Humans ; Pancreatic Neoplasms ; diagnosis ; therapy

Humans ; Pancreatic Neoplasms ; diagnosis ; therapy

Cystic neoplasm of the pancreas is a relatively uncommon condition covering a wide spectrum of pathology. The increasing incidence as a result of routine imaging tests in asymptomatic patients presents a diagnostic and therapeutic problem to the clinician. This paper discusses the role of the various investigative modalities in the management of cystic neoplasia of the pancreas.
Cystadenoma ; diagnosis ; therapy ; Pancreatic Neoplasms ; diagnosis ; therapy

Pancreatic cancer is a lethal disease since curative resection is available in only 20% of patients at the initial diagnosis. Even after radical resection of the cancer, most patients experience recurrence. Therefore, many clinical trials have been attempted to prevent recurrence of pancreatic cancer. The key clinical studies about adjuvant therapy of pancreatic cancer and currently available regimens in Korea will be reviewed concisely according to the chemotherapy, radiation therapy, or both.
Diagnosis ; Drug Therapy ; Humans ; Korea ; Pancreatic Neoplasms ; Recurrence

The key points on standardized diagnosis and treatment of pancreatic cancer include early detection, preoperative staging, and reasonable resection area and combined therapy, which is important to improve the prognosis of pancreatic cancer in general.
Combined Modality Therapy ; Early Diagnosis ; Humans ; Pancreatectomy ; Pancreatic Neoplasms ; diagnosis ; therapy

Surgical resection offers the only chance of cure for nonmetastatic exocrine pancreatic cancer. However, only 15 to 20 percent of patients have potentially resectable disease at diagnosis; approximately 40 percent have distant metastases, and another 30 to 40 percent have locally advanced unresectable tumors. Typically, patients with locally advanced unresectable pancreatic cancer have tumor invasion into adjacent critical structures, particularly the celiac and superior mesenteric arteries. The optimal management of these patients is controversial, and there is no internationally embraced standard approach. Therapeutic options include chemoradiotherapy or chemotherapy alone. While it is reasonable to restage and reevaluate the potential for resectability after neoadjuvant therapy, the frequency of a complete resection and long-term survival is low for patients who initially have categorically unresectable tumors. Others have disease that is categorized as "borderline resectable." While these patients are potentially resectable, the high likelihood of an incomplete resection has prompted interest in strategies to "downstage" the tumor or to increase the likelihood of a margin-negative resection prior to surgical exploration using neoadjuvant therapy. The rationale for neoadjuvant therapy is as follows. First, it is to improve the selection of patients for whom resection will not offer a survival benefit (i.e., those who rapidly progress to metastatic disease during preoperative therapy). Second, it is to increase rates of margin-negative resections, which is the major goal of surgery. Third, it is to start an early treatment of micrometastatic disease. Initial attempt at downstaging with chemotherapy, chemoradiotherapy, or a combination followed by restaging and surgical exploration in responders rather than upfront surgery is suggested.
Chemoradiotherapy ; Diagnosis ; Drug Therapy ; Humans ; Mesenteric Artery, Superior ; Neoadjuvant Therapy* ; Neoplasm Metastasis ; Pancreatic Neoplasms*

Accurate diagnosis of autoimmune pancreatitis (AIP) is important to clinicians since it is difficult to differentiate AIP from pancreatic malignancies. Furthermore, unlike pancreatic malignancies, AIP has dramatic response to steroids. A 61-years-old man presented with acute pancreatitis. Imaging studies showed two separate pancreatic masses, irregular narrowing of main pancreatic duct, and a renal mass that highly suggested AIP. Endoscopic ultrasound-guided core needle biopsy of the pancreatic masses and ultrasound-guided biopsy of the renal mass revealed peripheral T-cell lymphoma. The patient is currently undergoing chemotherapy. We present a case of pancreatic lymphoma masquerading as AIP with literature review.
Biopsy ; Biopsy, Large-Core Needle ; Diagnosis ; Drug Therapy ; Humans ; Lymphoma* ; Lymphoma, T-Cell, Peripheral ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatitis* ; Steroids

OBJECTIVETo improve the diagnosis and treatment of primitive neuroectodermal tumors (PNET) of the pancreas.

METHODSOne patient with PNET of the pancreas was reported in this article. The corresponding literatures on the diagnosis and treatment was reviewed.

RESULTSThe patient was diagnosed as pancreatic PNET by her clinical, microscopic, and immunohistochemical features as well as cytogenetic analysis after the resection of the tumor located in the uncinate process in PUMC Hospital. Radiochemotherapy was given after the operation for 8 months and no recurrence was observed. Since PNET of pancreas have no specific clinical symptoms and most patients have jaundice and/or abdominal pain, the diagnosis depended on the immunohistochemical features of positive P30/32(MIC2) and at least two of the neural markers. The cytogenetic analysis showed translocation mainly harbored the characteristic t (11; 22) (q24; q12). Since pancreatic PNET were highly aggressive, early chemotherapy, close follow-up, and immediate surgical interventions were required as early as possible.

CONCLUSIONPNET can occur in pancreas, and diagnosis and treatment should be made as early as possible to improve the outcome.

Child ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Neuroectodermal Tumors, Primitive ; diagnosis ; therapy ; Pancreatic Neoplasms ; diagnosis ; therapy

Cystic lesions of the pancreas are being incidentally recognized with increasing frequency and become a common finding in clinical practice. Despite of recent remarkable advances of radiological and endoscopic assessment and a better understanding of natural history of certain subgroups of cystic lesions, differentiating among lesions and making an optimal management plan is still challenging. A multimodal approach should be performed to evaluate incidentally detected cystic lesions. Emerging evidence supports selective nonoperative management for the majority of patients with cystic lesions, but, for those in whom a suspicion of malignancy remains, surgery is indicated. Concerning long-term follow-up, there is limited data to support the ideal modality, intensity, and duration. Therefore, evidence-based guidelines for the diagnosis, management, and follow-up of cystic lesions of the pancreas should be established.
Cystadenocarcinoma, Mucinous/diagnosis/epidemiology/therapy ; Cystadenocarcinoma, Papillary/diagnosis/epidemiology/therapy ; Cystadenocarcinoma, Serous/diagnosis/epidemiology/therapy ; Humans ; Incidence ; Incidental Findings ; Pancreatic Cyst/*diagnosis/epidemiology/therapy ; Pancreatic Neoplasms/*diagnosis/epidemiology/therapy ; Tomography, X-Ray Computed ; Tumor Markers, Biological/blood

Branch duct intraductal papillary mucinous neoplasms of the pancreas (BD-IPMN) without malignant features rarely developed into invasive cancer. However, invasive cancer is aggressive once an invasive change occurs. We report three cases of invasive cancers which developed in patients with BD-IPMN and they showed grave clinical courses. All patients were diagnosed with BD-IPMN < 3 cm without malignant features on imaging. Invasive cancer was detected at 2.5 years, 3.0 years, and 4.0 years after BD-IPMN detection in each patient. The intervals of invasive cancer and the last follow-up were 9 months, 3 years, and 1.5 years in the three patients, respectively. All patients were diagnosed with locally advanced pancreas invasive cancers and were treated with palliative chemotherapy or conservative management. The patients died at 3 months, 9 months, and 10 months after the diagnosis of invasive cancers, respectively. We report three cases of invasive cancer developed in BD-IPMN patients and followed fatal courses.
Diagnosis ; Drug Therapy ; Follow-Up Studies ; Humans ; Mucins ; Pancreas ; Pancreatic Neoplasms