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Veron Sanchez A, Santamaria Guinea N, Cayon Somacarrera S, Bennouna I, Pezzullo M, Bali MA. Rare Solid Pancreatic Lesions on Cross-Sectional Imaging. Diagnostics (Basel) 2023; 13:2719. [PMID: 37627978 PMCID: PMC10453474 DOI: 10.3390/diagnostics13162719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
Several solid lesions can be found within the pancreas mainly arising from the exocrine and endocrine pancreatic tissue. Among all pancreatic malignancies, the most common subtype is pancreatic ductal adenocarcinoma (PDAC), to a point that pancreatic cancer and PDAC are used interchangeably. But, in addition to PDAC, and to the other most common and well-known solid lesions, either related to benign conditions, such as pancreatitis, or not so benign, such as pancreatic neuroendocrine neoplasms (pNENs), there are solid pancreatic lesions considered rare due to their low incidence. These lesions may originate from a cell line with a differentiation other than exocrine/endocrine, such as from the nerve sheath as for pancreatic schwannoma or from mesenchymal cells as for solitary fibrous tumour. These rare solid pancreatic lesions may show a behaviour that ranges in a benign to highly aggressive malignant spectrum. This review includes cases of an intrapancreatic accessory spleen, pancreatic tuberculosis, solid serous cystadenoma, solid pseudopapillary tumour, pancreatic schwannoma, purely intraductal neuroendocrine tumour, pancreatic fibrous solitary tumour, acinar cell carcinoma, undifferentiated carcinoma with osteoclastic-like giant cells, adenosquamous carcinoma, colloid carcinoma of the pancreas, primary leiomyosarcoma of the pancreas, primary and secondary pancreatic lymphoma and metastases within the pancreas. Therefore, it is important to determine the correct diagnosis to ensure optimal patient management. Because of their rarity, their existence is less well known and, when depicted, in most cases incidentally, the correct diagnosis remains challenging. However, there are some typical imaging features present on cross-sectional imaging modalities that, taken into account with the clinical and biological context, contribute substantially to achieve the correct diagnosis.
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Affiliation(s)
- Ana Veron Sanchez
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | | | | | - Ilias Bennouna
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
| | - Martina Pezzullo
- Hôpital Universitaire de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - Maria Antonietta Bali
- Hôpital Universitaire de Bruxelles, Institut Jules Bordet, 1070 Brussels, Belgium; (I.B.)
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Diaconescu S, Gîlcă-Blanariu GE, Poamaneagra S, Marginean O, Paduraru G, Stefanescu G. Could the burden of pancreatic cancer originate in childhood? World J Gastroenterol 2021; 27:5322-5340. [PMID: 34539135 PMCID: PMC8409163 DOI: 10.3748/wjg.v27.i32.5322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
The presence of pancreatic cancer during childhood is extremely rare, and physicians may be tempted to overlook this diagnosis based on age criteria. However, there are primary malignant pancreatic tumors encountered in pediatric patients, such as pancreatoblastoma, and tumors considered benign in general but may present a malignant potential, such as the solid pseudo-papillary tumor, insulinoma, gastrinoma, and vasoactive intestinal peptide secreting tumor. Their early diagnosis and management are of paramount importance since the survival rates tend to differ for various types of these conditions. Many pediatric cancers may present pancreatic metastases, such as renal cell carcinoma, which may evolve with pancreatic metastatic disease even after two or more decades. Several childhood diseases may create a predisposition for the development of pancreatic cancer during adulthood; hence, there is a need for extensive screening strategies and complex programs to facilitate the transition from pediatric to adult healthcare. Nevertheless, genetic studies highlight the fact the specific gene mutations and family aggregations may be correlated with a special predisposition towards pancreatic cancer. This review aims to report the main pancreatic cancers diagnosed during childhood, the most important childhood diseases predisposing to the development of pancreatic malignancies, and the gene mutations associates with pancreatic malignant tumors.
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Affiliation(s)
- Smaranda Diaconescu
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
- Department of Pediatric Gastroenterology, St Mary Emergency Children's Hospital, Iasi 700309, Romania
| | - Georgiana Emmanuela Gîlcă-Blanariu
- Department of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi 700115, Romania
- Department of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, Iasi 700111, Romania
| | - Silvia Poamaneagra
- Department of Pediatric Gastroenterology, St Mary Emergency Children's Hospital, Iasi 700309, Romania
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures 540142, Romania
| | - Otilia Marginean
- Department of Pediatrics, Research Center of Disturbance of Growth and Development on Children-Belive, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara 300041, Romania
- First Clinic of Pediatrics, "Louis Turcanu" Emergency Childen's Hospital, Timisoara 300011, Romania
| | - Gabriela Paduraru
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi 700115, Romania
- Department of Pediatric Gastroenterology, St Mary Emergency Children's Hospital, Iasi 700309, Romania
| | - Gabriela Stefanescu
- Department of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi 700115, Romania
- Department of Gastroenterology and Hepatology, “St. Spiridon” Emergency Hospital, Iasi 700111, Romania
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Li Q, Staiculescu D, Zhou Y, Chen J. Pancreatic Leiomyosarcoma With Schistosomiasis Hematobia: A Case Report and Literature Review. Front Oncol 2021; 11:638905. [PMID: 33869026 PMCID: PMC8045707 DOI: 10.3389/fonc.2021.638905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
Pancreatic leiomyosarcoma (PL) is a very rare, malignant neoplasm with a very poor prognosis. Here, we examine a novel case of PL with schistosomiasis hematobia. The patient had been initially misdiagnosed by the first magnetic resonance imaging (MRI). The second imaging examination demonstrated an enlarged heterogeneous tumor mass in the body-tail of pancreas. Following image analysis, the patient underwent a pancreatectomy, splenectomy and lymph node dissections. Sixteen months after the tumor resection, follow-up computed tomography (CT) and MRI revealed tumor metastasis in the liver and lung. PL has non-specific clinical manifestations and imaging characteristics, making early diagnosis very challenging. When it is difficult to distinguish between benign and malignant pancreatic lesions, short-term imaging follow-up is preferred. In this case report, we discuss the relationship between PL and schistosomiasis hematobia.
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Affiliation(s)
- Qiang Li
- Department of Radiology, The Affiliated People's Hospital of Ningbo University, Ningbo, China
| | - Daniel Staiculescu
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Yurong Zhou
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jiang Chen
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
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Fadaee N, Sefa T, Das A, Rajkomar K. Pancreatic leiomyosarcoma: a diagnostic challenge and literature review. BMJ Case Rep 2019; 12:12/11/e231529. [PMID: 31780603 DOI: 10.1136/bcr-2019-231529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A 71-year-old woman was referred with abdominal pain and weight loss. An abdominal CT showed a 5-cm heterogeneous mass in the head of the pancreas with involvement of the superior mesenteric vein and artery. Her carcinoembryonic antigen (CEA) and CA 19-9 were normal. Two endoscopic ultrasound/fine needle aspirates (EUS/FNAs) of the mass diagnosed her with a mesenchymal tumour of myogenic origin but did not show features of malignancy. Frozen section analysis of laparoscopic core biopsies also failed to show malignant features, hence requiring an open biopsy which confirmed the diagnosis of pancreatic leiomyosarcoma (PLMS). She was eventually treated with radiotherapy. To our knowledge this is the only case in recent English literature of inoperable locally advanced PLMS that has required an open biopsy to formalise the diagnosis despite prior EUS FNAs. We include a review of the literature, highlighting the deficiencies of various biopsy techniques.
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Affiliation(s)
- Neesa Fadaee
- General Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Tasmea Sefa
- General Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Amitabah Das
- General Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia.,General Surgery, Bankstown Hospital, Bankstown, New South Wales, Australia
| | - Kheman Rajkomar
- General Surgery, Bankstown Hospital, Bankstown, New South Wales, Australia
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Moletta L, Sperti C, Beltrame V, Gruppo M, Blandamura S, Pasquali C, Pedrazzoli S. Leiomyosarcoma of the Pancreas with Liver Metastases as a Paradigm of Multimodality Treatment: Case Report and Review of the Literature. J Gastrointest Cancer 2016; 43 Suppl 1:S246-50. [PMID: 22733567 DOI: 10.1007/s12029-012-9405-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Lucia Moletta
- Department of Surgical, Oncological, and Gastroenterological Sciences, 4th Surgical Clinic, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Cosimo Sperti
- Department of Surgical, Oncological, and Gastroenterological Sciences, 4th Surgical Clinic, University of Padua, via Giustiniani 2, 35128, Padova, Italy.
| | - Valentina Beltrame
- Department of Surgical, Oncological, and Gastroenterological Sciences, 4th Surgical Clinic, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Mario Gruppo
- Clinica Chirurgica Geriatrica, University of Padua, Padova, Italy
| | | | - Claudio Pasquali
- Department of Surgical, Oncological, and Gastroenterological Sciences, 4th Surgical Clinic, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Sergio Pedrazzoli
- Department of Surgical, Oncological, and Gastroenterological Sciences, 4th Surgical Clinic, University of Padua, via Giustiniani 2, 35128, Padova, Italy
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Milanetto AC, Liço V, Blandamura S, Pasquali C. Primary leiomyosarcoma of the pancreas: report of a case treated by local excision and review of the literature. Surg Case Rep 2015; 1:98. [PMID: 26943422 PMCID: PMC4595416 DOI: 10.1186/s40792-015-0097-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/01/2015] [Indexed: 12/14/2022] Open
Abstract
Background First described by Ross in 1951, primary pancreatic leiomyosarcoma is a rare mesenchymal tumour of the pancreas, with nonspecific clinical and radiological features and a poor prognosis, if unresectable. Case report A 60-year-old woman presented with abdominal pain. Magnetic resonance imaging (MRI) and computed tomography (CT) scan detected a dishomogeneous egg-shaped 8-cm mass, arising from the pancreatic head, with duodenal compression, without dilation of the Wirsung duct. 18F-FDG positron-emission tomography (PET)-CT showed a moderate tracer uptake, and the endoscopic ultrasound (US) showed a hypoechoic lesion, arising from the duodenal wall, suspected to be a gastrointestinal stromal tumour (GIST). CEA, CA19-9, NSE, and chromogranin A were normal. At the surgical exploration, a 10-cm mass, adherent to the anterior aspect of the pancreatic head, was found. The lesion was easily separable from the duodenal wall and was totally excised. The frozen intraoperative examination showed a mesenchymal tumour, with spindle-shaped cells, suggesting that a GIST diagnosis was likely. Postoperative course was uneventful. Histology and immunohistochemistry demonstrated a well-differentiated leiomyosarcoma, with five to six mitotic counts per 10 high-power field (HPF) and proliferative index (MIB-1) 10 % (grade 2 according to Federation Nationale des Centres de Lutte Contre le Cancer (FNCLCC)), with positive smooth muscle actin, desmin, and caldesmon but negative CD117 (c-kit) and S-100. The patient is alive and asymptomatic 19 months after surgery, without evidences of disease. Conclusions In the English literature, only 44 cases of primary pancreatic leiomyosarcoma have been reported. If a pancreatic mass suspected for primary pancreatic leiomyosarcoma has no adjacent organ/vessel invasion or distant metastases, surgical resection is the therapy of choice.
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Affiliation(s)
- Anna Caterina Milanetto
- Pancreatic and Digestive Endocrine Surgical Unit-Department of Surgery, Gastroenterology and Oncology, University of Padua, Via Giustiniani, 2-35128, Padua, Italy.
| | - Valbona Liço
- Pancreatic and Digestive Endocrine Surgical Unit-Department of Surgery, Gastroenterology and Oncology, University of Padua, Via Giustiniani, 2-35128, Padua, Italy.
| | - Stella Blandamura
- Pathology-Department of Medicine, University of Padua, Via Gabelli, 61-35128, Padua, Italy.
| | - Claudio Pasquali
- Pancreatic and Digestive Endocrine Surgical Unit-Department of Surgery, Gastroenterology and Oncology, University of Padua, Via Giustiniani, 2-35128, Padua, Italy.
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Xu J, Zhang T, Wang T, You L, Zhao Y. Clinical characteristics and prognosis of primary leiomyosarcoma of the pancreas: a systematic review. World J Surg Oncol 2013; 11:290. [PMID: 24219646 PMCID: PMC3874640 DOI: 10.1186/1477-7819-11-290] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/02/2013] [Indexed: 12/12/2022] Open
Abstract
Background Primary pancreatic leiomyosarcoma (PLMS) is rare. The clinical characteristics and prognosis is still not completely understood. The aim of the present study is to identify the clinical characteristics and long-term outcomes of PLMS from the existing reported cases in different scientific literature. Methods PLMS cases reported in Chinese and English journals were collected and reviewed. Clinical features and long-term outcomes of these cases were summarized and analyzed statistically. Results A total of 69 cases reported from both Chinese and English journals were included in the present study. An equal incidence in gender was observed. The mean age was 53.9 ± 14.7 years. The most common symptoms were abdominal mass, abdominal pain, and weight loss. The mean size of the tumor was 11.4 ± 7.1 cm. The incidence of PLMS between the head and body-tail of the pancreas had a similar pattern. Twenty-five percent of patients had distant metastasis and 19% of patients had adjacent organs/vessels invasion at the time of diagnosis. But lymph node metastasis was documented in only one (1.5%) patient. The median survival time was 48 months. The overall 1-, 3-, 5-, and 10-year survival rates were 66.6%, 51.2%, 43.9%, and 29.3%, respectively. Results from the multivariate analysis showed that non-radical resection (P = 0.000; hazard ratio (HR) 5.128; 95% confidence interval (CI) 2.041-12.987) was the independent adverse prognostic factor. Adjacent organs/vessels invasion (yes) may be considered as an another potential independent adverse prognostic factor (P = 0.071; HR 2.708; 95% CI 0.981-7.474). Conclusions PLMS is rare without specific clinical features. PLMS is an aggressive tumor and has a poor prognosis. Radical resection can prolong survival time of the patients.
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Affiliation(s)
| | | | | | | | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No1 Shuaifuyuan, Wangfujing Street, Beijing 100730, China.
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Perysinakis I, Katopodi A, Avlonitis S, Georgiadou D, Choreftaki T, Christopoulos G, Margaris I. Metastatic leiomyosarcoma of the intrapancreatic bile duct. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 84:66-9. [PMID: 23323239 PMCID: PMC3539113 DOI: 10.4174/jkss.2013.84.1.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 06/21/2012] [Accepted: 07/03/2012] [Indexed: 11/30/2022]
Abstract
We report the case of a patient with a history of surgically treated pulmonary leiomyosarcoma, presenting with recurrent acute cholangitis and metastatic leiomyosarcoma of the common bile duct. Preoperative examinations had revealed a high grade malignant neoplasm and bilateral lung metastases. The patient underwent pylorus-preserving pancreaticoduodenectomy and survived for 5.5 years after the first diagnosis.
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Affiliation(s)
- Iraklis Perysinakis
- 3rd Surgical Department, George Gennimatas General Hospital of Athens, Athens, Greece
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[Leiomyosarcoma of the pancreas: a tumor with poor prognosis--clinical case and review of the literature]. Pan Afr Med J 2012; 12:71. [PMID: 23024830 PMCID: PMC3450933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 06/09/2012] [Indexed: 11/06/2022] Open
Abstract
Le léiomyosarcome (LMS) primitif du pancréas est une tumeur mésenchymateuse rare (0,1% des tumeurs pancréatiques), seulement 47 cas ont été publiés la littérature depuis 1951. Le diagnostique est basée sur l’immunohistochimie. C’est une tumeur très agressive et souvent découverte à un stade avancé. Nous rapportant le cas d’un patient de 40 ans qui présentait un léiomyosarcome primitif du pancréas de la queue du pancréas avec envahissement de la rate et la partie gauche du colon transverse. Une spléno-pancréatectomie caudale carcinologique avec une colectomie segmentaire était réalisée. Des nodules péritonéaux ont apparus 2 mois après l’intervention au niveau du site opératoire et le paient est décédé 3 mois en postopératoire. Le LMS primitif du pancréas doit être évoqués devant les volumineuses tumeurs du pancréas. Une chirurgie carcinologique est le seul traitement curatif. Le pronostic de ces tumeurs est mauvais et la médiane de survie de ces tumeurs ne dépasse pas 2 ans.
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