Ettore Montresor

Results of pancreaticoduodenectomy for pancreatic cancer: extended versus standard procedure.

In Western experience, the long-term survival benefit after extended pancreaticoduodenectomy (EPD) in patients with pancreatic ductal adenocarcinoma is still controversial. The aim of this work was to evaluate weather EPD for pancreatic ductal adenocarcinoma prolongs long-term survival compared to standard pancreaticoduodenectomy (SPD). From November 1992 to September 1996, we performed pancreatic resections in 30 patients affected by stage I–III pancreatic ductal adenocarcinoma: 13 patients underwent SPD and 17 patients underwent EPD, consecutively. The two groups of patients were similar for all the demographic, clinical, and pathological characteristics, and all the intraoperative factors considered except the number of resected lymph nodes (mean number per case=34.2 ± 15.5 in the EPD group versus 12.8 ± 3.6 in the SPD group, p<0.001) and the operative time (median time per case=375 minutes in the EPD group versus 270 minutes in the SPD group, p=0.009). Patients in the two groups experienced a similar postoperative course. The estimated survival probability at 1 and 3 years after operation was 0.76 (95% confidence interval [CI]: 0.49 to 0.90) and 0.24 (95% CI: 0.07 to 0.45) in the EPD group; 0.31 (95% CI: 0.09 to 0.55) and 0.08 (95% CI: 0.00 to 0.29) in the SPD group (p=0.014). According to a Cox model, the treatment was associated with R0 patients’ long-term survival (SPD versus EPD: hazard ratio (HR)=4.82, 95% CI: 1.66 to 14.00, p=0.004). Grading of tumor differentiation was confirmed to be a relevant prognostic factor (poor versus moderate: HR=4.33, 95% CI: 1.49 to 12.61, p=0.007), whereas type of resection had no significant effect (pylorus-preserving versus hemigastrectomy: HR=1.49, 95% CI: 0.56 to 3.95, p=0.42). The proportion of R0 patients with local recurrence was lower in the EPD group (20.0% versus 70.0%, p=0.034).RésuméDans l’Occident, les bénéfices à long terme en termes de survie, après duodénopancréatectomie céphalique étendue (DPCE) chez les patients présentant un adénocarcinome du pancréas, sont toujours controversés. Le but de cette étude a été d’évaluer si la DPCE augmentait la survie comparée aux DPC conventionnelles (DPCC). Entre novembre 1992 et septembre 1996, nous avons opéré 30 patients atteints d’adénocarcinome pancréatique stades I–III: 13 patients ont eu une DPCC et 17 patients, une DPCE, consécutivement. Les deux groupes de patients étaient comparables en ce qui concernaient les données démographiques, cliniques et pathologiques ainsi que les facteurs peropératoires sauf pour le nombre d’adénopathies réséquées (nombre moyen par cas=34.2 ± 15.5 dans le groupe DPCE versus 12.8 ± 3.6 dans le groupe DPCC, p<0.001) et la durée opératoire (temps médiane par cas=375 minutes pour la DPCE versus 270 minutes pour la DPCC, p=0.009), et les deux groupes ont eu une évolution postopératoire similaire. La probabilité de survie estimée à un et à trois ans après l’intervention a été de 0.76 (intervalle de confiance à 95% [IC]: 0.49–0.90) et 0.24 (95% IC: 0.07–0.45) dans le groupe DPCE et de 0.31 (95% IC: 0.09–0.55) et 0.08 (95% IC: 0.00–0.29) dans le groupe DPCC (p=0.014). Selon le modèle de Cox, deux facteurs influençaient la survie à long terme: les résection R0 (DPCC vs DPCE: Rapport de risque=4.82, 95% IC: 1.66–14.00, p=0.004), le degré de dédifférenciation tumorale (mal différencié vs modérément différencié: rapport de risque=4.33, 95% IC: 1.49–12.61, p=0.007), alors que le type de résection n’avait aucun effet significatif: pancréatectomie avec conservation du pylore versus hémi-gastrectomie: rapport de risque=1.49, 95% IC: 0.56–3.95, p=0.42). La proportion de patients réséqués R0 avec récidive locale a été plus bas dans le groupe DPCE (20.0% versus 70.0%, p=0.034).ResumenEn Occidente, siguen sujetos a discusión los resultados tardíos de la duodenopancreatectomía ampliada (EPD) en pacientes con adenocarcinoma ductal pancreático. El objetivo del trabajo fue determinar si la EPD prolonga la supervivencia tardía más que la duodenopancreatectomía estándar (SPD). De noviembre de 1992 a septiembre de 1996 se resecaron 30 adenocarcinomas ductales pancreáticos en estadio I–III. En 13 se practicó una SPD y en 17 una EPD. Ambos grupos eran homogéneos tanto desde el punto de vista demográfico, clínico y anatomopatológico como por lo que a la evolución postoperatoria y hallazgos intraoperatorios se refiere, excepción hecha de: el número de ganglios linfáticos extirpados (media por caso=34.2 ± 15.5 en el grupo EPD vs 12.8 ± 3.6 en el SPD, p<0.001) y la duración de la intervención (media por caso=375 minutos en el grupo EPD vs 270 m. en el SPD, p=0.009). Tras la operación la probabilidad estimada de supervivencia a 1 y 3 años fue: 0.76 (95% CI: 0.49–0.90) y 0.24 (95% CI: 0.07–0.45) en el grupo EPD. En el grupo SPD estos valores fueron: 0.31 (95% CI: 0.09–0.55) y 0.08 (95% CI: 0.00–0.29), p=0.014. De acuerdo con el modelo de Cox la modalidad de tratamiento, en pacientes RO, influye en la supervivencia tardía (SPD vs EPD: cociente de azar (HR)=4.82, 95% CI: 1.66–14.00, p=0.004); el estadio tumoral es el factor pronóstico más importante (poco diferenciados vs moderadamente diferenciados: HR=4.33, 95% CI: 1.49–12.61, p=0.007). Sin embargo, la técnica quirúrgica no tiene importancia alguna (preservación del píloro vs hemigastrectomía: HR=1.49, 95% CI: 0.56–3.95, p=0.42). En pacientes R0 la recidiva local fue menor en el grupo EPD (20% vs 70%, p=0.034).

Neoplastic epithelial cells in a subset of human thymomas express the B cell-associated CD20 antigen.

A series of 36 human thymomas have been immunohistochemically analyzed using a panel of antibodies recognizing B-cell markers including CD20. Most thymomas exhibiting the cortical pattern, according to the criteria of Marino and Muller-Hermelink, were characterized by areas of medullary differentiation containing variable numbers of CD20+ B lymphocytes, thus mimicking the medulla of normal thymus. On the other hand, B cells were absent or rare in thymomas recognized as mixed using the same morphological criteria. Surprisingly, we observed in most mixed thymomas variable numbers of CD20+ spindle cells, characterized by long slender processes. Using double-marker analysis we could demonstrate the epithelial nature of these cells (expression of keratin and lack of lymphoid and B-cell-related markers). The immunoreactivity of thymoma epithelial cells with L26, an antibody widely used in the characterization of B-cell lymphomas, can represent a drawback of practical relevance in the differential diagnosis of mediastinal tumors.

Lymphoepithelial cyst of the pancreas. Report of two cases and review of the literature.

SummaryConclusionLymphoepithelial cyst of the pancreas (LC) is a very rare benign lesion and preoperative diagnosis is difficult. Conservative surgery seems to be the appropriate therapy in symptomatic patients or when a precise preoperative diagnosis is not achieved. The benign behavior of all reported cases suggests that the asymptomatic patients with a certain morphological preoperative diagnosis might be clinically followed up. The histogenesis of LC remains to be elucidated.BackgroundLC of the pancreas is a cyst that is histologically characterized by a fibrous tissue, a lymphoid component and a lining squamous epithelium.MethodsClinical and pathological findings of two personal cases are reported with review of the literature.ResultsA 56-yr-old man, complaining of epigastric pain, and a 47-yr-old man, with a history of alcohol abuse, were admitted to hospital. In both cases the lesion was detected with abdominal ultrasound but a certain diagnosis was obtained only after histological examination of the resected cysts.

Dermoid cyst of the head of the pancreas area

SummaryWe report a case of dermoid cyst of the head of the pancreas area in a 26-yr-old woman radically treated with pancreatoduodenectomy and alive with no recurrence at 6-yr follow-up. The diagnostic and surgical procedures are described, and the literature is reviewed.

Carcinoma of the Papilla of Vater: Prognostic and Therapeutic Considerations

Sixty-seven cases of pancreaticoduodenectomy for adenocarcinoma of the papilla were observed over the period from 1970 to 2000 for the purposes of assessing results, and identifying possible prognostic factors based on pathology and biomolecular criteria.