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Möller K, Ntovas S, Hocke M, On W, Everett SM, Braden B, Jenssen C, Misselwitz B, Ge N, Sun S, Gerber M, Faiss S, Dietrich CF. Comments and illustrations of the European Federation of Societies for Ultrasound in Medicine guidelines: Rare pancreatic tumors, ultrasound and contrast-enhanced ultrasound features-Malignant mesenchymal tumors. Endosc Ultrasound 2024; 13:55-64. [PMID: 38947746 PMCID: PMC11213603 DOI: 10.1097/eus.0000000000000054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Rare malignant mesenchymal pancreatic tumors are systematized and reported in this review. The focus is on the appearance on imaging. The present overview summarizes the data and shows that not every pancreatic tumor corresponds to the most common entities of ductal adenocarcinoma or neuroendocrine tumor.
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Affiliation(s)
- Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Sotirios Ntovas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Hocke
- Medical Department II, Helios Klinikum Meiningen, Germany
| | - Wei On
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Simon M. Everett
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, United Kingdom
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch-Oderland, Strausberg, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS) at Medical University Brandenburg, Neuruppin, Germany
| | - Benjamin Misselwitz
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nan Ge
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Siyu Sun
- Department of Endoscopy Center, Shengjing Hospital of China Medical University, Liaoning Province, China
| | - Michael Gerber
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Siegbert Faiss
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin, Germany
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin der Kliniken (DAIM) Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Wilson N, Issak A, Amin K, Tuttle TM, Trikudanathan G, Mallery S. Primary Pancreatic Liposarcoma: An Unexpected Cause of a Pancreatic Mass. ACG Case Rep J 2023; 10:e01242. [PMID: 38107608 PMCID: PMC10723886 DOI: 10.14309/crj.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023] Open
Abstract
Liposarcoma is the most common type of soft-tissue sarcoma and typically occurs in the extremities or retroperitoneum. Primary liposarcoma of the pancreas is exceedingly rare, with only 10 cases reported since 1979. We present a patient who was incidentally discovered to have a pancreatic mass on imaging, which was ultimately diagnosed as dedifferentiated pancreatic liposarcoma. We review the clinical and histologic features of pancreatic liposarcoma in this case and in the 10 previously reported cases to increase awareness and knowledge of this rare disease.
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Affiliation(s)
- Natalie Wilson
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN
| | - Abdulfatah Issak
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, MN
| | - Khalid Amin
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center, Minneapolis, MN
| | - Todd M. Tuttle
- Department of Surgery, University of Minnesota Medical Center, Minneapolis, MN
| | - Guru Trikudanathan
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, MN
| | - Shawn Mallery
- Department of Internal Medicine, University of Minnesota Medical Center, Minneapolis, MN
- Division of Gastroenterology and Hepatology, University of Minnesota Medical Center, Minneapolis, MN
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Tanabe M, Matsui H, Higashi M, Tokumitsu Y, Nagano H, Ito K. Pancreatic liposarcoma: a case report. Abdom Radiol (NY) 2022; 47:1912-1916. [PMID: 35507066 DOI: 10.1007/s00261-022-03522-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/09/2022]
Abstract
An 81-year-old woman who had undergone total thyroidectomy for papillary thyroid cancer 12 years earlier was found to have a tumor in the tail of the pancreas. Four years earlier, skin, lung, and mediastinal lymph node metastases had appeared. Computed tomography (CT) showed a mass 26 mm in diameter in the tail of the pancreas. Thereafter, the pancreatic tumor increased in size, while the lung metastases remained stable. Unenhanced CT at the time of first detection showed that the tumor was heterogeneous, with low-attenuation areas indicating fat components. As the tumor grew, the fat components became unclear. Laparoscopic distal pancreatectomy and splenectomy were performed. The tumor was diagnosed as dedifferentiated liposarcoma with a well-differentiated liposarcoma component at the tumor margin. The pancreas is an extremely rare site of primary liposarcoma. In the present case, a pancreatic liposarcoma appeared during follow-up of thyroid cancer, and the changes over time were able to be observed with CT.
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Yang QK, Chen T, Wang SQ, Zhang XJ, Yao ZX. Apatinib as targeted therapy for advanced bone and soft tissue sarcoma: a dilemma of reversing multidrug resistance while suffering drug resistance itself. Angiogenesis 2020; 23:279-298. [PMID: 32333216 DOI: 10.1007/s10456-020-09716-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/24/2020] [Indexed: 02/07/2023]
Abstract
Bone and soft tissue sarcomas are rare malignant tumors originated from mesenchymal tissues. They harbor more than 50 distinct subtypes and differ in pathological features and clinical courses. Despite the significant improvements in modern multi-modality treatment, the outcomes and overall survival rates remain poor for patients with advanced, refractory, metastatic, or relapsed diseases. The growth and metastasis of bone and soft tissue sarcoma largely depend on angiogenesis, and VEGF/VEGFR pathway is considered as the most prominent player in angiogenesis. Therefore, blockade of VEGF/VEGFR pathways is a promising therapeutic strategy to retard neovascularization. Several VEGFR inhibitors have been developed and revealed their favorable anti-neoplastic effects in various cancers, but such desirable anti-tumor effects are not obtained in advanced sarcomas because of multiple reasons, such as drug tolerance, short duration of response, and severe adverse effects. Fortunately, preclinical and clinical studies have indicated that apatinib is a novel promising VEGFR2 inhibitor showing potent anti-angiogenic and anti-neoplastic activities in advanced sarcomas. Especially, apatinib has showed notable characteristics in multidrug resistance reversal, tumor regression, vascular normalization, immunosuppression alleviation, and enhancement of chemotherapeutic and radiotherapeutic effects. However, apatinib also gets struck in dilemma of reversing multidrug resistance of chemotherapeutic agents while suffering drug resistance itself, and several difficulties should be tackled before full use of apatinib. In this review, we discuss the outstanding characteristics and main predicaments of apatinib as targeted therapy in advanced sarcomas. Bone and soft tissue sarcomas are rare but malignant tumors originated from mesenchymal tissues. They harbor more than 100 distinct subtypes and differ in features of pathologies and clinical courses. Despite the significant improvements in modern multi-modality treatment, the outcomes and overall survival rates remain poor for patients with advanced, refractory, metastatic, or relapsed lesions. The growth and metastasis of bone and soft tissue sarcoma largely depend on angiogenesis and VEGF/VEGFR pathways play a pivotal role in angiogenesis. Therefore, blockade of VEGF/VEGFR pathways is a promising therapeutic strategy. Several VEGFR inhibitors have been developed and verified in clinical trials but with unfavorable outcomes. Fortunately, preclinical studies and clinical trials have indicated that apatinib is a novel promising VEGFR2 inhibitor showing potent anti-angiogenic and anti-neoplastic activities in advanced sarcomas. Actually, apatinib has showed notable characteristics in multidrug resistance reversal, tumor regression, vascular normalization, immunosuppression alleviation, enhancement of chemotherapeutic and radiotherapeutic effects. However, apatinib also gets struck in dilemma of reversing multidrug resistance of chemotherapeutic agents while suffering drug resistance itself, and several difficulties should be tackled before full use of apatinib. In this review, we discuss the outstanding characteristics and main predicaments of apatinib as targeted therapy in advanced sarcomas.
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Affiliation(s)
- Qian-Kun Yang
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, 110042, China
- Department of Physiology, Army Medical University, Chongqing, 400038, China
| | - Tong Chen
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, 110042, China
| | - Shi-Qi Wang
- Troops 65651 of Chinese People's Liberation Army, Jinzhou, 121100, China
| | - Xiao-Jing Zhang
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, 110042, China.
| | - Zhong-Xiang Yao
- Department of Physiology, Army Medical University, Chongqing, 400038, China.
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Liu Z, Fan WF, Li GC, Long J, Xu YH, Ma G. Huge primary dedifferentiated pancreatic liposarcoma mimicking carcinosarcoma in a young female: A case report. World J Clin Cases 2019; 7:1344-1350. [PMID: 31236399 PMCID: PMC6580340 DOI: 10.12998/wjcc.v7.i11.1344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 04/09/2019] [Accepted: 05/02/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pancreatic liposarcoma is a rare tumor. According to a literature review, the patient described in this study is the seventh case of pancreatic liposarcoma reported in the English literature and the third case of dedifferentiated liposarcoma. Furthermore, this case had the largest primary tumor volume, and a primary pancreatic liposarcoma was diagnosed based on sufficient evidence.
CASE SUMMARY We here report a rare case of a 28-year-old female with a huge dedifferentiated liposarcoma in the pancreatic tail. In June 2015, the patient underwent distal pancreatectomy with splenectomy. During the operation, a huge liposarcoma of approximately 28.0 cm × 19.0 cm × 8.0 cm was found, which had a yellow and white fish-like incisal surface. Based on both pathology and MDM2 gene amplification, the tumor was diagnosed as a dedifferentiated liposarcoma. The patient was treated with surgery but declined postoperative chemotherapy. She was well at the 26-mo follow-up, and no relapse was observed.
CONCLUSION Pancreatic liposarcoma has a low incidence. Chemotherapy should be included in the treatment regimens. Complete resection is the only effective treatment.
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Affiliation(s)
- Zhe Liu
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Wu-Feng Fan
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Gui-Chen Li
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Jin Long
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Yuan-Hong Xu
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
| | - Gang Ma
- Department of Pancreatic-Biliary Surgery, First Hospital of China Medical University, Shenyang 110001, Liaoning Province, China
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Jin J, Du J, Wu Y. Apatinib monotherapy for advanced VEGFR-2-negative nasopharyngeal carcinoma: A case report. Medicine (Baltimore) 2019; 98:e13491. [PMID: 30608382 PMCID: PMC6344178 DOI: 10.1097/md.0000000000013491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Due to the anatomical and biological characteristics of nasopharyngeal carcinoma (NPC), radiotherapy is the standard treatment of choice. Recent advances in small molecule therapies targeting tumor angiogenesis also hold promise for the treatment of advanced NPC. PATIENT CONCERNS The patient's symptoms, including nasal obstruction, nasal bleeding, and headache, reappeared periodically and eventually became so severe that the patient's vision became impaired. In January 2016, the patient presented with blurred vision, diplopia, language impairment, left temporal paralysis, and bilateral eyelid ptosis. DIAGNOSIS Advanced NPC without metastasis in a 55-year-old man. INTERVENTIONS The patient refused treatment with radiotherapy or chemotherapy and was treated with Chinese herbal medicines. Following a worsening of symptoms, the patient was subsequently treated with apatinib monotherapy (0.25 g, once daily). OUTCOMES Symptom improvement, including decreased nasal bleeding and headache, was observed after 1 week of apatinib treatment. After 100 days of treatment, the patient was nearly asymptomatic with stable disease and improved quality of life. LESSONS For patients with advanced NPC who refuse standard radiotherapy and chemotherapy, apatinib monotherapy may be a suitable treatment option to improve symptoms and quality of life even in those with vascular endothelial growth factor receptor-negative tumors.
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Affiliation(s)
- Jun Jin
- Guangdong Province Hospital of Integrated Traditional Chinese and Western Medicine, Foshan
| | - Jiahao Du
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yanwei Wu
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Yang Z, Chen G, Cui Y, Xiao G, Su T, Yu J, Zhang Z, Han Y, Yang K, Jin L. The safety and efficacy of TACE combined with apatinib on patients with advanced hepatocellular carcinoma: a retrospective study. Cancer Biol Ther 2018; 20:321-327. [PMID: 30332553 DOI: 10.1080/15384047.2018.1529099] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
As a novel vascular endothelial growth factor receptor-2 tyrosine kinase inhibitor (VEGFR2-TKI), apatinib has a certain anti-tumor effect for a variety of solid tumors. The present study evaluates its efficacy and safety in advanced hepatocellular carcinoma (HCC). In this study, 47 patients with advanced HCC were included. TACE monotherapy group included 22 patients that responded to TACE, while the group that received TACE and apatinib included 25 patients that progressed on TACE and were able to receive apatinib off label. Median overall survival (OS) was significantly improved in the apatinib plus TACE group compared with the TACE group. Similarly, apatinib in combination with TACE significantly prolonged median progression-free survival (PFS) compared with TACE monotherapy. Furthermore, there was a significant difference between combination therapy and monotherapy in both Barcelona clinic liver cancer (BCLC) B and BCLC C group. The combination therapy had a dramatic effect on OS and PFS for patients at both BCLC B and BCLC C level. The most common clinically adverse events of apatinib plus TACE group were fatigue, weight loss, hypertension, hand-foot syndrome and anorexia, which were manageable and tolerable. The efficacy analysis showed that there was no significant association of survival benefit with age, gender, Eastern Cooperative Oncology Group (ECOG) performance status, hypertension and hand-foot syndrome. Patients with macrovascular invasion and extrahepatic invasion showed worse survival benefits. In conclusion, apatinib combined with TACE revealed certain survival benefits for HCC patients who experienced progression following TACE, which can provide a promising strategy for HCC treatment.
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Affiliation(s)
- Zeran Yang
- a Interventional radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Guang Chen
- a Interventional radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Ye Cui
- b Department of Immunology, School of Basic Medical Sciences , Capital Medical University , Beijing , China
| | - Guowen Xiao
- a Interventional radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Tianhao Su
- a Interventional radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Jianan Yu
- a Interventional radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Zhiyuan Zhang
- a Interventional radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Yanjing Han
- a Interventional radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Kailan Yang
- a Interventional radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
| | - Long Jin
- a Interventional radiology, Beijing Friendship Hospital , Capital Medical University , Beijing , China
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Zhu B, Li J, Xie Q, Diao L, Gai L, Yang W. Efficacy and safety of apatinib monotherapy in advanced bone and soft tissue sarcoma: An observational study. Cancer Biol Ther 2018; 19:198-204. [PMID: 29261005 PMCID: PMC5790336 DOI: 10.1080/15384047.2017.1416275] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/26/2017] [Accepted: 12/07/2017] [Indexed: 12/22/2022] Open
Abstract
Sarcomas are rare but malignant tumors with high risks of local recurrence and distant metastasis. Anti-angiogenic therapy is a potential strategy against un-controlled and not-organized tumor angiogenesis. We aimed to assess the safety and efficacy of apatinib, an oral tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor-2, in patients with advanced sarcoma. Thirty-one patients who received initial apatinib between September 2015 and August 2016 were retrospectively reviewed. Among them, 19 (61.3%) patients were heavily pretreated with two or more lines of cytotoxic chemotherapy. Apatinib was given at a start-dose of 425 mg qd. During therapy, 9 (29.0%) patients required dose interruption and 7 (22.6%) needed dose reduction, and the mean dosage of apatinib was 372.9 ± 68.4 mg/day. In the study cohort, one patient was treated as adjunctive therapy and 6 patients stopped treatment before radiographic response assessment. Thus, 24 patients were eligible for tumor response evaluation. The objective response rate was 33.3% and clinical benefit rate was as high as 75.0%. The progression free survival was 4.25 (95% confidence interval [CI], 2.22-5.11) months, whereas the overall survival was 9.43 (95% CI, 6.64-18.72) months. Compared with other histological subtypes, leiomyosarcoma did not show significant survival benefits. Most of the adverse events (AEs) were at grade 1 or 2. The main grade 3 AEs were hypertension (6.5%), hand foot skin reaction (6.5%), and diarrhea (3.2%). In conclusion, apatinib showed promising efficacy and acceptable safety profile in metastatic or recurrent sarcoma, giving rationale clinical evidence to conduct clinical trials.
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Affiliation(s)
- Baorang Zhu
- Department of Oncology Minimally Invasive, The 307th Hospital of PLA, Affiliated Hospital of Military Medical Sciences, Beijing, China
| | - Jing Li
- Department of Oncology Minimally Invasive, The 307th Hospital of PLA, Affiliated Hospital of Military Medical Sciences, Beijing, China
| | - Qiaosheng Xie
- Department of Oncology Minimally Invasive, The 307th Hospital of PLA, Affiliated Hospital of Military Medical Sciences, Beijing, China
| | - Liyan Diao
- Department of Oncology Minimally Invasive, The 307th Hospital of PLA, Affiliated Hospital of Military Medical Sciences, Beijing, China
| | - Lvhua Gai
- Department of Oncology Minimally Invasive, The 307th Hospital of PLA, Affiliated Hospital of Military Medical Sciences, Beijing, China
| | - Wuwei Yang
- Department of Oncology Minimally Invasive, The 307th Hospital of PLA, Affiliated Hospital of Military Medical Sciences, Beijing, China
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