Current Diagnosis and Management of Unusual Pancreatic Tumors

8/6/2019 Current Diagnosis and Management of Unusual Pancreatic Tumors

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Current diagnosis andmanagement ofunusual pancreatic tumors

The American Journal of Surgery (2008) 196,100-113


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:

/


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:

(Solid pseudopapillary tumor)

(Acinar Cell Carcinoma)

(Lymphoplasmacytic Sclerotic Pancreatitis)

(Primary Pancreatic

Lymphoma)

(metastaticRenal Cell Carcinoma)


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Solid Pseudo-papillary

Tumor (SPT )


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Franzs tumor

2,7%

1-2%

(90%) 3

Tumors of the pancreas . Vol.7 , fascicle 27 and 28Solid and papillary neoplasm of the pancreas. J Surg Oncol 2004;85:193-8review of 718 patients reported in English literature. J Am Coll Surg 2005;200:965-72


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Pancreatic solid cystic papillary tumor: clinical features imaging findings and operative management. JOP 2006;7:137-44 Papillary cystic and solid tumors of the pancreas :a pancreatic embryonic tumor? Surgery 1995;118:821-828


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AFP, CEA, CA19-9,CA-125

Diagnosis and treatment of solid pseudopapillary tumor of the pancreas. HepatobiliaryPancreat Dis Int 2006;5:454-8


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6-30 cm U/S : ,

CT: ,

,

Solid pseudopapillary tumor of the pancreas: a typically cystic carcinoma of low malignant potential Semin Diagn Pathol 2000;17:66-80Solid pseudopapillary tumors of the pancreas Histopathology JOP 2006;7:131-6


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,

Solid pseudopapillary tumors of the pancreas Histopathology JOP 2006;7:131-6Solid pseudopapillary tumors of the pancreas :clinical experience and literature review WJ Gastroenterol 2005;11:1403-9


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(branching papillary fronds) ,

,

Clinically aggressive solid pseudopapillary tumors of the pancreas: a report of two cases with components of undifferentiated carcinomaand a comperative clincopathologic analysis of 34 conventional cases.


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CD10 ,CD56

AAT

- (ER)

Solid pseudopapillary tumor of the pancreas : its origin revisited Virchows Arch 2000;436:473-80


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pluripotent stem cells

7

Papillary cystic and solid tumors of the pancreas :a pancreatic embryonic tumor? Surgery 1995;118:821-828


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/

10-20%

, .

6,6%

-

Aggressive behavior of solid pseudopapillary tumor of the pancreas in adults: a case report and reviw of the literature. World J Gastroenterol 2008 February 14;14(6) : 960-965.Resection of a solid and papillary epithelial neoplasm of the pancreas following treatment with cisplatinum and 5-fluorouracil: a case report Med PediatrOncol 1993;21:365-7P

reoperative gemcitabiine for unresectable solid pseudopapillary tumor of the pancreas Lancet Oncol 2005;6:185-6A role for radiotherapy in the treatment of solid and papillary neoplasms of the pancreas.


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Acinar Cell Carcinoma (ACC)


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1-2%

1%

(5-7 )

50% (

)

50%, 5,9%

Morphological study of 391 cases of exocrine pancreatic tumors with special reference to the classification of exocrine pancreatic carcinoma.Acinar cell carcinoma of the pancreas Int J Gastrointest Cancer 2003;34:62-72Acinar Cell Carcinoma with and without endocrine differentiation. HPB 2002-Vol.4 Number 2 87-90

Acinar Cell Carcinoma of the pancreas : a clinopathological study of 28 cases Am J Surg Pathol 1992;16:815-37Acinar cell carcinoma of the pancreas: metastases from occult primary tumor. Arch Pathol Lab Med 1983;107:552-4


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15%

Lipase-secreting acinar cell carcinoma of the pancreas with polyarthropathy Cancer 1974;33:1002-9Pancreatic acinar cell carcinoma with subcutaneous and intraosseous fat necrosis Radiology 1986;158:67-8


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25%

CA 19-9

AFP

CEA

Acinar Cell Carcinoma of the pancreas : a clinopathological study of 28 cases Am J SurgPathol 1992;16:815-37Acinar cell carcinoma of the pancreas: clinical and computed tomography manifestations J Comput Assist Tomogr 2004;28:180-6Alpha-fetoprotein-positive carcinoma of the pancreas. A clinopathological study and comparison with acinar cell carcinoma.Virchows Arch 2004;445:231-5


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(56%)

10-15cm CT/MRI : , , ,

CT and MRI features of pure acinar cell carcinoma of the pancreas in adults AJR Am Roentgenol 2005;184:511-9Acinar Cell Carcinoma with and without endocrine differentiation. HPB 2002-Vol.4 Number 2 87-90


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.

.

Acinar Cell Carcinoma of the pancreas : a clinopathological study of 28 cases Am J SurgPathol 1992;16:815-37

Plasma carcinoembryonic antigen and acinar cell carcinoma of the pancreas Cancer 1984;53:1137-42Mixed acinar-endocrine carcinoma of the pancreas: a case report Anticancer Res 2005;25:1671-74


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AFP, CEA, CA19-9 p53

mixed acinar endocrine cell carcinoma

Mixed acinar-endocrine carcinoma of the pancreas: a case report Anticancer Res 2005;25:1671-74


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/

. 64%

.

19

/

RT.

* : -doxorubicin-5FU

Pancreatic neoplasia in Hepatobiliary and Pancreatic Surgery , edited by Garden OJ 1st edition pp.321-351, Londn: W B Saunders Company LtdEffective intra-arterial chemotherapy for acinar cell carcinoma of the pancreasDig Surg 1999;16:76-9


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Lymphoplasmacytic Sclerotic

Pancreatitis (LPSP)


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(64-68%) (60-65)

(

)

( )

Autoimmune PancreatitisDig Liver Dis 2005;37:211-5Results of pancreaticoduodenectomy for lymphoplasmatic sclerosing pancreatitis Ann Surg 2003;237:853-8Lymphoplasmatic sclerosing pancreatitis: inflammatory mmic of pancreatic carcinoma Gastrointest Surg 2003;7:129-37

Lymphoplasmatic Sclerosing(autoimmune) pancreatits SeminD

iagnP

athol 2004;21:237-46Serum antibodies to carbonic anydrase I and II in ppatients wth idiopathic chronic pancreatitis and Sjogrens Syndrome Gastroenterology1996;110:1579-86


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Controversies in clinical oancreatology: autoimmune pancreatitis: does it exist? Pancreas 2003;27:1-13


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, ,

(RF)

IgG IgG4( )

Kamisawa T Okamoto L Autoimmune pancreatitis : proposal of IgG4-related sclerosing diseaseAutoimmune-related pancreatitis is associated with autoantibodies and a Th1/Th2-type cellular immune response Gastroenterology 2000;118:573-81

High serum IgG4 concentrations in patients with sclerosing pancreatitis N Engl J Med 2001;344:732-8IgG4-associated idiopathic tubulointeerstitial nephritis complicating autoimmune pancreatitis Nephrol Dial Transplant 2004;19:474-6


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MRI/CT:

ERCP:

Acute tubulointerstitial nephritis associated with autoimmune-relAated pancreatitis Am J Kidney Dis 2004;43:18-25Autoimmune Pancreatitis associated with renal lesions mimicking metastatic tumors CMAJ 2006;175(4):367-9


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(

)

The Japanese diagnostic criteria for autoimmune chronic pancreatitis: is it completely satisfactory? Pancreas 2006;33:13-9


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CD3 CD8.

IgG4- .


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/

: 30-40 mg/ p.o. 4

5-10 mg/ p.o.

12% - - stent

2-3 stent :

Corticosteroid-responsive diabetes mellitus associated with autoimmune pancreatitis Lancet 2000;356:910-1Autoimmune pancreatitis: etiology, pathogenesis, clinical findings and treatment. The Japanese experience JOP 2005;6:89-96Lymphoplasmacytic sclerosing pancreatitis: inflammatory mimic of pancreatic carcinoma J Gastrointest Surg 2003;7:129-137


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Primary Pancreatic

Lymphoma (PPL)


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( 0,5%) : 7:1 5 -6 (.. 55 )

:

1)

2) 3)

4)

Primary pancreatic lymphomas: a cytopathologic analysis of a rare malignancy Cancer 2004;102:315-21

Primary pancreatic lymphoma report of five cases Haematologica 2005;90:ECR09Primary pancreatic lymphoma: report of six cases World J Gastroenterol 2006;12:5064-67


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( 83%)

Saif MW Primary pancreatic lymphomas JOP 2006;7:262-273


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.

. LDH 50%

Primary pancreatic lymphomas: a cytopathologic analysis of a rare malignancy Cancer 2004;102:315-21


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CT:

PDA

Pancreatic lymphoma: is it a surgical disease? Pancreas 1994;9:662-7Imaging findings in pancreatic lymphoma AJR Am J Roentgenol 2000;174:671-675


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, ,

-

- (CD20 ,CD79a)


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/

.

: ---

doxorubicin 63-77%

rituximab - 85%

Monoclonal antibody as therapy for malignant lymphomas C R Biol 2006;329:241-245


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Metastatic Renal CellCarcinoma (metastatic RCC)


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2-3%

(disease-free interval) (

10)

5 70%

Renal cancer metastasis into the pancreas: a single-center experience and overview of the literature Pancreas 2005;30:218-22Pancreatic resection for metastatic renal cell carcinoma: presentation, treatment and outcome. Ann Surg Oncol 2003;10:922-6


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follow-up


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CT: ,

Renal cell carcinoma metastatic to the pancreas: clinical and radiological features Mayo Clin Proc 2000;75:581-5


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.

Renal cancer pathology and prognostic factors Comprehensive textbook of genitourinary urology 3rd ed. 2006


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/

.

:

: 29-36%

Pancreatic resection for metastatic renal cell carcinoma: presentation, treatment and outcome. Ann Surg Oncol 2003;10:922-6


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Current Diagnosis and Management of Unusual Pancreatic Tumors

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