AIM: To analyze the clinico-pathological spectrum of primary duodenal neoplasms. METHODS: A total of 55 primary duodenal neoplasms reported in the last 10 years after excluding ampullary and periampullary tumors were ...AIM: To analyze the clinico-pathological spectrum of primary duodenal neoplasms. METHODS: A total of 55 primary duodenal neoplasms reported in the last 10 years after excluding ampullary and periampullary tumors were included in the study. Clinical details were noted and routine hematoxylin and eosin stained paraffin sections were studied for histological subtyping of the tumors. RESULTS: On histopathological examination primary duodenal neoplasms were categorized as: epithelial tumor in 27 cases (49.0%) including 10 cases of adenoma, 15 cases of adenocarcinoma, and 2 cases of Brunner gland adenoma; mesenchymal tumor in 9 cases (16.3%) consisting of 4 cases of gastrointestinal stromal tumor, 4 cases of smooth muscle tumor and I case of neurofibroma; lymphoproliferative tumor in 12 cases (21.8%), and neuroendocrine tumor in 7 cases (12.7%). CONCLUSION: Although non-ampullary/periampullary duodenal adenocarcinomas are rare, they constitute the largest group. Histopathological examination of primary duodenal tumors is important for correct histological subtyping.展开更多
We present a rare case of a gastrointestinal stromal tumor (GIST) in the stomach with prominent calcifica-tion at presentation. A 61-year-old woman visited our hospital because of epigastric discomfort. A spherical ca...We present a rare case of a gastrointestinal stromal tumor (GIST) in the stomach with prominent calcifica-tion at presentation. A 61-year-old woman visited our hospital because of epigastric discomfort. A spherical calcified lesion with a diameter of about 30 mm was incidentally shown in the left upper quadrant on an abdominal X-ray. Computed tomography demonstrated that the tumor was growing from the upper gastric body, with calcification in the peripheral ring area. A laparoscopic partial gastrectomy was performed, and the resected specimen revealed a well-circumscribed tumor with exophytic growth from the gastric muscularis propria. Microscopic examination revealed spindle- shaped tumor cells with calcification and hemorrhage. Additionally, positive immunoreactivity of the tumor to KIT and CD34 and a low mitotic index resulted in the diagnosis of very low risk GIST. There are a few case reports of heavily calcified GIST, although solitary or punctate calcification of primary GIST has been reported in several case series. Dystrophic calcification of necrotic or degenerative tissue is the supposed cause of primary calcified GISTs. In contrast, appearance of calcification after administration of imatinib mesylate, which may be one indicator of disease response, is possibly caused by a different mechanism.展开更多
We encountered a 65-year-old man with a carcinoid tumor of the minor duodenal papilla. Since he had liver cirrhosis and completely refused surgery, we performed an endoscopic snare papillectomy. The papillectomy was p...We encountered a 65-year-old man with a carcinoid tumor of the minor duodenal papilla. Since he had liver cirrhosis and completely refused surgery, we performed an endoscopic snare papillectomy. The papillectomy was performed successfully without procedure-related complication. The specimens revealed a carcinoid tumor showing that the margin of the tumor was positive. One week later, upper GI endoscopy was performed and the biopsy specimens obtained from base of ulcer showed no neoplastic cells. We performed a duodenoscopy and CT 3, 6 and 18 mo later, and there was no macroscopic or microscopic evidence of tumor recurrence after more than 4 years.展开更多
Small intestinal hemolymphangioma is a very rare benign tumor.There was only one report of a hemolymphangioma of the pancreas invading to the duodenum until March 2011.Here we describe the first case of small intestin...Small intestinal hemolymphangioma is a very rare benign tumor.There was only one report of a hemolymphangioma of the pancreas invading to the duodenum until March 2011.Here we describe the first case of small intestinal hemolymphangioma with bleeding in a 57-year-old woman.She presented with persistent gastrointestinal bleeding and endoscopy revealed a small intestinal tumor.Partial resection of the small intestine was thus performed and the final pathological diagnosis was hemolymphangioma.We also highlight the difficultly in making an accurate preoperative diagnosis in spite of modern imaging techniques.To arrive at a definitive diagnosis and exclude malignancy,partial resection of the small intestine was considered to be the required treatment.展开更多
Pancreatic carcinoma is a debilitating disease and carries a poor prognosis. It is a rare cause of upper gastrointestinal bleeding, even though pancreas, stomach, duodenum and jejunum are adjacent organs. The incidenc...Pancreatic carcinoma is a debilitating disease and carries a poor prognosis. It is a rare cause of upper gastrointestinal bleeding, even though pancreas, stomach, duodenum and jejunum are adjacent organs. The incidence of pancreatic adenocarcinoma directly invading the gastrointestinal tract leading to gastrointestinal hemorrhage is very low, and most of them present with melena and hematochezia. Here, we describe one unique case manifesting characteristically severe and unremitting hematemesis as an initial presentation of pancreatic adenocarcinoma. This tumor directly invaded the duodenal mucosa as a bleeding protruding tumor mass. Our MEDLINE search has confirmed that this is the first reported case with an initial manifestation of hematemesis from pancreatic adenocarcinoma in Asians.Pancreatic adenocarcinoma directly invading duodenum complicated by hemorrhage can be a rare cause of hematemesis, and clinicians should be reminded of it while they are making differential diagnosis.展开更多
Objective This study aimed to adapt relevant clinical practice guidelines for distress management in cancer patients based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT),and develop Canc...Objective This study aimed to adapt relevant clinical practice guidelines for distress management in cancer patients based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT),and develop Cancer-related Distress Management Guidelines in the context of the research site.Methods According to CAN-IMPLEMENT,the symptoms of cancer patients in Shanghai were investigated,and a work plan was formulated to adapt cancer-related distress management guidelines.The relevant clinical practice guidelines for distress management in cancer patients were searched,screened and assessed,the contents of the included clinical practice guidelines were screened,extracted and integrated,and the Cancer-related Distress Management Guidelines was developed.After peer review,the Cancer-related Distress Management Guidelines was finally formed.Results The physical symptom distress score was higher than the psychological symptom distress score among cancer patients in Shanghai.Two clinical practice guidelines related to distress management in cancer patients were included after searching,screening,assessment and selection systematically.The domain scores of the draft Cancer-related Distress Management Guidelines on Appraisal of Guidelines for Research and Evaluation II(AGREE II)were 73.75%–87.50%,respectively.The scores of most recommendations on feasibility,appropriateness,meaningfulness and effectiveness were at least 90%.The final guidelines included 13 recommendations.Conclusions The quality of the draft Cancer-related Distress Management Guidelines based on two included guidelines was well-accepted.The final Cancer-related Distress Management Guidelines needs to be further verified in clinical practice for feasibility,suitability and effectiveness.展开更多
Objective： To discuss the diagnosis and treatment of glomus tumor at the nail bed of the finger. Methods： The course and therapeutic outcome of 12 cases of glomus tumor which were resected and confirmed by histology...Objective： To discuss the diagnosis and treatment of glomus tumor at the nail bed of the finger. Methods： The course and therapeutic outcome of 12 cases of glomus tumor which were resected and confirmed by histology examination were analyzed. Results：All cases were followed up for six months up to 2 years, no recurrences were observed, the shape of the nait was normal. Conclusion： Microsurgical treatment of glomus tumors of the nail bed is effective.展开更多
The incidence of early gastric cancer （EGC） with duodenal invasion is extremely low, although advanced gastric cancer that arises in the antrum occasionally invades the duodenum. We investigated the clinicopathologi...The incidence of early gastric cancer （EGC） with duodenal invasion is extremely low, although advanced gastric cancer that arises in the antrum occasionally invades the duodenum. We investigated the clinicopathological features of EGC with duodenal invasion and provided strategies for clinical management.A Medline search was performed using the keyword early gastric cancer＂ and ＂duodenal invasion＇： Additional articles were obtained from references within the papers identified by the Medline search. We revealed that EGC with duodenal invasion was of the superficial spreading type of tumor. Tumors 〉 60 mm in size invaded the duodenum more extensively, and the distance of duodenal invasion from the pyloric ring was further in the elevated type than in the depressed type of tumor.There was no significant difference between the length of duodenal invasion and the histological type of the tumor. Gastric cancer located adjacent to the pyloric ring, even if cancer invasion was confined to the mucosa or submucosa, was more likely to invade the duodenum.The present study reveals that the elevated type of EGC is associated with more extensive duodenal invasion when the tumor size is 〉 60 ram, thus highlighting the importance of identification of duodenal invasion in these cases. We also reveal that sufficient duodenal resection with a cancer-free distal surgical margin should be performed in cases of duodenal invasion.展开更多
Next-generation sequencing(NGS) has been rapidly integrated into molecular pathology, dramatically increasing the breadth genomic of information available to oncologists and their patients. This review will explore th...Next-generation sequencing(NGS) has been rapidly integrated into molecular pathology, dramatically increasing the breadth genomic of information available to oncologists and their patients. This review will explore the ways in which this new technology is currently applied to bolster care for patients with solid tumors and hematological malignancies, focusing on practices and guidelines for assessing the technical validity and clinical utility of DNA variants identified during clinical NGS oncology testing.展开更多
AIM： To search for the optimal surgery for gastrinoma and duodenopancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1. METHODS： Sixteen patients with genetically confirmed multiple e...AIM： To search for the optimal surgery for gastrinoma and duodenopancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1. METHODS： Sixteen patients with genetically confirmed multiple endocrine neoplasia type 1 （MEN 1） and Zollinger-Ellison syndrome （ZES） underwent resection of both gastrinomas and duodenopancreatic neuroendocrine tumors （NETs） between 1991 and 2009. For localization of gastrinoma, selective arterial secretagogue injection test （SASI test） with secretin or calcium solution was performed as well as somatostatin receptor scintigraphy （SRS） and other imaging methods such as computed tomography （CT） or magnetic resonance imaging （MRI）. The modus of surgery for gastrinoma has been changed over time, searching for the optimal surgery： pancreaticoduodenectomy （PD） was first performed guided by localization with the SAST test, then local resection of duodenal gastrinomas with dissection of regional lymph nodes （LR）, and recently pancreas-preserving total duodenectomy （PPTD） has been performed for multiple duodenal gastrinomas. RESULTS： Among various types of preoperative localizing methods for gastrinoma, the SASI test was the most useful method. Imaging methods such as SRS or CT made it essentially impossible to differentiate functioning gastrinoma among various kinds of NETs. However, recent imaging methods including SRS or CT were useful for detecting both distant metastases and ectopic NETs; therefore they are indispensable for staging of NETs. Biochemical cure of gastrinoma was achieved in 14 of 16 patients （87.5%）; that is, 100% in 3 patients who underwent PD, 100% in 6 patients who underwent LR （although in 2 patients （33.3%） second LR was performed for recurrence of duodenal gastri- noma）, and 71.4% in 7 patients who underwent PPTD. Pancreatic NETs more than 1 cm in diameter were resected either by distal pancreatectomy or enucleations, and no hepatic metastases have developed postoperatively. Pathological study of the resected specimens revealed co-existence of pancreatic gastrinoma with duodenal gastrinoma in 2 of 16 patients （13%）, and G cell hyperplasia and/or microgastrinoma in the duodenal Brunner＇s gland was revealed in all of 7 duodenal specimens after PPTD. CONCLUSION： Aggressive resection surgery based on accurate localization with the SASI test was useful for biochemical cure of gastrinoma in patients with MEN 1.Imamura Metal. Curative resection of gastrinoma in MEN-1展开更多
AIM： To study the correlations of Pancreas duodenal homeobox-1 with pancreatic cancer characteristics, including pathological grading, TNM grading, tumor metastasis and tumor cell proliferation. METHODS： Reverse tra...AIM： To study the correlations of Pancreas duodenal homeobox-1 with pancreatic cancer characteristics, including pathological grading, TNM grading, tumor metastasis and tumor cell proliferation. METHODS： Reverse transcriptase-polymerase chain reaction （RT-PCR） was used to detect PDX-1 mRNA expression in pancreatic cancer tissue and normal pancreatic tissue. The expression of PDX-1 protein was measured by Western blot and immunohistochemistry. Immunohistochemistry was also used to detect proliferative cell nuclear antigen （PCNA）. Correlations of PDX-1 with pancreatic cancer characteristics, including pathological grading, TNM grading, tumor metastasis and tumor cell proliferation, were analyzed by using χ^2 test. RESULTS： Immunohistochemistry showed that 41.1% of pancreatic cancers were positive for PDX-1 expression, but normal pancreatic tissue except islets showed no staining for PDX-1. In consistent with the result of imunohistochemistry, Western blot showed that 37.5% of pancreatic cancers were positive for PDX-1. RT-PCR showed that PDX-1 expression was significantly higher in pancreatic cancer tissues than normal pancreatic tissues （2^-3.56±0.35 vs 2^-8.76±0.14, p 〈 0.01）. Lymph node metastasis （P 〈 0.01）, TNM grading （P 〈 0.05）, pathological grading （P 〈 0.05） and tumor cell proliferation （P 〈 0.01） were significantly correlated with PDX-1 expression levels. CONCLUSION： PDX-1 is re-expressed in pancreatic cancer, and PDX-l-positive pancreatic cancer cells show more malignant potential compared to PDX-l-negative cells. Therefore, PDX-l-positive cells may be tumor stemcells and PDX-1 may act as alternate surface marker of pancreatic cancer stem cells.展开更多
文摘AIM: To analyze the clinico-pathological spectrum of primary duodenal neoplasms. METHODS: A total of 55 primary duodenal neoplasms reported in the last 10 years after excluding ampullary and periampullary tumors were included in the study. Clinical details were noted and routine hematoxylin and eosin stained paraffin sections were studied for histological subtyping of the tumors. RESULTS: On histopathological examination primary duodenal neoplasms were categorized as: epithelial tumor in 27 cases (49.0%) including 10 cases of adenoma, 15 cases of adenocarcinoma, and 2 cases of Brunner gland adenoma; mesenchymal tumor in 9 cases (16.3%) consisting of 4 cases of gastrointestinal stromal tumor, 4 cases of smooth muscle tumor and I case of neurofibroma; lymphoproliferative tumor in 12 cases (21.8%), and neuroendocrine tumor in 7 cases (12.7%). CONCLUSION: Although non-ampullary/periampullary duodenal adenocarcinomas are rare, they constitute the largest group. Histopathological examination of primary duodenal tumors is important for correct histological subtyping.
文摘We present a rare case of a gastrointestinal stromal tumor (GIST) in the stomach with prominent calcifica-tion at presentation. A 61-year-old woman visited our hospital because of epigastric discomfort. A spherical calcified lesion with a diameter of about 30 mm was incidentally shown in the left upper quadrant on an abdominal X-ray. Computed tomography demonstrated that the tumor was growing from the upper gastric body, with calcification in the peripheral ring area. A laparoscopic partial gastrectomy was performed, and the resected specimen revealed a well-circumscribed tumor with exophytic growth from the gastric muscularis propria. Microscopic examination revealed spindle- shaped tumor cells with calcification and hemorrhage. Additionally, positive immunoreactivity of the tumor to KIT and CD34 and a low mitotic index resulted in the diagnosis of very low risk GIST. There are a few case reports of heavily calcified GIST, although solitary or punctate calcification of primary GIST has been reported in several case series. Dystrophic calcification of necrotic or degenerative tissue is the supposed cause of primary calcified GISTs. In contrast, appearance of calcification after administration of imatinib mesylate, which may be one indicator of disease response, is possibly caused by a different mechanism.
文摘We encountered a 65-year-old man with a carcinoid tumor of the minor duodenal papilla. Since he had liver cirrhosis and completely refused surgery, we performed an endoscopic snare papillectomy. The papillectomy was performed successfully without procedure-related complication. The specimens revealed a carcinoid tumor showing that the margin of the tumor was positive. One week later, upper GI endoscopy was performed and the biopsy specimens obtained from base of ulcer showed no neoplastic cells. We performed a duodenoscopy and CT 3, 6 and 18 mo later, and there was no macroscopic or microscopic evidence of tumor recurrence after more than 4 years.
文摘Small intestinal hemolymphangioma is a very rare benign tumor.There was only one report of a hemolymphangioma of the pancreas invading to the duodenum until March 2011.Here we describe the first case of small intestinal hemolymphangioma with bleeding in a 57-year-old woman.She presented with persistent gastrointestinal bleeding and endoscopy revealed a small intestinal tumor.Partial resection of the small intestine was thus performed and the final pathological diagnosis was hemolymphangioma.We also highlight the difficultly in making an accurate preoperative diagnosis in spite of modern imaging techniques.To arrive at a definitive diagnosis and exclude malignancy,partial resection of the small intestine was considered to be the required treatment.
文摘Pancreatic carcinoma is a debilitating disease and carries a poor prognosis. It is a rare cause of upper gastrointestinal bleeding, even though pancreas, stomach, duodenum and jejunum are adjacent organs. The incidence of pancreatic adenocarcinoma directly invading the gastrointestinal tract leading to gastrointestinal hemorrhage is very low, and most of them present with melena and hematochezia. Here, we describe one unique case manifesting characteristically severe and unremitting hematemesis as an initial presentation of pancreatic adenocarcinoma. This tumor directly invaded the duodenal mucosa as a bleeding protruding tumor mass. Our MEDLINE search has confirmed that this is the first reported case with an initial manifestation of hematemesis from pancreatic adenocarcinoma in Asians.Pancreatic adenocarcinoma directly invading duodenum complicated by hemorrhage can be a rare cause of hematemesis, and clinicians should be reminded of it while they are making differential diagnosis.
文摘Objective This study aimed to adapt relevant clinical practice guidelines for distress management in cancer patients based on A Guideline Adaptation and Implementation Planning Resource(CAN-IMPLEMENT),and develop Cancer-related Distress Management Guidelines in the context of the research site.Methods According to CAN-IMPLEMENT,the symptoms of cancer patients in Shanghai were investigated,and a work plan was formulated to adapt cancer-related distress management guidelines.The relevant clinical practice guidelines for distress management in cancer patients were searched,screened and assessed,the contents of the included clinical practice guidelines were screened,extracted and integrated,and the Cancer-related Distress Management Guidelines was developed.After peer review,the Cancer-related Distress Management Guidelines was finally formed.Results The physical symptom distress score was higher than the psychological symptom distress score among cancer patients in Shanghai.Two clinical practice guidelines related to distress management in cancer patients were included after searching,screening,assessment and selection systematically.The domain scores of the draft Cancer-related Distress Management Guidelines on Appraisal of Guidelines for Research and Evaluation II(AGREE II)were 73.75%–87.50%,respectively.The scores of most recommendations on feasibility,appropriateness,meaningfulness and effectiveness were at least 90%.The final guidelines included 13 recommendations.Conclusions The quality of the draft Cancer-related Distress Management Guidelines based on two included guidelines was well-accepted.The final Cancer-related Distress Management Guidelines needs to be further verified in clinical practice for feasibility,suitability and effectiveness.
文摘Objective： To discuss the diagnosis and treatment of glomus tumor at the nail bed of the finger. Methods： The course and therapeutic outcome of 12 cases of glomus tumor which were resected and confirmed by histology examination were analyzed. Results：All cases were followed up for six months up to 2 years, no recurrences were observed, the shape of the nait was normal. Conclusion： Microsurgical treatment of glomus tumors of the nail bed is effective.
文摘The incidence of early gastric cancer （EGC） with duodenal invasion is extremely low, although advanced gastric cancer that arises in the antrum occasionally invades the duodenum. We investigated the clinicopathological features of EGC with duodenal invasion and provided strategies for clinical management.A Medline search was performed using the keyword early gastric cancer＂ and ＂duodenal invasion＇： Additional articles were obtained from references within the papers identified by the Medline search. We revealed that EGC with duodenal invasion was of the superficial spreading type of tumor. Tumors 〉 60 mm in size invaded the duodenum more extensively, and the distance of duodenal invasion from the pyloric ring was further in the elevated type than in the depressed type of tumor.There was no significant difference between the length of duodenal invasion and the histological type of the tumor. Gastric cancer located adjacent to the pyloric ring, even if cancer invasion was confined to the mucosa or submucosa, was more likely to invade the duodenum.The present study reveals that the elevated type of EGC is associated with more extensive duodenal invasion when the tumor size is 〉 60 ram, thus highlighting the importance of identification of duodenal invasion in these cases. We also reveal that sufficient duodenal resection with a cancer-free distal surgical margin should be performed in cases of duodenal invasion.
文摘Next-generation sequencing(NGS) has been rapidly integrated into molecular pathology, dramatically increasing the breadth genomic of information available to oncologists and their patients. This review will explore the ways in which this new technology is currently applied to bolster care for patients with solid tumors and hematological malignancies, focusing on practices and guidelines for assessing the technical validity and clinical utility of DNA variants identified during clinical NGS oncology testing.
基金Supported by a Health and Labor Sciences Research Grant from the Ministry of Health, Labor and Welfare, Government of Japan (Grant No. H21-Nanchi-Ippan-037)
文摘AIM： To search for the optimal surgery for gastrinoma and duodenopancreatic neuroendocrine tumors in patients with multiple endocrine neoplasia type 1. METHODS： Sixteen patients with genetically confirmed multiple endocrine neoplasia type 1 （MEN 1） and Zollinger-Ellison syndrome （ZES） underwent resection of both gastrinomas and duodenopancreatic neuroendocrine tumors （NETs） between 1991 and 2009. For localization of gastrinoma, selective arterial secretagogue injection test （SASI test） with secretin or calcium solution was performed as well as somatostatin receptor scintigraphy （SRS） and other imaging methods such as computed tomography （CT） or magnetic resonance imaging （MRI）. The modus of surgery for gastrinoma has been changed over time, searching for the optimal surgery： pancreaticoduodenectomy （PD） was first performed guided by localization with the SAST test, then local resection of duodenal gastrinomas with dissection of regional lymph nodes （LR）, and recently pancreas-preserving total duodenectomy （PPTD） has been performed for multiple duodenal gastrinomas. RESULTS： Among various types of preoperative localizing methods for gastrinoma, the SASI test was the most useful method. Imaging methods such as SRS or CT made it essentially impossible to differentiate functioning gastrinoma among various kinds of NETs. However, recent imaging methods including SRS or CT were useful for detecting both distant metastases and ectopic NETs; therefore they are indispensable for staging of NETs. Biochemical cure of gastrinoma was achieved in 14 of 16 patients （87.5%）; that is, 100% in 3 patients who underwent PD, 100% in 6 patients who underwent LR （although in 2 patients （33.3%） second LR was performed for recurrence of duodenal gastri- noma）, and 71.4% in 7 patients who underwent PPTD. Pancreatic NETs more than 1 cm in diameter were resected either by distal pancreatectomy or enucleations, and no hepatic metastases have developed postoperatively. Pathological study of the resected specimens revealed co-existence of pancreatic gastrinoma with duodenal gastrinoma in 2 of 16 patients （13%）, and G cell hyperplasia and/or microgastrinoma in the duodenal Brunner＇s gland was revealed in all of 7 duodenal specimens after PPTD. CONCLUSION： Aggressive resection surgery based on accurate localization with the SASI test was useful for biochemical cure of gastrinoma in patients with MEN 1.Imamura Metal. Curative resection of gastrinoma in MEN-1
基金Supported by the grants from the National Natural Science Foundation of China, No.30571817the PhD Programs Foundation of Ministry of Education of China, No. 20050487077
文摘AIM： To study the correlations of Pancreas duodenal homeobox-1 with pancreatic cancer characteristics, including pathological grading, TNM grading, tumor metastasis and tumor cell proliferation. METHODS： Reverse transcriptase-polymerase chain reaction （RT-PCR） was used to detect PDX-1 mRNA expression in pancreatic cancer tissue and normal pancreatic tissue. The expression of PDX-1 protein was measured by Western blot and immunohistochemistry. Immunohistochemistry was also used to detect proliferative cell nuclear antigen （PCNA）. Correlations of PDX-1 with pancreatic cancer characteristics, including pathological grading, TNM grading, tumor metastasis and tumor cell proliferation, were analyzed by using χ^2 test. RESULTS： Immunohistochemistry showed that 41.1% of pancreatic cancers were positive for PDX-1 expression, but normal pancreatic tissue except islets showed no staining for PDX-1. In consistent with the result of imunohistochemistry, Western blot showed that 37.5% of pancreatic cancers were positive for PDX-1. RT-PCR showed that PDX-1 expression was significantly higher in pancreatic cancer tissues than normal pancreatic tissues （2^-3.56±0.35 vs 2^-8.76±0.14, p 〈 0.01）. Lymph node metastasis （P 〈 0.01）, TNM grading （P 〈 0.05）, pathological grading （P 〈 0.05） and tumor cell proliferation （P 〈 0.01） were significantly correlated with PDX-1 expression levels. CONCLUSION： PDX-1 is re-expressed in pancreatic cancer, and PDX-l-positive pancreatic cancer cells show more malignant potential compared to PDX-l-negative cells. Therefore, PDX-l-positive cells may be tumor stemcells and PDX-1 may act as alternate surface marker of pancreatic cancer stem cells.
