A prospective study to determine the lymph node involvement in 33 pancreatectomy specimens (regional pancreatectomy 18, total pancreatectomy 7, Whipple partial pancreatectomy 8) was undertaken. There were 22 patients with pancreas duct adenocarcinoma, 6 with ampullary carcinoma, 3 with duodenal adenocarcinoma, 1 bile duct carcinoma and 1 of undetermined site of origin. Peripancreatic lymph nodes were divided into 5 main groups with subgroups. They are 1) Superior, Superior Head, Superior Body and Gastric; 2) Inferior: Inferior Head and Inferior Body, 3) Antenor: Anterior Pancreaticoduodenal, Pyloric and Mesenteric, 4) Posterior: Posterior Pancreaticoduodenal, Common Bile Duct, and 5 ) Splenzc: lymph nodes at hilum of spleen and at the tail of pancreas. The average number of lymph nodes found in different types of surgical specimens was: regional pancreatectomy 70, total pancreatectomy 4 1, and Whipple procedure 33. The average number of lymph nodes involved with metastatic tumor in these specimens was, respectively, 5 , 3 and 1. The most common sites of metastasis were in the Superior Head and in the Posterior Pancreaticoduodenal groups. Pancreatic duct adenocarcinoma tended to metastasize to multiple lymph nodes of the Superior Head, Superior Body and Posterior Pancreaticoduodenal lymph nodes (88% of patients). Ampullary adenocarcinoma metastasized less often (33%), usually to fewer nodes and to one adjacent periampullary group. Since in 33% of patients nodal metastases of duct adenocarcinoma of the head of the pancreas were present in groups not usually removed in the Whipple procedure, it would appear that this operation is inadequate for surgical eradication of pancreas duct adenocarcinoma of the head of the pancreas.Cower 41 If survival after surgical extirpation were to be improved, it would be necessary to know the pathway of spread of the cancer. Although the
A 7000 g cystic tumor replacing the body and tail of the pancreas was resected in a 64-year-old man. Numerous peritoneal implants confirmed its malignant nature. Light microscopy of both the primary tumor and the implants revealed distinctive cytoplasmic eosinophilia and apical granules. Ultrastructural examination demonstrated numerous zymogen granules and abundant, rough endoplasmic reticulum, which confirmed that the tumor was composed of acinar cells. No mucinous or serous differentiation was detected. We have not found report of a similar tumor.
Subungual melanoma, a rare and easily misdiagnosed neoplasm, affected 52 patients. The lesion usually appeared as a dark spot under the nail, causing its destruction at a later stage. Diagnosis was missed by primary care physicians in 42% of the cases. Management in the hospital consisted of amputation of the involved finger or toe with or without regional node dissection. The study indicated that proper amputation should be at the tarsometatarsal or the carpometacarpal level. It also showed the node dissection should best be performed at the time of amputation, regardless of whether the nodes are clinically involved or not. Besides nodal metastasis, prognosis is adversely affected by nail destruction caused by the tumor. Subungual melanomas of the fingers have a better prognosis.
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