BACKGROUND/AIMS: Neuroendocrine tumors (NET) of the pancreas are rare. Its prognosis is better than pancreas adenocarcinoma due to the slow growth, however, malignant NET of the pancreas are observed. The purposes of this study were to evaluate the clinical characteristics and to find the predictive factors of NET which are associated with malignancy and survival. METHODS: We retrospectively evaluated the clinical outcomes of 122 patients with NET of the pancreas who were pathologically diagnosed at Asan Medical Center between 1990 and 2006. RESULTS: Mean age of the patients was 48.9+/-14.0 years and there was no gender predilection. The major clinical manifestations were abdominal pain (44.0%) in non-functional tumor, neuroglycopenic symptoms (100%) in insulinoma and diarrhea (60%) in gastrinoma. Tumor size ranged from 4 to 140 mm (average 29.8+/-23.22). Ninety cases (73.8%) were classified as benign tumors and 32 cases (26.2%) as malignant. In multivariate analysis of clinical characteristics, large sized tumor (>20 mm, p=0.001) was confirmed as sole independent factor to predict malignant NET. Surgical resection was performed in 114 patients. All patients with benign NET are still alive without recurrence. Six out of 32 patients with malignant NET died at an average 40.3 months after diagnosis. The factors indicating favorable outcome were small size of tumors (p=0.046), resection of primary tumor (p=0.000), absence of lymph node invasion (p=0.0116) and distant metastasis (p=0.0005). CONCLUSIONS: Large NET of the pancreas, regardless of their functioning status, were more likely to be associated with malignancy and predictor of worse survival.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neuroendocrine Tumors/*diagnosis/mortality/pathology ; Pancreatectomy ; Pancreatic Neoplasms/*diagnosis/mortality/pathology ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Survival Analysis

PURPOSE: Cystic pancreatic neoplasms are rare, but interesting, because of their high cure rate. With the exception of pseudocysts and serous cystadenomas, which are always benign, these cystic neoplasms are either premalignant or malignant. However, there is no reliable clinical criteria for differential diagnosis, and the treatment plan may be confusing. METHODS: From October 1994 to November 1999, 60 cases, diagnosed as a cystic neoplasm preoperatively were reviewed retrospectively. The clinical findings of benign lesions (benign group) and those for malignant or premalignant tumors (malignant group) were compared. RESULTS: The postoperative pathology results indicate 10 serous cystadenomas, 13 mucinous cystic neoplasms, 11 solid and papillary neoplasms, 10 duct ectasias, 2 cystic islet cell tumors, 1 metastatic papillary carcinoma, 1 lymphepithelial cyst, 2 simple cysts, 6 pseudocysts, and 4 retension cysts without malignancy. The mean age of the patients was 48.6 years, and the male-to-female ratio was 5 to 7. The accuracy of CT for diagnosing the malignancy of malignant tumors was 37.8% (14/37) and that of US was 22.2% (4/18). The rate of tumors having malignant potential was 71.7% (37/60). The mean size of the tumors in the benign group was smaller than that in the malignant group (p=0.014). There was a higher proportion of females in the malignant group than in the benign group (p=0.001). Heavy alcohol consumption was found more frequently in the benign group (p=0.021). There were no differences in the other clinical findings. The mortality rate of the operations was 0%, and the morbidity rate was 18%. CONCLUSION: Since it is difficult to determine the precise tumor type of a cystic pancreatic neoplasm preoperatively, all these lesions should be treated with surgical resection in order to identify and remove the malignant or premalignant neoplasms early. However, if the operative risk is high, malignant risk factors having large sized tumor, especially more than 6 cm, female, and having no history of heavy alcohol consumption may be useful for deciding the treatment plan.
Adenoma, Islet Cell ; Alcohol Drinking ; Carcinoma, Papillary ; Cystadenoma, Serous ; Diagnosis, Differential ; Dilatation, Pathologic ; Female ; Humans ; Mortality ; Mucins ; Pancreatic Cyst* ; Pancreatic Neoplasms ; Pathology ; Retrospective Studies ; Risk Factors

OBJECTIVETo explore diagnosis and surgery therapy and factors influencing the prognosis of tumor of body and tail of the pancreas.

METHODSThe clinical data of 117 cases of tumor of tail and body of pancreas who underwent operation were analysed.

RESULTSImaging and tumor marker detection can give exact diagnosis to cases with tumors of body and tail of pancreas. The medial survival time of radical resection, palliative resection and exploratory laparotomy were 18, 8 and 3.5 months.

CONCLUSIONSAtypical signs should be noticed, combined imaging and serum detection can diagnose the cases exactly, radical resection is the unique method for long survival, the diameter of the tumor and degree of infiltration to major vessels and organs is important.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; methods ; Pancreatic Neoplasms ; diagnosis ; mortality ; pathology ; surgery ; Pancreaticoduodenectomy ; Retrospective Studies ; Survival Rate ; Treatment Outcome

BACKGROUND/AIMS: MicroRNA (miRNA) regulates messenger RNA stability and translation. In cancer biology, miRNA affects the growth and metastasis of cancer cells by controlling epithelial-mesenchymal transition (EMT). MiR-200 family (200a/200b/200c/141) and miR-205 are associated with the regulation of EMT. We investigated the prognostic role of EMT-related miRNAs in pancreatic cancer. METHODS: We analyzed miR-200 family and miR-205 expression in tissue samples of 84 patients who underwent radical resection for pancreatic cancer. RESULTS: Patients were followed from the date of diagnosis until death or censoring. The mean overall survival was 25.0+/-2.0 months (2-140 months). The R0 resection rate was obtained in 84.5% (n=71) of patients. The relative expressions of miR-200a/200b/200c/141 and miR-205 were 266.9+/-57.3/18.5+/-2.2/0.7+/-0.1/27.2+/-6.6 folds and 0.1+/-0.1 compared with human pancreatic ductal epithelial cells, respectively. Overall survival was longer in the low miR-200c expression group than in the high expression group (35 vs. 19 months, p=0.013). Multivariate analysis confirmed that patients with low miR-200c expression survived longer than the high expression group (hazard ratio, 1.771; 95% CI, 1.081-2.900; p=0.023). There was a trend toward longer disease-free survival in low miR-200c group without statistical significance (p=0.061). CONCLUSIONS: The expression of miR-200c may be an important prognosis factor in pancreatic cancer, and it could be a novel therapeutic target of pancreatic cancer.
Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor/genetics/*metabolism ; Disease-Free Survival ; Female ; Humans ; Male ; MicroRNAs/*metabolism ; Middle Aged ; Multivariate Analysis ; Pancreatic Neoplasms/*diagnosis/mortality/pathology ; Prognosis ; Proportional Hazards Models ; Real-Time Polymerase Chain Reaction ; Survival Rate

BACKGROUND/AIMS: Since pancreatic endocrine tumors (PET) are rare and heterogeneous diseases, their survival and prognosis are not well known. Due to recent advances in CT/MRI technology, incidentalomas of the pancreas are detected with increasing frequency. This study presents results of clinical manifestations of PET and predictive factors associated with survival. METHODS: From year 1990 through 2006, medical records of 98 patients (56 men, 42 women) who were diagnosed as PET pathologically at Seoul National University Hospital were reviewed retrospectively. RESULTS: Ages ranged from 17 to 76 years (mean 51.6+/-1.3 years) with a mean follow-up of 3.6+/-0.4 years (range 0-10.1 years). Overall 5-year survival rate was 68.1%, and 5-year survival rate of the patients who had distant metastases at initial diagnosis was 43.9%. Functioning tumors [hazard ratio (HR) 0.229, 95% confidence interval (CI) 0.056-0.943, p=0.041] and lymph node or liver metastases (HR 5.537, 95% CI 2.106-14.555, p<0.001) were the significant prognostic factors associated with survival rate. However, tumor size and pathology showed no significant association with survival. CONCLUSIONS: Because small and pathologically benign nature do not predict good prognosis in PET, aggressive treatment such as curative resection would be considered initially even in the case of incidental PET.
Adenoma, Islet Cell/*diagnosis/epidemiology/*mortality ; Adolescent ; Adult ; Aged ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/diagnosis/secondary ; Lymph Nodes/pathology ; Male ; Middle Aged ; Multivariate Analysis ; Pancreatic Neoplasms/*diagnosis/epidemiology/*mortality ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed ; Treatment Outcome

PURPOSE: Recently, the importance of early diagnosis and early treatment has been increasing, and there are many cases where tumors have been discovered incidentally. However, due to lack of reports regarding pancreatic cases, the clear management plan remains in dispute. This study attempted to analyse pancreatic cases so as to offer a management direction. METHODS: From October 1994 to May 1999, we experienced 28 cases of incidentally discovered pancreatic tumors and those cases were reviewed retrospectively. RESULTS: In regards to initial referrals for diagnosis, 19 cases were from general medical examinations, and 9 cases were referred due to symptoms or signs not related to their tumors (2 cases with hepatitis B, 2 cases with lung lesions, 1 case with a gastric leiomyosarcoma, 1 case with vaginal bleeding, 1 case with acute enteritis, 1 case with a toothache and 1 case with a headache). Twenty cases were initially detected from abdominal US, 3 cases from abdominal CT, 2 case from chest CT, 2 case from the simple abdomen, and 1 case from CA 19-9 investigation. The accuracies for diagnosing the precise type of tumor were CT 42.3% (11/26), ERCP 15.3% (2/13), abdominal US 12.5%, and (3/24). Postoperative pathologies included 7 serous cystadenomas, 6 solid-pseudopapillary tumors, 4 mucinous cystic neoplasms, 4 nonfunctioning islet cell tumors, 2 intraductal papillary mucinous neoplasms, 2 simple cysts, 1 ductal adenocarcinoma, 1 benign retension cyst, and 1 pseudocyst. Among these were 5 malignant neoplasms (3 nonfunctional islet cell tumors, 1 ductal adenocarcinoma, and 1 mucinous cystic neoplasm), and 17 cases (60.7%) were premalignant tumors. All cases were treated with a pancreatic resection, and postoperative follow-up was carried out for a period of 3-66 months. During thisperiod, no recurrence or mortality was noted other than 1 case of liver metastasis 12 months postoperatively for ductal adenocarcinoma. CONCLUSION: Although presence of a ductal adenocarcinoma is rare in incidentally discovered pancreatic tumors pancreatic incidentaloma is common in premalignant neoplasms. Therefore, even in asymptomatic cases, aggressive surgical resection is necessary for accurate diagnosis and early treatment.
Abdomen ; Adenocarcinoma ; Adenoma, Islet Cell ; Cholangiopancreatography, Endoscopic Retrograde ; Cystadenoma, Serous ; Diagnosis ; Dissent and Disputes ; Early Diagnosis ; Enteritis ; Follow-Up Studies ; Hepatitis B ; Leiomyosarcoma ; Liver ; Lung ; Mass Screening* ; Mortality ; Mucins ; Neoplasm Metastasis ; Pancreatic Neoplasms* ; Pathology ; Recurrence ; Referral and Consultation ; Retrospective Studies ; Tomography, X-Ray Computed ; Toothache ; Uterine Hemorrhage