Accuracy for computed tomography (CT) diagnosis of extrapancreatic perineural invasion (EPNI) in pancreatic ductal adenocarcinoma (PDAC), which is a significant cause of recurrence, has not been established. The aim of the study was to evaluate the diagnostic accuracy of CT in detecting EPNI preoperatively in resectable PDAC of the pancreatic head. Retrospective study design was approved by institutional review board. Preoperative CT-series of 46 patients with resectable PDAC were evaluated by two independent observers. Plexus Pancreaticus Capitalis-II (PPC-II) was assessed as this area is more susceptible for EPNI. All patients underwent surgery with dedicated histopathology, which served as the reference standard. Histologically EPNI was confirmed in 63.1%. Sensitivity of MDCT was 93.1% (95% confidence interval (CI) 77.23% to 99.15%), specificity 64.7% (95% CI 38.33% to 85.79%) with area under the curve (AUC) 0.789 for the first observer. Positive predictive value (PPV) was 81.82% (95% CI 70.12% to 89.62%), negative predictive value (NPV—84.62% (95% CI 57.98% to 95.64%) with diagnostic accuracy of 82.61% (95% CI 68.58% to 92.18%). Interobserver agreement showed k-value of 0.893 ($${p} < 0.001$$ p < 0.001 ), which represents very good agreement between observers. Median actual survival in patients without EPNI was 30 months (95% CI 18.284–41.716), in patients with EPNI—13 months (95% CI 12.115–13.885). CT provides sufficient diagnostic information to detect PPC-II invasion in patients with resectable PDAC of the pancreatic head. Preoperative detection of EPNI might be an additional argument to perform neoadjuvant chemotherapy in patients with resectable PDAC. It should be included in preoperative evaluation form of CT-findings.
Background. Solid pseudopapillary tumor of the pancreas is a rare neoplasm, accounting for only 1–2 % of all pancreatic neoplasms and having a tendency to affect mainly young women.Material and methods. We report a case of a solid pseudopapillary tumor of the pancreas in a 28-year-old man treated with laparoscopic distal pancreatectomy in Moscow Botkin Hospital.Results. The tumor was discovered incidentally by routine survey ultrasound or computed tomography of the abdomen. The patient underwent distal pancreatectomy with splenectomy. The immunohistochemical study showed a pronounced positive nuclear staining for β-catenin and progesterone and a negative staining for chromogranin A and synaptophysin, thus confirming the presence of solid pseudopapillary tumor of the pancreas.Conclusion. In case of pancreatic tumor, even in male patients, a solid pseudopapillary tumor must be considered in the differential diagnosis. Surgical strategies should be based on the location, size of the tumor and the involvement of adjacent organs, because R0-resection with a solid pseudopapillary tumor leads to a good 5-year survival.
Вторичные опухоли поджелудочной железы: описание случаев и обзор литературы СЕТДИКОВА Г. Р., ПАКЛИНА О. В., РОТИН Д. Л.Введение: метастазы в поджелудочную железу крайне редки и составляют 4,5% всех опухолей поджелудочной железы. Как правило протекают бессимптомно и выявляются случайно. Наиболее частым раком, метастазирую-щим в поджелудочную железу, является почечно-клеточный рак, после него в убывающем порядке следуют коло-ректальный рак, меланома, саркома и рак легких. Прогноз жизни больных определяется гистогенезом первичной опухоли и распространенностью онкологического процесса.Описание случаев: в данной статье представлены случаи метастазов почечно-клеточного рака, рака толстой кишки, рака легкого и местнораспространенных поражений при раке желудка и лимфомы.Вывод: приведено 10 наблюдений вторичных опухолей поджелудочной железы, что составило 5,4% (10 из184) от всех исследованных опухолей железы за этот период. По типу распространения: в 6-и случаях отмечено мета-статическое поражение железы и 4-х случаях -локальная инвазия. Важным в обследовании подобных больных является проведение дифференциального диагноза с первичной опухолью поджелудочной железы, поскольку лечебная тактика может существенно отличаться. Трудно решить вопрос о выборе правильной тактики лечения больных с данными нозологическими формами, за счет их чрезвычайной редкости. Abstract:Introduction: metastasis of the pancreas is very rare. Only 4.5% of all pancreatic tumors are metastatic. They are often asymptomatic and detected incidentally or during follow-up investigations even several years after the removal of the primary tumor. Renal cell cancer represents the most common primary tumor by far, followed by colorectal cancer, melanoma, sarcoma and lung cancer. Pancreatic metastases typically occur a long time after the removal of the primary tumor. The effectiveness of resection for pancreatic metastasis is mainly dependent on the tumor biology of the primary cancer.Case: we reports metastases from renal cell carcinomas, colon cancer, lung cancer and regional invasion of gastric cancer and lymphomas to the pancreas.Conclusion: authors describe 10 cases of the secondary tumors of the pancreas, which was 5.4% (10/184) of all cancer tumors studied in this period. According to the type of distribution: in 6 cases were metastasis cancer and 4 cases, local invasion. Important in the examination of these patients is the differential diagnosis with primary tumors of the pancreas, as treatment policy may differ substantially. It is difficult to decide on the choice of the right treatment strategy of patients with these entities that due to their extreme rarity.
Human epidermal growth factor receptor HER2, a proto-oncogene involved in the proliferation and differentiation signaling pathway. The overexpression and amplification of the HER2 gene and their significance have been studied in breast cancer. Data on HER2 over expression in gastric cancer vary widely, and the value is presented by inconsistent disparate data. The interpretation of HER2 in gastric cancer differs from the evaluation in breast cancer. The purpose of this review is to summarize current data on the evaluation of HER2 in gastric cancer for the selection of targeted therapy. The search in modern databases of medical literature was carried out, more than 100 modern literary sources on the above-mentioned topic were studied and analyzed in detail and carefully. The most significant data on the evaluation of HER2 expression in gastric cancer and its prognostic and predictive value were selected and presented. Selected options evaluate the expression of HER2 receptor in operating and biopsy material of stomach cancer. Comparative data on the use of different antibody clones to solve the above problem are presented. The most frequent and important errors and possible interpretation disorders in the expression of HER2 in gastric cancer are analyzed. The use of transtuzumab for targeted therapy in gastric cancer makes it mandatory to test surgical and biopsy samples of gastric cancer to assess their expression of HER2. The development of various methods and the progress of molecular biology, however, the main role of the immunohistochemical method in solving this problem still left. Gastric cancer needs a single accessible standardized system for evaluating HER2 expression, and, most importantly, expert level interpretation of these results.
ФГБОУ ДПО Российская медицинская академия непрерывного постдипломного образования Минздрава России, Москва, Россия (1) ГБУЗ Городская клиническая больница имени С.П. Боткина Департамента здравоохранения Москвы, Москва, Россия (2) Цель. Оценить эффективность химиоэмболизации печеночной артерии (ХЭПА) в лечении больных метастатическим колоректальным раком печени, а также определить оптимальный временной интервал при ее комбинации с другими методами лечения. Материалы и методы. В исследование включен анализ результатов лечения 30 больных с резектабельными метастазами колоректального рака печени. Первую группу составили 15 пациентов, кому резекционное вмешательство выполнено через 1 неделю после проведенной ХЭ-ПА. Вторую группу составили 15 пациентов, кому резекционное вмешательство выполнено через 2 недели после проведенной ХЭПА с последующей оценкой морфологических изменений метастазов. Результаты. Лечебный патоморфоз зафиксирован у 25/30 больных. В первой группе лечебный патоморфоз наблюдался у 13/15 больных. У 11/13 больных зафиксирована 2 степень лечебного патоморфоза. У 2/13 больных -1 степень. Во второй группе лечебный патоморфоз, наблюдался у 12/15 больных. У всех больных зафиксирована 2 степень лечебного патоморфоза. Не зафиксировано достоверных различий в степени лечебного патоморфоза на 7 и 14 день после регионарной химиотерапии (p=0,436). Заключение. Химиоэмболизация печеночной артерии является эффективным методом лечения больных метастазами колоректального рака печени. При применении химиоэмболизации печеночной артерии в комбинации с другими хирургическими методами семидневный временной промежуток является оптимальным.Ключевые слова: метастазы колоректального рака печени, регионарная химиотерапия, лечебный патоморфоз.Aim. To assess effectiveness of chemoembolization of hepatic artery (CEHA) in treatment of patients with metastatic colorectal cancer, and also to determine the optimal interval in combination of CEHA with other treatment methods. Materials and Methods. The study includes analysis of the results of treatment of 30 patients with resectable metastases of ХИМИОЭМБОЛИЗАЦИЯ ПЕЧЕНОЧНОЙ АРТЕРИИ В ЛЕЧЕНИИ БОЛЬНЫХ МЕТАСТАТИЧЕСКИМ КОЛОРЕКТАЛЬНЫМ РАКОМ ПЕЧЕНИ ОРИГИНАЛЬНОЕ ИССЛЕДОВАНИЕ O R I GI N AL ST U DY
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