis and surgical management of 38 patients with RRTs presenting at our center between August 1981 and May 2012. Six patients were misdiagnosed on the basis of computerized tomography and one each by magnetic resonance imaging and magnetic resonance cholangiopancreatography. Tumors were localized posterior to the pancreatic head and uncinate process (n = 18); posterior to the neck and body of the pancreas (n = 9); or posterior to the body and tail of the pancreas (n = 11). Thirty-three patients underwent surgical resections. Operative approaches were chosen on the basis of tumor size and localization. The tumors were mostly commonly originating from neurogenic tissue (n = 16). There were 25 benign neoplasms (65.8%), 10 malignant tumors (26.3%), and three undefined tumors. The morbidity of postsurgical complications was 21 per cent (eight of 38). The number of patients who underwent follow-up was 21, and the mean follow-up time was 35 months (range, 2 to 90 months). Three patients died during follow-up. The morbility of local recurrence was 10.5 per cent (four of 38). Definitive diagnosis of RRTs is made at laparotomy. Complete resection remains the fundamental objective of disease management. Different operative approaches should be used according to tumor localization and size.

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Neuroma (schwannoma). A rare pancreatic tumor

Polish Journal of Surgery ◽

10.5604/01.3001.0012.8558 ◽

2019 ◽

Vol 91 (3) ◽

pp. 1-4

Author(s):

Grzegorz Witkowski ◽

Małgorzata Kołos ◽

Anna Nasierowska-Guttmejer ◽

Marek Durlik

Keyword(s):

Surgical Treatment ◽

Histopathological Examination ◽

English Literature ◽

Pancreatic Head ◽

Whipple Procedure ◽

Uncinate Process ◽

The Body ◽

Ct Guided ◽

Pancreatic Head Cancer ◽

Common Location

Neuroma (Schwannoma in Latin) is an encapsulated, mesenchymal tumor arising from Schwann cells surrounded by nerves. Hence it can be located in any area in the body with passing peripheral nerves. The most common location is the head, neck, and extremities. The tumor arising from Schwannoma cells was first described by Stout and Carson in 1935. Pancreatic schwannomas are extremely rare tumors. Until 2017, in English literature 68 cases have been described. Surgical treatment is the most common way of treating pancreatic schwannomas, and postoperative prognoses are good. A 63-year-old patient was admitted to the Clinical Department of Gastroenterological Surgery and Transplantation of the Central Clinical Hospital at the Ministry of Interior and Administration in Warsaw due to pancreatic head cancer. Needle biopsy–both ultrasound-guided and CT-guided as well as open biopsy for lesions in the pancreas did not show tumor cells in any of the collected samples. Abdominal CT in a projection of the uncinate process of the pancreas revealed an oval lesion highly suspected of neoplastic process. Next, diagnostics was extended by abdominal MRI which revealed a retroperitoneal tumorous thick-walled cystic mass filled with fluid. The patient was qualified for surgical treatment. Pancreaticoduodenectomy (Whipple Procedure) was done on August 22, 2017. Material sent for histopathological examination revealed Schwannoma capitis pancreatis. In surgical practice, pancreatic schwannoma occurs extremely rare, but in centers which conduct large numbers of surgical procedures in the pancreas, a case like this may occur.

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Small cell carcinoma of gall bladder: An uncommon histologic entity

Polish Journal of Surgery ◽

10.5604/01.3001.0014.3177 ◽

2020 ◽

Vol 92 (5) ◽

pp. 1-5

Author(s):

Amit Gupta ◽

ROHIK ANJUM ◽

Rishit Mani ◽

Navin Kumar ◽

Anoushika Mehan ◽

...

Keyword(s):

Gall Bladder ◽

Cell Carcinoma ◽

Small Cell Carcinoma ◽

Pancreatic Head ◽

Small Cell ◽

The Body ◽

Wall Thickening ◽

Main Portal Vein ◽

Significant Weight Loss ◽

Upper Abdomen

Gall bladder small cell carcinoma (scc) comprises of 0.5% of all GB cancers. It carries a poor prognosis in view of its aggressive nature. We here report a case of small cell carcinoma GB 55-year old lady presented with features of obstructive jaundice with significant weight loss. Examination revealed hard lump in right upper abdomen with multiple scratch marks all over the body. Clinically she had jaundice. Blood investigations revealed hyperbilirubinemia. Tumour markers showed raised CA 19-9. Staging CECT thorax and Abdomen reported polypoidal enhancing wall thickening of gall bladder with multiple metastatic deposits close to pancreatic head encasing main portal vein and common bile duct. Histopathology was suggestive of small cell carcinoma. Patient was referred to Oncology department and is receiving palliative cisplatin-etoposide chemotherapy

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Comparison of the mutation profile between pancreatic head/neck and body/tail cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15752 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15752-e15752 ◽

Cited By ~ 1

Author(s):

Junliang Lu ◽

Zhiyong Liang ◽

Huanwen M. Wu ◽

Junyi Pang ◽

Xiaolong Liang ◽

...

Keyword(s):

Protein Tyrosine Kinase ◽

Pancreatic Head ◽

Clinicopathological Characteristics ◽

The Body ◽

Receptor Protein ◽

Protein Amino Acid ◽

Kras Mutations ◽

Pancreatic Body ◽

Mutation Profile ◽

Head Neck

e15752 Background: Carcinomas in the pancreatic head/neck and body/tail represent different clinicopathological characteristics, but little is known about the underlying genetic mechanisms. The present study aims to explore the differences in mutation profile between pancreatic head and body/tail cancers. Methods: Fifty-four patients were retrospectively enrolled in the present study. DNA was purified from qualified formalin-fixed, paraffin-embedded tissue blocks of the tumor and corresponding adjacent normal tissue and subjected to target-capture next generation sequencing (TGS). Somatic mutations were identified, which further underwent gene ontology (GO) and KEGG pathway analysis. Results: The most frequently mutated genes in carcinomas of the pancreatic head were KRAS (61.3%), TP53(38.7%), and CDKN2A (16.1%), while that of the pancreatic body/tail were KRAS (95.7%), TP53(87%), CDKN2A (26.1%), and ARID1A (26.1%). The prevalence of TP53 and KRAS mutations in pancreatic head and body/tail cancers were significantly different from each other (p = 0.0006 and p = 0.0037, respectively). Pancreatic head/neck cancers also preserved a broader KRAS mutation spectrum than their counterparts of the body/tail. Pathway analyses revealed that mutations in cancer of pancreatic head/neck were enriched for genes involved in the protein amino acid phosphorylation, regulation of cell proliferation, transmembrane receptor protein tyrosine kinase signaling pathway, and phosphorylation pathways, while cancers of the pancreatic body/tail were enriched for genes involved in colorectal cancers. Conclusions: Cancer of the pancreatic head/neck and body/tail have distinct mutation profiles.

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The Role of Location of Tumor in the Prognosis of the Pancreatic Cancer

Cancers ◽

10.3390/cancers12082036 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2036

Author(s):

Mirang Lee ◽

Wooil Kwon ◽

Hongbeom Kim ◽

Yoonhyeong Byun ◽

Youngmin Han ◽

...

Keyword(s):

Pancreatic Cancer ◽

Multivariate Analysis ◽

Survival Rate ◽

Prognostic Factor ◽

Locally Advanced ◽

Pancreatic Head ◽

The Body ◽

Significant Prognostic Factor ◽

Clinicopathologic Characteristics ◽

Curative Intent

Identification of prognostic factors is important to improve treatment outcomes in pancreatic cancer. This study aimed to investigate the effect of the location of pancreatic cancer on survival and to determine whether it was a significant prognostic factor. Altogether, 2483 patients diagnosed with pancreatic cancer were examined. Comparative analysis of clinicopathologic characteristics, survival analysis, and multivariate analysis were performed. Cancers of the pancreatic head or the uncinate process were present in 49.5% of patients. The head/uncinate cancers had more clinical T1/T2 tumors (59.4% vs. 35.5%, p < 0.001) and a significantly higher 5-year survival rate (8.9% vs. 7.3%, p < 0.001) than the body/tail cancers. The 5-year survival rate in patients with head/uncinate cancers was significantly lower in the resectable (p = 0.014) and the locally advanced groups (p = 0.007). In patients who underwent resection with curative intent, the 5-year survival rate was lower in the head/uncinate group (p = 0.046). The overall outcome of the head/uncinate cancers was better than the body/tail cancers, due to the high proportion of resectable cases. In patients who underwent curative resection, the head/uncinate cancers had a higher number of T1/T2 tumors, but worse outcomes. In the multivariate analysis, tumor location was not an independent prognostic factor for pancreatic cancer.

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Granulocytic Sarcoma (GS) as First Manifestation of AML.

Blood ◽

10.1182/blood.v106.11.4596.4596 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4596-4596

Author(s):

Maged Khalil ◽

Tamer Malik ◽

Albeir Mousa ◽

Madhumati Kalavar ◽

Richard Fogler ◽

...

Keyword(s):

Chromosomal Abnormalities ◽

Epigastric Pain ◽

Gastric Wall ◽

Pancreatic Head ◽

Granulocytic Sarcoma ◽

The Body ◽

Myelogenous Leukemia ◽

Wall Thickening ◽

High Dose ◽

Extramedullary Tumor

Abstract Granulocytic sarcoma (GS), or chloroma is an extramedullary tumor of immature myeloid cells which occurs throughout the body, often associated with acute myeloid leukemia (AML) or in the accelerated phase of chronic myelogenous leukemia, but rarely as the first manifestation of AML, preceding the onset in marrow and blood by months or years[1, 2] Herein, we report GS of lymph nodes presenting as first manifestation of AML Case Report A 53 years old male presented with recurrent episodes of epigastric abdominal pain without history of trauma or infections, Physical examination was normal. Laboratory examination showed WBC 5.2, ANC 4.4, Hemoglobin 13.6 gm/dl, PLT.306, 000 and Retic 1.8. Computerized Tomography (CT) of abdomen and pelvis showed extensive abdominal and pelvic lymphadenopathy, gastric wall thickening and prominence of the pancreatic head versus peripancreatic lymphadenopathy. Subsequently Esophagogastroduodenscopy and colonoscopy were both negative for malignancy. Peripheral smear showed normal RBC, and no myeloblasts. Laparoscopic retroperitoneal lymph node biopsy revealed granulocytic sarcoma, with immunohistochemistry positive for CD43, CD117, CD68 and MPO Bone marrow biopsy and aspirate were performed, showing increased M: E ratio, increased blasts (29%), with flow cytometry reporting positivity for CD13, CD33, CD34, CD117, and HLA-DR supporting the diagnosis of AML. Chromosomal analysis including Fluorescence in situ hybridization studies (FISH) showed no evidence of chromosomal abnormalities. Patient continued to have epigastric pain radiating to the back without fever, night sweats or weight loss. He was treated with standard induction chemotherapy with Ara-c (7 days) and Idarubicin (3days), resulting in complete remission with resolution of the abdominal and pelvic lymphadenopathy. Patient is currently receiving consolidation therapy with high dose Ara-c Conclusion Granulocytic sarcoma is a rare disease. The overall prognosis is poor. However, AML-type chemotherapy appears to improve survival.

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Case 4.9

Mayo Clinic Body MRI Case Review ◽

10.1093/med/9780199915705.003.0107 ◽

2014 ◽

pp. 203-204

Author(s):

Christine U. Lee ◽

James F. Glockner

Keyword(s):

Abdominal Pain ◽

Pancreatic Duct ◽

Pancreatic Head ◽

Filling Defect ◽

Chronic Abdominal Pain ◽

The Body ◽

Pancreatic Parenchyma ◽

Previous Episode

72-year-old woman with chronic abdominal pain and a previous episode of pancreatitis 5 years ago Axial fat-suppressed 2D SSFP images (Figure 4.9.1) reveal marked diffuse dilatation of the pancreatic duct without any visible pancreatic parenchyma. Note also a large filling defect in the duct at the pancreatic head and a smaller filling defect in the body of the pancreas. MIP image from 3D FRFSE MRCP (...

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A48 USE OF ENDOSCOPIC ULTRASOUND FINE NEEDLE ASPIRATE AND ENDOSCOPIC ULTRASOUND FINE NEEDLE BIOPSY FOR DETECTION OF GATA6 EXPRESSON IN PANCREATIC DUCTAL ADENOCARINCOMA

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.046 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 297-299

Author(s):

C Law ◽

S Fischer ◽

J Knox ◽

S Gallinger ◽

S Ramotar ◽

...

Keyword(s):

Endoscopic Ultrasound ◽

Statistical Significance ◽

Pancreatic Head ◽

Primary Objective ◽

The Body ◽

Ductal Adenocarcinoma ◽

P Value ◽

Fine Needle Aspirate ◽

Fine Needle ◽

The Impact

Abstract Background GATA6 is a transcription factor that can be used to distinguish between the basal-like and classical subtypes of pancreatic ductal adenocarcinoma (PDAC). The basal-like subtype has been demonstrated to be less responsive to modified FOLFIRINOX chemotherapy and thus can be used to predict response to specific chemotherapies. To date, GATA6 expression has only been evaluated in surgically resected PDAC specimens. Less than 15% of patients with PDAC are eligible for surgery. Endoscopic ultrasound guided fine-needle aspirate (EUS-FNA) and biopsy (EUS-FNB) can potentially help assess GATA6 expression in PDAC and in turn, help guide personalized treatment selection in all cases of PDAC. Aims The primary objective of this study was to explore the yield of EUS-FNA and EUS-FNB for the detection of GATA6 among patients with PDAC. The study also aimed to explore the impact of lesion location on sample adequacy and type of fixative on validity of GATA6 staining. Methods This study was conducted from November 2017 to October 2019. Consecutive patients with a diagnosis of PDAC confirmed by biopsy were included. Patients underwent either EUS-FNB or EUS-FNA to obtain tissues samples. Samples were fixed in either neutral buffered formalin (NBF) or a methanol based buffered solution (Cytolyt) and evaluated by a specialized cytopathology team. Fisher’s exact test was used and a p-value ≤0.05 was considered to indicate statistical significance. Results Forty-four patients were included in the study. Twenty-three (52%) patients were male and the median age of patients was 67.5 years. Twenty-five lesions were located in the head and neck of the pancreas, 14 were located in the body, and 4 were located in the tail. One patient was found to have a local recurrence of PDAC at the surgical bed of a previous Whipple procedure. Eighteen lesions were sampled by EUS-FNA and 26 were sampled using EUS-FNB. Thirty-eight (86%) samples were adequate for assessment of GATA6. Sampling technique (p=0.68) and fixative type (p=1.00) did not appear to affect sample adequacy. Compared to pancreatic body or tail specimens, samples obtained from the head or neck of the pancreas were more likely to be inadequate for analysis (p=0.03). Conclusions EUS-FNA and EUS-FNB samples are efficacious methods of assessing GATA6 expression in PDAC. This is the first predictor of treatment response that has been demonstrated to be obtained without surgical resection. Neither EUS needle type or alcohol fixation before cell block preparation appear to impact GATA6 detection. Lesions in the pancreatic head or neck appear to be associated with higher rates of sample inadequacy. Larger, prospective studies are required to confirm our findings. Funding Agencies None

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