GOALSTo determine the optimal management of the intraductal papillary mucinous neoplasms (IPMNs) according to the morphologic type based on distinguishing between benign and malignant diseases.
...BACKGROUNDSIPMNs are increasingly recognized clinicopathologic entity. Extended pancreatic resection with radical lymph node dissection has been recommended for treatment.
STUDYA retrospective clinicopathologic study was carried out of the 57 cases with IPMNs who were treated between 1985 and 2001. Forty-three patients with IPMNs underwent resection, and 14 patients with small IPMNs were observed without resection.
RESULTSAmong the 43 resected IPMNs, 25 were benign and 18 were malignant. Malignant tumors were significantly greater in diameter than benign tumors (52.9 vs. 30.2 mm, P < 0.05). All main duct type tumors with mural nodules were malignant. All branch duct type tumors less than 30 mm in diameter and without mural nodules were benign. Twelve branch duct type IPMNs size less than 30 mm were not resected and have not progressed.
CONCLUSIONThese results suggest that the branch duct type IPMNs less than 30 mm and without mural nodules is benign and might be treatable with limited resection or careful observation.
Background/purpose
There are a few reports of laparoscopic distal pancreatectomy in the literature. We describe our experience with laparoscopic distal pancreatectomy and evaluate the safety and ...efficacy of the procedure in light of other reported findings.
Methods
A retrospective study was performed of all patients who underwent laparoscopic distal pancreatectomy between April 1996 and December 2002 at Oita University Faculty of Medicine.
Results
Laparoscopic distal pancreatectomy was attempted in seven patients (three men and four women) with a mean age of 65 years. One patient was converted to open surgery, and two patients required a hand‐assistance procedure. There were no complications in any patients. Median operation time for all seven patients was 300 min, and median blood loss was 330 ml. Median postoperative hospital stay was 12 days (range, 7 to 21 days).
Conclusions
Our limited results, together with reported outcomes, suggest that laparoscopic distal pancreatectomy is safe and effective for selected patients. The potential advantages of this procedure include reduced morbidity and reduced hospital stay.
Background: The infiltration of lymphocytes in tumor tissue has been associated with a good prognosis for patients with hepatocellular carcinoma (HCC). The purpose of the present study was to ...estimate the correlation between mRNA expression of chemokines and tumor‐infiltrating lymphocytes in HCC.
Methods: A total of 44 HCC were examined. Immunohistochemical staining was performed using antibodies to CD4, CD8, CD68, and L‐26. The mRNA expression of each chemokine was investigated: regulated upon activation normal T‐cell expressed and secreted (RANTES), interleukin‐8 (IL‐8), epithelial‐derived neutrophil attractant‐78 (ENA78), interferon‐inducible protein‐10 (IP‐10), monokine induced by interferon‐γ (Mig), and interferon‐γ in HCC were quantified via a real‐time polymerase chain reaction assay. Chemokine proteins of Mig and IP‐10 were examined by immunohistochemistry.
Results: The mean number of infiltrating lymphocytes in HCC was 136.9 ± 32.9/0.25 mm2. Of these infiltrating lymphocytes, CD8‐positive T lymphocytes were those predominantly seen around the tumor cells. The mean mRNA expression (copies/103 glyceraldehyde‐3‐phosphate dehydrogenase GAPDH mRNA) of the following chemokines was determined to be follows: 3.0 ± 1.9 copies/103 GAPDH mRNA, RANTES; 9.2 ± 4.9 copies/103 GAPDH mRNA, IL‐8; 44.6 ± 24.4 copies/103 GAPDH mRNA, ENA78; 215.7 ± 93.9 copies/103 GAPDH mRNA, IP‐10; 77.3 ± 38.5 copies/103 GAPDH mRNA, Mig; and 1.7 ± 0.4 copies/103 GAPDH mRNA, interferon‐γ. Significant close correlations were observed between the number of infiltrating lymphocytes in these HCC and the expression of Mig and IP‐10 mRNA. In the immunostaining, expression of Mig and IP‐10 proteins was found only in the HCC cells in the high‐infiltration group.
Conclusions: Some chemokines induced by interferon‐γ, such as Mig and IP‐10, may promote lymphocyte recruitment to HCC and may thus play important roles in cancer immunology.
Glucagonoma is a relatively rare type of pancreatic endocrine tumor, and is often well‐developed and malignant at detection. We report a case of nonfunctioning small glucagon‐producing tumor that was ...successfully resected by laparoscopic surgery. A 63‐year‐old woman was admitted to our hospital for further examination of a pancreatic tumor that had been detected incidentally. Hematological data and hormone concentrations were within normal ranges. Abdominal ultrasonography and computed tomography showed a small mass in the body of the pancreas. Laparoscopic distal pancreatectomy was done. Macroscopically, the resected tumor was a yellowish‐white, solid mass measuring 8 × 8 × 7 mm. The tumor cells showed positive immunohistochemical staining for chromogranin A and glucagon. The postoperative course was uneventful. To the best of our knowledge, this is the first report of laparoscopic surgery for a nonfunctioning small glucagon‐producung tumor. Because of recent improvements in laparoscopic surgery technique, use of this approach for resection of pancreatic benign small endocrine tumors will likely increase in the future.
The prognosis of pancreatic cancer with peritoneal dissemination has not improved. The aim of this study was to clarify whether oncolytic reovirus is effective against the peritoneal dissemination of ...pancreatic cancer in an immunocompetent animal model. The hamster pancreatic cancer cells HaP-T1 were inoculated into the peritoneal cavity of the hamster and reovirus (1x10(8) plaque-forming units) was administered into the peritoneal cavity on days 1, 3, 5 and 7 after HaP-T1 inoculations. The number and weight of the disseminated nodules in each group were recorded. Reovirus protein in the disseminated nodules was examined by immunohistochemical staining. The tumor volumes of peritoneal dissemination in the treatment group were significantly less than those in the control group (p<0.05). In addition, the amount of ascites was decreased in the treatment group in comparison to the control group. Immunohistochemical examination revealed that reovirus replication was seen only in the disseminated nodules but not in surrounding normal tissues. There were no serious side effects observed in this study. These data suggested that intraperitoneal administration of reovirus might be an effective form of oncolytic viral therapy for peritoneal dissemination of pancreatic cancer.
BACKGROUND:In general, serous cystic neoplasms of the pancreas are thought to be benign. Malignant serous cystic neoplasm of the pancreas is a rare clinical entity.
CASE REPORT:We report the case of ...an 87-year-old woman with a serous microcystic neoplasm in the tail of the pancreas that behaved in a malignant fashion. The neoplasm had also invaded the colonic mesentery and splenic hilum. The pancreatic lesion was diagnosed as a large malignant serous cystic neoplasm, and the patient underwent distal pancreatectomy with splenectomy and segmental colectomy. The resected specimen contained a large tumor, 12 × 9 × 8 cm, which occupied the body and tail of the pancreas. Histologically, the tumor was indistinguishable from serous cystadenoma. However, the tumor had invaded surrounding tissues including the splenic vein, and there were splenic invasion and a regional lymph node metastasis. The postoperative course was uneventful.
DISCUSSION:There are few reported cases of malignant serous cystic neoplasm, in which malignancy was histologically confirmed in the resected specimen. There are no reports of a negative outcome with complete resection of the tumor. Surgical treatment should be considered for serous cystic neoplasms, especially large ones, because of the malignant potential.
The groove area is localized between the head of the pancreas, the duodenum, and the common bile duct. Differentiating of groove pancreatitis from pancreatic carcinoma is often difficult. Herein, we ...report a 54-year-old woman with groove pancreatic adenocarcinoma presenting epigastralgia, jaundice, and vomiting. The diagnosis was confirmed by computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic biopsy. The patient underwent pancreatoduodenectomy. Microscopically, well-differentiated adenocarcinoma was mainly located in Santorini's duct, but there was no invasion to the main pancreatic duct. The patient followed a satisfactory post operative course. She is doing well without recurrence 15 months after the surgery. It is very difficult to differentiate groove pancreatic carcinoma from groove pancreatitis. To avoid unnecessary surgical treatment, endoscopic biopsy and observation of the duodenum are useful for diagnosis. However, keeping in mind the differential diagnosis of pancreatic head carcinoma is necessary.
Granular cell tumor in an uncommon tumor that usually appears as a solitary small nodular growth and has a benign course. It is usually located in the head and neck ; it is rarely described in the ...abdominal wall. We report a rare case of granular cell tumor in the external oblique muscle of the abdominal wall. A 57-year-old woman presented with a non-tender, hard mass in the left lower abdominal wall. She underwent a wide excision of the lesion, which measured 5×4 cm. Histological examination confirmed a granular cell tumor with atypia, and the surgical margins were negative. Ten months after surgery, she noted two recurrent masses at the site of the primary tumor and underwent en-bloc excision of these lesions. Three years after re-excision, she was doing well and free of recurrence.
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