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Introduction: Ampullary adenocarcinoma is a rare neoplasm often treated by the complex Whipple's procedure. Several histological factors predict poor prognosis including pancreatobiliary morphology, presence of lymphovascular, perineural invasion and local or distant metastasis. Systemic therapy with gemcitabine, 5-fluorouracil regimens are given with variable benefits. Immunotherapy checkpoint inhibitors have shown beneficial anti-tumor effects in several carcinomas, the most remarkable being in non-small cell lung cancer. Administration of these novel drugs is based on immunohistochemical expression (which may or may not be indicative of response to therapy) along with meticulous decision making by the multidisciplinary team. Immunohistochemistry (IHC) is an effective means of immune marker demonstration and has been used in various tumor types for predictive and prognostic purposes. Methods: PD-L1 IHC (clone E1L3N) was applied in 101 cases of ampullary adenocarcinoma. Tumor infiltrating lymphocytes were also evaluated. The immunoreactivity was assessed and categorized into following staining thresholds: <1%, <5%, <10% and ≥10% for tumor cells (membranous and/or cytoplasmic staining pattern), and 5% and 10% cut-offs for immune cells. Results: We found that at a 10% cut-off, 73.3% (74/101) patients were men (P =.006) older than 50 years of age (P <.001) presenting with a tumor measuring <3 cm (P =.001). It was significantly associated with intestinal differentiation (P =.004) and grade 1 tumors (P =.001). Twelve patients presented with recurrence as well (P =.03). Conclusion: In the context of ampullary adenocarcinoma, this study highlights the positivity observed with the PD-L1 IHC clone E1L3N at different thresholds, with the particularly stronger associations being evident at a 10% cut-off. [ABSTRACT FROM AUTHOR]

Background Pancreaticopleural fistula (PPF) is a rare complication associated with pancreatitis, caused by disruption of the pancreatic duct, either directly or through rupture of a peripancreatic fluid collection, resulting in leakage of pancreatic juice into the pleural space. It commonly presents as massive, relapsing pleural effusions, often on the left side with high amylase content. Nonspecific chest symptoms often predominate, making it a diagnostic challenge. There is a lack of clarity regarding the management of this rare entity. Objectives This study aimed to review the typical presentations, pathophysiology, and current role of endoscopic therapy in patients with PPF. Materials and Methods A retrospective analysis of the results of endoscopic treatment of patients with symptomatic PPF due to pancreatitis was done. Results Ten patients with pancreatitis (6 males; mean age 33.6 ± 15.4 years: 6 chronic, 4 acute) with symptomatic PPF were analyzed. Endoscopic retrograde cholangiopancreatography was performed in all, with pancreatic sphincterotomy and stenting of the main pancreatic duct (passive transpapillary drainage). Technical and clinical success was achieved in 7/10(70%) and 10/10(100%) patients, respectively. Though the leak was bridged in three patients, pancreatic sphincterotomy and downstream stenting (when bridging was not possible) were successful in closing PPF. One (10%) patient needed surgery for gastric outlet obstruction. The mean duration of endotherapy was 12.1 ± 9.4 months and the time taken for leak closure was 15.3 ± 10.4 weeks. Long-term success of endoscopic treatment (median follow-up period of 48.9 ± 28.7 months) was achieved in all patients. Conclusions Endoscopic treatment (passive trans-papillary drainage) is a safe and effective procedure for managing postinflammatory PPFs, and should be attempted in cases of failure of medical treatment. [ABSTRACT FROM AUTHOR]

Background: Primary hyperparathyroidism (PHPT) is rarely associated with the occurrence of acute or chronic pancreatitis, requiring complex perioperative management. This study aimed to assess the prevalence and disease characteristics of pancreatitis in PHPT. Materials and Methods: This study is a clinicopathological analysis of the medical records of patients who were diagnosed with PHPT with pancreatitis between 1989 and 2021 in the Endocrine Surgery department, SGPGI, Lucknow. Results: Out of 548 PHPT cases, 44 (8.03%) were found to be associated with pancreatitis. The mean age was 33.57 years (15-65 years); 5 were =20 years, while 26 were =30 years of age. There were 27 males and 17 females. Twenty-one cases were of acute (11 acute, nine recurrent acute, one acute on chronic), whereas 23 were of chronic pancreatitis (six chronic calcific pancreatitis). The major clinical presentation of PHPT with pancreatitis was abdominal pain (65.91%). The mean number of attacks per patient in recurrent acute pancreatitis was two. Mean PTH levels were 68.19 pmol/L. The mean tumor size (in the largest dimension) was 2.79 ± 1.4 cm while the mean tumor weight was 4.91 g. Nephrolithiasis was associated with 25 cases. An association with multiple endocrine neoplasia type 1 syndrome was seen in one case. The final histopathological diagnosis was parathyroid carcinoma in two, hyperplasia in three, and parathyroid adenoma in 39 cases. Normocalcemia was seen in 27.2%, hypercalcemic crisis in 15.9%, and 25% of patients required semi-emergency parathyroidectomy. The outcome was favorable in all, as none had any further attacks of pancreatitis. Conclusion: In our study, the prevalence of pancreatitis in PHPT cases was 8.03%. The majority of patients were young. Normocalcemia was seen in 12 patients, so even if calcium levels are normal, PHPT should be suspected in young patients with pancreatitis. Parathyroidectomy resulted in the complete resolution of symptoms of pancreatitis in all 44 patients. [ABSTRACT FROM AUTHOR]