Oncocytic-type intraductal papillary mucinous neoplasm (IPMN)-derived invasive oncocytic pancreatic carcinoma with brain metastasis - a case report

Chiang, Kun‐Chun; Yu, Chung‐Shan; Chen, Jim-Ray; Huang, Yu‐Ting; Huang, Chengcheng; Yeh, Chun‐Nan; Tsai, Chien-Sheng; Chen, Liwei; Chen, Hsien-Cin; Hsu, Jun‐Te; Wang, Cheng‐Hsu; Chen, Huang-Yang

doi:10.1186/1477-7819-10-138

Cited by 29 publications

(25 citation statements)

References 25 publications

(25 reference statements)

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“…[7] A second study comprised of 214 patients with histologically proven pancreatic adenocarcinoma found that those who had undergone resection tended to be younger (62.1 vs. 64.0, P = 0.047), and less symptomatic (97.8% vs. 99.8%, P = 0.018)[15] but as the values suggest, these appear to be of statistical rather than clinically significant differences.…”

Section: Discussionmentioning

confidence: 99%

“…And, a second group from Taiwan found that a CA 19 - 9 level of 37 U/mL was an independent predictor of resectability. [15] In a group of 51 patients who were initially thought to have resectable disease based on imaging but only a third were found to be resectable, a CA 19-9 level of 256.4 U/mL was found to have a specificity of 92.3% and a sensitivity of 82.4%. [22] A study by Fujioka et al .…”

Section: Discussionmentioning

confidence: 99%

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Clinical predictors of resectability of pancreatic adenocarcinoma

Almadi

Alharbi

Azzam

et al. 2013

Saudi J Gastroenterol

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Background/Aims:Identifying patient-related factors as well as symptoms and signs that can predict pancreatic cancer at a resectable stage, which could be used in an attempt to identify patients at an early stage of pancreatic cancer that would be appropriate for surgical resection and those at an unresectable stage be sparred unnecessary surgery.Materials and Methods:A retrospective chart review was conducted at a major tertiary care, university hospital in Riyadh, Saudi Arabia. The study population included individuals who underwent a computed tomography and a pancreatic mass was reported as well as the endoscopic reporting database of endoscopic procedures where the indication was a pancreatic mass, between April 1996 and April 2012. Any patient with a histologically confirmed diagnosis of adenocarcinoma of the pancreas was included in the analysis. We included patients’ demographic information (age, gender), height, weight, body mass index, historical data (smoking, comorbidities), symptoms (abdominal pain and its duration, anorexia and its duration, weight loss and its amount, and over what duration, vomiting, abdominal distention, itching and its duration, change in bowel movements, change in urine color), jaundice and its duration. Other variables were also collected including laboratory values, location of the mass, the investigation undertaken, and the stage of the tumor.Results:A total of 61 patients were included, the mean age was 61.2 ± 1.51 years, 25 (41%) were females. The tumors were located in the head (83.6%), body (10.9%), tail (1.8%), and in multiple locations (3.6%) of the pancreas. Half of the patients (50%) had Stage IV, 16.7% stages IIB and III, and only 8.3% were stages IB and IIA. On univariable analysis a lower hemoglobin level predicted resectability odds ratio 0.65 (95% confidence interval, 0.42-0.98), whereas on multivariable regression none of the variables included in the model could predict resectability of pancreatic cancer. A CA 19-9 cutoff level of 166 ng/mL had a sensitivity of 89%, specificity of 75%, positive likelihood ratio of 3.6, and a negative likelihood ratio of 0.15 for resectability of pancreatic adenocarcinoma.Conclusion:This study describes the clinical characteristics of patients with pancreatic adenocarcinoma in Saudi Arabia. None of the clinical or laboratory variables that were included in our study could independently predict resectability of pancreatic adenocarcinoma. Further studies are warranted to validate these results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical predictors of resectability of pancreatic adenocarcinoma

Almadi

Alharbi

Azzam

et al. 2013

Saudi J Gastroenterol

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“…[3] Despite significant advances in treatment modalities, the prognosis of pancreatic cancer remains poor with a median survival of less than 12 months. [4]…”

Section: Introductionmentioning

confidence: 99%

Is plasma caveolin-1 level a prognostic biomarker in metastatic pancreatic cancer?

Demi̇rci

Doğan

Erdem

et al. 2017

Saudi J Gastroenterol

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“…However, based on the limited reports in the literature, patients with oncocytic carcinoma experienced more favorable outcomes than those with PDAC and tubular adenocarcinomas, even when corrected for stage. 1,3,5,16 Our patient's long-term survival of more than 8 years is rare for stage IIB of the usual type of PDAC. This makes this the longest survival case in the literature of oncocytic carcinoma of the pancreas diagnosed by FNAB initially.…”

Section: Discussionmentioning

confidence: 93%

“…Oncocytic carcinoma of the pancreas is thought to be a subtype of PDAC; however, several reports have indicated that patients with oncocytic carcinoma have significantly better outcomes than do those with classic PDAC (median survival of 132 months for oncocytic carcinoma vs 18 months for PDAC). 1,[4][5][6] Moreover, KRAS mutations, which are seen in more than 90% of PDACs, were rare in oncocytic carcinomas (20%). 1 The different prognostic and molecular features may lead to different therapeutic interventions.…”

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confidence: 99%

Fine-Needle Aspiration Biopsy Diagnosis of Oncocytic Carcinoma of the Pancreas

Zhao¹,

Allam-Nandyala²,

Centeno³

2015

Pathology Case Reviews

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Oncocytic carcinoma of the pancreas is a very rare variant of pancreatic ductal adenocarcinoma. Fine-needle aspiration biopsy reports of this tumor are exceptionally rare. We report the case of a 65-year-old female patient who presented with a mass in the head of the pancreas. The mass was sampled by fine-needle aspiration biopsy on 2 separate occasions, and both samples were diagnosed as oncocytic carcinoma of the pancreas. The patient underwent a Whipple resection, and histopathologic examination of the resection specimen showed an invasive oncocytic carcinoma arising from intraductal oncocytic papillary neoplasm with highgrade dysplasia. Here we discuss the cytologic and histological features, differential diagnoses, utility of ancillary studies, and the recently updated knowledge about this rare entity.A s a very rare variant of pancreatic ductal adenocarcinoma (PDAC), oncocytic carcinoma of the pancreas has distinctive histological and cytologic features. Arising from the oncocytic subtype of the intraductal papillary mucinous neoplasm (IPMN-O), 1 also known as intraductal oncocytic papillary neoplasm, it was first described by Adsay et al 2 in 1996. The oncocytic subtype of IPMN is a very rare form of IPMN (<5% of all IPMNs), 3 consisting of complex, arborizing papillary intraductal projections of cuboidal cells with finely granular oncocytic cytoplasm, and diffusely present goblet cells. Oncocytic carcinoma of the pancreas is thought to be a subtype of PDAC; however, several reports have indicated that patients with oncocytic carcinoma have significantly better outcomes than do those with classic PDAC (median survival of 132 months for oncocytic carcinoma vs 18 months for PDAC). 1,4-6 Moreover, KRAS mutations, which are seen in more than 90% of PDACs, were rare in oncocytic carcinomas (20%). 1 The different prognostic and molecular features may lead to different therapeutic interventions. Therefore, it is essential to accurately diagnose this entity, especially on preoperative sampling. However, because of its rarity, oncocytic carcinoma of pancreas has been reported only in single case reports and small series. Reports describing the cytologic features in 4 prior cases are summarized in Table 1. [7][8][9] Here we report the case of a patient presenting with oncocytic carcinoma of the pancreas, which was diagnosed preoperatively by fine-needle aspiration biopsy (FNAB). Its morphological features, ancillary study results and follow-up information are described to enrich our understanding of this neoplasm. CASE REPORTThis case report is conducted following the guidelines of the Scientific Review Board of Moffitt Cancer Center and the institutional review board of the University of South Florida.A 65-year-old woman presented to an outside institution with an unexplained 25-lb weight loss and acute cholecystitis. Magnetic resonance cholangiopancreatography was performed to assess her biliary system for possible common bile duct stones. At magnetic resonance cholangiopancreatography, dilation of the main pancre...

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Oncocytic-type intraductal papillary mucinous neoplasm (IPMN)-derived invasive oncocytic pancreatic carcinoma with brain metastasis - a case report

Cited by 29 publications

References 25 publications

Clinical predictors of resectability of pancreatic adenocarcinoma

Clinical predictors of resectability of pancreatic adenocarcinoma

Is plasma caveolin-1 level a prognostic biomarker in metastatic pancreatic cancer?

Fine-Needle Aspiration Biopsy Diagnosis of Oncocytic Carcinoma of the Pancreas

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