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World Journal of Gastroenterology Apr 2021Bile duct epithelial tumours showing papillary neoplasm in the bile duct lumen are present in the intrahepatic and extrahepatic bile ducts. Clinicopathological images of... (Review)
Review
Bile duct epithelial tumours showing papillary neoplasm in the bile duct lumen are present in the intrahepatic and extrahepatic bile ducts. Clinicopathological images of these tumours are distinctive and diverse, including histological images with a low to high grade dysplasia, infiltrating and noninfiltrating characteristics, excessive mucus production, and similarity to intraductal papillary mucinous neoplasm (IPMN) of the pancreas. The World Health Organization Classification of Tumours of the Digestive System in 2010 named these features, intraductal papillary neoplasm of the bile duct (IPNB), as precancerous lesion of biliary carcinoma. IPNB is currently classified into type 1 that is similar to IPMN, and type 2 that is not similar to IPMN. Many of IPNB spreads superficially, and diagnosis with cholangioscopy is considered mandatory to identify accurate localization and progression. Prognosis of IPNB is said to be better than normal bile duct cancer.
Topics: Bile Duct Neoplasms; Bile Ducts, Extrahepatic; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Humans; Pancreatic Neoplasms
PubMed: 33958844
DOI: 10.3748/wjg.v27.i15.1569 -
World Journal of Gastroenterology May 2015Patients with pancreatic cancer have a poor prognosis with a median survival of 4-6 mo and a 5-year survival of less than 5%. Despite therapy with gemcitabine, patient... (Review)
Review
Patients with pancreatic cancer have a poor prognosis with a median survival of 4-6 mo and a 5-year survival of less than 5%. Despite therapy with gemcitabine, patient survival does not exceed 6 mo, likely due to natural resistance to gemcitabine. Therefore, it is hoped that more favorable results can be obtained by using guided immunotherapy against molecular targets. This review summarizes the new leading targeted therapies in pancreatic cancers, focusing on passive and specific immunotherapies. Passive immunotherapy may have a role for treatment in combination with radiochemotherapy, which otherwise destroys the immune system along with tumor cells. It includes mainly therapies targeting against kinases, including epidermal growth factor receptor, Ras/Raf/mitogen-activated protein kinase cascade, human epidermal growth factor receptor 2, insulin growth factor-1 receptor, phosphoinositide 3-kinase/Akt/mTOR and hepatocyte growth factor receptor. Therapies against DNA repair genes, histone deacetylases, microRNA, and pancreatic tumor tissue stromal elements (stromal extracellular matric and stromal pathways) are also discussed. Specific immunotherapies, such as vaccines (whole cell recombinant, peptide, and dendritic cell vaccines), adoptive cell therapy and immunotherapy targeting tumor stem cells, have the role of activating antitumor immune responses. In the future, treatments will likely include personalized medicine, tailored for numerous molecular therapeutic targets of multiple pathogenetic pathways.
Topics: Animals; Antineoplastic Agents; Biomarkers, Tumor; Cancer Vaccines; DNA Repair; Humans; Immunotherapy; Molecular Targeted Therapy; Neoplastic Stem Cells; Pancreatic Neoplasms; Precision Medicine; Protein Kinase Inhibitors; Signal Transduction; Treatment Outcome
PubMed: 26034349
DOI: 10.3748/wjg.v21.i20.6127 -
Archives of Pathology & Laboratory... Dec 2017- Invasive pancreatic ductal adenocarcinoma has a greater than 90% mortality rate at 5 years. Understanding noninvasive, curable precursor lesions gives us the best hope... (Review)
Review
CONTEXT
- Invasive pancreatic ductal adenocarcinoma has a greater than 90% mortality rate at 5 years. Understanding noninvasive, curable precursor lesions gives us the best hope for reducing mortality from pancreatic ductal adenocarcinoma. The 3 pancreatic precursor lesions that have been well studied include intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, and pancreatic intraepithelial neoplasia.
OBJECTIVE
- To give an update on the latest clinical, molecular, and pathologic advances in intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, and pancreatic intraepithelial neoplasia for the general surgical pathologist.
DATA SOURCES
- The current literature was analyzed and the authors' experiences with institutional and consult material were incorporated.
CONCLUSIONS
- Our understanding of the molecular alterations that lead from pancreatic precursor lesion to invasive carcinoma continues to evolve. These advances aid clinicians in their treatment decisions and researchers in their search for actionable, druggable targets.
Topics: Carcinoma in Situ; Carcinoma, Pancreatic Ductal; Humans; Mutation; Neoplasm Invasiveness; Pancreatic Neoplasms; Precancerous Conditions; Prognosis
PubMed: 29189063
DOI: 10.5858/arpa.2016-0426-RA -
Digestive Surgery 2013Hepatoid carcinomas (HCs) are extrahepatic neoplasms exhibiting features of hepatocellular tumors in terms of morphology and immunohistochemistry. They have been... (Review)
Review
BACKGROUND
Hepatoid carcinomas (HCs) are extrahepatic neoplasms exhibiting features of hepatocellular tumors in terms of morphology and immunohistochemistry. They have been described in several organs, most notably in the stomach and ovary. They can present in pure forms or in association with other morphological aspects, such as endocrine tumors or ductal adenocarcinomas. The aim of this review is to describe aspects of hepatoid adenocarcinoma of the pancreas with regard to epidemiology, diagnosis, and treatment.
METHODS
The PubMed database was searched for publications addressing hepatoid adenocarcinoma of the pancreas. We have searched for articles including the following keywords: 'pancreatic hepatoid carcinoma', 'ectopic liver cancer' and 'rare pancreas neoplasm' published to date. As references, we used case reports and review articles.
RESULTS
Pancreatic forms of HCs are extremely uncommon: only 22 cases have been reported.
CONCLUSIONS
The possibility of an HC of the pancreas should be considered in the differential diagnosis of an uncommon pathological mass of the pancreas. Treatment seems to be related to the association with other neoplasms, tumor extension at the time of diagnosis and the possibility to perform a radical resection. The common embryologic origin of the pancreas and liver, together with peculiar environmental factors, may explain the development of pancreatic HCs.
Topics: Adenocarcinoma; Carcinoma, Hepatocellular; Choristoma; Diagnosis, Differential; Humans; Liver Neoplasms; Pancreas; Pancreatic Neoplasms; Prognosis; Rare Diseases; Treatment Outcome
PubMed: 24281319
DOI: 10.1159/000355442 -
Revista Espanola de Enfermedades... Aug 2022Zollinger Ellison syndrome is an unusual entity. This termn is used to describe the clinical manifestations of a gastrin-synthesizing neoplasm. Gastrinomas occur mainly...
Zollinger Ellison syndrome is an unusual entity. This termn is used to describe the clinical manifestations of a gastrin-synthesizing neoplasm. Gastrinomas occur mainly in the duodenum and pancreas. Primary gastrinomas are rarely found in other intra-abdominal sites, such as the ovary, bile ducts, spleen or kidney, or even more unusual in extra-abdominal locations. Several studies provide strong evidence that gastrinomas can also occur in the lymph nodes. However, the existence of primary lymph node gastrinomas is controversial.
Topics: Female; Gastrinoma; Gastrointestinal Stromal Tumors; Humans; Pancreas; Pancreatic Neoplasms; Zollinger-Ellison Syndrome
PubMed: 35255699
DOI: 10.17235/reed.2022.8753/2022 -
International Journal of Surgery... Apr 2016Pancreatic neuroendocrine tumors (pNETs) represent about 7% of all NETs, 8.7% of gastroenteropancreatic NETs (GEP-NETs) and 1-2% of all pancreatic neoplasms. In the last... (Review)
Review
Pancreatic neuroendocrine tumors (pNETs) represent about 7% of all NETs, 8.7% of gastroenteropancreatic NETs (GEP-NETs) and 1-2% of all pancreatic neoplasms. In the last two decades, the increased diagnosis of pNETs has generated great interest and the development of different classifications, grading and staging systems. Recently, several trials were performed in order to improve the knowledge of biomarkers and imaging and to provide an early diagnosis, but their role is still under debate. Nowadays, surgery represents the only curative approach for pNETs. Approximately 90% of pNETs are silent and non-functional; therefore, most patients are diagnosed in late stage and present metastatic (60%) or locally unresectable advanced disease (21%) with a poor prognosis. Not many therapeutic options are available for pNETs, with different treatments for G1-G2 and G3 tumors, because these diseases are still rare and trials are made up of few series of patients. At present, medical treatments is controversial. On these bases, we believe that a multidisciplinary team composed of surgeons, oncologists, endocrinologists, radiation oncologists, radiologists, pathologists and medicals nuclear is required. This paper presents a review of present state-of-the-art in the field of pNETs.
Topics: Humans; Neoplasm Grading; Neoplasm Metastasis; Neoplasm Staging; Neuroendocrine Tumors; Pancreatic Neoplasms; Patient Care Team
PubMed: 26708853
DOI: 10.1016/j.ijsu.2015.12.052 -
World Journal of Surgery Jul 2020Due to the rarity of malignant insulinoma, a lack of the literature describing factors affecting outcomes exists. Our aim was to review malignant insulinoma incidence,... (Review)
Review
INTRODUCTION
Due to the rarity of malignant insulinoma, a lack of the literature describing factors affecting outcomes exists. Our aim was to review malignant insulinoma incidence, characteristics and survival trends.
METHODS
We identified all patients with malignant insulinoma in the SEER registries from 1973 to 2015. Incidence, neoplasm characteristics and factors affecting cancer-specific survival (CSS) were described.
RESULTS
A total of 121 patients were identified. The crude annual overall incidence was low (range 0.0-0.27 cases per million person years). The largest proportion had localized disease (40%), while 16% had regional disease, 39% distant metastatic disease, and stage was unreported in 5%. Most neoplasms were in the body/tail of the pancreas, followed by the head of the pancreas. Grade was reported in 40% of patients; only a single patient reported as having grade IV with the remainder all grades I/II. Surgical resection was performed in 64% of patients. Within surgical patients, the median primary neoplasm size was 1.8 cm. Regional lymph nodes were examined in 57.1% of surgical patients, while 34% of examined nodes were positive. The median CSS was 183 months. On multivariable analysis, surgical resection, male sex and absence of metastatic disease were associated with superior survival.
CONCLUSION
While the greatest proportion of patients with malignant insulinoma present with localized disease, regional lymph node involvement was found in 34% of whose nodes were tested. Further studies are needed to assess the role of lymph node dissection in improving survival and preventing recurrence given the observed frequency of lymph node involvement.
Topics: Humans; Insulinoma; Lymph Node Excision; Lymphatic Metastasis; Neuroendocrine Tumors; Pancreatic Neoplasms; Prognosis; Survival Rate
PubMed: 32128613
DOI: 10.1007/s00268-020-05445-x -
Diagnostic and Interventional Imaging Dec 2016Pancreatic ductal carcinoma is one of the deadliest cancers in the world. The only hope for prolonged survival still remains surgery with complete R0 resection even if... (Review)
Review
Pancreatic ductal carcinoma is one of the deadliest cancers in the world. The only hope for prolonged survival still remains surgery with complete R0 resection even if most patients will promptly develop metastases and/or local relapses. Due to the silent nature of the disease, fewer than 20% of patients are eligible for a curative-intent resection. As no gain in survival is expected in case of residual tumor, imaging plays a major role for diagnosis and staging to select patients who will undergo surgery. Multidetector-row computed tomography and magnetic resonance imaging are the key stones and radiologists must be aware of imaging protocols, standardized terms and critical points for structured reporting to assess the tumor staging, minimize potential the morbidity associated with surgery and offer patients the best therapeutic strategy.
Topics: Carcinoma, Pancreatic Ductal; Humans; Magnetic Resonance Imaging; Multidetector Computed Tomography; Neoplasm Staging; Pancreatectomy; Pancreatic Neoplasms; Prognosis; Risk Factors; Sensitivity and Specificity; Ultrasonography
PubMed: 27567314
DOI: 10.1016/j.diii.2016.07.008 -
Gastroenterology May 2019The desmoplastic reaction of pancreas cancer may begin as a wound healing response to the nascent neoplasm, but it soon creates an insidious shelter that can sustain the... (Review)
Review
The desmoplastic reaction of pancreas cancer may begin as a wound healing response to the nascent neoplasm, but it soon creates an insidious shelter that can sustain the growing tumor and rebuff therapy. Among the many cell types subverted by transformed epithelial cells, fibroblasts are recruited and activated to lay a foundation of extracellular matrix proteins and glycosaminoglycans that alter tumor biophysics and signaling. Their near-universal presence in pancreas cancer and ostensible support of disease progression make fibroblasts attractive therapeutic targets. More recently, however, it has also become apparent that diverse subpopulations of fibroblasts with distinct phenotypes and secretomes inhabit the stroma, and that targeted depletion of particular fibroblast subsets could either provide substantial therapeutic benefit or accelerate disease progression. An improved characterization of these fibroblast subtypes, along with their potential relationships to tumor subtypes and mutational repertoires, is needed in order to make anti-fibroblast therapies clinically viable.
Topics: Animals; Antineoplastic Agents; Cancer-Associated Fibroblasts; Carcinoma, Pancreatic Ductal; Humans; Pancreatic Neoplasms; Phenotype; Signal Transduction; Tumor Microenvironment
PubMed: 30721663
DOI: 10.1053/j.gastro.2018.12.044 -
The Ulster Medical Journal Jan 2020
Topics: Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Diagnosis, Differential; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Immunochemistry; Jaundice, Obstructive; Lymphoma, Non-Hodgkin; Male; Neoplasm Staging; Pancreas; Pancreatic Neoplasms; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 32218630
DOI: No ID Found