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Chen C, Lin X, Lin R, Huang H, Lu F. A high serum creatine kinase (CK)-MB-to-total-CK ratio in patients with pancreatic cancer: a novel application of a traditional marker in predicting malignancy of pancreatic masses? World J Surg Oncol 2023; 21:13. [PMID: 36653771 PMCID: PMC9847085 DOI: 10.1186/s12957-023-02903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The finding that some benign pancreatic masses mimic the imaging appearance of carcinomas poses a challenge for pancreatic surgeons. Preoperative markers that assist in the diagnosis are critical under this circumstance. Abnormal serum creatine kinase (CK) isozyme levels were reported in cancer patients, and this study aimed to explore the potential value of the CK-MB-to-total-CK ratio (CK ratio) in differentiating pancreatic cancer (PC) from benign masses when combined with carbohydrate antigen 19-9 (CA19-9). METHODS A total of 190 patients primarily diagnosed with pancreatic masses were retrospectively reviewed and assigned to the PC group and the benign pancreatic mass (BPM) group. Sixty-eight controls were enrolled for comparison. Levels of preoperative parameters, including total serum CK, CK-MB, absolute neutrophil count, absolute lymphocyte count, albumin, and CA19-9, were recorded as well as pathological information. A logistic regression model was established to assess the application value of the combination of CA19-9 and the CK ratio in diagnosis. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic value of the markers. RESULTS The CK ratio was significantly elevated in the PC group compared with the BPM group (P < 0.001). In the multivariate analysis, a CK ratio greater than 0.220 was a statistically significant variable for predicting malignancy of pancreatic masses (P=0.001). Patients with stage III/IV PC had a higher CK ratio than those with stage I/II PC (P<0.01). Combined detection of CA19-9 and the CK ratio produced an increased Youden index (0.739 vs. 0.815) with improved sensitivity (82.2% vs. 89.8%). CONCLUSIONS The CK ratio is elevated in patients with pancreatic adenocarcinoma and is an independent factor predicting pancreatic adenocarcinoma. The CK ratio augments the diagnostic capacity of CA19-9 in detecting malignancy.
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Affiliation(s)
- Cong Chen
- grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 Fujian China
| | - Xianchao Lin
- grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 Fujian China
| | - Ronggui Lin
- grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 Fujian China
| | - Heguang Huang
- grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 Fujian China
| | - Fengchun Lu
- grid.411176.40000 0004 1758 0478Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001 Fujian China
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Karidis NP, Paraskeva P, Mantas D. Synchronous primary epithelial tumors of the pancreas. Int J Surg Case Rep 2012; 3:428-30. [PMID: 22705936 DOI: 10.1016/j.ijscr.2012.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/05/2012] [Accepted: 05/10/2012] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Pancreatic incidentalomas are diagnosed at increased rates due to advanced pancreatic imaging. Coexistence of such lesions with another pancreatic pathology, however, is uncommon and their management might be perplexed by the anatomical location and the histological features of the lesion. PRESENTATION OF CASE A patient with obstructive jaundice was diagnosed with adenocarcinoma of the pancreatic head and underwent routine pancreatic imaging (CT) which revealed the coexistence of a small cystic lesion at the pancreatic body. Further investigation with MRCP and ERCP was unable to confirm a benign lesion and total pancreatoduodenectomy was performed. Histological examination showed a rare type of mixed serous-mucinous cystadenoma of borderline malignancy at the pancreatic body coexistent with an adenocarcinoma of the pancreatic head. DISCUSSION Coexistence of a peripheral pancreatic cystic tumor with a ductal adenocarcinoma of the pancreatic head is a very rare incidence in medical literature. The management of the peripheral lesion is not straightforward and there can be uncertainty as to the extent of the pancreatic resection that may be required. CONCLUSION Appropriate preoperative imaging has a significant impact on the definitive management of synchronous pancreatic tumors. Implications of a common pathogenetic pathway are also raised for this rare occurrence of two primary epithelial pancreatic tumors.
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Affiliation(s)
- Nikolaos P Karidis
- Second Department of Surgery, School of Medicine, University of Athens, General Hospital Laiko, Athens, Greece
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Jiao LR, Frampton AE, Jacob J, Pellegrino L, Krell J, Giamas G, Tsim N, Vlavianos P, Cohen P, Ahmad R, Keller A, Habib NA, Stebbing J, Castellano L. MicroRNAs targeting oncogenes are down-regulated in pancreatic malignant transformation from benign tumors. PLoS One 2012; 7:e32068. [PMID: 22384141 PMCID: PMC3284550 DOI: 10.1371/journal.pone.0032068] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 01/23/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND MicroRNA (miRNA) expression profiles have been described in pancreatic ductal adenocarcinoma (PDAC), but these have not been compared with pre-malignant pancreatic tumors. We wished to compare the miRNA expression signatures in pancreatic benign cystic tumors (BCT) of low and high malignant potential with PDAC, in order to identify miRNAs deregulated during PDAC development. The mechanistic consequences of miRNA dysregulation were further evaluated. METHODS Tissue samples were obtained at a tertiary pancreatic unit from individuals with BCT and PDAC. MiRNA profiling was performed using a custom microarray and results were validated using RT-qPCR prior to evaluation of miRNA targets. RESULTS Widespread miRNA down-regulation was observed in PDAC compared to low malignant potential BCT. We show that amongst those miRNAs down-regulated, miR-16, miR-126 and let-7d regulate known PDAC oncogenes (targeting BCL2, CRK and KRAS respectively). Notably, miR-126 also directly targets the KRAS transcript at a "seedless" binding site within its 3'UTR. In clinical specimens, miR-126 was strongly down-regulated in PDAC tissues, with an associated elevation in KRAS and CRK proteins. Furthermore, miR-21, a known oncogenic miRNA in pancreatic and other cancers, was not elevated in PDAC compared to serous microcystic adenoma (SMCA), but in both groups it was up-regulated compared to normal pancreas, implicating early up-regulation during malignant change. CONCLUSIONS Expression profiling revealed 21 miRNAs down-regulated in PDAC compared to SMCA, the most benign lesion that rarely progresses to invasive carcinoma. It appears that miR-21 up-regulation is an early event in the transformation from normal pancreatic tissue. MiRNA expression has the potential to distinguish PDAC from normal pancreas and BCT. Mechanistically the down-regulation of miR-16, miR-126 and let-7d promotes PDAC transformation by post-transcriptional up-regulation of crucial PDAC oncogenes. We show that miR-126 is able to directly target KRAS; re-expression has the potential as a therapeutic strategy against PDAC and other KRAS-driven cancers.
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Affiliation(s)
- Long R. Jiao
- Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, UK
| | - Adam E. Frampton
- Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, UK
| | - Jimmy Jacob
- Division of Oncology, Department of Surgery and Cancer, MRC Cyclotron Building, Imperial College, Hammersmith Hospital, London, UK
| | - Loredana Pellegrino
- Division of Oncology, Department of Surgery and Cancer, MRC Cyclotron Building, Imperial College, Hammersmith Hospital, London, UK
| | - Jonathan Krell
- Division of Oncology, Department of Surgery and Cancer, MRC Cyclotron Building, Imperial College, Hammersmith Hospital, London, UK
| | - Georgios Giamas
- Division of Oncology, Department of Surgery and Cancer, MRC Cyclotron Building, Imperial College, Hammersmith Hospital, London, UK
| | - Nicole Tsim
- Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, UK
| | - Panagiotis Vlavianos
- Department of Gastroenterology, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | - Patrizia Cohen
- Department of Histopathology, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | - Raida Ahmad
- Department of Histopathology, Imperial College NHS Trust, Hammersmith Hospital, London, UK
| | - Andreas Keller
- Department of Human Genetics, Saarland University, Homburg, Saar, Germany
| | - Nagy A. Habib
- Hepato-Pancreato-Biliary Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, UK
| | - Justin Stebbing
- Division of Oncology, Department of Surgery and Cancer, MRC Cyclotron Building, Imperial College, Hammersmith Hospital, London, UK
| | - Leandro Castellano
- Division of Oncology, Department of Surgery and Cancer, MRC Cyclotron Building, Imperial College, Hammersmith Hospital, London, UK
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Genevay M, Dumonceau JM, Berney T, Terraz S, Felley C, Morel P, Frossard JL. Unusual Masses of the Pancreas to Be Aware of. Case Rep Gastroenterol 2009; 3:389-394. [PMID: 21103259 PMCID: PMC2988935 DOI: 10.1159/000255401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This paper aims at emphasizing the difficulty in assessing preoperatively the diagnosis of solid masses of the pancreas whatever the initial clinical presentation may be. We illustrate our purpose describing consecutive cases of pancreatic masses of the pancreas we recently had and who were followed according to the internal guidelines of investigation of our referral hospital. Whereas malignant tumors of the pancreas represent the vast majority of solid tumors of the pancreas, other diagnoses must be evoked. We report three cases of pancreatic solid masses that were explored by endoscopic ultrasonography coupled with fine needle aspiration, a method universally considered to be both reliable and accurate but which failed to assess definitive diagnosis due to both cytological pitfalls and sampling error.
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Affiliation(s)
- Muriel Genevay
- Division of Clinical Pathology, Geneva University Hospitals, Geneva, Switzerland
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