1/242. learning from case reports: diagnostic issues in an epidemiologic study of pancreatic cancer.epidemiologic studies on exocrine pancreatic cancer show a large heterogeneity in diagnostic criteria applied to define "caseness." Reanalyses conducted after review of diagnostic information have yielded substantially different results than those based on more crude classifications of disease. During a multicenter prospective study on mutations in the K-ras gene in pancreatic and biliary diseases, hospital diagnoses from 602 patients were reviewed by a panel of experts. There were two main motivations to do so: a generic interest for the quality of the diagnostic data, and the anticipation that a firm diagnosis could be needed to assess whether patients whose tumors did not harbor the mutation were true negatives or false negatives. In addition, the review of diagnoses was helpful to minimize tissue misclassification, and it had a high educational value for clinicians and epidemiologists. This article illustrates why and how this was so through a brief presentation of the 10 most significant cases. With respect to selection and classification of subjects, the main issues that studies on pancreatic cancer need to address are the differential diagnosis of exocrine pancreatic cancer and pancreatitis, the differential diagnosis of exocrine pancreatic cancer and other abdominal tumors, and the use of survival as a hallmark of pancreatic cancer. In epidemiologic studies of pancreatic cancer, it is warranted that a panel of experts centrally reviews all the existing diagnostic evidence (cytohistological and other) of all patients, regardless of whether they have cytohistological confirmation and of their hospital discharge diagnosis.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
2/242. Metastasis-induced acute pancreatitis in a patient with small cell carcinoma of the lung.Acute pancreatitis in cancer patients can be secondary to the malignant process itself or a complication of antineoplastic agent administration. However, acute pancreatitis caused by metastatic carcinoma of the pancreas is an uncommon condition with a poor prognosis. We report a case of a 63-year-old man with small cell carcinoma of the lung, who developed acute pancreatitis lately. Thirteen months earlier, he developed small cell carcinoma of the lung and received 6 cycles of chemotherapy. Abdominal CT scan showed swelling of the pancreas with multiple masses. The patient was managed conservatively and pancreatitis subsided. This case indicates that metastasis induced acute pancreatitis can be a manifestation of lung cancer, especially in small cell carcinoma.- - - - - - - - - - ranking = 9keywords = pancreatitis (Clic here for more details about this article) |
3/242. Benign pancreatic tumor treated with duodenum-preserving resection of the head of the pancreas. Case report.Cystic neoplasms of the pancreas constitute about 9% of all cystic lesions of the pancreas and less than 1% of all pancreatic neoplasms. Authors report the case of a 70 year-old woman with microcystic cystadenoma. Computed tomography (CT) scan of the abdomen diagnosed a 5 cm multilocular septated cyst, with calcifications in the context, localized in the head-uncinate process of the pancreas. The mass was well separated by a sharp cleavage plane with portal vein and superior mesenteric vessels. An endoscopic retrograde cholangiopancreatography (ERCP) showed cephalic symmetrical stenosis (diameter: 3 mm) of the main pancreatic duct (MPD), mildly dilated in the remaining tract (diameter: 6 mm). An intra-operative biopsy of the cystic wall had been performed. Therefore, it was decided to proceed with a duodenum-preserving resection of the head of the pancreas (DPPHR), including stenosis tract of the MPD in the surgical specimen. The reconstructive procedure consisted, by i.v. jejunal loop transposition, of a side-to-side pancreatico-jejunostomy, including in the anastomosis both corpocaudal stump and the resection cavity of the pancreatic head, and an end-to-side Roux-en-Y jejuno-jejunostomy. With respect to long-lasting pain relief and preservation of the endocrine and exocrine functions of the pancreas, duodenum-preserving resection of the head of the pancreas is a highly effective surgical procedure with low early and late morbidity and mortality due to limited surgical resections. This technique, introduced into surgical practice in 1972 by Beger, is indicated in patients with chronic pancreatitis with an inflammatory mass in the head of the pancreas. The authors conclude that this procedure can also be performed in cases of pancreatic benign tumors, such as microcystic cystadenoma. Advantages of this technique make DPPHR an attractive alternative to pylorus-preserving pancreatico-duodenectomy (PPPD).- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
4/242. Intra-operative color Doppler ultrasonography for assessing splenic blood supply during spleen-preserving distal pancreatectomy: a case report.A 67 year-old Japanese woman presented with a cystic tumorous lesion, measuring 5 cm in diameter, in the tail of the pancreas. She underwent a spleen-preserving distal pancreatectomy (SPDP), in which the splenic artery and vein were divided because they were involved in scar formation around the lesion. Intra-operative color Doppler ultrasonography (CDUS) confirmed that splenic circulation via collaterals (short gastric and left gastroepiploic vessels) was preserved throughout the salvaged spleen. histology of the resected specimen showed localized pancreatitis with a pseudocyst without neoplastic tissue. The patient's post-operative course was uneventful with no evidence of splenic failure and she was discharged 20 days after the operation. A literature review suggests that SPDP without preserving the splenic artery and vein may result in failure of the preserved spleen due to inadvertent injury to the remaining collaterals. Based on the experience of our case, we think that intra-operative CDUS is useful for assessing splenic circulation after SPDP with division of the splenic artery and vein.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
5/242. panniculitis caused by acinous pancreatic carcinoma.subcutaneous fat necrosis is a form of panniculitis associated with pancreatitis or pancreatic carcinoma. The massive release in the bloodstream of lipolytic enzymes such as lipase, amylase and trypsin causes these lesions. As pancreatic disease is often asymptomatic, extensive investigations are mandatory in the presence of panniculitic lesions to search for an underlying disease.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
6/242. Detection of mutations of p53 tumor suppressor gene in pancreatic juice and its application to diagnosis of patients with pancreatic cancer: comparison with K-ras mutation.Because of the difficulty in obtaining biopsy specimens from pancreatic cancer patients, K-ras mutation analysis in pancreatic juice has been used for specific diagnosis. But recently, false positives have been obtained with this method. To improve the genetic diagnosis of pancreatic cancer, detection of p53 gene mutation in pancreatic juice was studied. pancreatic juice was sampled endoscopically. Single-strand conformation polymorphism analysis was used for p53 mutation analysis. Furthermore, K-ras mutations at codon 12 were also studied in the same pancreatic cancer patients. Of 26 cases of pancreatic cancer, p53 mutations were detected in 11 (42.3%). No mutations were seen in the cases with mucin-producing adenoma nor with chronic pancreatitis. K-ras mutations were detected in 84.0% of cases by RFLP analysis, which has high sensitivity, and in 65.3% by hybridization protection assay, which has high specificity. Using a combination assay with both genes, genetic abnormalities were detected in 92.0% by RFLP and 73.1% by hybridization protection assay including two cases in which p53 alone was positive by both methods. The specificity of p53 mutation for pancreatic cancer is very high. Therefore, simultaneous analysis of p53 and K-ras mutation is suggested to enhance the genetic diagnosis of pancreatic cancer.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
7/242. Intraductal papillary-mucinous tumor of the pancreas: presentation in a young adult.Intraductal papillary-mucinous tumor (IPMT) of the pancreas is a premalignant lesion that can result in the hypersecretion of mucous and subsequent pancreatitis. In this report, one of the youngest cases of IPMT is described. Initial pancreaticogram was normal. Pathognomonic changes of the pancreatic duct were found only years later; otherwise, the recurrent pancreatitis seen in this patient might have been repeatedly misdiagnosed as idiopathic. Pre- and perioperative evaluation resulted in pancreaticoduodenectomy for what was felt to be a curative resection. However, the patient suffered an aggressive metastatic course. More extensive surgery may be needed in IPMT, such as total pancreatectomy, especially in cases of diffuse ductal dilation of the pancreas.- - - - - - - - - - ranking = 2keywords = pancreatitis (Clic here for more details about this article) |
8/242. A rare malformation of the pancreaticobiliary junction long common channel choledochal cyst and pancreas divisum in a patient with pancreatic cancer.Congenital variants of the pancreaticobiliary junction are rare anomalies that are usually diagnosed in childhood because of recurrent abdominal pain and jaundice. These lesions are associated with several pancreaticobiliary diseases including pancreatitis and malignancy. We observed a rare anomaly of the pancreaticobiliary tract with a combination of several ductal malformations, i.e., choledochal cyst, long common channel and incomplete pancreas divisum in a patient with pancreatic cancer.- - - - - - - - - - ranking = 1keywords = pancreatitis (Clic here for more details about this article) |
9/242. pancreaticoduodenectomy for chronic pancreatitis: a case report and literature review.This is a case report of a patient with chronic pancreatitis who presented with biliary, duodenal and portal vein obstruction, a mass in the head of the pancreas, and a CA 19-9 level of 372 U/ml. Thus, the concern was raised as to the possibility of pancreatic cancer in this patient. We discuss the difficulties in the diagnosis of pancreatic cancer in patients with chronic pancreatitis and the treatment options available for patients with chronic pancreatitis where the significant findings involve the head of the pancreas. Finally, a brief review is given describing the pertinent literature on the surgical treatment of chronic pancreatitis and the current indications of pancreaticoduodenectomy for chronic pancreatitis.- - - - - - - - - - ranking = 9keywords = pancreatitis (Clic here for more details about this article) |
10/242. pancreatitis associated with Crohn's disease: a premalignant state for cystadenocarcinoma of pancreas?We report a 74-yr-old woman with Crohn's disease and acute pancreatitis who, 3 yr after resolution of the latter, developed cystadenocarcinoma of the pancreas. No drug, toxin, or other etiologies including contiguous duodenal involvement were identified as responsible for the pancreatitis, suggesting that pancreatitis was an extraintestinal manifestation of her Crohn's disease. Could Crohn's-associated pancreatitis be a premalignant state for cystadenocarcinoma of the pancreas?- - - - - - - - - - ranking = 4keywords = pancreatitis (Clic here for more details about this article) |
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