The Increasing Problem of Unusual Pancreatic Tumors

Sheehan, Maureen K.; Latona, Carmen R.; Aranha, Gerard V.; Pickleman, Jack

doi:10.1001/archsurg.135.6.644

Cited by 39 publications

(21 citation statements)

References 40 publications

(50 reference statements)

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“…Our national referral centre for the treatment of pancreatic diseases fits well within this definition. Paying particular attention to definitions and management [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35], in a prospective clinical audit we have verified the mortality and morbidity of 150 consecutive PDs performed in our centre in the last 3 years before the new millennium.…”

Section: Introductionmentioning

confidence: 99%

Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients / with Invited Commentary

et al. 2001

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Pancreaticoduodenectomy (PD) is still a difficult procedure with significant morbidity. We report 150 consecutive PDs performed during a 3-year period. All the cases have been prospectively evaluated with regard to the surgical outcome. Mortality in this series was 3/150 (2%) with a re-operation rate of 5/150 (3.3%); surgical complications were experienced in 57/150 (38%). The most frequent complications were collections in 25/150 (16.6%) and pancreatic fistulas in 16/150 (10.7%). The majority of these complications were conservatively managed: only one abscess and one fistula due to an anastomotic dehiscence required re-operation. The complication most responsible for mortality was haemorrhage secondary to arterial pseudoaneurysms in patients with severe post-operative pancreatitis. The continued high morbidity of PDs is compensated by the ability to treat complications non-operatively, resulting in a surgical risk that should now be considered medium to low in high volume centres.

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Section: Introductionmentioning

confidence: 99%

Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients / with Invited Commentary

et al. 2001

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“…1,2 The vast majority of solid pseudopapillary tumors (90%) occur in women 3 and are considered to have a low malignant potential; however, as many as 10% of solid pseudopapillary tumors have metastasized at the time of diagnosis. 3 Pancreatoblastomas are extremely rare neoplasms that can show multiple directions of differentiation including acinar, endocrine, and, less commonly, ductal differentiation.…”

mentioning

confidence: 99%

Expression of novel markers of pancreatic ductal adenocarcinoma in pancreatic nonductal neoplasms: additional evidence of different genetic pathways

et al. 2005

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Solid pseudopapillary tumor, pancreatoblastoma, undifferentiated carcinoma with osteoclastic-like giant cells, and acinar cell carcinomas are rare pancreatic nonductal neoplasms. Compared to the significant advances in our understanding of the pathogenesis of pancreatic ductal adenocarcinomas in the last decades, the molecular mechanisms underlying pancreatic nonductal neoplasms are poorly understood. In order to elucidate their molecular pathogenesis, we constructed tissue microarrays to study the expression of some novel pancreatic ductal adenocarcinoma-associated tumor markers in these nonductal pancreatic neoplasms. We analyzed nine markers including tumor suppressor gene (14-3-3 sigma), proliferation marker (topoisomerase II alpha), epithelial markers (prostate stem cell antigen, mesothelin and cytokeratin 19), stromal markers (fascin, hsp47 and fibronectin), and gamma-synuclein whose function is not delineated. In addition, we included tumor suppressor gene DPC4 and oncogene Beta-catenin to further confirm their expression in pancreatic nonductal tumors. Our results showed that in contrast to pancreatic ductal adenocarcinomas that show loss of Dpc4 protein in 55% of cases, loss of Dpc4 expression is absent in pancreatic nonductal neoplasms. Expression of 14-3-3 sigma is frequently seen in both pancreatic nonductal neoplasms (25-100%) and ductal adenocarcinomas (89%). Aberrant nuclear expression of beta-catenin is common in pancreatic nonductal neoplasms, specifically in solid pseudopapillary tumors (88%) and pancreatoblastomas (100%) but is rarely seen in pancreatic ductal adenocarcinomas (o5%). Expression of topoisomerase II alpha is not seen in solid pseudopapillary tumors and undifferentiated carcinomas with osteoclastic-like giant cells but is focally seen in pancreatoblastomas (50%) and acinar cell carcinomas (85%). Expression of PSCA and mesothelin was observed in pancreatic nonductal neoplasms but their expression was seen less frequently (0-50%) and weaker than that in pancreatic ductal adenocarcinomas (60-100%). CK19, a marker of pancreatic ductal adenocarcinomas, is not expressed in pancreatic nonductal neoplasms. Expression of gamma-synuclein as well as stromal markers (fascin, hsp47 and fibronectin) is frequently seen in both. Our findings indicate pancreatic nonductal neoplasms have distinctive patterns of protein expression relative to pancreatic ductal adenocarcinomas and suggest that pancreatic nonductal neoplasms have different genetic pathways from the more common pancreatic ductal adenocarcinomas.

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“…Distinguishing benign from malignant lesions can only be done with certainty in the presence of metastases [107]. While 59% -80% have liver metastases at diagnosis [8], no metastases have been reported in non-functional PNETs <10 mm [42].…”

Section: Non-functional Pnetsmentioning

confidence: 99%

Pancreatic Neuroendocrine Tumors in the 21<sup>st</sup> Century—An Update

Kanthan¹,

Senger²,

Ahmed³

et al. 2017

JCT

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Pancreatic neuroendocrine tumors (PNETs) are rare, reported to account for less than 1% -2% of all pancreatic tumors. This, however, is likely an underestimation, as improved radiologic techniques and heightened awareness have resulted in an increase in the detection of incidentalomas, with estimations of true prevalence as high as 10%. The term "PNET" is an umbrella name that encompasses a heterogeneous group of neoplasms each with distinct clinical presentations, diagnostic radiographic features, management principles, and tumor/patient outcomes. In this context, accurate diagnosis is challenging, and management guidelines remain unclear. A high degree of clinical suspicion is required for best patient management. This manuscript provides an update on PNETs in the 21 st century, in which we re-examine the terminology, epidemiology, classification, etiopathogenesis, radiographic and histopathologic diagnostic features, management for localized and metastatic disease, as well as a review of features defining functional and non-functional PNETS, and finally deliberates on the prognosis and predictive features of this unpredictable and largely unfathomable neoplasm.

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The Increasing Problem of Unusual Pancreatic Tumors

Cited by 39 publications

References 40 publications

Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients / with Invited Commentary

Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients / with Invited Commentary

Expression of novel markers of pancreatic ductal adenocarcinoma in pancreatic nonductal neoplasms: additional evidence of different genetic pathways

Pancreatic Neuroendocrine Tumors in the 21<sup>st</sup> Century—An Update

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The Increasing Problem of Unusual Pancreatic Tumors

Cited by 39 publications

References 40 publications

Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients / with Invited Commentary

Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients / with Invited Commentary

Expression of novel markers of pancreatic ductal adenocarcinoma in pancreatic nonductal neoplasms: additional evidence of different genetic pathways

Pancreatic Neuroendocrine Tumors in the 21&lt;sup&gt;st&lt;/sup&gt; Century—An Update

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Pancreatic Neuroendocrine Tumors in the 21<sup>st</sup> Century—An Update