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Background: Pancreatic neuroendocrine tumors (pNETs) represent a rare subset of pancreatic cancer. Functional tumors cause hormonal changes and clinical syndromes, while non-functional ones are often diagnosed late. Surgical management needs multidisciplinary planning, involving enucleation, distal pancreatectomy with or without spleen preservation, central pancreatectomy, pancreaticoduodenectomy or total pancreatectomy. Minimally invasive approaches have increased in the last decade compared to the open technique. The aim of this study was to analyze the current diagnostic and surgical trends for pNETs, to identify better interventions and their outcomes. Methods: The study adhered to the PRISMA guidelines, conducting a systematic review of the literature from May 2008 to March 2022 across multiple databases. Several combinations of keywords were used ("NET", "pancreatic", "surgery", "laparoscopic", "minimally invasive", "robotic", "enucleation", "parenchyma sparing") and relevant article references were manually checked. The manuscript quality was evaluated. Results: The study screened 3867 manuscripts and twelve studies were selected, primarily from Italy, the United States, and China. A total of 7767 surgically treated patients were collected from 160 included centers. The mean age was 56.3 y.o. Enucleation (EN) and distal pancreatectomy (DP) were the most commonly performed surgeries and represented 43.4% and 38.6% of the total interventions, respectively. Pancreatic fistulae, postoperative bleeding, re-operation, and follow-up were recorded and analyzed. Conclusions: Enucleation shows better postoperative outcomes and lower mortality rates compared to pancreaticoduodenectomy (PD) or distal pancreatectomy (DP), despite the similar risks of postoperative pancreatic fistulae (POPF). DP is preferred over enucleation for the pancreas body–tail, while laparoscopic enucleation is better for head pNETs. [ABSTRACT FROM AUTHOR]

Introduction Sarcomatoid variant of urothelial carcinoma infiltrates the perimeter and occurs occasionally. However, there are only few case reports. Case presentation A left renal tumor was incidentally detected in a 75‐year‐old woman and protruded outside the kidney, infiltrating the pancreatic tail and spleen. Tumor invasion was observed in the adjacent organs; therefore, the left kidney, pancreatic tail, spleen, and, descending colon were resected. Histopathological examination revealed a sarcomatoid variant of invasive urothelial carcinoma. She received two cycles of gemcitabine and carboplatin combination chemotherapy but succumbed to the disease after 5 months. Conclusion Sarcomatoid variant of urothelial carcinoma is rare, with aggressive malignancy. The diagnosis was difficult and required surgery. This is the first case of a sarcomatoid variant of urothelial carcinoma with direct invasion into the pancreas and descending colon.

Simple Summary: Based on the World Health Organization's global survey, conducted over the past five years, cancer is the second leading cause of death. According to its database, breast cancer is the third, melanoma malignum is fifth and pancreatic tumors rank as the twentieth. Undoubtedly, the early diagnosis and monitoring of these tumors and related research is important for both healthcare systems and societies, worldwide. In the present study, we compared the deconvoluted components of these blood plasma differential scanning calorimetry curves in patients with solid tumors. Our measurements showed individual, yet disease-specific, curves obtained from DSC measurements of patients' blood plasma, which were associated with disease severity, progression, or response to treatment. Further research is necessary to elucidate these results in order to raise the possibility of an early diagnosis of a potential tumor or for testing the efficacy of the therapy from a drop of blood. According to the World Health Organization's 2018 Global Cancer Survey, cancer is the second leading cause of death. From this survey, the third most common is breast cancer, the fifth is melanoma malignum and pancreatic adenocarcinoma ranks twentieth. Undoubtedly, the early diagnosis and monitoring of these tumors and related research is important for aspects of patient care. The aim of our present review was to explain an impressive methodology that is deemed suitable in reference to studying blood sample deviations in the case of solid tumors. Essentially, we compared the heat denaturation responses of blood plasma components through differential scanning calorimetry (DSC). In the control, between five and seven separable components can be detected, in which the primary component was albumin, while in the case of tumorous patients, the peaks of immunoglobulins were dominant. Moreover, the shape of the plasma DSC curves changed with a shift in the higher temperature ranges; thus, their pattern can be used as a suitable marker of direct immunological responses. The further development of the analysis of DSC curves raises the possibility of the early diagnosis of a potential tumor, the monitoring of diseases, or testing the efficacy of the therapy from a single drop of blood. [ABSTRACT FROM AUTHOR]

Purpose: Pancreas tumors are extremely rare in pediatric and adolescent patients. Surgical resection is the mainstay of treatment; however, the data are limited with respect to morbidity and mortality. We aimed to evaluate short- and long-term outcomes of pediatric and adolescent patients who underwent surgical resection of pancreatic tumors. Methods: Patients ≤ 18-year-olds who underwent resection of pancreas tumor at the National Institute of Neoplastic Diseases INEN during 2000–2020 were included. Results: Thirty-four patients were diagnosed; 28 patients were female and 6 were male. The median age was 13.4-years-old. Histological diagnosis was solid pseudopapillary neoplasm (SPN) (n = 29, 85.3%), pancreatoblastoma (n = 3), neuroendocrine carcinoma (n = 1), and insulinoma (n = 1). No patient experienced postoperative mortality and 15 (44.1%) patients developed postoperative complications including pancreatic fistula as the most frequent. Under a median follow-up period of 33.8 (0.5–138) months, four (11.8%) patients died. Of the 29 patients with SPN, the 3- and-5-year OS rates were 100% and 83.1%, respectively. Conclusions: SPN was the most frequent cause of surgical treatment for pediatric and adolescent patients in the high-volume cancer center in Peru and was associated with favorable survival. Pancreaticoduodenectomy was safely performed in this patient group with acceptable morbidity and zero mortality. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound (EUS) is a very sensitive examination to detect pancreatic masses and can provide useful information in cases where conventional radiologic workup remains inconclusive. We present three cases in which EUS was decisive in establishing the correct diagnosis. Case 1: A 74-year-old female was hospitalized because of acute pancreatitis. Medical history, CT and MRI gave no clue to etiology, but EUS diagnosed a small pancreatic tumor. Case 2: A female patient was admitted because of abdominal pain and weight loss. While MRI suspected a pancreatic tumor, EUS showed typical features of autoimmune pancreatitis. Case 3: A 50-year-old patient was hospitalized with cachexia, ascites and pulmonary embolism. At first, a pancreatic tumor was suspected, but EUS showed a cystic lesion with a solid component (pancreatic pseudocyst). [ABSTRACT FROM AUTHOR]

Background and Objective: Well-differentiated pancreatic neuroendocrine tumors (pNETs) are a group of rare, heterogeneous tumors that originate in the endocrine tissue of the pancreas and account for 1-2% of all pancreatic neoplasms. The majority of pNETs are non-functional and typically follow a more indolent course. Especially at early stages, the primary management of pNETs is surgical resection which is associated with relatively low rates of recurrence and excellent long-term prognosis. On the other hand, some patients will present with locally advanced primary tumors or low volume metastatic disease in which complete surgical resection may be more difficult to achieve and recurrence rates are significant. Unlike treatment of borderline resectable (BR) pancreatic adenocarcinoma, in which neoadjuvant treatment strategies are becoming standardized, borderline resectability is not a currently established terminology for pNETs and the optimal multidisciplinary treatment approach is poorly understood., Methods: We performed a literature search on PubMed, Google Scholar, and ClinicalTrials.gov using keywords, including 'pancreatic neuroendocrine tumor' and 'borderline resectable'. All studies and review articles in English with full text were considered. Each publication was independently reviewed., Key Content and Findings: We introduce the concept of BR-pNETs, focusing on important criteria that should be included in their definition by balancing the feasibility of resection and the clinical utility of surgery. We suggest that extended resection, involving vascular reconstruction, adjacent organ resection, and/or liver metastasis, should be considered at experienced, high volume centers. Furthermore, we outline multidisciplinary treatment strategies, including systemic and locoregional treatment options, for optimizing outcomes for this growing patient population., Conclusions: Formalizing the definition of resectability in pNETs through multidisciplinary collaborative research will be important for standardizing the indications for multimodality treatment and aggressive surgical approaches for patients.

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Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The TNM classification (Tumor-Node-Metastasis) is the most important coding scheme used to stage tumors based on size and location. Its coding rules may change across different TNM versions, such that the same tumor is represented by different codes in different versions. We present an ontology-based modular architecture for the management of TNM, using the coding rules for pancreas tumors in the considerably different TNM versions 7 and 8 in order to demonstrate how mappings (in the sense of re-classification) between TNM versions can be supported. To enable re-classification of tumor instances between TNM versions, mapping ontologies were created. This work describes two version mapping approaches, one using SWRL rules and the other intermediate classes representing the mapping criteria between the TNM versions. We show that tumor instances with defined characteristics were correctly classified in different TNM versions. In addition, ontological inconsistencies in classification systems based on informal text labels and possible conversion problems due to different categorization criteria in different TNM versions are demonstrated. [ABSTRACT FROM AUTHOR]

Objective To analyze the clinicopathologic characteristics of pancreatic cancer patients and explore the relationship between preoperative blood glucose level and prognosis of pancreatic cancer. Methods The clinical data of 267 patients treated in The First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to September 2016 were collected and retrospectively analyzed. We also studied the correlation between preoperative blood glucose level and clinicopathologic characteristics of pancreatic cancer. Results For the study we selected 110 patients (68 males and 42 females) aged between 41 and 84 years with the mean age of (61.34± 10.33) years. Among them, 74 (67.27%) of them had preoperative blood glucose level (>6.1mmol/L) higher than normal level. In addition, 57 patients (51.81%) and 33 patients (30.0%) had CEA level and CA125 level significantly higher than normal and 83 patients (75.45%) had higher CA199 level. There were 56 patients (50.91%) with tumor size over 3 cm and 73 (66.36%) with the tumor located in the head of pancreas. There were 92.73% of patients diagnosed with adenocarcinoma, 2.73% with squamous carcinoma, 2.73% with adenosquamous carcinoma and 1.81% with mucinous cystadenocarcinoma. As for pathological grading, there were 6 cases diagnosed with highly differentiated tumors, 65 cases moderate, 12 moderate to low differentiated, and 27 lowly differentiated tumors. For clinical stage, 2, 13, 27, 20, 15 and 33 patients were detected in stage IA, IIIB, IIA, IIB, III and IV, respectively. In addition, there were 19 patients detected with lymph node metastases, 22 with distal metastases and 22 with neural invasion. All the 110 patients were followed up effectively, with the average follow-up duration of (4.6±3.8) months. Until the last time we followed up all the patients, we found the tumor relapsed in 14 patients. The median survival time of patients with normal blood glucose was 10 months, while it was only 4 months in patients with high blood glucose. Preoperative blood glucose level was closely related with the patients' prognosis and tumor size, TNM stage, distal metastasis, lymph node metastasis, and neural invasion. Conclusion High blood glucose level is one of the risk factors for the poor prognosis of pancreatic cancer. [ABSTRACT FROM AUTHOR]

Pancreatic adenocarcinoma is important in oncology because of its high mortality rate. Deaths may be avoided if an early diagnosis could be achieved. Several types of tumors overexpress gastrin-releasing peptide receptors (GRPr), including pancreatic cancer cells. Thus, a radiolabeled peptide derivative of gastrin-releasing peptide (GRP) may be useful as a specific imaging probe. The purpose of the present study was to evaluate the feasibility of using99mTc-HYNIC-βAla-Bombesin(7-14)as an imaging probe for Capan-1 pancreatic adenocarcinoma. Xenographic pancreatic tumor was developed in nude mice and characterized by histopathological analysis. Biodistribution studies and scintigraphic images were carried out in tumor-bearing nude mice. The two methods showed higher uptake by pancreatic tumor when compared to muscle (used as control), and the tumor-to-muscle ratio indicated that99mTc-HYNIC-βAla-Bombesin(7-14)uptake was four-fold higher in tumor cells than in other tissues. Scintigraphic images also showed a clear signal at the tumor site. The present data indicate that99mTc-HYNIC-βAla-Bombesin(7-14)may be useful for the detection of pancreatic adenocarcinoma.

Objective To summarize the methods of diagnosing and treating solid-pseudopapillary neoplasm of pancreas SPN so as to provide reference for its early clinical diagnosis. Methods We collected the clinical data of 62 patients with pathologically confirmed diagnosis of SPN treated in the First Affiliated Hospital of Xi'an Jiaotong University between Feb. 2004 and Sep. 2014. Then we retroactively analyzed and summarized the clinical characteristics, diagnosis and treatment of the disease. Results Among the 62 patients, 55 were female and 7 were male; the mean age was (31.58±12.67) years old. The clinical features showed no specificity and the tumor was mostly detected upon physical check-up. The tumor was seen to be located mostly in the body and tail of the pancreas, and the average maximum diameter was (7.81±3.54)cm. We did not find obvious abnormality in routine pre-operative blood test results or liver and kidney functions. The imageological examination indicated tumor occupation in the pancreas. All the patients underwent surgical resection with no complications or death and had a good recovery after operation. Pathological diagnosis after operation was SPN without metastasis in lymph modes. Until the last time we followed up all the patients, we found relapse in two patients (3.2%). Conclusion SPN is a tumor that tends to affect young and middle-aged females. The malignancy grade of SPN is low, and patients with this disease show no specificity in clinical manifestation. The imageological examination is of vital importance in diagnosing SPN and surgical resection is an effective way to treat SPN. [ABSTRACT FROM AUTHOR]

Insulinoma is an exceedingly uncommon pancreatic islet cell neuroendocrine tumor. The estimated incidence is approximately four cases per million individuals per year and accounts for 60% of islets cell tumors. It causes glycopenic symptoms which includes headache, feeling irritable, confused, seizure or coma and leads to catecholamine excess which includes rapid heartbeat, sweating, palpitations and feelings of hunger. Early detection of the tumor prevents recurrent episodes of lethal hypoglycemia.

Background/objectives Laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for low-grade malignant pancreas tumors was recently demonstrated. Although the procedure with splenic vessel preservation (SVP) is optimal for LSPDP, SVP is not always possible in patients with a large tumor or a tumor attached to splenic vessels. This study aimed to analyze the safety of two procedures: LSPDP without SVP, known as the Warshaw technique (lap-WT), and LSPDP with SVP (lap-SVP). Methods Seventeen patients who underwent a lap-WT and seven patients who underwent a lap-SVP were investigated retrospectively. Results The median follow-up duration was 45 (range 17–105) months. In the lap-WT and lap-SVP patients, the sizes of the tumors were 5 (1.3–12) and 1.5 (1–4) cm; the operative times were 304 (168–512) and 319 (238–387) min; the blood loss was 210 (5–3250) and 60 (9–210) gr; the length of the postoperative hospital stay was 15 (8–29) and 18 (5–24) days; the peak platelet counts were 37.2 (14.6–65.2) and 26.4 (18.8–41) × 10 4 /μL, and splenomegaly was observed in 10 (59%) and three (43%) patients, respectively. In both procedures, there was no local recurrence. In the lap-WT group, splenic infarctions were seen in four (24%) patients and perigastric varices were seen in two (12%) patients. All of these patients were observed conservatively. Conclusions Both the lap-WT and lap-SVP were found to be safe and effective, and in cases in which the tumor is relatively large or close to the splenic vessels, lap-WT can be used as the more appropriate procedure. [ABSTRACT FROM AUTHOR]

Electrochemotherapy (ECT) is a local non-thermal treatment for cancer ablation. Currently, many studies and case report have investigated the differences in effectiveness of ECT with respect to tumor type, chemotherapeutic drug, and route of drug administration.This review has the purpose to summarize current knowledge about clinical effectiveness of electrochemotherapy and future prospects regarding its use, not only for cutaneous or superficial lesions, but also for treatment of deep-seated tumors and metastases. [ABSTRACT FROM AUTHOR]

Abstract: Fluorescent Cybesin (Cypate-Bombesin Peptide Analogue Conjugate) was synthesized from Indocyanine Green (ICG) and the bombesin receptor ligand as a contrast agent for detecting pancreas tumors. However, the LC–MS analysis indicated that the target compound was only a minor component in the reaction mixture. Since preparative HPLC can hardly separate such a small amount of the target compound directly from the original crude reaction mixture without a considerable adsorptive loss onto the solid support, high-speed counter-current chromatography (HSCCC) was used for purification since the method uses no solid support and promises high sample recovery. A suitable two-phase solvent system composed of hexane/ethyl acetate/methanol/methyl t-butyl ether/acetonitrile/water) at a volume ratio of 1:1:1:4:4:7 was selected based on the partition coefficient of Cybesin (K ≈0.9) determined by LC–MS. The separation was performed in two steps using the same solvent system with lower aqueous mobile phase. From 400mg of the crude reaction mixture the first separation yielded 7.7mg of fractions containing the target compound at 12.8% purity, and in the second run 1mg of Cybesin was obtained at purity of 94.0% with a sample recovery rate of over 95% based on the LC–MS analysis. [ABSTRACT FROM AUTHOR]

Expression of the tumor suppressor p16INK4a after stable transfection can restore the susceptibility of epithelial tumor cells to anoikis. This property is linked to increases in the expression and cell-surface presence of the fibronectin receptor. Considering its glycan chains as pivotal signals, we assumed an effect of p16INK4a on glycosylation. To test this hypothesis for human Capan-1 pancreatic carcinoma cells, we combined microarray for selected glycosyltransferase genes with 2D chromatographic glycan profiling and plant lectin binding. Major differences between p16-positive and control cells were detected. They concerned expression of β1,4-galactosyltransferases (down-regulation of β1,4-galactosyltransferases-I/V and up-regulation of β1,4-galactosyltransferase-IV) as well as decreased α2,3-sialylation of O-glycans and α2,6-sialylation of N-glycans. The changes are compatible with increased β1-integrin maturation, subunit assembly and binding activity of the α5β1-integrin. Of further functional relevance in line with our hypothesis, we revealed differential reactivity towards endogenous lectins, especially galectin-1. As a result of reduced sialylation, the cells' capacity to bind galectin-1 was enhanced. In parallel, the level of transcription of the galectin-1 gene increased conspicuously in p16INK4a-positive cells, and even figured prominently in a microarray on 1996 tumor-associated genes and in proteomic analysis. The cells therefore gain optimal responsiveness. The correlation between genetically modulated galectin-1 levels and anoikis rates in engineered transfectants inferred functional significance. To connect these findings to the fibronectin receptor, galectin-1 was shown to be co-immunoprecipitated. We conclude that p16INK4a orchestrates distinct aspects of glycosylation that are relevant for integrin maturation and reactivity to an endogenous effector as well as the effector's expression. This mechanism establishes a new aspect of p16INK4a functionality. [ABSTRACT FROM AUTHOR]

Abstract: Background: Pancreatic resections including pancreaticoduodenectomy and distal pancreatectomy are the standard of care for patients with malignant tumors of the pancreas. Patients with benign disease or unusual tumors may benefit from other nonstandard resections. Methods: A review of the literature and the author’s experiences were undertaken. Results: Parenchymal-sparing surgeries including pancreatic enucleation, central pancreatectomy, splenic-preserving distal pancreatectomy, and duodenal-preserving pancreatic head resection are described. The utility of each procedure is reviewed. Outcome results from published series are included. Conclusions: Nonstandard pancreatic resections should be considered in select patients with unusual lesions. Such procedures are safe and effective and may be associated with a reduced incidence of exocrine insufficiency. [Copyright &y& Elsevier]

Background. Glucagonomas are rare neuroendocrine tumors of the pancreas. Because of its rarity, its natural history is not well understood. Aim. We evaluated the natural history of glucagonomas treated at a teritary care cancer center. Methods. A retrospective analysis of 12 patients during 1970 to 2000 was performed. Six patients (50%) had a tumor located in the head of the pancreas. Results. Abdominal pain (83%) and weight loss (75%) were the most common symptoms. Median tumor size was 6 cm (range 0.04–10). Seven patients (58%) had liver metastases. Five patients (42%) underwent curative resection. Overall median survival was 66 mo, and 5-yr overall survival was 66%. Five-yr overall survival was 83% for patients who had resection versus 50% for the non-resected patients ( p=0.04). Patients who were disease-free had a complete resection of the primary tumor and no liver involvement. Conclusions. Glucagonomas generally present with liver metastases at the time of diagnosis. Cure is only possible if the disease is localized and completely resected. [ABSTRACT FROM AUTHOR]

A case of a solid and papillary (solid-cystic) tumor of the pancreas occurring in a 36-year-old man is herein reported. This patient was admitted with left hypochondrial pain and diagnostic imaging detected a large tumor consisting of both solid and cystic components in the tail of the pancreas. A distal pancreatectomy with splenectomy was performed. The resected tumor was diagnosed as a solid and papillary tumor of the pancreas by pathological examination. Detailed immunohistochemical studies showed that the tumor consisted of cells both exocrine and endocrine in character. Thus, this case appears interesting from the point of cellular differentiation in solid and papillary tumors, since they are generally considered to have an acinar cell origin. [ABSTRACT FROM AUTHOR]

Insulinoma is an exceedingly uncommon pancreatic islet cell neuroendocrine tumor. The estimated incidence is approximately four cases per million individuals per year and accounts for 60% of islets cell tumors. It causes glycopenic symptoms which includes headache, feeling irritable, confused, seizure or coma and leads to catecholamine excess which includes rapid heartbeat, sweating, palpitations and feelings of hunger. Early detection of the tumor prevents recurrent episodes of lethal hypoglycemia. [ABSTRACT FROM AUTHOR]