Hypothesis: Accurate differentiation between inflammatory and neoplastic tumors of the pancreas remains a diagnostic dilemma for surgeons. The aim of the study was to assess the utility of 2 neoplastic markers, cancer antigen (CA) 19-9 and CA 125, in the differential diagnosis of pancreatic tumors. Design: The patients were assigned to a malignant or benign group based on cytological and histological evaluation of pancreatic lesion samples. The serum from each patient was tested for CA 19-9 and CA 125. Setting and Patients: One hundred ten patients with heterogeneous pancreatic lesions (inflammatory and malignant tumors) treated at a surgical department of a university hospital were analyzed. Interventions: Samples for cytological and histological evaluation were taken during ultrasonography-guided fine-needle aspiration biopsy or open surgery. Main Outcome Measures: Sensitivity, specificity, and positive and negative predictive values of each test in the differential diagnosis of pancreatic tumors were determined. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of the CA 19-9 test were 80.8%, 89.1%, 93.7%, and 89.2%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of the CA 125 test were 60.8%, 83.3%, 88.2%, and 50.8%, respectively. The sensitivity and specificity of a combined evaluation of both CA 19-9 and CA 125 tests were 87.8% and 77.8%, respectively.
It seems that vascular endothelial growth factor and survivin play role in local invasion and spread of gastric adenocarcinoma and negatively influences survival. However, further studies are required to assess their true usefulness in the clinical practice.
This paper is a discussion of the case of a 51-year-old female patient admitted urgently for haemorrhage from the upper gastrointestinal tract and increased dysphagia. After preliminary treatment, the patient was qualified for surgery, during which a large lesion was discovered in the shape of a stromal tumor closely connected with the oesophago-gastric junction. A resection of the tumor and part of the oesophagus was carried out, and a cervical fistula was formed. After a 4-month period, the continuity of the gastrointestinal tract was restored by forming a substitute organ out of the ascending colon and the end of the small intestine, anastomosed on the cervix. The patient was discharged in good overall condition.
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