BACKGROUND: Serum cancer antigen 19-9 (CA19-9) pro-vides additional information about mucinous cystic pancre-atic neoplasm (MPN). This study was undertaken to assess both CA19-9 and carcinoembryonic antigen (CEA) seru...BACKGROUND: Serum cancer antigen 19-9 (CA19-9) pro-vides additional information about mucinous cystic pancre-atic neoplasm (MPN). This study was undertaken to assess both CA19-9 and carcinoembryonic antigen (CEA) serum concentrations in consecutive patients affected by MPNs and other chronic benign and malignant pancreatic diseases. We also evaluated whether serum CA19-9 and CEA determina-tions provide additional information such as the presence of invasive carcinoma in MPN patients. METHODS: Serum CA19-9 and CEA from 91 patients with pancreatic diseases were tested by commercially available kits at the time of diagnosis. The upper reference limit of serum CA19-9 was 37 U/mL and that of serum CEA was 3 ng/mL. RESULTS: Thirty-ifve patients was diagnosed with chronic pancreatitis (CP), 32 with MPN, and 24 with pancreatic ductal adenocarcinoma (PDAC) conifrmed histologically. Surgery was carried out in 5 CP patients, in 10 MPN patients (7 of them had severe dysplasia), and 9 PDAC patients. Serum CA19-9 activity was high in 12 (34.3%) CP patients, in 7 (21.9%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.089). High se-rum CEA concentrations were noted in 6 (17.1%) CP patients, in 6 (18.8%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.010). In the 7 MPN patients associated with histological-ly conifrmed severe dysplasia, 3 (42.9%) patients had elevated serum activity of serum CA19-9, and 2 (28.6%) patients had high levels of CEA. CONCLUSION: Serum determination of oncological markers is not useful in selecting MPN patients with malignant changes.展开更多
BACKGROUND Primary pancreatic lymphoma(PPL)is a rare neoplasm.Being able to distinguish it from other pancreatic malignancies such as pancreatic ductal adenocarcinoma(PDAC)is important for appropriate management.Unlik...BACKGROUND Primary pancreatic lymphoma(PPL)is a rare neoplasm.Being able to distinguish it from other pancreatic malignancies such as pancreatic ductal adenocarcinoma(PDAC)is important for appropriate management.Unlike PDAC,PPL is highly sensitive to chemotherapy and usually does not require surgery.Therefore,being able to identify PPL preoperatively will not only direct physicians towards the correct avenue of treatment,it will also avoid unnecessary surgical intervention.AIM To evaluate the typical and atypical multi-phasic computed tomography(CT)imaging features of PPL.METHODS A retrospective review was conducted of the clinical,radiological,and pathological records of all subjects with pathologically proven PPL who presented to our institutions between January 2000 and December 2020.Institutional review board approval was obtained for this investigation.The collected data were analyzed for subject demographics,clinical presentation,laboratory values,CT imaging features,and the treatment received.Presence of all CT imaging findings including size,site,morphology and imaging characteristics of PPL such as the presence or absence of nodal,vascular and ductal involvement in these subjects were recorded.Only those subjects who had a pre-treatment multiphasic CT of the abdomen were included in the study.RESULTS Twenty-nine cases of PPL were diagnosed between January 2000 and December 2020(mean age 66 years;13 males/16 females).All twenty-nine subjects were symptomatic but only 4 of the 29 subjects(14%)had B symptoms.Obstructive jaundice occurred in 24%of subjects.Elevated lactate dehydrogenase was seen in 81%of cases,whereas elevated cancer antigen 19-9 levels were present in only 10%of cases for which levels were recorded.The vast majority(90%)of tumors involved the pancreatic head and uncinate process.Mean tumor size was 7.8 cm(range,4.0-13.8 cm).PPL presented homogenous hypoenhancement on CT in 72%of cases.Small volume peripancreatic lymphadenopathy was seen in 28%of subjects.Tumors demonstrated encasement of superior mesenteric vessels in 69%of cases but vascular stenosis or occlusion only manifested in 5 out of the twentynine individuals(17%).Mild pancreatic duct dilatation was also infrequent and seen in only 17%of cases,whereas common bile duct(CBD)dilation was seen in 41%of subjects.Necrosis occurred in 10%of cases.Size did not impact the prevalence of pancreatic and CBD dilation,necrosis,or mesenteric root infiltration(P=0.525,P=0.294,P=0.543,and P=0.097,respectively).Pancreatic atrophy was not present in any of the subjects.CONCLUSION PPL is an uncommon diagnosis best made preoperatively to avoid unnecessary surgery and ensure adequate treatment.In addition to the typical CT findings of PPL,such as homogeneous hypoenhancement,absence of vascular stenosis and occlusion despite encasement,and peripancreatic lymphadenopathy,this study highlighted many less typical findings,including small volume necrosis and pancreatic and bile duct dilation.展开更多
Pancreatic cancer is a lethal malignancy,whose precursor lesions are pancreatic intraepithelial neoplasm,intraductal papillary mucinous neoplasm,intraductal tubulopapillary neoplasm,and mucinous cystic neoplasm.To bet...Pancreatic cancer is a lethal malignancy,whose precursor lesions are pancreatic intraepithelial neoplasm,intraductal papillary mucinous neoplasm,intraductal tubulopapillary neoplasm,and mucinous cystic neoplasm.To better understand the biology of pancreatic cancer,it is fundamental to know its precursors and to study the mechanisms of carcinogenesis.Each of these precursors displays peculiar histological features,as well as specific molecular alterations.Starting from such pre-invasive lesions,this review aims at summarizing the most important aspects of carcinogenesis of pancreatic cancer,with a specific focus on the recent advances and the future perspectives of the research on this lethal tumor type.展开更多
Pancreatic cancer currently has no subtypes that inform clinical decisions;hence,there exists an opportunity to rearrange the morphological and molecular taxonomy that guides a better understanding of tumor characteri...Pancreatic cancer currently has no subtypes that inform clinical decisions;hence,there exists an opportunity to rearrange the morphological and molecular taxonomy that guides a better understanding of tumor characteristics.Nonetheless,accumulating studies to date have revealed the large-duct type variant,a unique subtype of pancreatic ductal adenocarcinoma(PDA)with cystic features.This subtype often radiographically mimics intraductal papillary mucinous neoplasms(IPMNs)and involves multiple small cysts occasionally associated with solid masses.The“bunch-of-grapes”sign,an imaging characteristic of IPMNs,is absent in large-duct PDA.Large-duct PDA defines the mucin profile,and genetic alterations are useful in distinguishing large-duct PDA from IPMNs.Histologically,neoplastic ducts measure over 0.5 mm,forming large ductal elements.Similar to classic PDAs,this subtype is frequently accompanied by perineural invasion and abundant desmoplastic reactions,and KRAS mutations in codon 12 are nearly ubiquitous.Despite such morphological similarities with IPMNs,the prognosis of large-duct PDA is equivalent to that of classic PDA.Differential diagnosis is therefore essential.展开更多
Pancreatic carcinoma occasionally associated with prominent mucin production and this type of tumor designated as PCM (pancreatic carcinoma with prominent mucin production) was diagnosed depends on subjective estimati...Pancreatic carcinoma occasionally associated with prominent mucin production and this type of tumor designated as PCM (pancreatic carcinoma with prominent mucin production) was diagnosed depends on subjective estimation of the amount of mucous area, and there has been no report on a quantitative evaluation of the amount of mucinous area in the tumor. To examine the feature of PCM, we analyzed 9 cases of PCM among 243 cases of pancreas carcinoma and evaluated the amount of mucin by imaging analysis. Morphologically, 5 cases were classified as intradactal papillary mucinous neoplasms (IPMN)-derived PCM and 4 cases were as ductal adenocarcinoma (DA)-derived PCM. Mucous composition was found to be more than 50% in all IPMN-derived PCM cases, and that was 40% - 50% in DA-derived PCM cases with one exception. IPMN-derived PCM cases showed expansive growth with pancreatic duct dilatation filled with mucin, while DA-derived PCM cases possessed mucin infiltration into interstitial tissue. Immunohisto-chemically, three of 4 DA-derived PCM cases were MUC1(–)/MUC2(+), and the results of expressions for p16 and Dpc4 suggesting that DA-derived PCM was similar to IPMN-derived PCM rather than ordinary DA. Survival rate of DA-derived PCM cases was lower than that of IPMN-derived PCM cases. We advocate that DA-derived PCM may constitute a borderline group between IPMN and ordinary DA.展开更多
目的探究着丝粒蛋白F(centromere protein F,CENPF)在胰腺导管腺癌(pancreatic ductual adenocarcinoma,PDAC)中的表达及其与临床病理特征和预后的关系。方法基于美国国家生物信息中心(National Center for Biotechnology Information,N...目的探究着丝粒蛋白F(centromere protein F,CENPF)在胰腺导管腺癌(pancreatic ductual adenocarcinoma,PDAC)中的表达及其与临床病理特征和预后的关系。方法基于美国国家生物信息中心(National Center for Biotechnology Information,NCBI)的微阵列/基因谱公共数据库(Gene Expression Omnibus,GEO),运用GEO2R、维恩、Cytoscape及GEPIA软件筛选出PDAC中可疑差异基因CENPF;基于癌症基因组图谱(The Cancer Genome Atlas,TCGA)及基因组织表达数据库(The Genotype-Tissue Expression,GTEx),通过NCBI网络、GEPIA、Ualcan、Oncomine、TIMER软件及Kaplan-Meier在线生存分析工具,从信使核糖核酸(messenger RNA)层面分析其表达与免疫细胞浸润的关系及其可能的分子机制。同时收集2007~2021年间经福建医科大学附属第一医院病理科确诊的胰腺导管腺癌手术标本121例,从组织蛋白层面分析CENPF与PDAC临床病理特征及预后的关系。结果CENPF基因在人类多种癌症中表达异常,在PDAC中,癌组织中的表达水平显著高于癌旁正常胰腺组织(P<0.05),并且与PDAC组织学分级(P<0.05)、预后(P=0.0038)有关。免疫组化显示CENPF的表达与PDAC的神经侵犯(P=0.036)、TNM分期(P=0.041)、淋巴结转移(P=0.023)、分化程度(P=0.020)、总生存期有关(Log-rank=18.608,P=0.000016),CENPF高表达(HR=2.654,95%CI=1.373~5.131,P=0.004)是PDAC患者预后差的独立危险因素。CENPF联合其他关键模块基因在PDAC中,主要富集于外泌体、细胞外基质等,并与丝氨酸内肽酶活性、金属肽链内切酶活性有关等。CENPF在胰腺导管腺癌中的作用通路主要与细胞周期、P53通路、泛素介导的蛋白水解等相关,并与P53、MDM2在PDAC中联合发挥作用。免疫浸润研究表明CENPF表达与CD4+T淋巴细胞浸润负相关、与树突细胞的浸润正相关(均P<0.05)。结论CENPF可能参与PDAC疾病的进程,其高表达与PDAC预后不良相关,该研究有望为胰腺导管腺癌的防治提供更多科学基础。展开更多
文摘BACKGROUND: Serum cancer antigen 19-9 (CA19-9) pro-vides additional information about mucinous cystic pancre-atic neoplasm (MPN). This study was undertaken to assess both CA19-9 and carcinoembryonic antigen (CEA) serum concentrations in consecutive patients affected by MPNs and other chronic benign and malignant pancreatic diseases. We also evaluated whether serum CA19-9 and CEA determina-tions provide additional information such as the presence of invasive carcinoma in MPN patients. METHODS: Serum CA19-9 and CEA from 91 patients with pancreatic diseases were tested by commercially available kits at the time of diagnosis. The upper reference limit of serum CA19-9 was 37 U/mL and that of serum CEA was 3 ng/mL. RESULTS: Thirty-ifve patients was diagnosed with chronic pancreatitis (CP), 32 with MPN, and 24 with pancreatic ductal adenocarcinoma (PDAC) conifrmed histologically. Surgery was carried out in 5 CP patients, in 10 MPN patients (7 of them had severe dysplasia), and 9 PDAC patients. Serum CA19-9 activity was high in 12 (34.3%) CP patients, in 7 (21.9%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.089). High se-rum CEA concentrations were noted in 6 (17.1%) CP patients, in 6 (18.8%) MPN patients, and in 12 (50.0%) PDAC patients (P=0.010). In the 7 MPN patients associated with histological-ly conifrmed severe dysplasia, 3 (42.9%) patients had elevated serum activity of serum CA19-9, and 2 (28.6%) patients had high levels of CEA. CONCLUSION: Serum determination of oncological markers is not useful in selecting MPN patients with malignant changes.
文摘BACKGROUND Primary pancreatic lymphoma(PPL)is a rare neoplasm.Being able to distinguish it from other pancreatic malignancies such as pancreatic ductal adenocarcinoma(PDAC)is important for appropriate management.Unlike PDAC,PPL is highly sensitive to chemotherapy and usually does not require surgery.Therefore,being able to identify PPL preoperatively will not only direct physicians towards the correct avenue of treatment,it will also avoid unnecessary surgical intervention.AIM To evaluate the typical and atypical multi-phasic computed tomography(CT)imaging features of PPL.METHODS A retrospective review was conducted of the clinical,radiological,and pathological records of all subjects with pathologically proven PPL who presented to our institutions between January 2000 and December 2020.Institutional review board approval was obtained for this investigation.The collected data were analyzed for subject demographics,clinical presentation,laboratory values,CT imaging features,and the treatment received.Presence of all CT imaging findings including size,site,morphology and imaging characteristics of PPL such as the presence or absence of nodal,vascular and ductal involvement in these subjects were recorded.Only those subjects who had a pre-treatment multiphasic CT of the abdomen were included in the study.RESULTS Twenty-nine cases of PPL were diagnosed between January 2000 and December 2020(mean age 66 years;13 males/16 females).All twenty-nine subjects were symptomatic but only 4 of the 29 subjects(14%)had B symptoms.Obstructive jaundice occurred in 24%of subjects.Elevated lactate dehydrogenase was seen in 81%of cases,whereas elevated cancer antigen 19-9 levels were present in only 10%of cases for which levels were recorded.The vast majority(90%)of tumors involved the pancreatic head and uncinate process.Mean tumor size was 7.8 cm(range,4.0-13.8 cm).PPL presented homogenous hypoenhancement on CT in 72%of cases.Small volume peripancreatic lymphadenopathy was seen in 28%of subjects.Tumors demonstrated encasement of superior mesenteric vessels in 69%of cases but vascular stenosis or occlusion only manifested in 5 out of the twentynine individuals(17%).Mild pancreatic duct dilatation was also infrequent and seen in only 17%of cases,whereas common bile duct(CBD)dilation was seen in 41%of subjects.Necrosis occurred in 10%of cases.Size did not impact the prevalence of pancreatic and CBD dilation,necrosis,or mesenteric root infiltration(P=0.525,P=0.294,P=0.543,and P=0.097,respectively).Pancreatic atrophy was not present in any of the subjects.CONCLUSION PPL is an uncommon diagnosis best made preoperatively to avoid unnecessary surgery and ensure adequate treatment.In addition to the typical CT findings of PPL,such as homogeneous hypoenhancement,absence of vascular stenosis and occlusion despite encasement,and peripancreatic lymphadenopathy,this study highlighted many less typical findings,including small volume necrosis and pancreatic and bile duct dilation.
基金Supported by the Associazione Italiana Ricerca sul Cancro,No.12182Cassini Project
文摘Pancreatic cancer is a lethal malignancy,whose precursor lesions are pancreatic intraepithelial neoplasm,intraductal papillary mucinous neoplasm,intraductal tubulopapillary neoplasm,and mucinous cystic neoplasm.To better understand the biology of pancreatic cancer,it is fundamental to know its precursors and to study the mechanisms of carcinogenesis.Each of these precursors displays peculiar histological features,as well as specific molecular alterations.Starting from such pre-invasive lesions,this review aims at summarizing the most important aspects of carcinogenesis of pancreatic cancer,with a specific focus on the recent advances and the future perspectives of the research on this lethal tumor type.
基金Japan Society for the Promotion of Science(JSPS)KAKENHI,No.19K17480(to Sato H),and No.20H03655(Mizukami Y).
文摘Pancreatic cancer currently has no subtypes that inform clinical decisions;hence,there exists an opportunity to rearrange the morphological and molecular taxonomy that guides a better understanding of tumor characteristics.Nonetheless,accumulating studies to date have revealed the large-duct type variant,a unique subtype of pancreatic ductal adenocarcinoma(PDA)with cystic features.This subtype often radiographically mimics intraductal papillary mucinous neoplasms(IPMNs)and involves multiple small cysts occasionally associated with solid masses.The“bunch-of-grapes”sign,an imaging characteristic of IPMNs,is absent in large-duct PDA.Large-duct PDA defines the mucin profile,and genetic alterations are useful in distinguishing large-duct PDA from IPMNs.Histologically,neoplastic ducts measure over 0.5 mm,forming large ductal elements.Similar to classic PDAs,this subtype is frequently accompanied by perineural invasion and abundant desmoplastic reactions,and KRAS mutations in codon 12 are nearly ubiquitous.Despite such morphological similarities with IPMNs,the prognosis of large-duct PDA is equivalent to that of classic PDA.Differential diagnosis is therefore essential.
文摘Pancreatic carcinoma occasionally associated with prominent mucin production and this type of tumor designated as PCM (pancreatic carcinoma with prominent mucin production) was diagnosed depends on subjective estimation of the amount of mucous area, and there has been no report on a quantitative evaluation of the amount of mucinous area in the tumor. To examine the feature of PCM, we analyzed 9 cases of PCM among 243 cases of pancreas carcinoma and evaluated the amount of mucin by imaging analysis. Morphologically, 5 cases were classified as intradactal papillary mucinous neoplasms (IPMN)-derived PCM and 4 cases were as ductal adenocarcinoma (DA)-derived PCM. Mucous composition was found to be more than 50% in all IPMN-derived PCM cases, and that was 40% - 50% in DA-derived PCM cases with one exception. IPMN-derived PCM cases showed expansive growth with pancreatic duct dilatation filled with mucin, while DA-derived PCM cases possessed mucin infiltration into interstitial tissue. Immunohisto-chemically, three of 4 DA-derived PCM cases were MUC1(–)/MUC2(+), and the results of expressions for p16 and Dpc4 suggesting that DA-derived PCM was similar to IPMN-derived PCM rather than ordinary DA. Survival rate of DA-derived PCM cases was lower than that of IPMN-derived PCM cases. We advocate that DA-derived PCM may constitute a borderline group between IPMN and ordinary DA.
文摘目的探究着丝粒蛋白F(centromere protein F,CENPF)在胰腺导管腺癌(pancreatic ductual adenocarcinoma,PDAC)中的表达及其与临床病理特征和预后的关系。方法基于美国国家生物信息中心(National Center for Biotechnology Information,NCBI)的微阵列/基因谱公共数据库(Gene Expression Omnibus,GEO),运用GEO2R、维恩、Cytoscape及GEPIA软件筛选出PDAC中可疑差异基因CENPF;基于癌症基因组图谱(The Cancer Genome Atlas,TCGA)及基因组织表达数据库(The Genotype-Tissue Expression,GTEx),通过NCBI网络、GEPIA、Ualcan、Oncomine、TIMER软件及Kaplan-Meier在线生存分析工具,从信使核糖核酸(messenger RNA)层面分析其表达与免疫细胞浸润的关系及其可能的分子机制。同时收集2007~2021年间经福建医科大学附属第一医院病理科确诊的胰腺导管腺癌手术标本121例,从组织蛋白层面分析CENPF与PDAC临床病理特征及预后的关系。结果CENPF基因在人类多种癌症中表达异常,在PDAC中,癌组织中的表达水平显著高于癌旁正常胰腺组织(P<0.05),并且与PDAC组织学分级(P<0.05)、预后(P=0.0038)有关。免疫组化显示CENPF的表达与PDAC的神经侵犯(P=0.036)、TNM分期(P=0.041)、淋巴结转移(P=0.023)、分化程度(P=0.020)、总生存期有关(Log-rank=18.608,P=0.000016),CENPF高表达(HR=2.654,95%CI=1.373~5.131,P=0.004)是PDAC患者预后差的独立危险因素。CENPF联合其他关键模块基因在PDAC中,主要富集于外泌体、细胞外基质等,并与丝氨酸内肽酶活性、金属肽链内切酶活性有关等。CENPF在胰腺导管腺癌中的作用通路主要与细胞周期、P53通路、泛素介导的蛋白水解等相关,并与P53、MDM2在PDAC中联合发挥作用。免疫浸润研究表明CENPF表达与CD4+T淋巴细胞浸润负相关、与树突细胞的浸润正相关(均P<0.05)。结论CENPF可能参与PDAC疾病的进程,其高表达与PDAC预后不良相关,该研究有望为胰腺导管腺癌的防治提供更多科学基础。
