BACKGROUND Pancreatic,periampullary/ampullary,and choledochal adenocarcinomas are aggressive malignancies with a poor prognosis.Immune checkpoint blockade is a promising treatment option for several tumor types.H long...BACKGROUND Pancreatic,periampullary/ampullary,and choledochal adenocarcinomas are aggressive malignancies with a poor prognosis.Immune checkpoint blockade is a promising treatment option for several tumor types.H long terminal repeatassociating 2(HHLA2),which is analogous to programmed death-ligand 1(PDL1),is a recently discovered member of the B7/cluster of differentiation 28 family and is expressed in many malignancies.AIM To analyze the expression of HHLA2 and its association with the pathologic biomarkers that predict sensitivity to immunotherapy.METHODS Ninety-two adenocarcinoma cases located in the pancreas,ampulla,and distal common bile duct were identified.This study assessed 106 pancreaticoduodenectomy and distal/total pancreatectomy samples that were delivered to Ankara City Hospital between 2019 and 2021.Immunohistochemistry was conducted to examine the expression of DNA mismatch repair(MMR),PD-L1,and HHLA2 proteins.RESULTS Patients with high HHLA2 expression had a higher mean age than those with low expression.Low HHLA2 expression was associated with high perineural invasion.HHLA2 expression was low in pathological stage T3(pT)3 cases and high in pathological stage T1,T2,and T4 cases.There was no correlation between HHLA2 expression and the expression of MMR proteins and PD-L1.CONCLUSION Evaluation of HHLA2 expression in microsatellite stable and PD-L1-negative tumors may be useful for predicting the response of individuals to immunotherapy and may serve as a novel therapeutic target for immunotherapy in advanced-stage disease.展开更多
We present a case of a 76-year-old man with right upper quadrant abdominal pain and weight loss,who was found to have an intraductal papillary neoplasm of the bile duct(IPNB)of the pancreaticobiliary subtype,deemed cu...We present a case of a 76-year-old man with right upper quadrant abdominal pain and weight loss,who was found to have an intraductal papillary neoplasm of the bile duct(IPNB)of the pancreaticobiliary subtype,deemed curatively resectable.The patient declined surgery and opted for endoscopic therapy.He underwent two sessions of endoscopic retrograde cholangiopancreatography(ERCP)-guided radiofrequency ablation(RFA).Ten months later,no evidence of recurrence was identified on repeat ERCP.To our knowledge,this is the first reported case of successful use of RFA as a primary treatment modality for resectable IPNB.展开更多
AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty s...AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty six （58%） biliary endoscopists returned the questionnaire. Of these, 63% were in academia and in practice for an average of 16.4 years （± 8.6）. Endoscopists performed an average of 1.1 （± 0.8） ampullectomies per month. Prior to ampullectomy, endoscopic ultrasound was ＂always＂ utilized by 67% of respondents vs ＂sometimes＂ in 31% of respondents. Empiric biliary sphincterotomy was not utilized uniformly, only 26% ＂always＂ and 37% ＂sometimes＂ performed it prior to resection. Fifty three percent reported ＂never＂ performing empiric pancreatic sphincterotomy prior to ampullectomy. Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy （OR = 10.9; P = 0.09）. Participants overwhelmingly favored ＂always＂ placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection （23%）. Argon plasma coagulation was the favored adjunct modality （83%） for removal of residual adenomatous tissue. Practitioners uniformly （100%） preferred follow-up examination to be within 6 mo postmpullectomy.CONCLUSION： Among biliary experts, there is less variation in ampultectomy practices than is reflected in the literature.展开更多
目的:探讨跨越壶腹部支架置入后犬胆道压力和Oddi括约肌(sphincter of Oddi,SO)病理学的变化机制。材料与方法:选取成年实验犬5只,建立经皮经肝胆囊穿刺和跨越壶腹部置入金属支架的模型,应用胆道测压的方法比较支架置入前和支架置入5周...目的:探讨跨越壶腹部支架置入后犬胆道压力和Oddi括约肌(sphincter of Oddi,SO)病理学的变化机制。材料与方法:选取成年实验犬5只,建立经皮经肝胆囊穿刺和跨越壶腹部置入金属支架的模型,应用胆道测压的方法比较支架置入前和支架置入5周后十二指肠压(duodenal pressure,DP)、SO基础压(sphincter of Oddi basal pressure,SOBP)、收缩幅度(sphincter of Oddi contractive amplitude,SOCA)、收缩间期(sphincter of Oddi duration,SOD)以及胆总管压(common bile duct pressure,CBDP)的变化。同时,应用胶原纤维染色观察支架置入后SO的病理变化。对实验所获得的计量资料采用配对t检验进行比较,P<0.05为差异有统计学意义。结果:以DP作为零点,获得其他各项指标的相对值结果。支架置入前SOBP、SOCA、SOD、CBDP分别为:13.69±4.29mmHg、42.65±8.50mmHg、6.69±1.46s、12.98±2.86mmHg;支架置入5周后分别为:10.58±3.98mmHg、31.95±9.00mmHg、4.47±1.21s、7.43±2.20mmHg,其中SOCA较支架置入前降低,SOD相比支架置入前缩短,两者的差异均有统计学意义(P<0.05)。而CBDP明显低于支架置入前,差异具有统计学意义(P<0.05)。支架置入5周后,壶腹部SO肌层中发生了不同程度的纤维化、腺体病变和炎性反应等病理变化。结论:跨越壶腹部植入支架5周后,SO运动功能的减弱以紧张性收缩的减弱为主,而基础性收缩仍然存在。CBDP虽然下降,但仍高于正常的DP,并保持与之的压力梯度,从而为抑制肠胆反流提供了可能。而壶腹部SO肌层中则发生了不同程度的纤维化、腺体病变和炎性反应等病理变化。展开更多
文摘BACKGROUND Pancreatic,periampullary/ampullary,and choledochal adenocarcinomas are aggressive malignancies with a poor prognosis.Immune checkpoint blockade is a promising treatment option for several tumor types.H long terminal repeatassociating 2(HHLA2),which is analogous to programmed death-ligand 1(PDL1),is a recently discovered member of the B7/cluster of differentiation 28 family and is expressed in many malignancies.AIM To analyze the expression of HHLA2 and its association with the pathologic biomarkers that predict sensitivity to immunotherapy.METHODS Ninety-two adenocarcinoma cases located in the pancreas,ampulla,and distal common bile duct were identified.This study assessed 106 pancreaticoduodenectomy and distal/total pancreatectomy samples that were delivered to Ankara City Hospital between 2019 and 2021.Immunohistochemistry was conducted to examine the expression of DNA mismatch repair(MMR),PD-L1,and HHLA2 proteins.RESULTS Patients with high HHLA2 expression had a higher mean age than those with low expression.Low HHLA2 expression was associated with high perineural invasion.HHLA2 expression was low in pathological stage T3(pT)3 cases and high in pathological stage T1,T2,and T4 cases.There was no correlation between HHLA2 expression and the expression of MMR proteins and PD-L1.CONCLUSION Evaluation of HHLA2 expression in microsatellite stable and PD-L1-negative tumors may be useful for predicting the response of individuals to immunotherapy and may serve as a novel therapeutic target for immunotherapy in advanced-stage disease.
文摘We present a case of a 76-year-old man with right upper quadrant abdominal pain and weight loss,who was found to have an intraductal papillary neoplasm of the bile duct(IPNB)of the pancreaticobiliary subtype,deemed curatively resectable.The patient declined surgery and opted for endoscopic therapy.He underwent two sessions of endoscopic retrograde cholangiopancreatography(ERCP)-guided radiofrequency ablation(RFA).Ten months later,no evidence of recurrence was identified on repeat ERCP.To our knowledge,this is the first reported case of successful use of RFA as a primary treatment modality for resectable IPNB.
文摘AIM： To investigate the endoscopic ampullectomy practices of expert biliary endoscopists. METHODS： An anonymous expert biliary endoscopists practices. survey was mailed to 79 to assess ampullectomy RESULTS： Forty six （58%） biliary endoscopists returned the questionnaire. Of these, 63% were in academia and in practice for an average of 16.4 years （± 8.6）. Endoscopists performed an average of 1.1 （± 0.8） ampullectomies per month. Prior to ampullectomy, endoscopic ultrasound was ＂always＂ utilized by 67% of respondents vs ＂sometimes＂ in 31% of respondents. Empiric biliary sphincterotomy was not utilized uniformly, only 26% ＂always＂ and 37% ＂sometimes＂ performed it prior to resection. Fifty three percent reported ＂never＂ performing empiric pancreatic sphincterotomy prior to ampullectomy. Practitioners with high endoscopic retrograde cholangiopancreatography volumes were the most likely to perform a pancreatic sphincterotomy （OR = 10.9; P = 0.09）. Participants overwhelmingly favored ＂always＂ placing a prophylactic pancreatic stent, with 86% placing it after ampullectomy rather than prior to resection （23%）. Argon plasma coagulation was the favored adjunct modality （83%） for removal of residual adenomatous tissue. Practitioners uniformly （100%） preferred follow-up examination to be within 6 mo postmpullectomy.CONCLUSION： Among biliary experts, there is less variation in ampultectomy practices than is reflected in the literature.
文摘目的:探讨跨越壶腹部支架置入后犬胆道压力和Oddi括约肌(sphincter of Oddi,SO)病理学的变化机制。材料与方法:选取成年实验犬5只,建立经皮经肝胆囊穿刺和跨越壶腹部置入金属支架的模型,应用胆道测压的方法比较支架置入前和支架置入5周后十二指肠压(duodenal pressure,DP)、SO基础压(sphincter of Oddi basal pressure,SOBP)、收缩幅度(sphincter of Oddi contractive amplitude,SOCA)、收缩间期(sphincter of Oddi duration,SOD)以及胆总管压(common bile duct pressure,CBDP)的变化。同时,应用胶原纤维染色观察支架置入后SO的病理变化。对实验所获得的计量资料采用配对t检验进行比较,P<0.05为差异有统计学意义。结果:以DP作为零点,获得其他各项指标的相对值结果。支架置入前SOBP、SOCA、SOD、CBDP分别为:13.69±4.29mmHg、42.65±8.50mmHg、6.69±1.46s、12.98±2.86mmHg;支架置入5周后分别为:10.58±3.98mmHg、31.95±9.00mmHg、4.47±1.21s、7.43±2.20mmHg,其中SOCA较支架置入前降低,SOD相比支架置入前缩短,两者的差异均有统计学意义(P<0.05)。而CBDP明显低于支架置入前,差异具有统计学意义(P<0.05)。支架置入5周后,壶腹部SO肌层中发生了不同程度的纤维化、腺体病变和炎性反应等病理变化。结论:跨越壶腹部植入支架5周后,SO运动功能的减弱以紧张性收缩的减弱为主,而基础性收缩仍然存在。CBDP虽然下降,但仍高于正常的DP,并保持与之的压力梯度,从而为抑制肠胆反流提供了可能。而壶腹部SO肌层中则发生了不同程度的纤维化、腺体病变和炎性反应等病理变化。
