Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0030305 (pancreatitis)
 16,014 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 68-year-old woman with papillary adenoma of the pancreas with excessive mucin secretion is reported. The patient was initially diagnosed as having chronic pancreatitis because of a history of repeated attacks of pancreatitis and localized dilatation of the main pancreatic duct. Four years later, endoscopic retrograde pancreatography showed markedly diffuse dilatation of the entire main pancreatic duct with amorphous filling defects of mucin. Excretion of mucin was observed through the enlarged orifice of Vater's ampulla. The patient was treated with distal pancreatectomy, and papillary adenoma with abundant mucin in the cytoplasm was histologically demonstrated. We describe unique clinical features of "mucin-producing pancreatic tumor" and discuss an important role of endoscopic retrograde pancreatography in the diagnosis.
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PMID:Papillary adenoma of the pancreas with excessive mucin secretion. 155 39

Intraductal mucin-hypersecreting neoplasms of the pancreas with extreme dilatation of the main duct were studied in eight patients. They included five men and three women, aged 47-85 years. Five patients had a history of symptoms mimicking pancreatitis; four developed steatorrhea and/or diabetes. At endoscopic retrograde pancreatography, five patients showed an open ampulla filled with mucin, and six patients showed patchy filling defects in the ectatic main duct. Morphological examination showed extreme dilatation of the entire pancreatic duct in six patients and its tail segment in two patients. The duct segments filled with viscous mucin were lined by well-differentiated mucin-secreting cells, forming papillary foldings and occasionally showing cellular atypia. None of the patients had invasive tumor or metastasis. Six patients whose lesions were resected are alive and doing well (mean follow-up, 5.5 years). It is concluded that intraductal mucin-hypersecreting neoplasm is a pancreatic tumor with favorable prognosis. Because it shares many features with intraductal papillary neoplasm, a common pathogenesis of these pancreatic tumors is suggested.
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PMID:Intraductal mucin-hypersecreting neoplasms of the pancreas. A clinicopathologic study of eight patients. 153 10

We report our experience with nine patients with "mucin-producing tumor of the pancreas," in which abundant mucin secreted by the tumor cells played a major role in the characteristic alterations of the pancreatic duct system. Four of nine patients presented with pancreatitis. Ultrasound and computed tomography demonstrated a well-defined cystic mass and dilated main pancreatic duct. Endoscopic retrograde pancreatography showed ductectatic character, i.e., diffuse dilatation of main duct and/or cystic dilatation of the branch ducts with filling defects of mucin. Ultrasound proved to be a good screening test. However, the diagnosis was confirmed on endoscopic retrograde pancreatography. Nine of our cases had no peripancreatic invasion or metastasis, resulting in a good prognosis after pancreatectomy. Mucin-producing tumor of the pancreas is a unique clinical entity that should be distinguished from "common" pancreatic carcinomas, and a favorable prognosis can be expected after surgical operation.
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PMID:Mucin-producing tumor of the pancreas: a unique clinical entity. 165 83

Black and brown pigment gallstones are morphologically, compositionally, and clinically distinct. Black stones form primarily in the gallbladder in sterile bile and are associated with advanced age, chronic hemolysis, alcoholism, cirrhosis, pancreatitis, and total parenteral nutrition. Brown stones form not only within the gallbladder but also within the intrahepatic and extrahepatic ducts; they are uniformly infected with enteric bacteria and are usually associated with ascending cholangitis. Brown stones are related to juxtapapillary duodenal diverticula and are the predominant type of de novo common bile duct stones. Cholecystectomy is usually curative in black pigment stone disease, whereas stones often recur after cholecystectomy for brown stone disease. The pathogenesis of black stones is probably related to nonbacterial, nonenzymatic hydrolysis of bilirubin conjugates. At the pH of bile, this results in two monohydrogenated bilirubin anions that precipitate with calcium ions. Bilirubin monoconjugates that are increased in several conditions, such as Gilbert's syndrome and chronic hemolysis, may play a pivotal role in black stone formation as a source of unconjugated monohydrogenated bilirubin and as a possible co-precipitant with calcium. The precipitation of calcium carbonate and phosphate is influenced by local gallbladder factors. Brown pigment stones are formed in bile infected with enteric bacteria that elaborate hydrolytic enzymes: beta-glucuronidase, phospholipase A, and conjugated bile acid hydrolase. The resulting anions of bilirubin and fatty acids form insoluble calcium salts. We used nb/nb mice with a chronic hemolytic anemia as a model of hemolysis-induced black stone disease. The presence of 40% bilirubin monoconjugates in mouse gallstones indicated the importance of this moiety in the pathogenesis of black stones. Other data obtained by marrow transplantation experiments in mice revealed the relative importance of genotype versus the hemolytic anemia on determinants such as biliary bile acid composition and mucin secretory glands in the mouse gallbladder neck. Additional physical chemical studies of the interaction of unconjugated bilirubin in model bile solutions will be helpful in further delineating the pathogenesis of both black and brown pigment gallstones.
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PMID:Pigment gallstone disease. 202 17

In a retrospective study pancreatic juice samples (n = 213) and corresponding serum samples (n = 110) were assayed for their concentration of monoclonal antibody defined CA 19-9/GICA (gastrointestinal cancer associated antigen). Serum CA 19-9 values were found to be good diagnostic and discriminating markers for pancreatic disorders and were raised (greater than 50 u/ml) in more than 80% of the pancreatic cancer patients compared to 8.5% of the pancreatitis group and none of the control group. In contrast pancreatic juice CA 19-9 values showed a considerable overlap between groups. On the basis of recent molecular data on the monoclonal antibody 19-9 defined antigen(s)--that is, monosialoganglioside, mucin--it is proposed that the discrepancies between serum and pancreatic juice findings are due to a specific undirected endocrine release of the mucin into sera in pancreatic tumour patients while in pancreatic juices of all diagnostic groups high CA 19-9 activities are either owing to coexistence of glycolipid and mucin or that the latter is a physiologically exocrine product.
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PMID:Monoclonal antibody defines CA 19-9 in pancreatic juices and sera. 385 6

This pharmacokinetic study was performed to assess the potential usefulness of the murine monoclonal antibody (MoAb) PAM4-IgG1 as an immunotargeting agent for pancreatic cancer imaging or therapy. This MoAb reacts specifically with mucin purified from human pancreatic cancer. 131I-labeled PAM4-IgG1 was injected i.v. into five patients with suspected pancreatic cancer. Whole-body scans and spot views of the abdominal area were recorded with a computerized gamma camera, and specific regions of interest were drawn over the liver and spleen to define the kinetics of activity in these organs. Blood samples taken from 0.1-144 h after injection served to define the kinetics of plasma distribution and removal of activity from the body. Surgery confirmed pancreatic cancer in four of the five patients, whereas chronic pancreatitis was present in the fifth patient; in all four pancreatic cancer patients, immunostaining with the MoAb PAM4 demonstrated the presence of the specific antigen, with a cytoplasmic and endoluminal/secretory pattern of distribution. Nonspecific radioactivity accumulation in the liver, spleen, and bone marrow was low, linked essentially to the blood pool effect of circulating activity in these organs. The overall quality of scintigraphic maps recorded over the abdomen was quite satisfactory due to the low liver and spleen activity, with good scintigraphic demonstration of the pancreatic cancers (either primary or metastatic); the patient subsequently found to have pancreatitis failed to show PAM4 targeting. Except in one patient with widespread peritoneal metastases (in whom these tumor implants were detected scintigraphically already 24-48 hours after tracer injection), scintigraphic evidence of the tumor lesions was usually late, starting at about 72-96 h after tracer injection. The results obtained in this preliminary study indicate the potential usefulness of MoAb PAM4 for immunoscintigraphy in patients with either primary and/or recurrent pancreatic cancer while also suggesting that the use of the faster-clearing Fab fragments of this MoAb probably would result in improved immunoscintigraphic properties.
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PMID:Initial tumor targeting, biodistribution, and pharmacokinetic evaluation of the monoclonal antibody PAM4 in patients with pancreatic cancer. 749 69

A monoclonal antibody (MAb), PAM4, having reactivity with pancreatic carcinoma has been developed. PAM4 is an IgG1 immunoglobulin produced by immunization of mice with mucin purified from the xenografted RIP1 human pancreatic carcinoma. An immunohistochemical study of normal adult tissues showed the PAM4 reactive epitope to be restricted to the gastrointestinal tract and absent from normal pancreas. In neoplastic tissue, PAM4 was reactive with 85% of the pancreatic carcinomas, approximately half of the colon cancers and none of the breast, ovarian, prostate, renal and liver cancers. PAM4 was, in general, non-reactive with pancreatitis specimens whereas CA19.9 and DUPAN2 were strongly reactive with each one. Treatment of the mucin antigen by heating, reduction of disulfide bonds, or protease digestion abolished immunoreactivity with PAM4. Treatment of the mucin by neuraminidase or periodate oxidation reduced immunoreactivity but did not completely abolish it. Our data are consistent with the proposal that the PAM4 epitope is a conformationally dependent peptide epitope and that certain carbohydrate structures are necessary in order to maintain the correct peptide conformation. The high specificity and intense reactivity of PAM4 with pancreatic carcinoma tissue suggests that the antibody may prove useful for in vitro diagnostic assays as well as in vivo targeting of diagnostic and therapeutic agents.
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PMID:Characterization of monoclonal antibody PAM4 reactive with a pancreatic cancer mucin. 751 37

Mucinous pancreatic neoplasms present diagnostic and therapeutic challenges. These tumors behave in an indolent nature, with frequent overlap of symptoms and radiographic appearance with other forms of pancreatic cysts, pseudocysts, and malignancy. Some authors propose that all mucin-producing tumors of the pancreas are variants of the same basic entity and have subclassified them on the basis of their predominant location within the pancreas. These disorders must be considered in the evaluation of chronic abdominal pain, particularly in the presence of a cystic pancreatic lesion or when associated with idiopathic chronic or acute recurrent pancreatitis. The clinicopathologic features of IMHN overlap to a great extent with classic mucinous cystic neoplasms but are different significantly enough to be distinct clinical entities. These tumors originate from the pancreatic duct epithelium, produce mucin, demonstrate a papillary growth pattern, and are considered premalignant or frankly malignant at the time of diagnosis. Both lesions biologically are much less aggressive than that of pancreatic ductal adenocarcinoma and appear to infiltrate peripancreatic tissue and to metastasize to lymph nodes or other adjacent structures late in the course of disease. Nevertheless, IMHNs are located primarily in the head of the pancreas, commonly affect elderly men, and present clinically with obstructive pancreatitis, often leading to pancreatic insufficiency, whereas mucinous cystic neoplasms are more likely to develop in the pancreatic body or tail, predominate in young women, and present with symptoms referable to tumor compression of adjacent structures. The location of the lesion is the primary differentiating feature because the lining epithelium of the two tumor types is indistinguishable pathologically. In mucinous cystic tumors, the mucus is secreted and retained within the cyst lumen because of the absence of communication between the cyst and the main pancreatic duct. In contrast, mucus produced in MDE flows into the main pancreatic duct, resulting in obstructive pancreatitis and, ultimately, dilatation of the pancreatic duct. Intraductal mucus provides an important clue to the diagnosis of intraductal pancreatic neoplasms and, whenever present, should prompt an aggressive diagnostic evaluation. Both lesions are managed by resectional surgery because the opportunity for cure is high in the absence of metastatic disease.
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PMID:Mucin-secreting tumors of the pancreas. 772 46

We review the pathogenesis of cholesterol gallstones, which occur in five steps: 1) metabolic; 2) chemical; 3) nucleation, 4) growing and maturation of gallstones; 5) clinical. It is emphasized that in the third step it could occur an arenous precipitate formed by cholesterol crystals, calcium bilirrubinate granules, calcium phosphate, or fatty acids anions and calcium, and mucin, called "biliary sludge", which has been associated with cholecystitis and pancreatitis. We describe the gallbladder motor abnormalities that occur during the lithogenesis and the diagnostic approach through scintigraphy and real time ultrasound. We review the pancreatobiliary dyskinesia, a condition associated with the postcholecystectomy syndrome. This later condition can result from anatomic stenosis or dyskinetic dysfunction of the sphincter of Oddi. Likewise, it is pointed out that at the present time, the manometric evaluation of the sphincter of Oddi is the gold standard in the diagnostic approach of this condition.
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PMID:[Laboratory studies and special tests for assessing gallbladder and bile duct function]. 774 24

The expression of cripto gene product was examined immunohistochemically in 45 surgically resected pancreatic tumors, including 32 invasive ductal carcinomas, 4 intraductal papillary adenocarcinomas, 4 intraductal papillary adenomas, 2 mucinous cystadenomas, 2 islet cell tumors, and one solid and cystic tumor, and compared with that in 32 areas of accompanying chronic pancreatitis present in the cases of invasive ductal carcinomas and 5 non-tumorous areas of pancreas without pancreatitis. All pancreatic ductal tumors including adenomas and carcinomas showed positive staining with no difference in terms of staining intensity among intraductal tumors and invasive carcinomas with or without mucin hypersecretion. Islet cell tumors were positively stained but the solid and cystic tumor was negative. Duct epithelial cells and acinar cells were negative but islet cells were positive in the pancreas tissues without pancreatitis. Cells arranged in duct-like structures in areas of accompanying chronic pancreatitis were positively stained. The results suggest that cripto expression might be associated with a growth advantage of tumor cells and also with differentiation to form duct-like structures.
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PMID:Expression of cripto in human pancreatic tumors. 814 92


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