Vincenzo Costantino

Solitary true cyst of the pancreas in adults. Report of three cases and review of the literature.

SummarySolitary true cysts of the pancreas are extremely rare: to date, only eight cases have been reported in the English literature, four of which had clinical significance. An additional three cases of solitary true cysts of the pancreas are presented. One patient was incidentally found at operation, performed for other disease, to have a cystic lesion in the body of the pancreas; the other two patients experienced abdominal pain and nausea. Abdominal US, CT, and MR showed a unilocular cyst in the body and tail of the pancreas. In both cases, preoperative diagnosis of pancreatic cystic neoplasm was made. Two patients underwent excision of the mass and one distal pancreatectomy. Analysis of the cyst fluid revealed high CA 19-9 levels in two and CA 125 levels in one case. All cysts were lined by cuboidal epithelium, without morphological alterations. Preoperative differential diagnosis with the most common cystic pancreatic lesions (inflammatory or neoplastic) is difficult.

Clinical value of seram TAG-72 as a tumor marker for pancreatic carcinoma

SummaryWe evaluated the sensitivity and specificity of the carbohydrate antigen TAG-72 as a tumor marker for pancreatic cancer compared with the serum values of CA 19-9. Forty healthy controls, 58 patients with pancreatic carcinoma, and 45 patients with chronic pancreatitis were studied. In patients with pancreatic cancer, 47/58 (81%) and 26/58 (45%) had raised serum levels of CA 19-9 and TAG-72, respectively; the sensitivity of the tests was not influenced by jaundice. In the chronic pancreatitis patients, both CA 19-9 and TAG-72 were elevated in 2/45 patients (44%). Both tests showed a specificity of 95%. Consequently, the sensitivity of TAG-72 was too low compared with CA 19-9. Moreover, serum TAG-72 could not detect small pancreatic cancers. High levels of both tumor markers were found in advanced stages of cancer. No advantage was found using both CA 19-9 and TAG-72 for improving the detection of pancreatic cancer. TAG-72 serum levels > 10 U/mL are closely related to unresectability of the tumor. Only 4/17 (23 %) of patients with resectable tumor had high TAG-72 levels. Serum TAG-72 expression seems to be more frequent in poorly-differentiated tumors than in well-differentiated cancers (56 vs 30% positivity rate).

Human Fibrin Sealants and Postoperative Fistulas: 25 Cases

Human fibrin sealant was used to accelerate the healing process in a total of 25 fistulas: 9 intestinal, 2 biliary, 1 vaginal, and 13 pancreatic. All patients received adequate nutritional support, and their secretions were reduced by pharmacological treatment. They underwent repeated X-ray check-ups to achieve a proper positioning of the drainages and to control the healing process. As soon as the fistulas showed a regular tract and a low outflow, they were treated with fibrin sealant. Quick and stable healing was obtained in 22 cases. In three patients we obtained only a reduction of secretions and lumen.