scholarly journals Protective or Risk Factors for Postoperative Pancreatic Fistulas in Malignant Pathology

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1216
Author(s):  
Vasilescu Alin Mihai ◽  
Andriesi Rusu Delia Florina ◽  
Bradea Costel ◽  
Vlad Nutu ◽  
Ursulescu-Lupascu Corina ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Protective Factor ◽  
Malignant Tumors ◽  
Fibrous Tissue ◽  
Ductal Adenocarcinoma ◽  
Main Diagnosis ◽  
Entire Study ◽  
Periampullary Adenocarcinoma ◽  
Pancreatic Resections ◽  
Pancreatic Fistulas

Introduction: Malignant tumors are associated with a low incidence of postoperative pancreatic fistulas. The presence of peritumoral fibrosis is considered the protective factor for the development of postoperative pancreatic fistulas after pancreatic resections for pancreatic ductal adenocarcinomas. Methods: We analyzed a series of 109 consecutive patients with pancreatic resections for malignant pathology: pancreatic ductal adenocarcinomas and periampullary adenocarcinomas. The incidence of postoperative pancreatic fistulas has been reported in tumor histological type, in the presence of peritumoral fibrosis, and in the association between adenocarcinomas and areas of acute pancreatitis. The data obtained were processed with the statistical analysis program SPSS, and statistically significant p were considered at a value <0.05. Results: For the entire study group, the incidence of postoperative pancreatic fistulas was 11.01%. The lowest incidence was observed in the group of patients with pancreatic ductal adenocarcinomas (4.06% vs. 25.72% in the group with periampullary adenocarcinoma), with a p = 0.002. The presence of peritumoral fibrous tissue was observed in 49.31% of cases without pancreatic fistulas, and in 54.54% of cases that developed this postoperative complication (p = 0.5). Also, the peritumoral fibrous tissue had a uniform distribution depending on the main diagnosis (56.14% in pancreatic ductal adenocarcinoma group vs. 37.04% in periampullary adenocarcinoma group, with a p = 0.08). In the group of patients who associated areas of acute pancreatitis on the resections, the incidence of postoperative pancreatic fistulas was 7.8 times higher (30% vs. 3.8%, p = 0.026). Conclusions: Peritumoral fibrous tissue was not a factor involved in the developing of postoperative pancreatic fistulas. The association of adenocarciomas with areas of acute pancreatitis has led to a significant increase in postoperative pancreatic fistulas, which is a significant and independent risk factor.

scholarly journals The impact of obesity on the risk of postoperative pancreatic fistula in malignant surgical pathology

2021 ◽  
Vol 17 (2) ◽  
pp. 112-118
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Obese Patients ◽  
Independent Predictive Factor ◽  
Entire Study ◽  
Cardiac Pathology ◽  
Pancreatic Resections ◽  
Pancreatic Fistulas ◽  
The Impact

Postoperative pancreatic fistulas are one of the most serious postoperative complications, with important implications for the prognosis, postoperative evolution and quality of life. Patients' comorbidities play an important role in the process of producing this postoperative complication. Methods: a retrospective study was performed that included 109 patients with pancreatic resections for malignant pathology. the incidence of pancreatic fistula in relation to the associated pathology was analyzed: obesity, diabetes, hypertension and non-hypertensive cardiac pathology. Results: the incidence of pancreatic fistula on the entire study group was 11.01%. Obesity was the only factor with which a statistically significant association was obtained, the incidence of pancreatic fistula being 3.59 times higher in the group of obese patients. Conclusions: obesity is an important and independent predictive factor, which increases the risk of postoperative pancreatic fistula by increasing the difficulty of pancreatic dissection and anastomosis.

scholarly journals СT and MRI in the assessment of resectable and borderline resectable pancreatic tumors

2021 ◽  
Vol 26 (1) ◽  
pp. 34-47
Author(s):  
A. V. Kudryavtseva ◽  
S. S. Bagnenko ◽  
I. I. Dzidzawa ◽  
I. S. Zheleznyak ◽  
G. E. Trufanov ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
The Body ◽  
Ductal Adenocarcinoma ◽  
Pancreatic Tumors ◽  
Borderline Resectable ◽  
Dynamic Contrast Enhancement ◽  
Pancreas Head ◽  
Diffusion Weighted Images ◽  
Depth Analysis ◽  
Ct And Mri

Aim. To evaluate the capabilities of CT and MRI in the assessment of resectable and potentially resectable pancreatic tumors.Materials and methods. From 2015 to 2020 CT and MRI examination of the abdomen was performed in 220 patients with pancreatic ductal adenocarcinoma. The average age of the patients was 54.6 ± 9.9 years. 198 (90%) patients had a tumor of the pancreas head, 22 (10%) patients had a tumor of the body or tail of the organ. 110 (50%) people were recognized as inoperable. The results of examination of 88 (40%) patients were subjected to in-depth analysis.Results. Eighty eight patients were assessed for tumor resectability. In 36 (40.9%) cases, the neoplasm was recognized as resectable, and the standard resection was performed. In 52 (59.1%) cases, the tumor was determined as borderline resectable; extended gastropancreatoduodenal resection was performed.The usefulness of CT was shown in assessing the features of the variable vascular anatomy of the hepatopancreatobiliary area, determining the nature of the involvement of key vessels in the pathological process and lesions of the pancreas as a whole. The importance of using multiphase CT scanning is demonstrated and emphasized. The advantages of the MRI are indicated, including examples of the effective use of diffusion-weighted images.Conclusion. Multiphase MDCT and MRI with dynamic contrast enhancement are the leading methods of radiological diagnosis of malignant tumors of the pancreas and effectively complement each other.

scholarly journals The Emerging Role of Microbiota and Microbiome in Pancreatic Ductal Adenocarcinoma

Biomedicines ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. 565
Author(s):  
Sona Ciernikova ◽  
Maria Novisedlakova ◽  
Danka Cholujova ◽  
Viola Stevurkova ◽  
Michal Mego
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Malignant Tumors ◽  
Current Knowledge ◽  
Early Stage ◽  
Poor Response ◽  
Response To Therapy ◽  
Oral Microbiome ◽  
Ductal Adenocarcinoma ◽  
The Impact

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignant tumors due to the absence of biomarkers for early-stage detection and poor response to therapy. Since mounting evidence supports the role of microbiota composition in tumorigenesis and cancer treatment, the link between microbiome and PDAC has been described. In this review, we summarize the current knowledge regarding the impact of the gut and oral microbiome on the risk of PDAC development. Microenvironment-driven therapy and immune system interactions are also discussed. More importantly, we provide an overview of the clinical trials evaluating the microbiota role in the risk, prognosis, and treatment of patients suffering from PDAC and solid tumors. According to the research findings, immune tolerance might result from the microbiota-derived remodeling of pancreatic tumor microenvironment. Thus, microbiome profiling and targeting represent the potential trend to enhance antitumor immunity and improve the efficacy of PDAC treatment.

Increased Incidence of Pancreatic Fistulas after the Introduction of a Bioabsorbable Staple Line Reinforcement in Distal Pancreatic Resections

2009 ◽  
Vol 75 (10) ◽  
pp. 954-957 ◽  
Author(s):  
Eduardo A. Guzman ◽  
Rebecca A Nelson ◽  
Joseph Kim ◽  
Alessio Pigazzi ◽  
Vijay Trisal ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Resection ◽  
Staple Line ◽  
Parenchymal Transection ◽  
Staple Line Reinforcement ◽  
Distal Pancreatic Resection ◽  
Pancreatic Resections ◽  
Clinicopathologic Factors ◽  
Pancreatic Fistulas ◽  
Definition Of

Pancreatic fistula is a major cause of morbidity after distal pancreatic resection. When resections are performed with linear stapling devices, the use of bioabsorbable staple line reinforcement has been suggested to decrease the rate of pancreatic fistula. Our objective was to investigate the incidence of pancreatic fistula when using the Gore Seamguard® staple line reinforcement in stapled distal pancreatic resections. A retrospective review of 30 consecutive patients with stapled distal pancreatectomy was conducted. A broad definition of pancreatic fistula was used. Clinicopathologic factors and outcomes were compared between groups. Pancreatic fistula was diagnosed in 11 of 15 patients (73%) and three of 15 patients (20%) in the Seamguard® and non-Seamguard® groups, respectively ( P = 0.002). Pancreatic parenchymal transection at the neck of the gland was associated with pancreatic fistula, whereas laparoscopic procedures, splenic preservation, or additional organ resection were not. On multivariate analysis, the association between Seamguard® use and pancreatic fistula was significant ( P = 0.005). In conclusion, after introduction of the Gore Seamguard® bioabsorbable staple line reinforcement, we experienced a significant increase in the rate of pancreatic fistula. This experience raises concern about the efficacy of this device in limiting pancreatic fistula after stapled distal pancreatic resection.

scholarly journals Mo1345 Pancreas Divisum (PD), A Protective Factor Against Biliary Acute Pancreatitis (AP)?

2014 ◽  
Vol 146 (5) ◽  
pp. S-625 ◽  
Author(s):  
Roxana Stan-Iuga ◽  
Caroline Bertin ◽  
Marie-Pierre Vullierme ◽  
Pascal Hammel ◽  
Philippe Ruszniewski ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Protective Factor ◽  
Pancreas Divisum ◽  
Biliary Acute Pancreatitis ◽  
Pancréas Divisum

Impact of age on genomic alterations associated with pancreatic ductal adenocarcinoma (PDAC).

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 282-282
Author(s):  
Ben George ◽  
Mark Bailey ◽  
Alexa Betzig Schrock ◽  
Lauren Thorpe ◽  
Laurie M. Gay ◽  
...  
Keyword(s):  
Large Scale ◽  
Kinase Domain ◽  
Ductal Adenocarcinoma ◽  
Genomic Alterations ◽  
Kras Mutations ◽  
Entire Study ◽  
Formalin Fixed Paraffin Embedded ◽  
Comprehensive Genomic Profiling ◽  
Tumor Mutational Burden ◽  
Metastatic Sites

282 Background: Large scale, retrospective, sequencing projects have identified well-defined subtypes of PDAC, but therapeutic paradigms remain unchanged. We hypothesized that genomic alterations associated with PDAC in young adults (YA, age < 50) are distinctly different from that of older adults (OA, age > 50) to identify an enrichment of targetable alterations. Methods: DNA was extracted from formalin fixed paraffin embedded (FFPE) PDAC clinical specimens and comprehensive genomic profiling (CGP) was performed on hybrid-capture, adaptor ligation based libraries to a mean coverage depth of > 600 for up to 315 genes plus 47 introns from 19 genes frequently rearranged in cancer. Results: CGP was performed on 1533 FFPE PDAC specimens, 566 (36.9%) were from the primary tumor, 967 (63.1%) from metastatic sites. Median age at diagnosis was 63 years (yrs), 180 (11.7%) were YA. KRAS mutations were identified in 78.7 of YA and 87.7% of OA. The differentially altered genes between the two groups were KRAS (p = 0.004), TP53 (p = 0.04), BRCA2 (p = 0.02), AKT2 (p = 0.03), MAP2K4 (P = 0.003) and DNMT3A (p = 0.0002). The median tumor mutational burden (TMB) for the entire study set was 2.7 (YA – 2.5, OA –2.7). BRAF kinase domain deletion was observed in 1 patient (OA). ALK fusions were present in 2 patients (1 YA & 1 OA) and these patients had durable responses to specific ALK inhibitors. Conclusions: The majority of the genomic alterations identified were not significantly different on the basis of age. However, identification of subpopulations, such as ALK kinase fusions and BRAF kinase domain deletions that can translate into sustained clinical benefit from matched targeted therapy is promising. This underscores the importance of CGP in PDAC to investigate other targetable genomic alterations.

Preoperative diabetes mellitus does not impact on postoperative morbidity after pancreatic resections for ductal adenocarcinoma

Pancreatology ◽  
2012 ◽  
Vol 12 (6) ◽  
pp. 589-590 ◽  
Author(s):  
G. Malleo ◽  
F. Mazzarella ◽  
A. Malpaga ◽  
G. Marchegiani ◽  
R. Salvia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Postoperative Morbidity ◽  
Ductal Adenocarcinoma ◽  
Pancreatic Resections

scholarly journals Development and validation of a nomogram risk prediction model for malignancy in dermatomyositis patients: a retrospective study

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e12626
Author(s):  
Jiaojiao Zhong ◽  
Yunan He ◽  
Jianchi Ma ◽  
Siyao Lu ◽  
Yushi Wu ◽  
...  
Keyword(s):  
Protective Factor ◽  
Validation Cohort ◽  
Malignant Tumors ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Area Under The Curve ◽  
Poor Prognostic Factor ◽  
Training Cohort ◽  
Discrimination Ability ◽  
Logistic Analysis

Background Dermatomyositis accompanied with malignancy is a common poor prognostic factor of dermatomyositis. Thus, the early prediction of the risk of malignancy in patients with dermatomyositis can significantly improve the prognosis of patients. However, the identification of antibodies related to malignancy in dermatomyositis patients has not been widely implemented in clinical practice. Herein, we established a predictive nomogram model for the diagnosis of dermatomyositis associated with malignancy. Methods We retrospectively analyzed 240 cases of dermatomyositis patients admitted to Sun Yat-sen Memorial Hospital, Sun Yat-sen University from January 2002 to December 2019. According to the year of admission, the first 70% of the patients were used to establish a training cohort, and the remaining 30% were assigned to the validation cohort. Univariate analysis was performed on all variables, and statistically relevant variables were further included in a multivariate logistic regression analysis to screen for independent predictors. Finally, a nomogram was constructed based on these independent predictors. Bootstrap repeated sampling calculation C-index was used to evaluate the model’s calibration, and area under the curve (AUC) was used to evaluate the model discrimination ability. Results Multivariate logistic analysis showed that patients older than 50-year-old, dysphagia, refractory itching, and elevated creatine kinase were independent risk factors for dermatomyositis associated with malignancy, while interstitial lung disease was a protective factor. Based on this, we constructed a nomogram using the above-mentioned five factors. The C-index was 0.780 (95% CI [0.690–0.870]) in the training cohort and 0.756 (95% CI [0.618–0.893]) in the validation cohort, while the AUC value was 0.756 (95% CI [0.600–0.833]). Taken together, our nomogram showed good calibration and was effective in predicting which dermatomyositis patients were at a higher risk of developing malignant tumors.

scholarly journals Identification of FEZ2 as a potential oncogene in pancreatic ductal adenocarcinoma

PeerJ ◽  
2022 ◽  
Vol 9 ◽  
pp. e12736
Author(s):  
Chaozhi Yang ◽  
Xuebing Wang ◽  
Chenjie Qiu ◽  
Ziruo Zheng ◽  
Kai Lin ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Cancer Progression ◽  
Poor Prognosis ◽  
Malignant Tumors ◽  
Enrichment Analysis ◽  
The Cancer Genome Atlas ◽  
Ductal Adenocarcinoma ◽  
Pathway Enrichment Analysis ◽  
Conserved Gene

Pancreatic ductal adenocarcinoma (PDAC) is one of the common malignant tumors with high lethal rate and poor prognosis. Dysregulation of many genes have been reported to be involved in the occurrence and development of PDAC. However, as a highly conserved gene in eukaryotes, the role of Fasciculation and Elongation protein Zeta 2 (FEZ2) in pancreatic cancer progression is not clear. In this study, we identified the oncogenic effect of FEZ2 on PDAC. By mining of The Cancer Genome Atlas (TCGA) database, we found that FEZ2 was upregulated in PDAC tissues and FEZ2 expression was negatively regulated by its methylation. Moreover, high expression and low methylation of FEZ2 correlated with poor prognosis in PDAC patients. Besides, we found that FEZ2 could promote PDAC cells proliferation, migration and 5-FU resistance in vitro. Furthermore, Gene pathway enrichment analysis demonstrated a positive correlation between Wnt signaling activation and FEZ2 expression in PDAC patients. Western blot showed that FEZ2 knockdown significantly suppressed β-catenin expression. Collectively, our finding revealed that FEZ2 functioned as a potential oncogene on PDAC progression and migration, and the expression of FEZ2 had guidance value for the treatment and chemotherapy program of PDAC patients.

Granular Cell Traumatic Neuroma

2000 ◽  
Vol 124 (5) ◽  
pp. 709-711 ◽  
Author(s):  
Renato Rosso ◽  
Mario Scelsi ◽  
Luciano Carnevali
Keyword(s):  
Malignant Tumors ◽  
Soft Part ◽  
S100 Protein ◽  
Fibrous Tissue ◽  
Neuron Specific Enolase ◽  
Granular Cell ◽  
Granular Cells ◽  
Traumatic Neuroma ◽  
Nerve Bundles ◽  
Cell Changes

Abstract Background.—Granular cell changes can be observed in a variety of benign and malignant tumors, and are seen more commonly in granular cell tumors, which in about 5% of cases develop in the breast. Granular cells also have been observed in sites of previous trauma, such as surgery, and are found to be inflammatory reactions of histiocytic origin. Methods and Results.—We investigated, morphologically and immunohistochemically, 2 granular cell lesions occurring in mastectomy scars after surgery for carcinoma. Both lesions were composed of strands and nests of large granular cells, haphazardly set in a background of fibrous tissue, with sparse inflammatory infiltrates. Several tortuous hypertrophic nerve bundles were also embedded in the fibrous tissue. A few of these nerve bundles showed degenerative changes and contained granular cells. Immunohistochemically, granular cells were positive for S100 protein, neuron-specific enolase, vimentin, and CD68 antigen. Conclusions.—We consider these proliferative lesions of peripheral nerves to have the features of both granular cell tumor and traumatic neuroma. These cases indicate that traumatic neuroma can undergo extensive granular cell changes and constitute a previously unrecognized entity, which we provisionally label granular cell traumatic neuroma. Granular cell traumatic neuroma has to be taken into consideration when evaluating lesions occurring at mastectomy scars and should be differentiated from malignant tumors with granular cells, such as apocrine carcinoma and alveolar soft part sarcoma.

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