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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the period from 1978 to 1986, 106 patients were diagnosed with carcinoma of the pancreas; 30 of these patients were excluded from this study. Of the remaining 76 patients, 40 did not receive intraoperative radiotherapy (IORT) and were used as the nonrandomized control group for the 36 patients who did receive IORT after histologic confirmation of carcinoma of the pancreas. The records of 35 patients were available for review. The group receiving IORT ranged in ages from 43 to 89 years (20 males and 15 females). Seventeen patients had distant metastatic disease. The primary was located in the head of the pancreas in 32 and the body in three. No patient in this group had a curative resection. All patients were treated by a combination of biliary and gastric bypass prior to or concurrent with IORT. IORT was begun only after obtaining a histologic diagnosis and prior to the completion of any anastomosis. Necrotizing pancreatitis occurred in the treated group. There was no statistically significant difference in the survival of the nonrandomized control and treated groups.
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PMID:Intraoperative radiotherapy for patients with carcinoma of the pancreas. The Howard University Hospital experience, 1978-1986. 338 33

The sonographic appearance of histologically verified pancreatic metastases is reported in seven patients with advanced spread of tumor. All metastases appeared as homogeneous, solid, space-occupying lesions with a more hypoechoic internal structure than the pancreatic parenchyma. In five cases, multiple metastases were demonstrated; in two cases, there was a solitary metastasis in the head and tail of the pancreas. Pancreatic metastases are diagnosed infrequently because of the paucity of clinical symptoms and the small size of the foci. In six patients, the diameters of the metastases were 0.5-2.0 cm, and only three patients had organ-related clinical symptoms. The putative diagnosis of organ metastases must be made when multiple hypoechoic foci can be demonstrated in the pancreas in a patient with a malignant tumor. Pancreatic carcinoma, acute pancreatitis, and focal infiltrates in Hodgkin and non-Hodgkin lymphomas must be considered when diagnosing multiple pancreatic lesions.
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PMID:Pancreatic metastases: US evaluation. 352 91

An autopsy case of extremely rare mucoepidermoid carcinoma of the pancreas in a 58-year-old male was reported. The main tumor in the pancreatic tail associated with wide-spreading metastases, was histologically composed of squamous cancer cell nests intermingled with mucin-containing cells, but not true glandular structures except for metastatic foci in the liver. Electron microscopic findings of the main tumor revealed roughly three kinds of cancer cells, namely undifferentiated cells, squamous cells, and squamous cells with mucin-containing intracytoplasmic lumina, accompanied by variety of transitional forms. The mucin was similar to that of the intra-or interlobular duct epithelium of pancreas in mucin stains. Immunohistochemically, positive immune reaction of the cancer cells was observed by anti-keratin, -epithelial membrane antigen and -carcinoembryonic antigen sera. These findings suggested that the cancer cells originated from undifferentiated cells of pancreatic duct, which showed multipotency to differentiate predominantly into squamous cells, but also into mucin-producing cells.
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PMID:Electron microscopic study of mucoepidermoid carcinoma in the pancreas. 366 Nov 98

We present a series of eight cases of pleomorphic carcinoma of the pancreas, an uncommon lesion that contains bizarre giant cells and resembles sarcoma histologically. To our knowledge, this entity has not been described in the radiological literature. Clinical symptoms are similar to those of the usual pancreatic ductal cell carcinoma, but at presentation the primary tumor mass is usually large, and widespread metastatic disease is present. The most striking finding is massive lymphadenopathy, which may mimic lymphoma. A combination of clinical history, imaging findings, and results of percutaneous biopsy should lead to the proper diagnosis and may help to differentiate this entity from others that may affect lymph nodes.
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PMID:Pleomorphic carcinoma of the pancreas: computed-tomographic, sonographic, and pathologic findings. 388 Sep 2

Extent of the tumor in carcinoma of the pancreas seems an important factor in stage classification. The purpose of this report is to present the results of studies on the relationship between the size of the tumor (T) and prognosis, and the correlation between the size and the other factors influencing prognosis such as invasion to the pancreatic capsule, invasion to the retroperitoneal tissue, metastasis to the regional lymph node, and so on. T was divided into four groups: T1, T2, T3, T4. Tumor diameter of 2 cm or less was designated as T1, 2.1-4 cm as T2, 4.1-6 cm as T3, and 6.1 cm or more as T4. Case reports of 163 patients who underwent resection of carcinoma of the pancreatic head were submitted by 10 major institutions and retrospectively analyzed. There was significant differences in 1-year cumulative survival rates between T1 and T3, T1 and T4, and T1 and T2 + T3 + T4, but no significant difference in 3- or 5-year survival rates among the T groups. The incidence of no capsular invasion, no retroperitoneal invasion, and no lymph node metastasis had a tendency to decrease along with increase in tumor size and the incidence of definite capsular invasion, and lymph node metastases increase with increase in the size. Attempts to diagnose tumors of less than 2 cm should be made to ameliorate the poor surgical results. However, it should be stressed that even in the T1 group regional lymph node metastases were seen in about half of the cases.
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PMID:Size of the tumor and other factors influencing prognosis of carcinoma of the head of the pancreas. 400 74

We reviewed our personal experience with insulin-secreting carcinoma of the pancreas to determine the clinical course and the role of surgery in this disease. Seventeen patients with high-grade metastatic carcinoma were treated at our institution between 1957 and 1982. To this series we have added 45 cases of metastatic carcinoma reported in the literature. All patients had symptoms with manifestations of hypoglycemia. Patients with metastatic insulin-secreting carcinoma had an average age of 48.5 years, with male predominance. The average duration of symptoms at presentation was 2.0 years. The tumors were usually single and averaged 6.2 cm. All tumors had metastases, most commonly to the liver and/or lymph nodes. The median disease-free survival after curative resection was 5 years. The recurrence rate was 63%, with the median interval to recurrence 2.8 years, and the median survival with recurrent tumor was 19 months. Palliative resection was associated with a median survival of 4 years, and biopsy only, 11.0 months. Insulin-secreting carcinomas are slow-growing tumors with significant metastatic potential. Surgical resection of primary and metastatic tumors represents the treatment of choice when possible. Long-term follow-up is required.
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PMID:Metastatic insulin-secreting carcinoma of the pancreas: clinical course and the role of surgery. 609 77

Seventeen patients with histologically proven pancreatic cancers were studied in order to clarify the relationship of histologic types to plasma carcinoembryonic antigen (CEA) values. Two cases with marked elevation of plasma CEA values having 6100 ng/ml and 2500 ng/ml, respectively, disclosed histologically acinar cell carcinoma and mixed acinar and ductal cell carcinoma, respectively. Despite of massive hepatic metastases, the other 15 cases with ductal cell carcinoma, including 3 cases with cystadenocarcinoma, adenoacanthoma, and undifferentiated pancreatic cancer, respectively, showed normal or very modest elevation of plasma CEA values. No correlation was obtained between plasma CEA values and several biochemical tests. Two patients with marked elevation of plasma CEA value revealed strong staining in the cancerous areas of the pancreas by using a peroxidase-antiperoxidase staining technique. These findings suggest that acinar cell carcinoma of the pancreas may contribute to increase the circulating plasma CEA value.
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PMID:Plasma carcinoembryonic antigen and acinar cell carcinoma of the pancreas. 631 61

This essay is based on the injection and dissection of 100 cadaver specimens (fetuses, new borns and infants), the study of 34 case reports of pancreatic carcinoma, the injection of the lymphatic system in 14 living dogs and the reconstruction of the dorsal mesentery of an embryo of 30 mm according to Born's method. The results are as follows: the anatomy of the pancreas and of the lymphatic channels show that there are two distinct portions, one is right-sided and corresponds to the primitive ventral bud, the other is situated on the left and corresponds to the primitive dorsal bud. The primitive dorsal mesentery is formed by a double contingent: one right, for the right pancreas, this is the retroportal process (RPP). The other left, for the left pancreas. This is a formation which up until now, has never been described in the literature, the left lateral portal process (LLPP). While the anterior lymphatic drainage of the pancreas does not seem to hold any surprises, the posterior lymphatic drainage, arising from the posterior and anterior surfaces of the pancreas, is very particular. In the right side (anterior and posterior aspects), the drainage runs to the RPP, while in the left side (anterior and posterior aspects) it courses to the LLPP and here, in an exclusive manner. Only a few borderline regions, those situated precisely in the area of inosculation of the two buds, escape this systematisation. The terminal network of the pancreatic lymphatic channels have a short distance to bridge in order to reach the thoracic duct. The study of the distribution of lymph node metastases in carcinoma of the pancreas seems to confirm the anatomical results in the cadaver, but our series is too short to be of statistical value. Very early spread via the thoracic duct probably greatly reduces the value of supra-enlarged operations whose justification is precisely more complete lymph node removal. It might be useful, however, if proof could be provided that tumor reduction in the case of carcinoma of the pancreas is a necessary prelude to complementary therapeutic measures. The anatomy of the pancreas and of the lymphatic channels in mammals seems to confirm the results found in man, i.e. the division of the pancreas into a right and a left pancreas. The precise knowledge of the anatomy of the lymphatic ducts of the pancreas might be the starting point for progress in the experimental studies concerning the modifications of the lymphatic circulation during acute pancreatitis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Anatomoclinical and anatomosurgical essay on the lymphatic circulation of the pancreas. 639 76

Eighty-eight patients with localized unresectable carcinoma of the pancreas were treated at Thomas Jefferson University Hospital between 1974 and 1981. Four treatment regimens were used which were sequential modifications of the technique based on the experience in the preceding group of patients. Each treatment changed the course of the disease, and as patterns of failure were identified, the treatment was altered to deal with them. Initially, all patients were treated with external beam radiation. Subsequently, Iodine-125 implantation was added to improve local control; low-dose preoperative radiotherapy to reduce the risk of peritoneal seeding; and adjuvant chemotherapy to reduce the risks of distant metastases. The addition of 125I implantation increased the local control from 22% to 81%, but did not increase the median survival, which was unchanged from 7 months. The addition of adjuvant chemotherapy increased the median survival from 7 months to 14 months, but had no impact on the control of the pancreatic tumor. Adjunctive chemotherapy and low-dose preoperative radiotherapy appear synergistic in reducing the risk of peritoneal seeding. The combination of 125I implantation, external beam radiation, and adjunctive chemotherapy is safe and effective. This regimen produces excellent local control with acceptable morbidity. This regimen produced a 30% survival at 18 months. The patterns of failure among these patients suggest future modifications of the technique.
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PMID:Multimodality therapy of localized unresectable pancreatic adenocarcinoma. 647 33

Papillary-cystic carcinoma of the pancreas is an extremely rare tumor which occurs in young adults, may invade locally, but is late to metastasize. As opposed to adenocarcinoma of the pancreas, portal vein invasion should not be included as a criteria for nonresectability. In the absence of metastatic disease, pancreatectomy combined with portal vein resection, if invasion is present, may offer a good prognosis and comparatively long survival time.
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PMID:Papillary-cystic carcinoma of the pancreas. 682 24


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