Laura Frison

18-fluorodeoxyglucose positron emission tomography enhances computed tomography diagnosis of malignant intraductal papillary mucinous neoplasms of the pancreas.

Objective:To assess the reliability of 18-fluorodeoxyglucose positron emission tomography (18-FDG PET) in distinguishing benign from malignant intraductal papillary mucinous neoplasms (IPMNs) of the pancreas and its contribution to surgical decision making. Summary Background Data:Pancreatic IPMNs are increasingly recognized, often as incidental findings, especially in people over age 70 and 80. Computed tomography (CT) and magnetic resonance (MR) are unreliable in discriminating a benign from a malignant neoplasm. 18-FDG PET as imaging procedure based on the increased glucose uptake by tumor cells has been suggested for diagnosis and staging of pancreatic cancer. Methods:From January 1998 to December 2005, 64 patients with suspected IPMNs were prospectively investigated with 18-FDG PET in addition to conventional imaging techniques [helical-CT in all and MR and magnetic resonance cholangiopancreatography (MRCP) in 60]. 18-FDG PET was analyzed visually and semiquantitatively using the standard uptake value (SUV). The validation of the diagnosis was made by a surgical procedure (n = 44), a percutaneous biopsy (n = 2), main duct cytology (n = 1), or follow-up (n = 17). Mean and median follow-up times were 25 and 27.5 months, respectively (range, 12–90 months). Results:Twenty-seven patients (42%) were asymptomatic. Forty-two patients underwent pancreatic resection, 2 palliative surgery, and 20 did not undergo surgery. An adenoma was diagnosed in 13 patients, a borderline tumor in 8, a carcinoma in situ in 5, and an invasive cancer in 21; in 17 patients a tumor sampling was not performed and therefore the histology remained undetermined. Positive criteria of increased uptake on 18-FDG PET was absent in 13 of 13 adenomas and 7 of 8 borderline IPMNs, but was present in 4 of 5 carcinoma in situ (80%) and in 20 of 21 invasive cancers (95%). Conventional imaging technique was strongly suggestive of malignancy in 2 of 5 carcinomas in situ and in 13 of 21 invasive carcinomas (62%). Furthermore, conventional imaging had findings that would be considered falsely positive in 1 of 13 adenomas (8%) and in 3 of 8 borderline neoplasms (37.5%). Therefore, positive 18-FDG PET influenced surgical decision making in 10 patients with malignant IPMN. Furthermore, negative findings on 18-FDG PET prompted us to use a more limited resection in 15 patients, and offered a follow-up strategy in 18 patients (3 positive at CT scan) for the future development of a malignancy. Conclusions:18-FDG PET is more accurate than conventional imaging techniques (CT and MR) in distinguishing benign from malignant (invasive and noninvasive) IPMNs. 18-FDG PET seems to be much better than conventional imaging techniques in selecting IPMNs patients, especially when old and asymptomatic, for surgical treatment or follow-up.

Ureteral Stenosis in HDAF Pig‐to‐Primate Renal Xenotransplantation: A Phenomenon Related to Immunological Events?

The aim of this study was to analyze the incidence of ureteral stenosis in a life‐supporting human decay‐accelerating factor (hDAF) transgenic pig‐to‐cynomolgus monkey kidney transplantation model and determine the role of possible immunological events in its pathogenesis.

Metastasis to the Pancreas from Colorectal Cancer: Is There a Place for Pancreatic Resection?

PURPOSE: Pancreatic metastases from colorectal cancer are very rare, and the possible benefit of surgical treatment is not clearly defined. This study was designed to evaluate the outcome of patients undergoing pancreatic resection for metastatic colorectal cancer to the pancreas. METHODS: Nine patients underwent pancreatic resection for metastatic colorectal cancer between January 1980 and December 2006. The primary cancers were colon (n = 7) and rectal carcinoma (n = 2). The median interval between primary treatment and detection of pancreatic metastases was 32.5 months. In three cases pancreatic metastases were synchronous with the primary tumor. RESULTS: Five patients underwent pancreaticoduodenectomy, and four underwent distal pancreatectomy. A left lateral liver section and three colon resections were simultaneously performed in four patients. There was no postoperative mortality, and only two patients experienced complications. Survival averaged 19.8 (median, 17.0; range, 5-30) months: seven patients died of metastatic disease, one for unrelated disease after five months, and one is alive with liver metastases 30 months after surgery. CONCLUSION: Surgical resection can be performed safely in patients with isolated pancreatic metastases from colorectal cancer and in selected patients with associated extrapancreatic disease. Although long-term survival is rare, surgery should be included, whenever possible, in the multimodality approach to this disease.

Monolateral placement of both kidneys in dual kidney transplantation: low surgical complication rate and short operating time.

Dual kidney transplantation (DKT) from marginal donors is increasingly used at many centers to help cope with the organ shortage problem. The disadvantages of DKT consist in longer operating times and the risk of surgical complications. DKT can be performed in two ways, i.e. using monolateral or bilateral procedures. From October 1999 to June 2005, 58 DKTs were performed at our unit. In 29 cases (group I), the kidneys were extraperitoneally placed bilaterally in the iliac fossae via two separate incisions; as of June 2003, monolateral kidney placement was preferred in 29 cases, whenever compatible with the recipients morphological status (group II). After a mean follow‐up of 51 ± 19 months for group I and 15 ± 7 months for group II, all patients are alive with 1‐year graft survival rates of 93% and 96%, respectively. Mean operating times were 351 ± 76 min in group I and 261 ± 31 min in group II (P = 0.0001). The mean S‐creatinine levels in groups I and II were 132 ± 47 and 119 ± 36 μmol/l, respectively, at 1 year. We observed eight surgical complications in group I and seven in group II. Both techniques proved safe, with no differences in surgical complication rates. The monolateral procedure has the advantage of a shorter operating time and the contralateral iliac fossa remains available for further retransplantation procedures.

Abdominal localization of Tangier disease mimicking a pancreatic neoplasm.

Tangier disease is a rare genetic disorder of lipid metabolism, characterized by severe deficiency of plasma high-density lipoprotein cholesterol, low-plasma total cholesterol, and accumulation of cholesteryl ester in macrophages. Abdominal manifestation of Tangier disease is extremely rare, being reported only once in the English literature. We describe a 55-year-old patient with this condition, who underwent splenectomy 37 years before, because of splenomegaly with thrombocytopenia, and subsequently presented with abdominal pain and pancreatic mass, simulating a pancreatic tumor. The preoperative diagnosis of endocrine or solid-cystic neoplasm was made, and the tumor was successfully resected with distal pancreatectomy. Histological examination showed that the mass was composed of histiocytic cells containing lipids; some aggregates of giant polynucleated histiocytes with intracytoplasmic cholesterol crystals. To our knowledge, this is the first report of pancreatic manifestation of Tangier disease. As suggested earlier, splenectomy in these patients seems to predispose to deposition of lipids and infiltration of the abdomen by inflammatory cells.

Outcome of pancreatic resection in elderly patients

Clinical background The increasing aging of the Western population is obviously accomplished by an increasing number of older patients with cancer, including pancreatic cancer. Since surgical resection remains the treatment of choice for pancreatic and periampullary neoplasms, increasing number of elderly patients are being referred for pancreatic resection. Recently, some surgical experiences reported an acceptable morbidity rate and outcome in patients with advanced age. This retrospective study analyzes the effects of age on short-term and long-term outcome in a large series of patients who underwent resection for pancreatic or periampullary disease.

M1540 High Complication Rate After Pancreas Preserving Surgical Procedures for Benign or Borderline Pancreatic Lesions. Careful Selection of Patients Is Needed

in 23 pts, a third in 4 of them: Group 1: 6+0, Group 2: 11+2, Group 3: 3+1, Group 4: 3+1. The actual status at December 31 2006 of all pts was retrieved. The cause of death was retrieved for 111/117 pts. Of the 6 remaining, 1 died abroad, and privacy prevented us to retrieve the cause for the other 5. Results: Hospital mortality was 4/174 (2.3%). 57 pts (32.8%) are still alive. 49 pts (28.2%) developed cancer and 38 died of their cancer, 5 of another disease, 1 of unknown cause, and 5 are still alive. The more frequent was the lung cancer (22 pts) followed by oral, pharynx, larynx and esophageal cancers (10 pts). A small pancreatic cancer (PC) was found in the surgical specimen in 3 pts: 1 died of PC 18.3 years later, 1 died of unknown cause 30.5 years later, and 1 is alive & well 29 years later. A further patient died of PC 9 years after surgery. The other main causes of death were: liver cirrhosis (15 pts), vascular disease (11 pts), MI or failure (10 pts), acute pancreatitis, accidental trauma, complications of diabetes, bronchopneumonia (4 pts each). The overall 5, 10, 15, 20, 25 and 30 years survival rate was 82.8, 63.5, 49.7, 36.4, 27.5 and 23.1 and was the same for the 4 groups (P=0.8447). Conclusions: The incidence of PC was 2.3%, but only 1 (0.6%) appeared during follow-up. The high incidence of lung, oral, pharynx, larynx & esophageal cancers (32/170; 18.8%) during follow-up is due to the smoking habits of almost 100% of our pts (Int J Cancer 2008;122:155-64). Eliminating smoking and increasing tests on organs at risk of cancer during follow-up may prolong survival in these pts.