Solid papillary tumor of the pancreas. A clinical case

A method is presented for the investigation of surfactant function after isolation and preparation of pulmonary surfactant from tracheobronchial aspirates of mechanically ventilated infants and children. This method involved purification of surfactant from contaminating non-surfactant phospholipids and mucus by sodium bromide density gradient centrifugation. The surfactant concentration in undiluted fluids (3.5 +/- 0.8 mg mL-1; mean +/- SD) was calculated by extrapolating from the urea concentration in aspirates and serum. Phospholipid concentration was adjusted to approximately 3 mg mL-1 and the surface activity was determined by means of a pulsating bubble surfactometer. Mean minimal and maximal tension values of all cycles were calculated after reaching steady state. Measurements obtained from surfactant isolated with this method showed a high reproducibility: the coefficient of variation for minimal surface tension was 6.1%. Therefore this method enables functional surfactant analysis in tracheobronchial aspirates.     

Papillary cystic neoplasm of the pancreas: radiological findings

We report a series of 10 papillary cystic neoplasms of the pancreas evaluated in our institution. The lesions are analyzed in retrospect to define the existence of eventual specific imaging patterns as well as to point out the existing problems of differential diagnosis versus other pancreatic tumors.     

Dermoid cyst of the pancreas: a rare cystic neoplasm

Dermoid cysts of the pancreas, also called cystic teratomas, are a rare entity and are included in the group of neoplasms with a germ cell origin. Only twelve cases have been described in the world literature. The symptomatology is due to tumor compression of the neighboring tissues. Ultrasonography and computed tomography may be helpful, but there are no pathognomonic data for their preoperative recognition. The differential diagnosis should include all other cystic tumors of the pancreas. Complete surgical removal is mandatory. We describe the diagnostic and surgical procedures in a 74 year-old man with a pre-operatively unsuspected dermoid cyst. We review the previously published cases and emphasize the appropriate therapeutical management.     

A newly recognized entity: intraductal "oncocytic" papillary neoplasm of the pancreas

Intraductal papillary-mucinous tumors of the pancreas are increasingly recognized, and their characteristic endoscopic and radiological features are well reported in the literature in recent years. Oncocytic features in these tumors are uncommon and unrecognized. Intraductal oncocytic papillary neoplasm is a distinct pancreatic tumor and is a recently recognized entity. We report a case of a 69-yr-old patient who presented with symptoms mimicking pancreatitis, resulting in delay in the diagnosis of her pancreatic tumor. She underwent a successful Whipple's procedure and subsequently has remained well. The resected specimen showed an intraductal oncocytic papillary-mucinous neoplasm. The entity is new and the literature information is inadequate at present to judge the biological behavior of this tumor. We discuss this recently recognized entity.     

Solid and papillary neoplasm of the pancreas: a case presentation

Solid and papillary tumors of the pancreas are very rare malignancies, more commonly occurring in young women. They usually present as asymptomatic, large abdominal masses, and different from the most common neoplasm of the pancreas, which is the adenocarcinoma, these tumors have a high percentage of curability when treated by complete surgical resection. (6) For this reason, when the diagnosis of Frantz's tumor is made or strongly suspected, every attempt should be made for complete surgical excision since curability is high and radiotherapy and, or chemotherapy are of no use for its treatment.     

Solid and papillary epithelial neoplasm of the pancreas, diagnosis by cytology

In this paper, I report a rare, low-grade malignant tumor, solid and papillary epithelial neoplasm of the pancreas (SPENP). I also discuss and review 157 previously reported cases. Unlike other malignant tumors of the pancreas, this neoplasm is typically found in young women, does not have metastases, and is amenable to cure after complete surgical resection. I discuss clinical features, diagnostic procedures, and differential diagnosis. Fine-needle aspiration can be effective in obtaining a preoperative diagnosis of SPENP, since the tumor has characteristic cytologic features. Also, use of clinical data, ultrasonography studies, computed tomography, magnetic resonance imaging, arteriography, and cytologic findings in the preoperative workup are important in obtaining an accurate diagnosis. Although potentially curable, late metastases and current inability to predict aggressive behavior by some tumors require lengthy follow-up.     

Serous cystic neoplasm involving the pancreas and liver: an unusual clinical entity

Allele frequencies for four short tandem repeat loci were determined in a population sample from Catalonia (NE Spain). After denaturing PAGE electrophoresis, 8 alleles were identified for D3S1358 (n=201), 10 alleles for D8S1179 (n=198), 13 alleles for D18S51 (n=197) and 11 alleles for D19S253 (n=201). No deviation from Hardy-Weinberg equilibrium was found. Complete and relative uniformity in Caucasoid populations has been observed for D18S51 and D8S1179 respectively. Pronounced differences were found between different ethnic groups for both systems. Catalonia and Portugal do not differ for D3S1358 locus. Multiplex PCR amplifications of three loci (D3S1358, D18S51 and D19S253) without overlapping fragment size ranges could be interesting for monochrome automated laser fluorescence devices.     

Papillary cystic and solid tumor of the pancreas

The papillary cystic and solid tumor of the pancrease (PCSTP) is a primary pancreatic neoplasm of unknown etiology occurring most commonly in young women and regularly containing hemorrhagic areas. Clinical symptoms are non-specific. Although these tumors reach an average diameter of 10 cm, they are often discovered by accident. Because patients with surgically resected PCSTP have very good prognoses, it is important to distinguish these tumors from other growths in the pancreas, for example mucinous cystadenoma. Whereas, due to the variable proportion of fluid components, these tumors offer non-characteristic structure at ultrasonography, computed tomography (CT) possesses high specificity for PCSTP, particularly when calcifications are present. Angiography distinguishes these tumors from hypervascular neoplasms, such as the endocrinologically inactive islet cell tumor. Magnetic resonance tomography (MRT) is especially suited for imaging the hemorrhagic areas in solid tumor formations, as well as hemorrhagic debris in the fluid portions and layer phenomena are frequently observed.     

Characteristics and treatment of mucin-producing tumor of the pancreas

BACKGROUND/AIMS: There has been no thorough clinicopathological analysis of a large number of cases with mucin-producing tumor of the pancreas. The aim of this study was to investigate the clinicopathological features of and therapeutic strategy for this ailment. METHODOLOGY: Two hundred and fifty-nine cases of mucin-producing tumor of the pancreas were analyzed clinicopathologically. RESULTS: Mucin-producing tumor of the pancreas was found in 177 males and 82 females (M:F=2.2:1). The mean age was 65.5 years. Jaundice, diabetes mellitus and a past history of pancreatitis were found in 15-19% of the cases. The tumor was most frequently (62%) found in the head of the pancreas. Pathologically, hyperplasia or adenoma was found in 58 cases, and adenocarcinoma in 160 cases. Five-year survival rate by the Kaplan-Meier method was 82.6% in all of the cases, and the post-operative survival curve was much better in cases with this type of carcinoma than in cases with ordinary pancreatic duct cell carcinoma (5-year survival rate: 17.3%). Organ-function preserving procedures, such as duodenum preserving subtotal resection of the head of the pancreas or spleen preserving distal pancreatectomy, might be recommended for this disease without infiltration. CONCLUSIONS: Mucin-producing tumor has unique clinicopathological characteristics, such as the dilated main pancreatic duct or branches, dilatation of the orifice of the papilla of Vater, or a good prognosis. Organ-function preserving procedures should be recommended in some cases with this ailment.     

Clinicopathologic view of intraductal papillary-mucinous tumor of the pancreas

Intraductal papillary-mucinous tumors (IPMTs) of the pancreas form a special group of neoplasms characterized by intraductal papillary growth of mucin-producing columnar cells. Included among these neoplasms are papillary and villous adenomas, lesions with mucinous duct ectasia and mucin-producing carcinomas. Most patients are males and present with episodic pancreatitis-like symptoms, which may have been noted for years. These symptoms are due to incomplete and later complete duct obstruction by papillary proliferations and/or mucin, which eventually cause fibrotic atrophy of the normal parenchyma. At the time of diagnosis, malignant non-invasive IPMTs are observed in 5-30% of the cases. Fifteen to forty percent of the IPMTs show invasion and half of the invasive IPMTs have metastases. Pre-operatively, invasiveness cannot be predicted. Patients with non-invasive IPMT survive for long periods after surgery, as do many patients with invasive, non-metastatic IPMT, although intraductal proliferation with a mild degree of atypia may be present at the resection margin. In patients with invasive and metastatic IPMT, survival ranges from a few months up to 3 years.     

Solitary cystic tumor of the pancreas: EUS-pathologic correlation

BACKGROUND: It is clinically important to distinguish neoplastic from non-neoplastic pancreatic cysts. METHODS: Retrospective correlations were made between pathologic and EUS data from 52 pancreatic solitary cystic tumors: mucinous cystadenoma (10), mucinous cystadenocarcinoma (7), serous cystadenoma (5), ductectatic mucinous cystic tumor (10), solid and papillary epithelial neoplasm (5), and non-neoplastic cyst (15). The mean tumor size was 3.5 cm (range, 1.2 cm to 6.0 cm). RESULTS: Six classifications of the internal structures of these cysts were developed: thick wall type, tumor protruding type, thick septal type, microcystic type, thin septal type, and simple type. Although all neoplastic cysts belonged to the first four types, all non-neoplastic cysts belonged to the last two types. The accuracy of EUS for differentiating tumors was estimated at 96% and 92%, respectively, by two observers. CONCLUSIONS: EUS may become a mandatory modality for differentiating pancreatic solitary cystic tumors and choosing an optimal treatment.     

Papillary cystic neoplasm of the pancreas: a report of three pediatric cases and literature review

BACKGROUND/PURPOSE: Papillary cystic neoplasms are rare pancreatic tumors that typically present in women in their third decade of life. Few cases have been reported in children. METHODS/RESULTS: The authors report on three pediatric patients: a 10-year-old boy, an 11-year-old girl, and a 14-year-old girl. The authors have reviewed the existing literature on papillary cystic neoplasms of the pancreas and suggest that these tumors probably arise early in life, grow slowly, and metastasize infrequently. CONCLUSION: Even when these tumors metastasize, patients seldom die as a result of the malignancy.     

胰腺实性假乳头状瘤的CT征象分析

Objective: The aim of our study was to demonstrate the CT features of solid pseudopapillary tumor of the pancreas (SPTP) so as to improve the imaging diagnostic abilities. Methods: The CT materials of 10 cases with surgery andpathology proved SPTP were retrospectively analyzed, including 8 females and 2 males, their age ranged from 12 to 54years (average being 27.2 years). All of the 10 cases underwent spiral CT scan and also with contrast enhancement before surgery. Results: All of the 10 cases were isolated mass. They were located at the head (n = 5), tail (n = 4), and body (n =1) of the pancreas. Their shapes were round (n = 3), oval (n = 4), and irregular (n = 3). The long-axis diameter ranged from 2.1-8.6 cm (mean 6.5 cm). All of neoplasms consisted of solid and cystic components. Mostly solid components in 5 cases,nearly the same proportion of solid and cystic part in 3 cases, and mostly cystic components in 2 cases. After dynamic contrast-enhanced, the solid parts of the lesion showed progressive enhancement and the cystic parts of the lesion showed no enhancement. Calcification was noted in 5 cases, such as the spot, line-like, small nodules or patchy calcification. Fluiddebris level and "floating cloud" sign were noted in one case. In one case of mostly cystic components, patchy area of high attenuation were shown on CT imaging which then was proved as old hemorrhage by pathologic evaluation. Seven cases were completely encapsulated and made more remarkable on post-contrast images. Three cases had incomplete capsules,and adhesion to the surrounding tissues could be seen during operation, including one case in which invasion to the adjacent adipose tissues near the inferior vena cava and walls of the duodenum could be seen under the microscope. Pancreatic duct broadening or hepatic duct dilatation was caused by tumor each in 1 case. All of the 10 cases had no enlargement of the intra-abdominal lymph nodes or distant organ metastasis. Conclusion: SPTP occurs mainly in young women and has comparatively characteristic CT imaging features: a large solid and cystic tumor of pancreas, sharp edges, the solid parts of the lesion showed progressive enhancement, a few with hemorrhage and calcification.     

Solid cystic tumor of the head of the pancreas in a young woman

This a case report of a solid papillary tumor of the pancreas in a young woman of 18 years, who was referred to after having suffered for a period of 8 months with a rather vague symptomatology, characterized by dyspepsia, fatigue and, towards the end of the 8 month period, weight loss (approximately 2 kg). In the last week, as a consequence of a modest abdominal trauma, the patient was submitted to abdominal CT that showed a burden at the head of the pancreas, demonstrating a round neoformation about 6 cm in diameter with solid echogenicity slightly hypodense. Subsequently, she underwent an operation with the diagnosis of pseudocystis of the pancreas. During surgery, a big cystic formation of the head of the pancreas, into which a drain was introduced, was revealed. The histological postoperative examination was compatible with pancreatic tumor with a low grade of malignancy, cystic papillary or solid papillary type. Therefore, the patient came under our observation and underwent an operation of pancreatoduodenectomy. Two years after the operation, the patient had completely recovered. In this case, we discussed the problem of performing certain preoperative diagnoses despite the aid of modern diagnostic imaging, this being a very rare illness that almost exclusively plagues young women (median age 19 years). This diagnosis has an uncertain histological origin and is generally accompanied by a modest and vague symptomatology. The surgical procedure, given the low grade of malignancy of the neoplasm and the excellent long-term prognosis, must be, with respect to the oncological radicality, as conservative as possible.