1,720,971 research outputs found
Non ductal-adenocarcinoma neoplasms of the pancreas.
No full textPancreatic Non Ductal-Adenocarcinoma Neoplasms (PNDAN) represent about 20\% of pancreatic and periampullary tumors and should be considered in differential diagnosis with ductal adenocarcinoma in the presence of isolated pancreatic mass. From January 1992 to December 1998, 238 patients were operated on for pancreatic and periampullary masses. Fifty-five patients had PNDAN: 24 endocrine tumors, 7 serous cystadenomas, 6 intraductal papillary-mucinous tumors, 5 acinar carcinomas, 4 mucinous cystadenomas, 3 metastatic tumors, 2 cystic papillary tumors, 2 solid cystadenocarcinomas, 1 neurilemmoma, and 1 pancreatoblastoma; 19 were benign and 36 were malignant or borderline tumors. A correct preoperative diagnosis was obtained in 58\% of the cases. In all other cases, diagnosis was achieved intraoperatively. Major (18 pancreaticoduodenectomies, 17 left splenopancreatectomies, 1 total pancreatectomy) and minor resections (5 central pancreatectomy, 10 enucleations) were performed; curative surgical operations were carried out on 39/55 patients (curative resectability: 71\%). Operative mortality and morbidity were 1.8\% and 21.8\%, respectively. Three and 5-year actuarial survival for malignant or borderline PNDANs are 65\% and 40\% versus 31\% (3-year) for ductal adenocarcinoma of pancreatic head treated by pancreaticoduodenectomy (p-value = 0.03). We believe that pancreatic masses that are not ductal adenocarcinomas, can be aggressively resected even if large in size, resulting in a better outcome than ductal adenocarcinoma itself
Multimodal Treatment (resection and Chemoembolization) In Hepatic Metastasis of Leiomyosarcoma
No full textParagangliomi extrasurrenalici a localizzazione retroperitoneale
No full textParagangliomi extrasurrenalici a localizzazione retroperitoneal
Lymphoepithelial cyst of the pancreas
No full textCONCLUSION.Lymphoepithelial 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. BACKGROUND. LC of the pancreas is a cyst that is histologically characterized by a fibrous tissue, a lymphoid component and a lining squamous epithelium. METHODS. Clinical and pathological findings of two personal cases are reported with review of the literature. RESULTS. A 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
Adenocarcinoma of the Ampulla of Vater: T-Stage, Chromosome 17p Allelic Loss, and Extended Pancreaticoduodenectomy are Relevant Prognostic Factors
No full textOBJECTIVE:To evaluate the prognostic significance of different clinico-pathological and molecular factors, and to compare survival after standard and extended pancreaticoduodenectomy (PD) in ampulla of Vater adenocarcinoma (AVAC). There are discordant data on factors affecting prognosis, and hence therapeutic choices, in AVAC.PATIENTS AND METHODS:Clinical-pathological factors were evaluated in 59 patients, subjected to PD for AVAC; in 42 subjects information on chromosome 17p and 18q allelic losses (LOH) and microsatellite instability (MSI) was also available. The association between survival and type of PD was investigated in the 25 patients operated between 1990 and 2001 (16 standard and nine extended).RESULTS:The overall 5- and 10-year tumor-related survival rates were 46% and 33%, respectively. Sixteen patients had T-stages 1-2, 14 T-stage 3, and 29 T-stage 4 cancers. Chromosome 17p and 18q LOH were detected in 23 (55%) and 15 cases (36%), respectively, and in 12 cases (29%) coexisted. Five cases were MSI-positive (12%). At univariate analysis, poor survival was associated with cancer ulceration (P = 0.051), poor differentiation (P = 0.008), T-stage 4 (P 12 yrs), whereas only 30% of MSI-negative cancer patients survived at 5 years. Extended pancreaticoduodenectomy was associated with a 3-year disease-related survival higher than standard resection (83% vs 31%; P = 0.018).CONCLUSION:MSI and chromosome 17p status allow to better define prognosis within ampullary cancers at the same stage. Surgery alone resulted curative in MSI-positive cancer patients, whereas it was inadequate in patients showing allelic losses, who might benefit from adjuvant therapy. In this observational study, extended PD was associated with increased survival compared to standard procedures
Retroperitoneal paragangliomas: role of immunohistochemistry in the diagnosis of malignancy and in assessment of prognosis [see comments]
No full textOBJECTIVE: To present our experience of 10 patients with extra-adrenal retroperitoneal paragangliomas, and assess prognostic tests. DESIGN: Retrospective study of casenotes. SETTING: University hospital, Italy. SUBJECTS: 10 Patients who presented with paragangliomas between 1970 and 1991. MAIN OUTCOME MEASURES: Histological and immunohistochemical results, and outcome. RESULTS: All tumours were completely resected and there was no operative mortality. Of the 8 patients who had no metastases at presentation 3 died of recurrence 3, 5, and 10 years later, respectively; 4 were alive and free of disease 2-7 years after diagnosis. The 2 patients with synchronous bone metastases at presentation died 1 and 4 years later. Immunohistochemical analysis of type I cells (chromogranin A and neurone-specific enolase) showed little correlation with progression of disease, but there was a correlation between the presence of type II cells (S100 protein) and good prognosis. CONCLUSIONS: Excision is the treatment of choice for paraganglioma. Immunohistochemical techniques may provide useful information about prognosis, in particular about those patients who are at increased risk of recurrence. Long term follow up is essential, because successful management of recurrence is dependent on early recognition
[The ND-Yag laser in the treatment of non-resectable esophageal neoplasms: evaluation and results]
No full textThe Authors show a set of 9 cases of patients suffering from oesophagus flaky carcinoma, judged radically non-operable, and treated with endoscopic laser-therapy. They illustrate the patients' main clinical data, method followed, complications observed and results obtained. What seems to emerge from the analysis of the data is: the effectiveness of laser-therapy in the control of disphagia, simplicity of the technique and its acceptability by the patient, as well as the rareness of complications. Three are the clinical parameters used for the checking of patients before and after the laser treatment: disphagia, odynophagia and thoracic ache. The intenseness of symptoms was classed from 0 up to 3. Before the treatment, six patients out of nine showed class 3 disphagia; after the treatment, two could assume fluids (class 2), two fed also on minced foods (class 1), and two fed normally; in the two cases with initial class 2 disphagia a normal feed could be adopted; in one case no initial disphagia was present. Odynophagia was initially present in one case only at class 3, in three cases at class 1, and in all the other cases it was absent (0). After the treatment, odynophagia disappeared totally, except in one class 1 case, which remained unchanged. The presence of thoracic ache before the treatment was class 1 in four cases, class 3 in one case, and absent in four cases. After the treatment, the class 3 ache turned into class 1: in one class 1 case it was not modified; in the remaining cases the ache, if present, disappeared. Some questions remain opened, concerning the effect on survival, even in relation to other palliative methods, to the duration of the palliation obtained and to the eventual associability of lasertherapy to radiotherapy
[Primary germinal tumors of the mediastinum: our experience in 9 cases].
No full text9 patients (8 males 1 female, middle age 24.3 years, range 20-41) affected by primary mediastinal germ cell tumor were surgically treated in our department. They were 4 seminomas, 2 embryonal carcinomas, 1 malignant teratoma and 2 benign teratomas. Three patients were asymptomatic; cough, dyspnea and chest pain were the most frequently observed symptoms. The staging work-up did not show signs of metastatic disease in the malignant types. Benign teratomas underwent complete excision. In one patient suffering from seminoma radiotherapy and chemotherapy caused complete remission of the disease. In the others cases remission of the neoplasm was obtained by resection and adjuvant therapy in 3 cases, by neoadjuvant treatment and excision of the residual mass in 3 cases. Among the patients suffering from seminoma, 2 are dead at 60 months since initial treatment and 2 are alive at 132 and 120 months respectively. Among the patients with malignant nonseminomatous tumours, 2 are alive at 60 and 36 months and 1 patient is dead at 13 months. Two patients with benign teratoma are alive at 189 and 168 months respectively. At present a multimodality treatment including surgery, radiotherapy and cisplatin-based combination chemotherapy, give the most satisfactory results in the treatment of malignant mediastinal germ cell tumours
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