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Fleming AM, Hendrick LE, Yakoub D, Abdelhafeez H, Deneve JL, Langham MR, Glazer ES, Davidoff AM, Merchant NB, Dickson PV, Murphy AJ. Malignant Solid Pseudopapillary Neoplasm of the Pancreas: An Orthogonal Analysis. Ann Surg Oncol 2024; 31:475-487. [PMID: 37768414 DOI: 10.1245/s10434-023-14343-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Pancreatic solid pseudopapillary neoplasms (SPN) are generally indolent; however, some patients present with "malignant" SPN. An orthogonal analysis of multiple datasets was performed to investigate the utility of complete surgical resection (CSR) for malignant SPN. METHODS A systematic review was performed for cases of malignant SPN, defined as T4, N1, and/or M1. Malignant SPN was analyzed within the National Cancer Database (NCDB) and compared with T1-3N0M0 SPN. Predictors of malignant SPN were assessed, and treatments were analyzed by using survival analysis. RESULTS The systematic review yielded 164 cases of malignant SPN. Of 31 children, only one died due to malignant SPN. Among adults, CSR was associated with improved disease-specific survival (DSS) (P = 0.0002). Chemotherapy did not improve malignant SPN DSS, whether resected (P = 0.8485) or not (P = 0.2219). Of 692 adults with SPN within the NCDB, 93 (13.4%) had malignant SPN. Pancreatic head location (odds ratio [OR] 2.174; 95% confidence interval [CI] 1.136-4.166; P = 0.0186) and tumor size (OR 1.154; 95% CI 1.079-1.235; P < 0.0001) associated with the malignant phenotype. Malignant SPN predicted decreased overall survival (OS) compared with T1-3N0M0 disease (P < 0.0001). Resected malignant SPN demonstrated improved OS (P < 0.0001), including resected stage IV malignant SPN (P = 0.0003). Chemotherapy did not improve OS for malignant SPN, whether resected (P = 0.8633) or not (P = 0.5734). Within a multivariable model, resection was associated with decreased hazard of death (hazard ratio 0.090; 95% CI 0.030-0.261; P < 0.0001). CONCLUSIONS Approximately 13% of patients with SPN present with a malignant phenotype. Pediatric cases may be less aggressive. Resection may improve survival for malignant SPN, which does not appear chemosensitive.
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Affiliation(s)
- Andrew M Fleming
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Leah E Hendrick
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Danny Yakoub
- Department of Surgery, Augusta University Medical Center, Augusta, GA, USA
| | - Hafeez Abdelhafeez
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Max R Langham
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nipun B Merchant
- Department of Surgery, University of Miami Health System, Miami, FL, USA
| | - Paxton V Dickson
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrew J Murphy
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
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2
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Wang GC, Huang GJ, Zhang CQ, Ding Q. Percutaneous transhepatic intraportal biopsy using gastroscope biopsy forceps for diagnosis of a pancreatic neuroendocrine neoplasm: A case report. World J Gastroenterol 2023; 29:1235-1242. [PMID: 36926671 PMCID: PMC10011950 DOI: 10.3748/wjg.v29.i7.1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Pancreatic neuroendocrine neoplasms (PNENs) are a rare group of neoplasms originating from the islets of the Langerhans. Portal vein tumor thrombosis has been reported in 33% of patients with PNENs. While the histopathological diagnosis of PNENs is usually based on percutaneous biopsy or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), these approaches may be impeded by gastric varices, poor access windows, or anatomically contiguous critical structures. Obtaining a pathological diagnosis using a gastroscope biopsy forceps via percutaneous transhepatic intravascular pathway is an innovative method that has rarely been reported.
CASE SUMMARY A 72-year-old man was referred to our hospital for abdominal pain and melena. Abdominal contrast-enhanced magnetic resonance imaging revealed a well-enhanced tumor (size: 2.4 cm × 1.2 cm × 1.2 cm) in the pancreatic tail with portal vein invasion. Traditional pathological diagnosis via EUS-FNA was not possible because of diffuse gastric varices. We performed a percutaneous transportal biopsy of the portal vein tumor thrombus using a gastroscope biopsy forceps. Histopathologic examination revealed a pancreatic neuroendocrine neoplasm (G2) with somatostatin receptors 2 (+), allowing systemic treatment.
CONCLUSION Intravascular biopsy using gastroscope biopsy forceps appears to be a safe and effective method for obtaining a histopathological diagnosis. Although well-designed clinic trials are required to obtain more definitive evidence, this procedure may help improve the diagnosis of portal vein thrombosis and related diseases.
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Affiliation(s)
- Guang-Chuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Guang-Jun Huang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Chun-Qing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Qian Ding
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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Tian Y, Qi X, Aljbri A, Xu K, Zhong H. Case Report: Pancreatic Neuroendocrine Tumor With Liver Metastasis and Portal Vein Thrombosis. Front Oncol 2022; 11:809129. [PMID: 35237502 PMCID: PMC8882680 DOI: 10.3389/fonc.2021.809129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/31/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Pancreatic neuroendocrine neoplasms (PNENs) are rare pancreatic tumors originating from pancreatic neuroendocrine cells. There is no consensus on the treatment for PNENs with unresectable liver metastases. Transcatheter arterial chemoembolization (TACE) is the preferred treatment for unresectable primary liver cancer. But the efficacy of TACE and anticoagulation in PNENs with unresectable liver metastases and portal vein thrombosis has never been reported. METHODS AND RESULTS We present the case of a 50-year-old male patient with hepatitis C who was found to have a single liver mass during a regular physical examination in 2016. The liver mass was surgically removed. Postoperative pathology suggested a neuroendocrine tumor of the liver, and it was suggested to look for the primary tumor. The patient was followed up until 2020, and the primary pancreatic tumor was found, along with multiple liver metastases and portal vein thrombosis. After transcatheter arterial embolization, anticoagulation, and endocrine therapy, the patient's tumor load was relieved, and the portal vein was recanalized. CONCLUSION The article reports the disease course in a case of a functional pancreatic neuroendocrine tumor with liver metastasis and portal vein thrombosis and reviews previous literature. To our knowledge, we reported for the first time the efficacy of TACE and anticoagulation in PNENs with unresectable liver metastases and portal vein thrombosis.
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Affiliation(s)
- Yulong Tian
- Department of Interventional radiology, the First Hospital of China Medical University, Shenyang, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Afaf Aljbri
- Department of Interventional radiology, the First Hospital of China Medical University, Shenyang, China
| | - Ke Xu
- Department of Interventional radiology, the First Hospital of China Medical University, Shenyang, China
| | - Hongshan Zhong
- Department of Interventional radiology, the First Hospital of China Medical University, Shenyang, China
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Udagawa D, Shimazu M, Sakuragawa T, Maruyama S, Uchi Y, Miura E, Masugi Y, Sakamoto M. Surgery for colloid carcinoma of the pancreas with portal vein tumor thrombus: a case report. Surg Case Rep 2020; 6:252. [PMID: 33001318 PMCID: PMC7530155 DOI: 10.1186/s40792-020-01025-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The portal vein is occasionally invaded by advanced malignant tumors in the pancreatic head region. However, pancreatic cancer rarely has portal vein tumor thrombi. We report a case of pancreatic cancer with a massive portal vein tumor thrombus undergoing pancreatoduodenectomy with combined resection of the portal vein. CASE PRESENTATION A 71-year-old man visited a clinic with complaints of abdominal discomfort and vomiting. Gastroscopy showed a massive tumor in the duodenum. He was referred to our hospital for further examinations and treatment. The CT showed a low-density tumor with a maximum diameter of 10 cm located on the pancreas head. A tumor widely invaded the duodenum and had a 6-cm portal vein tumor thrombus. MRCP did not show obvious stenosis of the pancreatic duct due to tumor invasion. There were no findings suggesting distant metastases. Biopsy of the duodenum revealed adenocarcinoma. He was diagnosed with primary pancreatic cancer or duodenal cancer with portal vein tumor thrombus and underwent pancreatoduodectomy with resection and reconstruction of the portal vein. He suffered no postoperative complications and was discharged 2 months after surgery. The final histopathological diagnosis was pancreatic colloid carcinoma. He received adjuvant chemotherapy, but died 16 months after surgery. CONCLUSIONS Colloid carcinoma of the pancreas is rare, and pancreatic carcinoma seldom forms a portal vein tumor thrombus. We experienced a very rare case of pancreatic colloid carcinoma with portal vein tumor thrombus and performed radical resection of the pancreas and portal vein.
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Affiliation(s)
- Daisuke Udagawa
- Department of Surgery, Tama Kyuryo Hospital, 1491 Shimooyamadacho, Machida-shi, Tokyo, 194-0297, Japan
| | - Motohide Shimazu
- Department of Surgery, Tama Kyuryo Hospital, 1491 Shimooyamadacho, Machida-shi, Tokyo, 194-0297, Japan.
| | - Tadayuki Sakuragawa
- Department of Surgery, Tama Kyuryo Hospital, 1491 Shimooyamadacho, Machida-shi, Tokyo, 194-0297, Japan
| | - Shotaro Maruyama
- Department of Surgery, Tama Kyuryo Hospital, 1491 Shimooyamadacho, Machida-shi, Tokyo, 194-0297, Japan
| | - Yusuke Uchi
- Department of Surgery, Tama Kyuryo Hospital, 1491 Shimooyamadacho, Machida-shi, Tokyo, 194-0297, Japan
| | - Eisuke Miura
- Department of Pathology, Keio University School of Medicine, 35 Shinamomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, 35 Shinamomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Michiie Sakamoto
- Department of Pathology, Keio University School of Medicine, 35 Shinamomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Cheng K, Shen B, Peng C, Yuan F, Yin Q. Synchronous Portal-superior Mesenteric Vein or Adjacent Organ Resection for Solid Pseudopapillary Neoplasms of the Pancreas: A Single-institution Experience. Am Surg 2020. [DOI: 10.1177/000313481307900531] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Solid pseudopapillary neoplasms of the pancreas (SPN) have been reported increasingly; however, series focusing on portal-superior mesenteric vein (PV/SMV) or adjacent organ resection are limited in the literature. The aim of this study was to present our experience in treating patients with SPN who underwent this extensive resection. Ten eligible patients were retrospectively reviewed and analyzed. Eight females and two males with a median age of 23 years (range, 11 to 58 years) and a median tumor diameter of 12 cm (range, 4 to 20 cm) were observed. All patients had imaging signs of vascular and/or adjacent organ involvement. Resection with curative intent was performed in all patients; eight underwent synchronous PV/SMV resection and two underwent synchronous left nephrectomy. Malignant SPN was confirmed in seven patients. Postoperative mortality was nil and morbidity occurred in five patients. At a median follow-up of 67.5 months (range, 12 to 110 months), nine patients were alive with no evidence of disease and one died of liver metastases. In conclusion, malignant SPN are low-grade tumors with good prognosis. More aggressive attitude should be adopted when PV/SMVor adjacent organ involvement is indicated on preoperative imaging. En bloc synchronous PV/SMV or adjacent organ resection should be applied, when necessary, to achieve complete resection.
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Affiliation(s)
- Kun Cheng
- Departments of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Baiyong Shen
- Departments of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenghong Peng
- Departments of General Surgery, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Yuan
- Departments of Pathology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qihua Yin
- Departments of Pathology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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6
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De Robertis R, Paiella S, Cardobi N, Landoni L, Tinazzi Martini P, Ortolani S, De Marchi G, Gobbo S, Giardino A, Butturini G, Tortora G, Bassi C, D'Onofrio M. Tumor thrombosis: a peculiar finding associated with pancreatic neuroendocrine neoplasms. A pictorial essay. Abdom Radiol (NY) 2018; 43:613-619. [PMID: 28677005 DOI: 10.1007/s00261-017-1243-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
While abutment, encasement or vessel occlusion are identified in most patients with a pancreatic tumor, tumor thrombosis is an uncommon finding. In particular, there are no description in the literature of tumor thrombosis associated with ductal adenocarcinoma, the most common pancreatic tumor. On the other hand, surgical series reveal that tumor thrombosis is associated with about 5% of pancreatic neuroendocrine neoplasms (PanNENs), and literature data suggest that this finding is frequently underreported on pre-operative imaging examinations. Tumor thrombosis may be clinically relevant, causing splenoportomesenteric hypertension, possibly responsible for life-threatening upper gastrointestinal bleeding. Bland thrombosis caused by direct infiltration of peri-pancreatic vessels frequently determines surgical unresectability, even in neuroendocrine tumors; on the opposite, tumor thrombosis associated with PanNENs do not exclude surgery per se, even though both morbidity and mortality can be increased by such condition. Considering the favorable prognosis of PanNENs and the frequent need to treat tumor thrombosis in order to prevent complications or to relieve symptoms, it is of paramount importance for radiologists the knowledge of the variety of findings associated with tumor thrombosis in PanNENs.
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Affiliation(s)
- Riccardo De Robertis
- Department of Radiology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy.
| | - Salvatore Paiella
- Department of General and Pancreatic Surgery, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Nicolò Cardobi
- Department of Radiology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy
| | - Luca Landoni
- Department of General and Pancreatic Surgery, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Paolo Tinazzi Martini
- Department of Radiology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy
| | - Silvia Ortolani
- Department of Oncology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy
| | - Giulia De Marchi
- Department of Gastroenterology, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Stefano Gobbo
- Department of Pathology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy
| | - Alessandro Giardino
- Department of Pancreatic Surgery, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy
| | - Giovanni Butturini
- Department of Pancreatic Surgery, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy
| | - Giampaolo Tortora
- Department of Medical Oncology, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Claudio Bassi
- Department of General and Pancreatic Surgery, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
| | - Mirko D'Onofrio
- Department of Radiology, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy
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7
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Widespread portal venous thrombosis in a patient with pancreatic cancer. Int Cancer Conf J 2014. [DOI: 10.1007/s13691-014-0154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Computed Tomography and Magnetic Resonance Imaging Findings of Malignant Solid Pseudopapillary Tumors of the Pancreas With Macroscopic Venous Tumor Thrombosis. J Comput Assist Tomogr 2014; 38:383-90. [DOI: 10.1097/rct.0000000000000047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Yamato H, Kawakami H, Kuwatani M, Shinada K, Kondo S, Kubota K, Asaka M. Pancreatic carcinoma associated with portal vein tumor thrombus: three case reports. Intern Med 2009; 48:143-50. [PMID: 19182424 DOI: 10.2169/internalmedicine.48.1049] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pancreatic carcinoma associated with portal vein tumor thrombus (PVTT) is rare. Here, we report three cases of resected pancreatic carcinoma associated with PVTT. In all three cases, preoperative images obtained using computed tomography and endoscopic ultrasonography revealed a tumor thrombus in the portal vein, which was connected to an irregular mass in the pancreas. All cases underwent surgical resection of the primary lesion and the PVTT. The pathological diagnoses of the tumors were two cases of tubular adenocarcinoma and one case of nonfunctioning endocrine carcinoma. We also retrospectively examined other patients who underwent surgical excision with portal vein resection.
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Affiliation(s)
- Hiroaki Yamato
- Department of Gastroenterology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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10
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Igarashi H, Shinozaki S, Mukada T. A case of acinar cell carcinoma of the pancreas that formed extensive tumor thrombus of the portal vein. Clin J Gastroenterol 2008; 2:96-102. [PMID: 26192173 DOI: 10.1007/s12328-008-0044-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 10/01/2008] [Indexed: 11/24/2022]
Abstract
A 58-year-old man was admitted to our hospital because of anorexia and back pain. He had been previously diagnosed with chronic pancreatitis with blood thrombus of the splenic vein at another hospital. Abdominal ultrasonography and computed tomography revealed a large mass in the body and tail of the pancreas, which directly invaded the stomach and the spleen. Small nodular metastases in both lungs were also detected. Furthermore, tumor thrombus continuously involved the splenic and proximal superior mesenteric vein, main portal vein, and its right intrahepatic branch. A metastatic mass was disclosed in the adjacent liver. The specimens obtained from portal tumor thrombus were histologically compatible with acinar cell carcinoma. Portal tumor thrombus is a rare condition in pancreatic tumors; however, it seems to be important to differentiate tumor thrombus from blood thrombus of the portal vein in order to know the true clinical stage and provide a suitable treatment.
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Affiliation(s)
- Hiroaki Igarashi
- Department of Gastroenterology, Kawakita Hospital, 1-7-3 Asagayakita, Suginami, Tokyo, 166-8488, Japan.
| | - Sachiko Shinozaki
- Department of Internal Medicine, Okubo Hospital, Shinjuku, Tokyo, Japan
| | - Takeo Mukada
- Department of Internal Medicine, Gunma Chuo Sogo Hospital, Maebashi, Gunma, Japan
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11
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Sperti C, Berselli M, Pasquali C, Pastorelli D, Pedrazzoli S. Aggressive behaviour of solid-pseudopapillary tumor of the pancreas in adults: a case report and review of the literature. World J Gastroenterol 2008; 14:960-965. [PMID: 18240360 PMCID: PMC2687069 DOI: 10.3748/wjg.14.960] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 12/17/2007] [Indexed: 02/06/2023] Open
Abstract
Solid-pseudopapillary tumor (SPT) is a rare neoplasm of the pancreas that usually occurs in young females. It is generally considered a low-grade malignant tumor that can remain asymptomatic for several years. The occurrence of infiltrating varieties of SPT is around 10%-15%. Between 1986 and 2006, 282 cystic tumors of the pancreas were observed. Among them a SPT was diagnosed in 8 patients (2.8%) with only one infiltrating variety. This was diagnosed in a 49-year-old female 13 years after the sonographic evidence of a small pancreatic cystic lesion interpreted as a pseudocyst. The tumor invaded a long segment of the portal-mesenteric vein confluence, and was removed with a total pancreatectomy, resection of the portal vein and reconstruction with the internal jugular vein. Histological examination confirmed the R-0 resection of the primary SPT, although a vascular invasion was demonstrated. The postoperative course was uneventful, but 32 mo after surgery the patient experienced diffuse liver metastases. Chemotherapy with different drugs was started. The patient is alive and symptom-free, with stable disease, 75 mo after surgery. Twenty-five patients with invasion of the portal vein and/or of mesenteric vessels were retrieved from the literature, 16 recent patients with tumor relapse after potentially curative resection were also retrieved. The best treatment remains a radical resection whenever possible, even in locally advanced or metastatic disease. The role of chemotherapy, and/or radiotherapy, is still to be defined.
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12
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Roldán-Valadez E, Ortega-López N, Valdivieso-Cárdenas G, Vega-González I, Herrera-Gómez A. (18)F-FDG PET/CT for discrimination between tumor extension and blood thrombus in pancreatic adenocarcinoma associated with portal vein thrombosis. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2008; 27:40-44. [PMID: 18208781 DOI: 10.1157/13114369] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Pancreatic cancer is a malignancy with an extremely poor prognosis. Less than 3 % of patients are alive 5 years after diagnosis. Pancreatic neoplasms represent a possible but uncommon etiology of portal venous invasion. It is important to differentiate the nature of the thrombus, if it is a bland thrombus or is a direct tumor extension. Intense uptake of 18F-fluorodeoxyglucose ((18)F-FDG) has been reported in portal vein tumor thrombus. We present a case of pancreatic adenocarcinoma and clinical findings of portal hypertension due to portal vein thrombosis. (18)F-FDG positron emission tomography (PET)/computed tomography (CT) evaluation discarded a tumor thrombus; imaging findings of the pancreatic tumor and the bland thrombus are presented.
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Affiliation(s)
- E Roldán-Valadez
- PET/CT Unit, Medica Sur Hospital and Clinical Foundation, Mexico City, Mexico.
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13
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Kandpal H, Sharma R, Das CJ, Sahni P, Das AK, Neyaz Z. Solid pseudopapillary tumor of the pancreas with portal vein compression presenting as portal hypertension. ACTA ACUST UNITED AC 2007; 51 Suppl:B287-91. [PMID: 17991087 DOI: 10.1111/j.1440-1673.2007.01839.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Solid pseudopapillary tumour (SPT) of the pancreas is a rare neoplasm, which occurs predominantly in young females and is usually amenable to cure by surgical resection. Imaging plays an important role in its diagnosis. We present the sonographic, CT and MRI features of SPT in a young female whose chief complaint was recurrent haematemesis secondary to portal venous compression.
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Affiliation(s)
- H Kandpal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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14
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Shah ZK, McKernan MG, Hahn PF, Sahani DV. Enhancing and expansile portal vein thrombosis: value in the diagnosis of hepatocellular carcinoma in patients with multiple hepatic lesions. AJR Am J Roentgenol 2007; 188:1320-3. [PMID: 17449777 DOI: 10.2214/ajr.06.0134] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The objective of this study was to determine whether the presence of enhancing and expansile portal vein thrombus is suggestive of the diagnosis of hepatocellular carcinoma. CONCLUSION In the presence of hepatic tumors, enhancing expansile portal vein thrombus is highly suggestive of hepatocellular carcinoma.
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Affiliation(s)
- Zarine K Shah
- Department of Abdominal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., White 270, Boston, MA 02114, USA
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15
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Abstract
Tumor thrombus differentiates itself from bland thrombus by its contrast enhancement features on cross-sectional imaging and its intense uptake of F-18 FDG on PET as a result of its hypervascularity and high metabolic neoplastic activity. This PET pattern has been reported in cases of renal cell carcinoma and adrenal cortical carcinoma with invasion of the inferior vena cava. Tumor thrombus may involve the superior mesenteric and portal veins in patients with abdominal or pelvic malignancy. The author presents a case of recurrent pancreatic neuroendocrine tumor with mesenteric and portal venous thrombotic invasion imaged by PET and computed tomography.
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Affiliation(s)
- Ba D Nguyen
- Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona 85259, USA.
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