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

Radiological diagnostic techniques for the evaluation of pancreatic duct cell adenocarcinoma and their findings are discussed. Pancreatic carcinoma may demonstrate one or more of these diagnostic signs: focal enlargement or deformity, density changes, obliteration and dilatation of the pancreatic and/or biliary duct, local invasion, and metastases. Ultrasonography is commonly used as a screening examination. The presence of pancreatic carcinoma may best be evaluated by dynamic computed tomography (CT) or dynamic magnetic resonance (MR) imaging with administration of intravenous contrast material. Both CT and MR imaging are used for the preoperative assessment of local invasion and vascular involvement. MR cholangiopancreatography (MRCP) allows noninvasive three-dimensional delineation of the pancreatic and biliary duct systems. Angiography may demonstrate vascular involvement questionable on noninvasive examinations. In the near future, the value and efficacy of MR imaging in the diagnosis of small pancreatic carcinoma need to be assessed in comparison with CT and endoscopic studies.
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PMID:Radiologic diagnosis of pancreatic carcinoma. 967 53

We report two cases of carcinoma of the pancreas with anomalous junction of the pancreaticobiliary tracts. A 71-year-old Japanese woman had obstructive jaundice. Ultrasonography showed a hypoechoic mass in the pancreatic head and computed tomography demonstrated a low-density nodule in the pancreatic head. Endoscopic retrograde cholangiopancreatography displayed a double duct sign and an anomalous junction of the pancreaticobiliary tracts. The patient underwent a pancreatoduodenectomy. The histopathologic diagnosis of the resected specimen was adenocarcinoma of the pancreatic head. A 56-year-old Japanese man also developed obstructive jaundice. Ultrasonography and computed tomography showed a huge mass almost replacing the whole pancreas and involving the superior mesenteric artery, splenic artery, splenic vein, and portal vein. Multiple hepatic metastases and peritoneal dissemination were present. Endoscopic retrograde cholangiopancreatography demonstrated an anomalous junction of the pancreaticobiliary tracts. The patient died of hemorrhage from esophageal varices. We discuss the relationship between the anomalous junction of the pancreaticobiliary tracts and pancreatic carcinoma.
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PMID:Carcinoma of the pancreas associated with anomalous junction of pancreaticobiliary tracts: report of two cases and review of the literature. 968 64

Ductal adenocarcinoma of the pancreas was the fourth leading cause of cancer related deaths in the United States in 1996. Pancreatic cancer is often considered a uniformly fatal disease due to its usually advanced stage at presentation. Only 5-25% of cases are resectable and surgery offers the only single modality hope of potential cure. In the past, even resectable tumors were considered incurable. Retrospective analyses of patterns of failure and prognostic variables following surgical resection, however, have resulted in randomized and non-randomized trials that have succeeded in doubling the median and long-term survival with the use of adjuvant postoperative chemoradiation. Subsequent analyzes of failure patterns following adjuvant treatment in patients with resected pancreas cancer have shown an improvement in local control, but the majority of patients continue to develop either liver and/or peritoneal metastases. To further improve survival in surgically resectable carcinoma of the pancreas, better systemic treatment and/or abdominal prophylaxis needs to be evaluated in controlled clinical trials.
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PMID:Adjuvant postoperative radiation therapy +/- 5-FU in resected carcinoma of the pancreas. 968 6

A 33 years old woman presented with cramp-like abdominal pain. Ultrasound examination revealed multiple lesions in the liver of hyper- and hypoechoic echogenicity which in accordance to subsequently performed computed tomography and dynamic hepatobiliary scintigraphy were considered to be a focal nodular hyperplasia (FNH). A severe increase of the serum lipase concentration, suspected to be an acute pancreatitis, was treated conservatively and led to a short improvement of symptoms. Some months later, a severe progression of the pain symptoms occurred, along with a measurable expansion of the abdominal circumference and palpable tumors of the liver. The dynamic hepatobiliary imaging and the static liver scan showed a decreased perfusion and function of the nodes as well as a reduced RES activity, respectively. A subsequently performed Positron Emission Tomography (PET) with F-18-Fluorodeoxyglucose (FDG) showed a massively increased glucose metabolism of the liver tumors. The histologic result of several biopsies of the tumors revealed metastases of an acinus cell carcinoma of the pancreas. Under systemic and local chemotherapy, a temporary remission could be obtained that was clearly detectable in a second FDG-PET. Nevertheless, during the further course of the disease, a progression occurred being detectable in an additional control PET-study by an increase in tumor size as well as in tumor glucose metabolism. The patient died in liver coma 15 months after the histologic diagnosis was obtained.
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PMID:[Long-term follow-up and therapeutic control of a hepatic metastatic acinar cell carcinoma of the pancreas using FDG PET]. 972 47

A 5-year review of 50 patients, 28 males, 22 females, with a mean age of 42 years, operated for obstructive jaundice at Ile-Ife, Nigeria was undertaken. Neoplasms of the pancreas, liver, and bile duct were the common causes. Percutaneous Transhepatic Cholangiography (PTC) with hypotonic duodenography was excellent in determining the underlying lesions. Pancreatic carcinoma accounted for 28% of cases, cholelithiasis 24%, hepatoma 22%, metastatic cancer 14%, bile duct carcinoma 10%, and traumatic pancreatic pseudocyst 2%. The patients with malignancies were older than those with biliary calculi. Biochemically, elevated alkaline phosphatase, and conjugated hyperbilirubinaemia, particularly in malignant obstructions, were diagnostic. Benigh bile ductal obstructions were surgically managed without any mortality. Malignant obstructions were surgically managed without any mortality. Malignant obstructions with their advanced presentations were less successfully managed. Biopsy alone or palliative bypass procedure could only be offered and the survival rate was dismal.
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PMID:Diagnosis, management and prognosis of obstructive jaundice in Ile-Ife, Nigeria. 992 Oct 92

Pancreatic carcinoma has a dismal prognosis. In the last years, great efforts have been made to improve diagnosis and preoperative staging of potentially curable carcinomas. Actually, the diagnosis of fairly small tumours is possible. Chemoradiation therapy protocols prior to pancreatectomy, aiming to improve survival, are currently being held. This therapy allows radiation to be distributed into well oxygenated cells before surgical devascularization. This procedure can be done with acceptable morbidity and mortality rates. In selected cases of irresectable carcinoma, surgical palliation allows a better quality of life. Pancreatoduodenal resection, along with other traditional oncological therapies, will continue to be the therapy of choice for patients with carcinoma of the head of the pancreas, without local or regional metastases. However, an intensive search for new therapeutic strategies, specially in the field of molecular biology, is being carried out.
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PMID:[Advances in the diagnosis and treatment of pancreatic carcinoma]. 1051 85

Splenic metastases are found with a frequency varying from 2.4 to 7.1%. The primary tumours most often followed by metastases are breast, lung, pancreas and melanoma. They may also be the direct extension of retroperitoneal tumours and carcinoma of the pancreas. The authors report a case which came to their attention; by examining the literature, they discover the rarity of this pathology which confirms the possibility of this localisation for both intra-abdominal and extra-abdominal tumours.
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PMID:[Splenic metastases]. 1038 May 28

Intraoperative radiotherapy (IORT) involves the administration of therapeutic radiation to malignancies during surgical procedures. IORT permits high dose delivery to tumors with the simultaneous reduction of radiation exposure to normal tissues, which may be directly shielded or operatively mobilized from the treatment volume. IORT has been investigated in various intra-abdominal malignancies, including carcinoma of the pancreas. Techniques of IORT were initially developed in Japan during the 1970's. Reports of therapeutic benefit in some patients with unresectable pancreatic cancer encouraged further examinations by various institutions in the United States. Experiences at the Massachusetts General Hospital in the early 1980's suggested that IORT enhanced survival in selected patients with locally advanced but non-metastatic disease. However, subsequent investigations studies by a variety of institutions, including the Mayo Clinic, failed to establish any conclusive evidence that IORT significantly prolonged the survival enhancement of unresectable pancreatic cancer patients. A prospective multi-institutional study carried out by the Radiation Therapy Oncology Group (RTOG) showed an 8-month median survival, similar to conventional therapy and indicating that IORT failed to prolong survival. However, the RTOG did show that IORT rapidly and consistently palliated the severe viseral pain which often accompanied pancreatic cancer. By 1990, some institutions had explored IORT as an adjunct to pancreatectomy, in patients with resectable tumors. Studies typically involved highly selected uncontrolled patients but did suggest that IORT could enhance local disease control and, in some cases, overall survival, when performed in conjunction with pancreatic resection. IORT appeared to be most conspicuously beneficial when used with extended radical resections. A small prospectively randomized trial conducted at the National Cancer Institute showed significant improvement in local disease control in patients receiving IORT compared with patients receiving conventional external beam postoperative radiotherapy after resection. Current evidence suggests that IORT may have an important palliative role in patients with unresectable pancreatic cancers, ameliorating visceral pain and promoting local control of the primary tumor; however, IORT appears to have no significant effect on overall survival. For patients with resectable disease, especially patients with locally extensive tumor, IORT appears to have benefit in enhancing disease control and in some cases survival. It is reasonable to further explore the potential role of IORT in pancreatic cancer, especially as a component of multimodal therapy, since IORT's demonstrated enhancement of local control could be an important factor in eventual disease control.
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PMID:Studies of intraoperative radiotherapy in carcinoma of the pancreas. 1043 28

We report an autopsy case of mixed ductal-endocrine carcinoma of the pancreas presenting as gastrinoma with Zollinger-Ellison syndrome. A 38-year-old Japanese male was found to have Zollinger-Ellison syndrome and pancreatic gastrinoma, and gastrectomy and resection of the pancreatic tumor were performed. However, hypergastrinemia persisted, and the patient died of disseminated carcinomatosis at 62 years of age, 24 years after the onset of Zollinger-Ellison syndrome. At autopsy, the main tumor was present in the residual pancreas, and metastases were noted in many organs. In the pancreas and other organs, ductal and endocrine carcinoma areas were mixed and there was a gradual transition between the two. No acinar differentiation was noted. The ductal elements were positive for mucins and carcinoembryonic antigen but negative for neuroendocrine markers, while endocrine elements were positive for chromogranin A and synaptophysin and to a lesser extent for gastrin, but negative for mucins and carcinoembryonic antigen. The ductal elements comprised about 30% of the tumor cells, and endocrine elements 70%. According to the revised World Health Organization classification, our case was diagnosed as mixed ductal-endocrine carcinoma. Our case is rare because the tumor manifested as gastrinoma with Zollinger-Ellison syndrome and the patient survived for 24 years. To the best of our knowledge, no such case has been reported. Our case suggests that pancreatic endocrine tumors may evolve into mixed ductal-endocrine carcinomas.
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PMID:Mixed ductal-endocrine carcinoma of the pancreas presenting as gastrinoma with Zollinger-Ellison syndrome: an autopsy case with a 24-year survival period. 1062 3

Useful nonsurgical treatments like chemoradiotherapy have been developed for the management of patients with unresectable pancreatic cancer. The General Rules for the Study of Pancreatic Cancer (Japan Pancreas Society) should therefore take diagnostic imaging techniques into account in order to deal with nonsurgical cases under the classification system as well as with surgical ones. The anatomic extent of disease based on preoperative dynamic CT images was evaluated in comparison with the results of pathology in a total of 35 patients with pancreatic cancer. The CT findings accurately represented the pathology for peripancreatic invasion, including vascular involvement, with a diagnostic accuracy ranging from 72% to 88%. However, it failed to detect almost half of lymphatic metastases. The staging of pancreatic cancer with dynamic CT was accurate in 66% of the patients, was underestimated in 25%, and was rarely overestimated. The detection of minute metastases is a crucial problem in the CT staging of tumors. The significant correlation of the RP factor (retroperitoneal tumor invasion) with lymphatic metastases as noted in this study offers a clue to solving this problem.
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PMID:[The general rules for the study of pancreatic cancer from the viewpoint of internal medicine]. 1073 42


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