Pancreatic cancer (PC) is a malignant tumor of the digestive tract with poor patient prognosis. The PC incidence is still increasing with a 5-year survival rate of only 10%. At present, surgical resection is the most effective method to treat PC, however, 80% of the patients missed the best time for surgery after they have been diagnosed as PC. Chemotherapy is one of the main treating methods but PC is insensitive to chemotherapy, prone to drug resistance, and is accompanied by many side effects which are related to a lack of specific target. Exosomes are nanoscale vesicles secreted by almost all cell types and can carry various bioactive substances which mediate cell communication and material transport. They are characterized by a low immunogenicity, low cytotoxicity, high penetration potential and homing capacity, and possess the potential of being used as advanced drug carriers. Therefore, it is a hot research topic to use drug-loaded exosomes for tumor therapy. They may alleviate chemotherapy resistance, reduce side effects, and enhance the curative effect. In recent years, exosome drug carriers have achieved considerable results in PC chemotherapy studies.
Humans ; Exosomes/metabolism* ; Drug Carriers/metabolism* ; Pancreatic Neoplasms/diagnosis* ; Antineoplastic Agents/therapeutic use*

OBJECTIVETo study the clinicopathologic and immunohistochemical features, and the prognosis of intraductal papillary mucinous neoplasms (IPMN) of the pancreas.

METHODSThe clinical findings, morphologic features, immunophenotype and prognosis were investigated in 61 cases of IPMN.

RESULTSOf these 61 cases, 33 were in the pancreatic head and 14 were in the body and tail, and 14 in the entire pancreas. The average patients' age was 61.8 years. The initial symptom was abdominal pain in 37 cases, and the tumors were detected at routine checkup in 14 cases. The imaging examination showed dilated ducts and/or cystic and solid masses. Grossly, 32 cases were multi-loculated cystic masses containing mucin and papillary areas; 13 cases were solid. Microscopically, the IPMN showed four patterns, including gastric-type (16 cases), intestinal-type (21 cases), pancreatobiliary-type (21 cases) and eosinophilic-type (3 cases). The IPMN cohort included 13, 13 and 6 IPMN with low, intermediate and high-grade dysplasia respectively, and 29 IPMN associated with invasive carcinoma. The IPMN associated carcinomas were mainly ductal adenocarcinoma (23/29, 79.3%), followed by colloid carcinoma (4/29, 13.8%) and undifferentiated carcinoma (2/29, 6.9%). Immunohistochemically, IPMN expressed MUC5AC (51/57, 89.4%), MUC2 (21/57, 36.8%), and MUC1 (13/46, 28.3%). The mean postoperative follow-up period was 32 months (range 12-112 months). Six of 61 patients were lost to follow-up. Overall 5-year survival rate was 76%. The 5-year survival rate of IPMN with low, intermediate or high-grade dysplasia was 100%, and recurrence was local in 3 patients. The 3-year survival rate of IPMN associated with invasive carcinoma was 55%. 12 of 13 patients died within 2 years after operation.

CONCLUSIONSIPMN is a common cystic neoplasm of the pancreas located in the ducts. The pathologic types and classifications are clearly defined. MUC stains are helpful for the diagnosis and papillary typing. IPMN with invasive carcinoma was associated with significantly worse survival than IPMN with dysplasia.

Adenocarcinoma, Mucinous ; diagnosis ; pathology ; Carcinoma, Pancreatic Ductal ; diagnosis ; pathology ; Humans ; Middle Aged ; Mucins ; metabolism ; Neoplasm Recurrence, Local ; Pancreas ; pathology ; Pancreatic Neoplasms ; diagnosis ; pathology ; Prognosis ; Survival Rate

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

OBJECTIVETo explore the relationship between the expression of Survivin and Ki67 with prognosis of pancreatic endocrine tumors (PETs).

METHODSImmunohistochemistry for Survivin and Ki67 was performed in 25 cases of normal pancreatic tissues and 81 cases of PETs by tissue microarrays and to observe the expression and evaluate the relationship with prognosis.

RESULTS(1)The expression of Survivin and Ki67 in PETs was significantly higher than that in normal pancreatic tissues (P <0.01); (2)The expression of Survivin and Ki67 in PETs was correlated with tissue grading and the TNM-staging (P < 0.05), but not related with tumor size, location and functional status. In addition, the expression of nuclear Survivin was association with lymph node metastasis (P < 0.05). (3)The high expression of Ki67 was related with the expression of nuclear Survivin, but not related with the expression of cytoplasmic Survivin.

CONCLUSIONSurvivin and Ki67 were both expressed in PETs, which were closely related to the clinical pathological characteristics. They could be used as new indicators in the evaluation of prognosis of PETs. The expression of Survivin in nucleus had more diagnostic significance than that in cytoplasm, and that could be highly correlated with lymph node metastasis, which would be used as a new marker of poor prognosis.

Biomarkers, Tumor ; metabolism ; Cell Nucleus ; metabolism ; Cytoplasm ; metabolism ; Humans ; Immunohistochemistry ; Inhibitor of Apoptosis Proteins ; metabolism ; Ki-67 Antigen ; metabolism ; Lymphatic Metastasis ; Neoplasm Staging ; Pancreatic Neoplasms ; diagnosis ; Prognosis

Herein, we report the case of a large benign insulinoma in an obese young man with a three-year history of asymptomatic hypoglycaemia. He presented to our outpatient department with a two-week history of dizziness and morning cold sweats. A random serum glucose test revealed hypoglycaemia. Upon admission, computed tomography and magnetic resonance imaging of the abdomen with intravenous contrast media showed an enhancing mass lesion in the uncinate process of the pancreas. To confirm the diagnosis, an intra-arterial calcium stimulation test with hepatic venous sampling was performed for preoperative localisation and to exclude the presence of occult insulinomas. The patient underwent an exploratory laparotomy, with successful resection of the pancreatic head tumour. Histology confirmed the diagnosis of insulinoma. The patient's postoperative recovery was uneventful, and he has not developed further episodes of hypoglycaemia three years post surgery.
Adult ; Blood Glucose ; analysis ; Calcium ; metabolism ; Contrast Media ; chemistry ; Hepatic Veins ; pathology ; Humans ; Insulinoma ; blood ; complications ; diagnosis ; Magnetic Resonance Imaging ; Male ; Obesity ; blood ; complications ; Pancreatic Neoplasms ; blood ; complications ; diagnosis ; Tomography, X-Ray Computed

OBJECTIVETo find the potential serum specific miRNAs with diagnostic value in early pancreatic cancer and study the alteration of miRNAs levels in the process of origin and development of pancreatic cancer and discuss the diagnostic value of miRNAs in early pancreatic cancer.

METHODSDMBA-induced rat model was established. The miRNAs expression profile of early stage was screened out by microarray. And confirmation study was performed.

RESULTSThe 35 and 12 abnormally expressed miRNAs were acquired in pancreatic tissue and blood respectively. There were no significant differences between normal pancreas and pancreatic cancer in expressions of hsa-let-7c, hsa-miR-122-5p, hsa-miR-142-5p, hsa-miR-199a-3p and hsa-miR-451a (P > 0.05).

CONCLUSIONSmiRNAs are the potential biomarkers of early pancreatic cancer. The establishment of the miRNAs expression profile has build the foundation of exploring the molecular mechanism of origin of pancreatic cancer.

Animals ; Biomarkers, Tumor ; blood ; metabolism ; Disease Models, Animal ; Male ; MicroRNAs ; blood ; metabolism ; Pancreas ; metabolism ; Pancreatic Neoplasms ; diagnosis ; genetics ; Prognosis ; Rats ; Rats, Sprague-Dawley ; Transcriptome

Pancreatic cancer patients often have a poor prognosis and suffer from nutritional problems. Malnutrition is characterized by weight loss and decreased dietary intake, and is common among pancreatic cancer patients. The objective of this report was to describe the changes in dietary intake, body weight, nutritional status, and metabolic rate on a continuum from the time of diagnosis until the end of life in a patient with pancreatic cancer. In summary, the patient's nutritional status gradually declined, accompanied by extreme weight loss and decreased dietary intake. Conversely, resting energy expenditure, measured by indirect calorimetry, increased from 24 kcal/kg/day to 35 kcal/kg/day. Nutritional management during cancer treatment is important but may be challenging in pancreatic cancer patients.
Basal Metabolism ; Body Weight* ; Calorimetry, Indirect ; Diagnosis ; Diet Records ; Energy Metabolism ; Humans ; Malnutrition ; Nutritional Status* ; Pancreatic Neoplasms* ; Prognosis ; Weight Loss

While long-standing diabetes is a risk factor of pancreatic cancer, new-onset diabetes could be a consequence of underlying pancreatic malignancy. About 30% to 50% of pancreatic cancer patients have new-onset diabetes. Because diabetes develops in preclinical or early stages of pancreatic cancer, it could serve as an excellent clue for early detection of pancreatic cancer. Insulin resistance associated with hyperglycemia and hyperinsulinemia by diabetogenic factors secreted from cancer cells have been suggested to be a possible mechanism of pancreatic cancer-induced diabetes. It is difficult to differentiate pancreatic cancer-induced diabetes from the more common type 2 diabetes. Although several clinical features and potential biomarkers have been investigated, optimal strategies and modalities to screen pancreatic cancer among the new-onset diabetes have not yet been fully determined.
Adiponectin/metabolism ; Age Factors ; Body Mass Index ; Cytokines/metabolism ; Diabetes Mellitus, Type 2/*complications/*diagnosis/pathology ; Humans ; Pancreatic Neoplasms/*complications/*diagnosis/pathology ; Tomography, X-Ray Computed

OBJECTIVETo detect the expression of eukaryotic translation initiation factor 5A2(EIF5A2) in pancreatic adenocarcinoma and its correlation with the clinicopathological characteristics and prognosis.

METHODSA total of 73 patients who were treated in our hospital from March 2007 to December 2008 were enrolled in this study. The expression of EIF5A2 in the surgical samples was detected using immunohistochemical staining. Complete clinicopathological data were obtained from all the patients. The potential correlation between EIF5A2 expression and the clinicopathological features, particularly its role in prognosis, were analyzed.

RESULTSOf these 73 patients, 43 had a high EIF5A2 expression. EIF5A2 expression was significantly correlated with the pathological T stage(P<0.001), N stage(P=0.004), M stage(P=0.039), and TNM stage(P=0.005). Kaplan-Meier method demonstrated that the survival was significantly longer in the low EIF5A2 expression group than in the high EIF5A2 expression group(P=0.003). Cox's hazard model showed EIF5A2 was a significant predictor of overall survival in patients with pancreatic adenocarcinoma.

CONCLUSIONEIF5A2 may be a potential predictor of the poor prognosis in patients with pancreatic adenocarcinoma.

Adenocarcinoma ; diagnosis ; metabolism ; Humans ; Neoplasm Staging ; Pancreatic Neoplasms ; diagnosis ; metabolism ; Peptide Initiation Factors ; metabolism ; Prognosis ; RNA-Binding Proteins ; metabolism

Humans ; Hypoxia-Inducible Factor-Proline Dioxygenases ; metabolism ; Ki-67 Antigen ; metabolism ; MicroRNAs ; metabolism ; Neoplasm Grading ; Neoplasm Staging ; Neprilysin ; metabolism ; Neuroendocrine Tumors ; classification ; diagnosis ; metabolism ; pathology ; surgery ; PAX8 Transcription Factor ; Paired Box Transcription Factors ; metabolism ; Pancreatic Neoplasms ; classification ; diagnosis ; metabolism ; pathology ; surgery ; Prognosis ; Tumor Suppressor Proteins ; metabolism