Search

Simple Summary: Insulinomas are the most common tumors of the endocrine pancreas in dogs, often resulting in severe hypoglycemia and neurological symptoms. Surgical resection has been the traditional treatment, but it poses significant risks. This study explores the use of ultrasound-guided radiofrequency ablation (RFA) as a safer and less invasive alternative. RFA was found to effectively control glucose levels and reduce tumor size in most treated dogs while reducing recovery times and complications. These findings suggest that RFA offers a valuable treatment option for managing insulinomas and their metastasis in canine patients. Insulinomas are the most common neoplasms of the endocrine pancreas in dogs, leading to persistent hypoglycemia due to inappropriate insulin secretion. The standard treatment is surgical resection, but it carries significant risks, including pancreatitis and diabetes mellitus. This study investigates the efficacy and safety of percutaneous ultrasound-guided radiofrequency ablation (RFA) as an alternative to surgery. A total of 29 dogs diagnosed with insulinoma were treated with RFA, targeting both primary pancreatic tumors and metastases in regional lymph nodes or the liver. Blood glucose levels and tumor size were monitored before and after the procedure. RFA led to a significant increase in blood glucose levels and a reduction in tumor size in all patients, with minimal postoperative complications. The results suggest that RFA is a feasible and effective treatment option for insulinomas in dogs. [ABSTRACT FROM AUTHOR]

Pancreatic schwannomas are exceedingly rare tumors arising from Schwann cells of the peripheral nerve sheath within the pancreas. Often asymptomatic or presenting with nonspecific symptoms, these tumors pose a diagnostic challenge due to their mimicry of other pancreatic neoplasms on imaging studies. Histologically, pancreatic schwannomas demonstrate spindle cell proliferation with a distinct Immunohistochemical profile, including positive staining for S-100 protein. Surgical resection remains the cornerstone of treatment, with excellent long-term prognosis following complete excision. Here, we present a case report of a pancreatic schwannoma in a woman presenting with a cystic pancreatic mass, underscoring the importance of considering this rare entity in the differential diagnosis of pancreatic lesions. [ABSTRACT FROM AUTHOR]

Objective To evaluate the application of robot-assisted laparoscopy for solid pancreastic pseudopapilloma (SPP) in children. Methods From April 2020 to July 2023, retrospective analysis was con- ducted for the relevant clinical data of 5 SPP children. Lesion sites, imaging examinations, periostoperative laboratory tests, operative duration, intraoperative volume of blood loss, drainage tubing time, perioperative complications, length of hospitalization and postoperative pathological examinations were recorded. Results There were 1 boy and 4 girls, ranging in age from 6 years 9 months to 14 years 9 months, with a median age of 10 years 11 months. Weight 21.5-45.0 kg, median weight 29. 1 kg. Preoperative imaging examinations of ultrasonography, enhanced computed tomography (CT) and magnetic resonance imaging (MRI) hinted at SPP. Robot-assisted laparoscopic resection was performed with a median operative duration of 103(95-180) min. There was no conversion into open surgery. One child of intraoperative pancreatic duct rupture was repaired. SPP was confirmed by postoperative pathological examination. The median postoperative hospitalization stay was 14(7-20) day. Preoperative leucocyte count was 7.600 (7.300, 10.000) x 109/L, high-sensitivity C-reactive protein (Hs- CRP) 0.200(0.200,0.460) mg/L, alanine aminotransferase (ALT) 11.000 (9.000, 17.000) U/L, aspartate aminotransferase (AST) 24.000 (21.000, 35.000) U/L, amylase 67. 700 (62.900, 107. 10) U/L, lipase 23.500 (21.200,53.700) U/L; Postoperative leucocyte count was 5. 190 (5.070,5.590) x 109/L, Hs-CRP 7.520(1.080,7.800) mg/L, ALT 17.000 (15.00,34.000) U/L, AST 35.000 (28.000,42.000) U/L, amylase 95.700(73.000104.400) U/L, lipase 62. 300 (58.900,64.000) U/L. The comparison of leucocyte count, Hs-CRP, ALT, AST, amylase and lipase before and after surgery showed p-values greater than 0.05. There were no statistically significant differences. All of them were discharged smoothly. During a follow-up period of 2 to 36 month, there was no onset of pancreatitis, pancreatic leakage, pancreatic duct stenosis or recurrence. Conclusions For SPP children, robot-assisted laparoscopy is both safe, mini-invasive and feasible with distinct anatomy, precise handling and quick postoperative recovery. [ABSTRACT FROM AUTHOR]

Background: Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is highly accurate for diagnosing pancreatic mass. However, making diagnosis is challenging in 5–20% of patients. This study investigated the challenging features associated with reduced diagnostic performance in EUS-FNB and potential rescue methods that can improve the diagnostic rate. Methods: This single-center retrospective study included patients with solid pancreatic tumors who underwent EUS-FNB between January 1, 2019, and December 12, 2021. Patients without a computed tomography (CT) scan or definite diagnosis were excluded. Challenging features were features that reduced diagnostic accuracy in EUS-FNB, as determined through multivariate analysis. Rescue methods were methods that assisted operators in assessing lesions in patients with challenging features. Results: Of 332 enrolled patients, an accurate diagnosis obtained using EUS-FNB was achieved in 286 (86.1%). Univariable analysis revealed that the diagnostic accuracy was lower in cases of pancreatic tumors with isoattenuation in CT images (77.3% vs. 89.8%, odds ratio [OR]: 0.39, p = 0.003), an ill-defined margin on EUS (61.2% vs. 92.5%, OR: 0.13, p < 0.001), or tumor size < 20 mm (65.5% vs. 88.1%, OR: 0.26, p = 0.002). However, only ill-defined margins on EUS (OR: 0.14, p < 0.001) and tumor size < 20 mm (OR: 0.25, p = 0.005) were independent predictors of inconclusive EUS-FNB in the multivariate analysis. The use of contrast (OR: 4.46, p = 0.026) and a highly experienced endosonographer (> 5cases/month; OR: 3.25, p = 0.034) improved diagnostic performance in difficult cases. Conclusions: Pancreatic tumors with ill-defined tumor margins on EUS or size < 20 mm are challenging features in EUS-FNB. The use of contrast and a highly experienced endosonographer can improve diagnostic performance in difficult cases. [ABSTRACT FROM AUTHOR]

In the last few decades, poor prognosis of pancreatic tumor has been an issue of concern in spite of the recent advancements in the different imaging modalities. Small size, similar attenuation to normal sized pancreas or concealed position of pancreas during CT scans are the factors that leads to failure in early diagnosis of pancreatic tumor. In this research, an organized framework is proposed for monitoring, classifying and diagnosing of pancreatic tumor. The suggested model integrates the technique of Deep Neural Network (DNN) and optimistic aspects of nature-inspired algorithms; this model aims to achieve a harmonious combination of both the techniques. The proposed model examines the medical images obtained from CT scans for the presence of pancreatic tumor using SSA-ML image segmentation on CT dataset. Evaluation of suggested model in comparison to other contemporary models IDLDMS, ODL, weighted KLM, Kernel-ELM, and ELM models is also performed in reference to sensitivity, specificity, accuracy and F1 score. The classification accuracy of our model is 99.44 % which reflects its supremacy over other recent models.

Abstract Natural killer group 2 member D ligands (NKG2DLs) are expressed as stress response proteins in cancer cells. NKG2DLs induce immune cell activation or tumor escape responses, depending on their expression. Human pancreatic cancer cells, PANC-1, express membrane MHC class I polypeptide-related sequence A/B (mMICA/B), whereas soluble MICB (sMICB) is detected in the culture supernatant. We hypothesized that sMICB saturates NKG2D in NKG2DLow T cells and inhibits the activation signal from mMICB to NKG2D. Knockdown of MICB by siRNA reduced sMICB level, downregulated mMICB expression, maintained NKG2DLow T cell activation, and inhibited NKG2DHigh T cell activation. To maintain mMICB expression and downregulate sMICB expression, we inhibited a disintegrin and metalloproteinase (ADAM), a metalloproteinase that sheds MICB. Subsequently, the shedding of MICB was prevented using ADAM17 inhibitors, and the activation of NKG2DLow T cells was maintained. In vivo xenograft model revealed that NKG2DHigh T cells have superior anti-tumor activity. These results elucidate the mechanism of immune escape via sMICB and show potential for the activation of NKG2DLow T cells within the tumor microenvironment.

Animal tumor models are used for preclinical studies of drugs and cancer therapy. The aim of this work was to analyze the growth of murine pancreatic tumor cells Pan02, carrying GFP marker, injected subcutaneously (s. c.), intraperitoneally (i. p.) or orthotopically into the pancreas (ortho) of C57BL/6 mice. Mice were injected with 2 × 105 cells: s. c. in the right flank; i. p. with a syringe into the abdominal cavity, or ortho surgically under the pancreas capsule. The weight of mice was determined in the dynamics of tumor growth, and blood serum was taken to analyze the antibody response to the GFP reference protein. At the 2nd and 4th weeks of tumor growth, some mice were slaughtered and the expression of GFP by the tumor cells, as well as the composition of the immune cells in the tumor, were analyzed by flow cytometry and confocal microscopy. It was shown that with the different localization, the pancreatic tumors grew at different rates and lethality. When the tumor was injected i. p., mice lost weight with rapid tumor growth. In the ortho model, the mice increased their weight. Mortality in the s. c. and i. p. groups was comparable. In the s. c. model, the tumor grew slowly to a volume of 200-400 mm3 and stopped growing. There was no mortality in this group during the follow-up period (2 months). The same antibody response to GFP was formed with all injection schemes. The subpopulation composition of immune cells varied greatly in the different models of tumor cell administration. Regardless of the type of immune response, Pan02-GFP cells rapidly suppressed GFP gene expression in vivo. The data obtained showed that murine pancreatic tumor Pan02 is immunogenic and causes the formation of an adaptive immune response. Regardless of the presence or absence of an immune response and elimination of GFP+ cells, the tumor continued to grow in the i. p. and ortho models, but not in the s. c. one, and caused the death of mice. When conducting preclinical studies, it is necessary to use several ways of tumor cell injection to obtain a more objective result.

Objective: To delineate the risk factors and causes of unplanned reoperations within 30 days following laparoscopic pancreaticoduodenectomy (LPD). Methods: A retrospective study reviewed 311 LPD patients at Ningbo Medical Center Li Huili Hospital from 2017 to 2024. Demographic and clinical parameters were analyzed using univariate and multivariate analyses, with P < 0.05 indicating statistical significance. Results: Out of 311 patients, 23 (7.4%) required unplanned reoperations within 30 days post-LPD, primarily due to postoperative bleeding (82.6%). Other causes included anastomotic leakage, abdominal infection, and afferent loop obstruction. The reoperation intervals varied, with the majority occurring within 0 to 14 days post-surgery. Univariate analysis identified significant risk factors: diabetes, liver cirrhosis, elevated CRP on POD-3 and POD-7, preoperative serum prealbumin < 0.15 g/L, prolonged operation time, intraoperative bleeding > 120 ml, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter =3 mm (all P < 0.05). Multivariate analysis confirmed independent risk factors: pre-operative serum prealbumin < 0.15 g/L (OR = 3.519, 95% CI 1.167-10.613), CRP on POD-7 (OR = 1.013, 95% CI 1.001-1.026), vascular reconstruction (OR = 9.897, 95% CI 2.405-40.733), soft pancreatic texture (OR = 5.243, 95% CI 1.628-16.885), and a main pancreatic duct diameter =3 mm (OR = 3.462, 95% CI 1.049-11.423), all associated with unplanned reoperation within 30 days post-LPD (all P < 0.05). Conclusion: Postoperative bleeding is the primary cause of unplanned reoperations after LPD. Independent risk factors, confirmed by multivariate analysis, include low pre-operative serum prealbumin, elevated CRP on POD-7, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter of =3 mm. Comprehensive peri-operative management focusing on these risk factors can reduce the likelihood of unplanned reoperations and improve patient outcomes. [ABSTRACT FROM AUTHOR]

The WDR5/MLL1-H3K4me3 epigenetic axis is often activated in both tumor cells and tumor-infiltrating immune cells to drive various cellular responses in the tumor microenvironment and has been extensively studied in hematopoietic cancer, but its respective functions in tumor cells and immune cells in the context of tumor growth regulation of solid tumor is still incompletely understood. We report here that WDR5 exhibits a higher expression level in human pancreatic tumor tissues compared with adjacent normal pancreas. Moreover, WDR5 expression is negatively correlated with patients' response to chemotherapy or immunotherapy in human colon cancer and melanoma. However, WDR5 expression is positively correlated with the HLA level in human cancer cells, and H3K4me3 enrichment is observed at the promoter region of the HLA-A, HLA-B, and HLA-C genes in pancreatic cancer cells. Using mouse tumor cell lines and in vivo tumor models, we determined that WDR5 deficiency or inhibition significantly represses MHC I expression in vitro and in vivo in pancreatic tumor cells. Mechanistically, we determine that WDR5 deficiency inhibits H3K4me3 deposition at the MHC I (H2K) promoter region to repress MHC I (H2K) transcription. On the other hand, WDR5 depletion leads to the effective downregulation of immune checkpoints and immunosuppressive cytokines, including TGFβ and IL6, in the pancreatic tumor microenvironments. Our data determine that WDR5 not only regulates tumor cell immunogenicity to suppress tumor growth but also activates immune suppressive pathways to promote tumor immune evasion. Selective activation of the WDR5-MHC I pathway and/or selective inhibition of the WDR5–immune checkpoint and WDR5–cytokine pathways should be considered in WDR5-based epigenetic cancer immunotherapy. [ABSTRACT FROM AUTHOR]

A 9-year-old, neutered male, domestic short-haired cat was referred for recurrent ascites of unknown etiology over a week. Physical examination revealed abdominal distension and ultrasonography revealed a large volume of ascites throughout the abdominal cavity; this was interpreted as modified transudate. The mesentery and abdominal fat were hyperechoic and edematous. Fat tissue was assessed using fine-needle aspiration cytology, and adipocytes, fat-phagocytizing macrophages, and neutrophils were identified. Computed tomography revealed a pancreatic mass connected to the left pancreatic leg. Exploratory laparoscopy confirmed nodular masses and organ adhesions, leading to a tentative diagnosis of sclerosing encapsulating peritonitis. The cat was administered prednisolone, vitamin E, and tamoxifen but died 22 days after the initial therapy. Necropsy revealed a multi-lobulated pancreatic tumor (10 × 10 cm) tightly attached to the stomach and intestine, with a large amount of ascites. The peritoneum, stomach, intestine, and mesentery were covered with numerous disseminated nodules of various sizes (1-5 mm diameter). Microscopically, the tumor consisted of extensive adipose tissue, locally extensive inflammatory infiltrates, fibrous connective tissue, and small invasive proliferative glands. Well-defined small irregular glands composed of singlelayered epithelial cells that appear to be of ductal origin were surrounded by an abundant desmoplastic stroma. Neoplastic nodules were widespread in the liver, stomach, peritoneum, mesentery, mesenteric lymph nodes, lungs, and urinary bladder. Immunohistochemistry revealed that the neoplastic glands were positive for pan-cytokeratin, confirming the pancreatic epithelial origin of the tumor. This is the first report of sclerosing encapsulating peritonitis accompanied by aggressive pancreatic adenocarcinoma of presumed ductal origin and extensive metastasis in a cat. [ABSTRACT FROM AUTHOR]

Pancreatic tumor is one of the deadliest malignancies and the effective rate of chemotherapy for pancreatic tumor is still low. It is important to identify effective treatments and drugs that are sensitive to chemotherapy drugs. Tubeimoside-1 is a natural compound is traditionally used to treat snake venom and inflammation, and it has anti-tumor activities in multiple tumors. However, the role and mechanism of Tubeimoside-1 in pancreatic tumor has been unclear. Herein, we investigated the role of TBMS1 in the chemotherapy resistance of pancreatic tumor. We revealed that TBMS1 restrained the growth of pancreatic tumor cells. In addition, TBMS1 contributed to the apoptosis of pancreatic tumor cells. Further, tubeimoside-1 enhanced the sensitivity of pancreatic tumor gemcitabine resistant cells to gemcitabine. Mechanically, tubeimoside-1 inhibited the phosphatidylinositol-3-kinase/protein kinase B/mammalian target of rapamycin axis in pancreatic tumor cells. In summary, tubeimoside-1 inhibited the phosphatidylinositol-3-kinase/protein kinase B/mammalian target of rapamycin axis, thereby restraining pancreatic tumor cell growth and gemcitabine resistance. [ABSTRACT FROM AUTHOR]

Pancreatic cancer remains a significant health issue with limited treatment options. The tumor stroma, a complex environment made up of different cells and proteins, plays a crucial role in tumor growth and chemoresistance. Targeting tumor stroma, consisting of diverse non-tumor cells such as fibroblasts, extracellular matrix (ECM), immune cells, and also pre-vascular cells is encouraging for remodeling solid cancers, such as pancreatic cancer. Remodeling the stroma of pancreas tumors can be suggested as a strategy for reducing resistance to chemo/immunotherapy. Several studies have shown that phytochemicals from plants can affect the tumor environment and have anti-cancer properties. By targeting key pathways involved in stromal activation, phytochemicals may disrupt communication between the tumor and stroma and make tumor cells more sensitive to different treatments. Additionally, phytochemicals have immunomodulatory and anti-angiogenic properties, all of which contribute to their potential in treating pancreatic cancer. This review will provide a detailed look at how phytochemicals impact the tumor stroma and their effects on pancreatic tumor growth, spread, and response to treatment. It will also explore the potential of combining phytochemicals with other treatment options like chemotherapy, immunotherapy, and radiation. [ABSTRACT FROM AUTHOR]

Pancreatoblastoma, a rare pancreatic tumor, exhibits diverse differentiation pathways, including acinar, ductal, and neuroendocrine lineages, often with distinct squamoid nests [ 3 ]. We present a notable case of pancreatoblastoma coexisting with large cell neuroendocrine carcinoma in a 10-year-old boy, presenting with abdominal discomfort, weight loss, and lesions in the pancreas, spleen, and liver visible on imaging. A liver biopsy revealed a poorly differentiated carcinoma with neuroendocrine features, while a splenic biopsy showed acinar cell differentiation, raising possible diagnoses of pancreatoblastoma or acinar cell carcinoma. Subsequent surgical resection after chemotherapy revealed diverse components within the pancreatoblastoma, including well-differentiated acinar and neuroendocrine cells, squamoid nests, and a high-grade neuroendocrine carcinoma. Genetic analysis detected pathogenic variants in TP53 and SMAD4, rarely found in pancreatoblastomas. This juxtaposition of large cell neuroendocrine carcinoma and pancreatoblastoma suggests a potential evolution from well-differentiated neuroendocrine tumors to poorly-differentiated carcinomas within pancreatoblastomas. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate the accuracy of contrast-enhanced ultrasound diagnostic reports for pancreatic lesions.MethodsIn this retrospective study, we included patients who underwent contrast-enhanced ultrasound examination of pancreatic lesions at Peking Union Medical College Hospital from January 2017 to December 2022 and received a confirmed pathological diagnosis. Using pathological diagnosis as the gold standard, the study evaluated the accuracy of contrast-enhanced diagnostic ultrasound. It also analyzed the misdiagnosis of contrast-enhanced ultrasound in diagnosing various pathological types of pancreatic lesions.ResultsOf the 859 patients who met inclusion and exclusion criteria, 489 were male(56.9%) and 370 were female(43.1%).Their age ranged from 16 to 85 years, with a median age of 60(53, 66) years. Except for 47 pancreatic space-occupying lesions that were difficult to categorize as either benign or malignant, a total of 812 cases were included in the diagnostic efficacy analysis of benign and malignant lesions. The results suggested that the diagnostic sensitivity and specificity of contrast-enhanced ultrasound for pancreatic malignant lesions were 98.3%(95% CI: 97.1%-99.1%) and 79.0%(95% CI: 70.1%-86.4%), AUC was 0.887(95% CI: 0.863-0.908), positive and negative predictive value were 96.9%(95% CI: 95.6%-97.9%) and 87.4%(95% CI: 79.6%-92.4%), positive and negative likelihood ratio were 4.69(95% CI: 3.24-6.80) and 0.02(95% CI: 0.01-0.04). The diagnostic accuracy rate of contrast-enhanced ultrasound for diagnosing benign and malignant pancreatic lesions was 95.8%. Of the 859 lesions examined, 48 cases were misdiagnosed by contrast-enhanced ultrasound, with a misdiagnosis rate of 5.6%(48/859), including 7 cases(0.8%) of undetermined diagnosis, while the diagnostic accuracy of pancreatic ductal adenocarcinoma was as high as 98.8%. No complications occurred in any of the patients.ConclusionsContrast-enhanced ultrasound is a safe and effective imaging method for evaluating microvascular perfusion in various pancreatic lesions. It has significant clinical value in diagnosing both benign and malignant pancreatic lesions, particularly in diagnosing pancreatic ductal adenocarcinoma.

Copyright of Romanian Journal of Veterinary Medicine & Pharmacology is the property of Innovation in Health Center 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.)

OBJECTIVE: The present study reviews the records of patients with solid pseudopapillary pancreas neoplasm (SPT). METHODS: A total of 13 patients diagnosed with SPT were included in the study. The criteria for SPT in the pathology specimens were the presence of cells with an oval round orthochromatic nucleus, with a thin chromatin structure and no nucleolus distinction, lined around a fibrovascular papilla in cystic areas. RESULTS: The study included 11 female and two male patients, with a mean age of 33.07 (range: 16-73) years. All operated patients underwent open surgery, with five undergoing a subtotal pancreatectomy and splenectomy; one a distal pancreatectomy and splenectomy; four a spleen-preserving distal pancreatectomy; and one a pancreaticoduodenectomy. None of the operated patients developed recurrence during the long-term follow-up. The mean follow-up time of operable patients was 69.18 (range: 22-97) months, and none had metastasis at follow-up. The mean follow-up time for the malignant SPT patients was 2.75 (1.5-4) months. CONCLUSION: SPTs are rare pancreatic tumors encountered more frequently today due to advances in imaging methods and have a low potential of recurrence and a good prognosis. [ABSTRACT FROM AUTHOR]

Xanthogranulomatous inflammation is a chronic inflammatory reaction microscopically characterized by aggregation of foamy histiocytes, fibrous tissue, and infiltration of various inflammatory cells. In contrast to xanthogranulomatous inflammation in the gallbladder or kidney, xanthogranulomatous pancreatitis is rare. We herein present a case of xanthogranulomatous pancreatitis in a patient who underwent distal pancreatectomy with splenectomy under preoperative suspicion of a pancreatic pseudocyst or pancreatic tumor. A 77-year-old woman with a 1 month history of epigastric pain, anorexia, and general fatigue was admitted to our hospital. Contrast-enhanced computed tomography revealed a cystic mass with ill-defined margins at the pancreatic tail together with a splenic abscess. Contrast-enhanced endoscopic ultrasound detected a hyperechoic cystic lesion at the tail of the pancreas with heterogeneous internal echogenicity, and part of the intra-cystic content was enhanced by the contrast agent. Endoscopic retrograde cholangiopancreatography showed a cystic lesion at the tail of the pancreas that continued into the main pancreatic duct, and the main pancreatic duct was slightly narrowed downstream of the cystic lesion. Pancreatic juice cytology revealed suspicious cells, leading to the possibility of intraductal papillary mucinous carcinoma. Distal pancreatectomy with splenectomy was performed, and the histopathological diagnosis was xanthogranulomatous pancreatitis with no malignant findings. [ABSTRACT FROM AUTHOR]

Pancreatic schwannomas are exceedingly rare tumors arising from Schwann cells of the peripheral nerve sheath within the pancreas. Often asymptomatic or presenting with nonspecific symptoms, these tumors pose a diagnostic challenge due to their mimicry of other pancreatic neoplasms on imaging studies. Histologically, pancreatic schwannomas demonstrate spindle cell proliferation with a distinct Immunohistochemical profile, including positive staining for S-100 protein. Surgical resection remains the cornerstone of treatment, with excellent long-term prognosis following complete excision. Here, we present a case report of a pancreatic schwannoma in a woman presenting with a cystic pancreatic mass, underscoring the importance of considering this rare entity in the differential diagnosis of pancreatic lesions.

IntroductionPancreatic neoplasms are rare among children and very few studies have reported on surgical outcomes for pediatric pancreatic neoplasms. Therefore, we aimed to describe patient and tumor characteristics and report on the surgical outcomes of pediatric pancreatic neoplasm.MethodsIn this retrospective single-center study, we reviewed and analyzed the data of patients who underwent surgery for pediatric pancreatic neoplasms at Severance Children's Hospital between January 2007 and December 2022. Clinical data including demographics, surgical procedures, and postoperative and long-term outcomes were evaluated.ResultsA total of 28 patients underwent surgical treatment for pancreatic neoplasms with a median age of 11.7 years (range: 0.4–17.8). The most common histological diagnosis among benign tumors was solid pseudopapillary neoplasm (SPN), which occurred in 20 patients (71.4%). This was followed by a mucinous cyst, nesidioblastosis, pseudocyst, duplication cyst, and benign cyst, each occurring in one patient (3.5%). Regarding malignant tumors, pancreatoblastoma, solid pseudopapillary carcinoma, and malignant pheochromocytoma were noted in one patient each (3.5%). Tumor locations included the head in 4 patients (14.2%), the body in 7 (25%), and the tail in 16 (57.1%), and was diffuse in 1 (3.5%). The most common surgical resection range was distal pancreatectomy, found in 22 patients (78.5%), followed by pylorus-preserving pancreaticoduodenectomy, found in 2 (7.2%); duodenum-preserving pancreatic resection, central pancreatectomy, tumor enucleation, and near-total pancreatectomy were performed in one patient each (3.5%). Overall, 4 patients developed grade B or C postoperative pancreatic fistulas, and 1 experienced postoperative mortality due to uncontrollable bleeding. The mean follow-up period was 6.1 years (range: 1–15.6 years), during which no significant impact on growth after surgery was detected. Among the 20 patients with SPN, tumor rupture occurred in 4 (20%), among whom 2 experienced tumor recurrences.ConclusionsHistological diagnosis of benign tumors was predominant in this case series and various extents of surgical resection were performed. Surgical treatment for pediatric pancreatic neoplasms appears to be safe and effective. However, considering the long-term prognosis of these patients, it is essential to determine the appropriate extent of surgical resection based on the location of the tumor.

Abstract Background PEComa is a mesenchymal tumor that can occur in various organs including the uterus and soft tissues. PEComas are composed of perivascular epithelioid cells, and angiomyolipoma (AML), clear cell sugar tumor (CCST), and lymphangiomyomatosis (LAM) are considered lesions of the same lineage as tumors of the PEComa family. Histologically, a common PEComa shows solid or sheet-like proliferation of epithelioid cells. This is accompanied by an increase in the number of dilated blood vessels. Here, we report a case of pancreatic PEComa with marked inflammatory cell infiltration. Case presentation A 74-year-old male patient underwent an appendectomy for acute appendicitis. Postoperative computed tomography and magnetic resonance imaging revealed a 30 × 25 mm non-contrast-enhanced circular lesion in the tail of the pancreas. The imaging findings were consistent with a malignant tumor, and distal pancreatectomy was performed. Histologically, most area of the lesion was infiltrated with inflammatory cells. A few epithelioid cells with large, round nuclei, distinct nucleoli, and eosinophilic granular cytoplasm were observed. Spindle-shaped tumor cells were observed. Delicate and dilated blood vessels were observed around the tumor cells. Immunohistochemically, the atypical cells were positive for αSMA, Melan A, HMB-45, and TFE3. The cytological characteristics of the tumor cells and the results of immunohistochemical staining led to a diagnosis of pancreatic PEComa. Conclusions A histological variant known as the inflammatory subtype has been defined for hepatic AML. A small number of tumor cells present with marked inflammatory cell infiltration, accounting for more than half of the lesions, and an inflammatory myofibroblastic tumor-like appearance. To our knowledge, this is the first report of pancreatic PEComa with severe inflammation. PEComa is also a generic term for tumors derived from perivascular epithelioid cells, such as AML, CCST, and LAM. Thus, this case is considered an inflammatory subtype of PEComa. It has a distinctive morphology that is not typical of PEComa. This histological phenotype should be widely recognized.

Insulinomas are the most common neoplasms of the endocrine pancreas in dogs, leading to persistent hypoglycemia due to inappropriate insulin secretion. The standard treatment is surgical resection, but it carries significant risks, including pancreatitis and diabetes mellitus. This study investigates the efficacy and safety of percutaneous ultrasound-guided radiofrequency ablation (RFA) as an alternative to surgery. A total of 29 dogs diagnosed with insulinoma were treated with RFA, targeting both primary pancreatic tumors and metastases in regional lymph nodes or the liver. Blood glucose levels and tumor size were monitored before and after the procedure. RFA led to a significant increase in blood glucose levels and a reduction in tumor size in all patients, with minimal postoperative complications. The results suggest that RFA is a feasible and effective treatment option for insulinomas in dogs.

Objective: Solid pseudopapillary neoplasm of the pancreas (SPN) is a rare exocrine tumor of the pancreas. The aim of our study is to summarize the clinical features of SPN and to analyze the risk factors for malignant SPN. Methods: From May 2013 to September 2022, patients who were pathologically confirmed to have SPN were retrospectively reviewed. Demographic data, clinical and pathological features, follow-up data were collected and analyzed. To investigate the factors influencing the benign or malignant nature of SPN, we employed logistic regression. Additionally, we utilized Kaplan-Meier curves to depict and analyze the overall prognosis. Results: A total of 195 patients were included, 163 of whom were female and the average age of all patients was 31.7 years old. Among 195 patients, 101 patients (51.8%) had no obvious clinical symptoms and their pancreatic lesions were detected during routine examination. The primary symptom was abdominal pain and distension in 64 cases (32.8%). The maximum diameter of SPN tumors ranged from 1-17 cm (mean 6.19 cm). Forty-eight postoperative complications developed in 43 (22.1%) patients. After a median follow-up duration of 44.5 months, the overall 5-year survival rate was 98.8% and the recurrence rate was 1.5%. Furthermore, we observed a statistically significant difference in the completeness of the tumor capsule between benign and malignant SPN. Conclusion: SPN is associated with a favorable long-term survival after surgery in our large sample size cohort. For malignant SPN, tumor capsule incompleteness is an independent risk factor. [ABSTRACT FROM AUTHOR]

Although the incidence of solid pseudopapillary neoplasm (SPN) is <2% of the incidence of pancreatic tumor, the prevalence seems to be increasing. SPNs are mostly benign. However, they also show malignant features. This study aimed to identify the clinical outcomes of patients who underwent surgery for SPN at a single center. Data on 217 patients with SPN who underwent surgery in Samsung Medical Center between 2000 and 2020 were retrospectively analyzed. Herein, the mean age of the 217 patients was 40.0 ± 12.6 years, with a female predominance (80.6%). Most patients had no comorbidity. The mean tumor size was 4.4 ± 3.1 cm. The tumor was located at the pancreatic head in 36 patients (16.6%), the body of the pancreas in 69 patients (31.8%), and the pancreatic tail in 96 patients (44.2%). Of note, 35 patients (16.1%) underwent pancreaticoduodenectomies, 148 patients (68.2%) had distal pancreatectomies, and the other patients had subtotal /total pancreatectomy (9.7%) or enucleation/mass excision (6.0%). No patient had lymph node (LN) metastasis. Moreover, 6 patients (2.8%) had a recurrence in the liver or regional LNs. The 5-year recurrence-free survival rate was 96.8%. The only factor affecting recurrence was tumor size (P =.007). Because SPN predominates in relatively young women, patients often hesitate to undergo surgery. Nevertheless, as size is the prognostic factor, early resection is recommended for a better prognosis in the case of surgically feasible, young age, and healthy patients. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In this noteworthy case series regarding pancreatic pseudo tumors, we intend to spread knowledge among physicians for the diagnostic and therapeutic approach and eventual disease prognosis. Inflammatory pseudotumor of pancreatic head greatly mimics pancreatic head tumor. One of them is IgG4‐related pancreatic disease, which is commonly mistaken as neoplastic disease on imaging. In our novel case series, we report three cases of IgG4‐related pancreatic head pseudotumor with patients ranging from 35 to 72 years of age. Patients presented with jaundice and abdominal pain. Alongside initial laboratory workup, abdominal CTs and serum IgG4 levels were also obtained. Imaging features in conjunction with IgG4 levels confirmed the diagnosis of IgG4‐related autoimmune pancreatitis. Pancreatic pseudotumors are notorious for being often reported as real tumors. Through our noteworthy case series, we intend to highlight the imaging features and laboratory markers that are crucial in such cases to avoid invasive procedures. [ABSTRACT FROM AUTHOR]

Key Clinical Message In this noteworthy case series regarding pancreatic pseudo tumors, we intend to spread knowledge among physicians for the diagnostic and therapeutic approach and eventual disease prognosis. Abstract Inflammatory pseudotumor of pancreatic head greatly mimics pancreatic head tumor. One of them is IgG4‐related pancreatic disease, which is commonly mistaken as neoplastic disease on imaging. In our novel case series, we report three cases of IgG4‐related pancreatic head pseudotumor with patients ranging from 35 to 72 years of age. Patients presented with jaundice and abdominal pain. Alongside initial laboratory workup, abdominal CTs and serum IgG4 levels were also obtained. Imaging features in conjunction with IgG4 levels confirmed the diagnosis of IgG4‐related autoimmune pancreatitis. Pancreatic pseudotumors are notorious for being often reported as real tumors. Through our noteworthy case series, we intend to highlight the imaging features and laboratory markers that are crucial in such cases to avoid invasive procedures.

Cancer is one of the deadliest diseases affecting the health of human beings. With limited therapeutic options available, complementary and alternative medicine has been widely adopted in cancer management and is increasingly becoming accepted by both patients and healthcare workers alike. Chinese medicine characterized by its unique diagnostic and treatment system is the most widely applied complementary and alternative medicine. It emphasizes symptoms and ZHENG (syndrome)-based treatment combined with contemporary disease diagnosis and further stratifies patients into individualized medicine subgroups. As a representative cancer with the highest degree of malignancy, pancreatic cancer is traditionally classified into the "amassment and accumulation". Emerging perspectives define the core pathogenesis of pancreatic cancer as "dampness-heat" and the respective treatment "clearing heat and resolving dampness" has been demonstrated to prolong survival in pancreatic cancer patients, as has been observed in many other cancers. This clinical advantage encourages an exploration of the essence of dampness-heat ZHENG (DHZ) in cancer and investigation into underlying mechanisms of action of herbal formulations against dampness-heat. However, at present, there is a lack of understanding of the molecular characteristics of DHZ in cancer and no standardized and widely accepted animal model to study this core syndrome in vivo. The shortage of animal models limits the ability to uncover the antitumor mechanisms of herbal medicines and to assess the safety profile of the natural products derived from them. This review summarizes the current research on DHZ in cancer in terms of the clinical aspects, molecular landscape, and animal models. This study aims to provide comprehensive insight that can be used for the establishment of a future standardized ZHENG-based cancer animal model. [ABSTRACT FROM AUTHOR]

Purpose: There were limited data on the diagnostic efficacy of liquid-based cytology (LBC) for pancreatic tissues acquired by percutaneous ultrasound-guided fine-needle aspiration (US-FNA). This study aimed to evaluate the diagnostic value of LBC acquired via percutaneous US-FNA for pancreatic tumors compared with LBC combined with smear cytology (SC). Methods: A retrospective database search (January 2014 and February 2022) was performed for patients who underwent percutaneous US-FNA with both LBC and SC. Clinical and pathological data were collected from 298 patients; eventually, 251 cases met the inclusion criteria. Diagnostic accuracy, sensitivity (SEN), specificity (SPE), positive predictive value (PPV) and negative predictive value (NPV) were compared. Rapid on-site evaluation (ROSE) was not available in all cases. Results: Based on the pancreaticobiliary cytology guidelines published by the Papanicolaou Society of Cytopathology, 224 (89.2%), 13 (5.2%) and 14 (5.6%) cases were diagnosed as malignant, pre-malignant and benign lesions, respectively. The diagnostic accuracy of the LBC + SC (88.5%) was better than that of LBC (87.3%) but without statistical significance (P = 0.125). The SEN, SPE, PPV and NPV were 87.5%, 85.2%, 98.0% and 45.1%, respectively, in the LBC group and 88.8%, 85.2%, 98.0% and 47.9%, respectively, in the LBC + SC group. According to univariate and multivariate analyses, there were no factors have significant association with the diagnostic sensitivity of LBC. Conclusions: LBC obtained via percutaneous US-FNA provides good diagnostic value for pancreatic lesions and there was no significant difference between the diagnostic accuracy of LBC and LBC + SC when ROSE was unavailable. [ABSTRACT FROM AUTHOR]

Primary pancreatic lymphoma is an extremely rare malignant tumor that accounts for 1% and 0.5% of all extranodal malignant lymphomas and pancreatic tumors, respectively. The clinical and radiographic characteristics of primary pancreatic lymphoma are non-specific, and it is often misdiagnosed as pancreatic cancer or pancreatic tuberculosis, delaying treatment. The most common histological subtype of primary pancreatic lymphoma is diffuse large B-cell lymphoma. Herein, we report a case of a 48-year-old female patient who was hospitalized for complaints of lower back pain, jaundice, dark brown urine, nausea, and ascites. Radiological evaluation revealed a pancreatic head mass that was diagnosed as diffuse large B-cell lymphoma following ultrasound-guided percutaneous fine-needle biopsy. During hospitalization, the patient's jaundice worsened, and percutaneous transhepatic drainage was performed. However, hemorrhagic ascites and disorders of consciousness occurred after surgery, and the patient died due to multiple organ failure. Considering the outcome of this case, we reviewed the existing relevant literature on primary pancreatic lymphoma to better understand the disease to facilitate timely diagnosis and initiation of treatment. [ABSTRACT FROM AUTHOR]

Upconverting nanoparticles are interesting materials that have the potential for use in many applications ranging from solar energy harvesting to biosensing, light-triggered drug delivery, and photodynamic therapy (PDT). One of the main requirements for the particles is their surface modification, in our case using poly(methyl vinyl ether-alt-maleic acid) (PMVEMA) and temoporfin (THPC) photosensitizer to ensure the colloidal and chemical stability of the particles in aqueous media and the formation of singlet oxygen after NIR irradiation, respectively. Codoping of Fe2+, Yb3+, and Er3+ ions in the NaYF4 host induced upconversion emission of particles in the red region, which is dominant for achieving direct excitation of THPC. Novel monodisperse PMVEMA-coated upconversion NaYF4:Yb3+,Er3+,Fe2+ nanoparticles (UCNPs) with chemically bonded THPC were found to efficiently transfer energy and generate singlet oxygen. The cytotoxicity of the UCNPs was determined in the human pancreatic adenocarcinoma cell lines Capan-2, PANC-01, and PA-TU-8902. In vitro data demonstrated enhanced uptake of UCNP@PMVEMA-THPC particles by rat INS-1E insulinoma cells, followed by significant cell destruction after excitation with a 980 nm laser. Intratumoral administration of these nanoconjugates into a mouse model of human pancreatic adenocarcinoma caused extensive necrosis at the tumor site, followed by tumor suppression after NIR-induced PDT. In vitro and in vivo results thus suggest that this nanoconjugate is a promising candidate for NIR-induced PDT of cancer. [ABSTRACT FROM AUTHOR]

The title compounds were synthesized by the reaction of 5-oxo-1-(4-(phenylamino)phenyl)pyrrolidine-3-carbohydrazide with various aldehydes bearing aromatic and heterocyclic moieties and acetophenones, and their cytotoxicity was tested via MTT assay against human triple-negative breast cancer MDA-MB-231, human melanoma IGR39, human pancreatic carcinoma Panc-1, and prostate cancer cell line PPC-1. Furthermore, the selectivity of compounds towards cancer cells compared to fibroblasts was also investigated. Four compounds were identified as the most promising anticancer agents out of a series of pyrrolidinone-hydrazone derivatives bearing a diphenylamine moiety. These compounds were most selective against the prostate cancer cell line PPC-1 and the melanoma cell lines IGR39, with EC50 values in the range of 2.5–20.2 µM against these cell lines. In general, the compounds were less active against triple-negative breast cancer MDA-MB-231 cell line, and none of them showed an inhibitory effect on the migration of these cells. In the 'wound healing' assay, N′-((5-nitrothiophen-2-yl)methylene)-5-oxo-1-(4-(phenylamino)phenyl)pyrrolidine-3-carbohydrazide was identified as the most promising derivative that could be further developed as an antimetastatic agent. N′-(5-chloro- and N′-(3,4-dichlorobenzylidene)-5-oxo-1-(4-(phenylamino)phenyl)pyrrolidine-3-carbohydrazides most efficiently reduced the cell viability in IGR39 cell spheroids, while there was no effect of the investigated pyrrolidinone-hydrazone derivatives on PPC-1 3D cell cultures. Antioxidant activity determined via FRAP assay of N′-(1-(4-aminophenyl)ethylidene)-5-oxo-1-(4-(phenylamino)phenyl)pyrrolidine-3-carbohydrazide was 1.2 times higher than that of protocatechuic acid. [ABSTRACT FROM AUTHOR]

Statistics suggest a high proportion of mortality rate by pancreatic cancer, which is a solid tumor characterized by high heterogeneity and the presence of a complex extracellular matrix. The very low effectiveness of pancreatic cancer treatment roots in the high metastatic potential and drug resistance of this tumor. Therefore, the quest for efficient cellular models enabling precise mimicking in vivo conditions, and anticancer drug development is emerging as a priority. Routinely used 2D culture models offer an initial evaluation of the therapeutic potential of a compound against tumors, while scaffold-free and next-generation scaffold-based 3D hydrogel-based models are found to be promising for appropriate mimicking of the tumor environment and cell interactions. Over the last few years, attention was paid to the use of naturally-derived hydrogel as 3D models for pancreatic tumor modeling. Herein we first overview scaffold-free and scaffold-based 3D tumor models as advanced approaches, followed by placing the focus on naturally-derived hydrogels applied as scaffolds in pancreatic cancer modeling. This short review emphasizes that sustainable hydrogels can almost precisely imitate the complex in vivo microenvironment of pancreatic tumor, thereby hydrogel-based scaffold tumor models may be a breakthrough in pancreatic cancer studies and, in result, significantly improve the poor pancreatic tumor survivability prognosis. Nevertheless, anticancer drug development might be overshadowed by using this family of biomaterials. [ABSTRACT FROM AUTHOR]

Introduction: Hypoxia is one of the important reasons for the poor therapeutic efficacy of current pancreatic cancer treatment, and the dense stroma of pancreatic cancer restricts the diffusion of oxygen within the tumor. Methods: A responsive oxygen-self-supplying adv-miRT-CAT-KR (adv-MCK) cascade reaction system to improve hypoxia in pancreatic cancer is constructed. We utilized various experiments at multiple levels (cells, organoids, in vivo) to investigate its effect on pancreatic cancer and analyzed the role of immune microenvironment changes in it through high-throughput sequencing. Results: The adv-MCK system is an oncolytic adenovirus system expressing three special components of genes. The microRNA (miRNA) targets (miRTs) enable adv-MCK to selectively replicate in pancreatic cancer cells. Catalase catalyzes the overexpressed hydrogen peroxide in pancreatic cancer cells to generate endogenous oxygen, which is catalyzed by killerRed to generate singlet oxygen (1O2) and further to enhance the oncolytic effect. Meanwhile, the adv-MCK system can specifically improve hypoxia in pancreatic cancer, exert antitumor effects in combination with photodynamic therapy, and activate antitumor immunity, especially by increasing the level of γδ T cells in the tumor microenvironment. Conclusion: The responsive oxygen-self-supplying adv-MCK cascade reaction system combined with photodynamic therapy can improve the hypoxic microenvironment of pancreatic cancer and enhance antitumor immunity, which provides a promising alternative treatment strategy for pancreatic cancer.

A 40-year-old woman presented with dull, boring periumbilical region pain radiating to the back and vomiting for 1 year. Magnetic resonance cholangiopancreatography detected a polypoid growth in the ampullary region. The patient underwent Whipple’s procedure. The specimen revealed a 4.9 × 4.5 × 3.7 cm tumor arising from the pancreas, abutting the posterior pancreatic surface and infiltrating the terminal common bile duct and the ampulla. Microscopic examination showed a pancreatic tumor composed of neuroendocrine cells. In addition, many large foci showing solid sheets of oncocytic cells with abundant granular eosinophilic cytoplasm were observed. Immunohistochemistry studies revealed positivity for synaptophysin, chromogranin, and Ki67 index above 70%. A diagnosis of oncocytic neuroendocrine tumor of Grade 3 was made. In electron microscopy, oncocytic cells showed abundant mitochondria dispersed throughout the cytoplasm. Oncocytic pancreatic neuroendocrine neoplasms are uncommon and can be diagnosed only on histopathological examination. These tumors tend to show a malignant behavior. [ABSTRACT FROM AUTHOR]

Pancreatic tuberculosis (TB) is extremely rare and has similar clinical and radiological findings compared to pancreatic malignancy. Challenges in detecting individuals with pancreatic TB, especially in rural areas with limited supporting resources, are the reasons for a more complete care strategy. We report a case of pancreatic TB in a 25-year-old woman admitted to the emergency department (ED), who was initially suspected of having a pancreatic tumor. Her chief complaints were fever, fatigue, and abdominal pain, while she also experienced weight loss. Exploratory laparotomy and further pathological evaluation suggested pancreatic TB. Subsequently, the patient was given anti-TB drugs and showed clinical improvement. In conclusion, this case report highlighted that pancreatic TB could mimic pancreatic cancer; however, it is a treatable condition. Thus, it is important for physicians to consider this as a differential diagnosis, especially in high-risk populations and in rural areas with limited diagnostic tools. [ABSTRACT FROM AUTHOR]

Here, we report the first adult case of pancreatic yolk sac tumor with ectopic adrenocorticotropic hormone (ACTH) syndrome. The patient was a 27-year-old woman presenting with abdominal distension, Cushingoid features, and hyperpigmentation. Endogenous Cushing’s syndrome was biochemically confirmed. The ACTH level was in the normal range, which raised the suspicion of ACTH precursor-dependent disease. Elevated ACTH precursors were detected, supporting the diagnosis of ectopic ACTH syndrome. Functional imaging followed by tissue sampling revealed a pancreatic yolk sac tumor. The final diagnosis was Cushing’s syndrome due to a yolk sac tumor. The patient received a steroidogenesis inhibitor and subsequent bilateral adrenalectomy for control of hypercortisolism. Her yolk sac tumor was treated with chemotherapy and targeted therapy. Cushing’s syndrome secondary to a yolk sac tumor is extremely rare. This case illustrated the utility of ACTH precursor measurement in confirming an ACTH-related pathology and distinguishing an ectopic from a pituitary source for Cushing’s syndrome.

The first approved RNAi therapeutics, ONPATTRO, in 2017 moves the concept of RNA interference (RNAi) therapy from research to clinical reality, raising the hopes for the treatment of currently incurable diseases. However, RNAi therapeutics are still facing two main challenges—susceptibility to enzymatic degradation and low ability to escape from endo/lysosome into the cytoplasm. Therefore, we developed disulfide-based nanospheres (DBNPs) as universal vehicles to achieve efficient RNA delivery to address these problems. Notably, the DBNPs possess unique and desirable features, including improved resistance to nuclease degradation, direct cytoplasmic delivery through thiol-mediated cellular uptake, and cytosolic environment-responsive release, greatly enhancing the bioavailability of RNA therapeutics. Additionally, DBNPs are superior in terms of overcoming formidable physiological barriers, including vascular barriers and impermeable tumor tissues. Owning to these advantages, the DBNPs exhibit efficient gene silencing effect when delivering either small interfering RNA (siRNA) or microRNA in various cell lines and generate remarkable growth inhibition in the zebrafish and mouse model of pancreatic tumors as compared to traditional delivery vectors, such as PEI. Therefore, DBNPs have potential application prospect in RNAi therapy both in vitro and in vivo. RNA interference (RNAi) therapeutics could target and alter any disease-related mRNA translation, thus have great potential in clinical application. Delivery efficiency of RNA modalities into cell cytoplasm is the main problem that currently limit RNAi therapeutics to release their full potential. Most of the known delivery materials suffer from the endo/lysosomal entrapment and enzymatic degradation during endocytosis-dependent uptake, resulting unsatisfied efficiency of the cytoplasmic release. Here, we developed disulfide-based nanospheres could directly transfer RNA modalities into the cytoplasm and significantly enhance the delivery efficiency, thus holding great potential in RNAi therapy. [Display omitted] [ABSTRACT FROM AUTHOR]

Background and aims: Endoscopic ultrasonography (EUS) is commonly utilized in the diagnosis of pancreatic tumors, although as this modality relies primarily on the practitioner's visual judgment, it is prone to result in a missed diagnosis or misdiagnosis due to inexperience, fatigue, or distraction. Deep learning (DL) techniques, which can be used to automatically extract detailed imaging features from images, have been increasingly beneficial in the field of medical imagebased assisted diagnosis. The present systematic review included a meta-analysis aimed at evaluating the accuracy of DL-assisted EUS for the diagnosis of pancreatic tumors diagnosis. Methods: We performed a comprehensive search for all studies relevant to EUS and DL in the following four databases, from their inception through February 2023: PubMed, Embase, Web of Science, and the Cochrane Library. Target studies were strictly screened based on specific inclusion and exclusion criteria, after which we performed a meta-analysis using Stata 16.0 to assess the diagnostic ability of DL and compare it with that of EUS practitioners. Any sources of heterogeneity were explored using subgroup and meta-regression analyses. Results: A total of 10 studies, involving 3,529 patients and 34,773 training images, were included in the present meta-analysis. The pooled sensitivity was 93% (95% confidence interval [CI], 87-96%), the pooled specificity was 95% (95% CI, 89- 98%), and the area under the summary receiver operating characteristic curve (AUC) was 0.98 (95% CI, 0.96-0.99). Conclusion: DL-assisted EUS has a high accuracy and clinical applicability for diagnosing pancreatic tumors. [ABSTRACT FROM AUTHOR]