pancreatic tumor

胰腺肿瘤
  • 文章类型: Case Reports
    一个9岁的孩子,绝育的男性,家养短毛猫因病因不明的腹水反复发作超过一周。体格检查显示腹胀,超声检查显示整个腹腔内有大量腹水;这被解释为改良的渗出物。肠系膜和腹部脂肪高回声和水肿。使用细针穿刺细胞学检查评估脂肪组织,和脂肪细胞,吞噬脂肪的巨噬细胞,并鉴定了中性粒细胞。计算机断层扫描显示胰腺肿块与左胰腺腿相连。探究性腹腔镜检查证实结节性肿块和器官粘连,导致硬化包囊性腹膜炎的初步诊断。这只猫服用了泼尼松龙,维生素E,和他莫昔芬,但在初始治疗后22天死亡。尸检显示胰腺多叶肿瘤(10×10厘米)紧密附着在胃和肠道上,有大量的腹水。腹膜,胃,肠,肠系膜上覆盖着许多不同大小(直径1-5mm)的播散性结节。微观上,肿瘤由广泛的脂肪组织组成,局部广泛的炎症浸润,纤维结缔组织,和小的浸润性增生腺体。由单层上皮细胞组成的清晰的不规则小腺体似乎是导管起源的,被丰富的纤维增生性基质包围。肿瘤结节广泛存在于肝脏,胃,腹膜,肠系膜,肠系膜淋巴结,肺,还有膀胱.免疫组织化学显示肿瘤腺体为泛细胞角蛋白阳性,确认肿瘤的胰腺上皮起源。这是首次报道硬化包囊性腹膜炎,并伴有假定的导管起源的侵袭性胰腺腺癌和猫的广泛转移。
    A 9-year-old, neutered male, domestic short-haired cat was referred for recurrent ascites of unknown etiology over a week. Physical examination revealed abdominal distension and ultrasonography revealed a large volume of ascites throughout the abdominal cavity; this was interpreted as modified transudate. The mesentery and abdominal fat were hyperechoic and edematous. Fat tissue was assessed using fine-needle aspiration cytology, and adipocytes, fat-phagocytizing macrophages, and neutrophils were identified. Computed tomography revealed a pancreatic mass connected to the left pancreatic leg. Exploratory laparoscopy confirmed nodular masses and organ adhesions, leading to a tentative diagnosis of sclerosing encapsulating peritonitis. The cat was administered prednisolone, vitamin E, and tamoxifen but died 22 days after the initial therapy. Necropsy revealed a multi-lobulated pancreatic tumor (10 × 10 cm) tightly attached to the stomach and intestine, with a large amount of ascites. The peritoneum, stomach, intestine, and mesentery were covered with numerous disseminated nodules of various sizes (1-5 mm diameter). Microscopically, the tumor consisted of extensive adipose tissue, locally extensive inflammatory infiltrates, fibrous connective tissue, and small invasive proliferative glands. Well-defined small irregular glands composed of single-layered epithelial cells that appear to be of ductal origin were surrounded by an abundant desmoplastic stroma. Neoplastic nodules were widespread in the liver, stomach, peritoneum, mesentery, mesenteric lymph nodes, lungs, and urinary bladder. Immunohistochemistry revealed that the neoplastic glands were positive for pan-cytokeratin, confirming the pancreatic epithelial origin of the tumor. This is the first report of sclerosing encapsulating peritonitis accompanied by aggressive pancreatic adenocarcinoma of presumed ductal origin and extensive metastasis in a cat.
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  • 文章类型: Case Reports
    与胰腺恶性肿瘤相比,胰腺结核(TB)极为罕见,具有相似的临床和放射学发现。检测胰腺结核病患者的挑战,特别是在支持资源有限的农村地区,是更完整的护理策略的原因。我们报告了一例在急诊科(ED)住院的25岁女性中的胰腺结核病例,最初被怀疑患有胰腺肿瘤。她的主要抱怨是发烧,疲劳,还有腹痛,同时她也经历了减肥。剖腹探查术和进一步的病理评估提示胰腺结核。随后,患者接受抗结核药物治疗,临床症状好转.总之,该病例报告强调胰腺结核可以模仿胰腺癌;然而,这是一种可以治疗的疾病。因此,对于医生来说,将其视为鉴别诊断很重要,特别是在高危人群和诊断工具有限的农村地区。
    Pancreatic tuberculosis (TB) is extremely rare and has similar clinical and radiological findings compared to pancreatic malignancy. Challenges in detecting individuals with pancreatic TB, especially in rural areas with limited supporting resources, are the reasons for a more complete care strategy. We report a case of pancreatic TB in a 25-year-old woman admitted to the emergency department (ED), who was initially suspected of having a pancreatic tumor. Her chief complaints were fever, fatigue, and abdominal pain, while she also experienced weight loss. Exploratory laparotomy and further pathological evaluation suggested pancreatic TB. Subsequently, the patient was given anti-TB drugs and showed clinical improvement. In conclusion, this case report highlighted that pancreatic TB could mimic pancreatic cancer; however, it is a treatable condition. Thus, it is important for physicians to consider this as a differential diagnosis, especially in high-risk populations and in rural areas with limited diagnostic tools.
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  • 文章类型: Journal Article
    胰腺导管腺癌(PDAC)的存活率为12%,并且针对PDAC的抗PD1疗法的多项临床试验均失败,表明需要新的治疗策略。在这项研究中,我们评估了米尔贝霉素肟(MBO)的潜力,一种抗寄生虫化合物,作为PDAC中的免疫调节剂。我们的结果表明,MBO通过诱导凋亡抑制多种PDAC细胞系的生长。体内研究表明,口服5mg/kgMBO可以抑制皮下和原位模型中PDAC肿瘤的生长49%和56%,分别。此外,与对照组相比,MBO治疗显著增加了荷瘤小鼠27天的存活率。有趣的是,MBO治疗小鼠的肿瘤CD8+T细胞浸润增加.值得注意的是,CD8+T细胞的消耗显著降低了MBO在小鼠中的抗肿瘤功效。Further,MBO显著增强抗PD1治疗的疗效,和联合治疗导致TME内更大比例的活性细胞毒性T细胞。在我们所有的临床前毒理学研究中,MBO是安全且耐受性良好的。总的来说,我们的研究为MBO对抗PDAC的应用提供了新的方向,并强调了MBO再利用以增强抗PD1免疫治疗的潜力.
    Pancreatic ductal adenocarcinoma (PDAC) has a survival rate of 12%, and multiple clinical trials testing anti-PD-1 therapies against PDAC have failed, suggesting a need for a novel therapeutic strategy. In this study, we evaluated the potential of milbemycin oxime (MBO), an antiparasitic compound, as an immunomodulatory agent in PDAC. Our results show that MBO inhibited the growth of multiple PDAC cell lines by inducing apoptosis. In vivo studies showed that the oral administration of 5 mg/kg MBO inhibited PDAC tumor growth in both subcutaneous and orthotopic models by 49% and 56%, respectively. Additionally, MBO treatment significantly increased the survival of tumor-bearing mice by 27 days as compared to the control group. Interestingly, tumors from MBO-treated mice had increased infiltration of CD8+ T cells. Notably, depletion of CD8+ T cells significantly reduced the anti-tumor efficacy of MBO in mice. Furthermore, MBO significantly augmented the efficacy of anti-PD-1 therapy, and the combination treatment resulted in a greater proportion of active cytotoxic T cells within the tumor microenvironment. MBO was safe and well tolerated in all our preclinical toxicological studies. Overall, our study provides a new direction for the use of MBO against PDAC and highlights the potential of repurposing MBO for enhancing anti-PD-1 immunotherapy.
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  • 文章类型: Journal Article
    胰腺癌仍然是一个重要的健康问题,治疗选择有限。肿瘤间质,由不同的细胞和蛋白质组成的复杂环境,在肿瘤生长和化疗耐药中起着至关重要的作用。靶向肿瘤基质,由不同的非肿瘤细胞如成纤维细胞组成,细胞外基质(ECM),免疫细胞,血管前细胞也鼓励重塑实体癌,比如胰腺癌。重塑胰腺肿瘤的基质可以被建议作为降低对化学/免疫疗法的抗性的策略。一些研究表明,来自植物的植物化学物质可以影响肿瘤环境并具有抗癌特性。通过靶向参与基质激活的关键途径,植物化学物质可能会破坏肿瘤和间质之间的交流,使肿瘤细胞对不同的治疗方法更敏感。此外,植物化学物质具有免疫调节和抗血管生成特性,所有这些都有助于他们治疗胰腺癌的潜力。这篇综述将详细介绍植物化学物质如何影响肿瘤基质及其对胰腺肿瘤生长的影响。传播,以及对治疗的反应。它还将探索将植物化学物质与化疗等其他治疗方案相结合的潜力,免疫疗法,和辐射。
    Pancreatic cancer remains a significant health issue with limited treatment options. The tumor stroma, a complex environment made up of different cells and proteins, plays a crucial role in tumor growth and chemoresistance. Targeting tumor stroma, consisting of diverse non-tumor cells such as fibroblasts, extracellular matrix (ECM), immune cells, and also pre-vascular cells is encouraging for remodeling solid cancers, such as pancreatic cancer. Remodeling the stroma of pancreas tumors can be suggested as a strategy for reducing resistance to chemo/immunotherapy. Several studies have shown that phytochemicals from plants can affect the tumor environment and have anti-cancer properties. By targeting key pathways involved in stromal activation, phytochemicals may disrupt communication between the tumor and stroma and make tumor cells more sensitive to different treatments. Additionally, phytochemicals have immunomodulatory and anti-angiogenic properties, all of which contribute to their potential in treating pancreatic cancer. This review will provide a detailed look at how phytochemicals impact the tumor stroma and their effects on pancreatic tumor growth, spread, and response to treatment. It will also explore the potential of combining phytochemicals with other treatment options like chemotherapy, immunotherapy, and radiation.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    背景:手术是胰腺神经内分泌肿瘤(pNETs)的标准治疗方法,获得良好的结果,但与高发病率和死亡率相关。这项研究评估了立体定向身体放射治疗(SBRT)作为小(<2cm)无功能pNETs的激进方法。
    方法:从2017年1月至2023年6月,在IRB批准的研究中,20名患有小pNETs的患者接受了SBRT。端点包括本地控制,容忍度,无进展生存期,总生存率(OS)。诊断评估包括内窥镜检查,CT扫描,OctreScan或PET-Dotatoc,腹部MRI,和组织学证实样本。
    结果:在对20名患者(中位年龄55.5岁)的30个月随访中,SBRT耐受性良好,无>2级毒性。40%表现出形态学反应,55%保持稳定。代谢,50%取得了显著的进步。中位OS为41.5个月,所有患者均存活,无局部或远处进展,也不需要手术切除.
    结论:SBRT是治疗胰腺小神经内分泌肿瘤的可行且耐受性良好的方法,显示有效的本地控制。进一步的调查对于验证和扩展这些发现至关重要。
    BACKGROUND: Surgery is the standard treatment for pancreatic neuroendocrine tumors (pNETs), obtaining favorable results but associating high morbidity and mortality rates. This study assesses stereotactic body radiation therapy (SBRT) as a radical approach for small (< 2 cm) nonfunctioning pNETs.
    METHODS: From January 2017 to June 2023, 20 patients with small pNETs underwent SBRT in an IRB-approved study. Endpoints included local control, tolerance, progression-free survival, and overall survival (OS). Diagnostic assessments comprised endoscopy, CT scans, OctreScan or PET-Dotatoc, abdominal MRI, and histological confirmatory samples.
    RESULTS: In a 30-month follow-up of 20 patients (median age 55.5 years), SBRT was well-tolerated with no grade > 2 toxicity. 40% showed morphological response, 55% remained stable. Metabolically, 50% achieved significant improvement. With a median OS of 41.5 months, all patients were alive without local or distant progression or need for surgical resection.
    CONCLUSIONS: SBRT is a feasible and well-tolerated approach for small neuroendocrine pancreatic tumors, demonstrating effective local control. Further investigations are vital for validation and extension of these findings.
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  • 文章类型: Case Reports
    背景:PEComa是一种间充质肿瘤,可发生在包括子宫和软组织在内的各种器官中。PEComas由血管周围上皮样细胞组成,血管平滑肌脂肪瘤(AML),透明细胞糖肿瘤(CCST),和淋巴管肌瘤病(LAM)被认为是与PEComa家族肿瘤相同谱系的病变。组织学上,常见的PEComa显示上皮样细胞的固体或片状增殖。这伴随着扩张血管数量的增加。这里,我们报告一例胰腺PEComa伴明显炎性细胞浸润。
    方法:一名74岁男性患者因急性阑尾炎行阑尾切除术。术后计算机断层扫描和磁共振成像显示胰腺尾部有30×25mm非对比增强的圆形病变。影像学表现与恶性肿瘤一致,并进行了远端胰腺切除术。组织学上,病变的大部分区域浸润有炎症细胞。几个上皮样细胞有很大的,圆形原子核,不同的核仁,观察到嗜酸性粒细胞胞浆。观察到梭形肿瘤细胞。在肿瘤细胞周围观察到精致和扩张的血管。免疫组织化学,异型细胞αSMA阳性,MelanA,HMB-45和TFE3。肿瘤细胞的细胞学特征和免疫组织化学染色结果导致胰腺PEComa的诊断。
    结论:已经定义了肝AML的一种组织学变异,称为炎性亚型。少量肿瘤细胞存在明显的炎性细胞浸润,占病变的一半以上,和炎性肌纤维母细胞瘤样外观。据我们所知,这是胰腺PEComa伴严重炎症的首次报道。PEComa也是来自血管周围上皮样细胞的肿瘤的通用术语,比如AML,CCST,还有LAM.因此,该病例被认为是PEComa的炎性亚型.它具有不典型的PEComa的独特形态。这种组织学表型应得到广泛认可。
    BACKGROUND: PEComa is a mesenchymal tumor that can occur in various organs including the uterus and soft tissues. PEComas are composed of perivascular epithelioid cells, and angiomyolipoma (AML), clear cell sugar tumor (CCST), and lymphangiomyomatosis (LAM) are considered lesions of the same lineage as tumors of the PEComa family. Histologically, a common PEComa shows solid or sheet-like proliferation of epithelioid cells. This is accompanied by an increase in the number of dilated blood vessels. Here, we report a case of pancreatic PEComa with marked inflammatory cell infiltration.
    METHODS: A 74-year-old male patient underwent an appendectomy for acute appendicitis. Postoperative computed tomography and magnetic resonance imaging revealed a 30 × 25 mm non-contrast-enhanced circular lesion in the tail of the pancreas. The imaging findings were consistent with a malignant tumor, and distal pancreatectomy was performed. Histologically, most area of the lesion was infiltrated with inflammatory cells. A few epithelioid cells with large, round nuclei, distinct nucleoli, and eosinophilic granular cytoplasm were observed. Spindle-shaped tumor cells were observed. Delicate and dilated blood vessels were observed around the tumor cells. Immunohistochemically, the atypical cells were positive for αSMA, Melan A, HMB-45, and TFE3. The cytological characteristics of the tumor cells and the results of immunohistochemical staining led to a diagnosis of pancreatic PEComa.
    CONCLUSIONS: A histological variant known as the inflammatory subtype has been defined for hepatic AML. A small number of tumor cells present with marked inflammatory cell infiltration, accounting for more than half of the lesions, and an inflammatory myofibroblastic tumor-like appearance. To our knowledge, this is the first report of pancreatic PEComa with severe inflammation. PEComa is also a generic term for tumors derived from perivascular epithelioid cells, such as AML, CCST, and LAM. Thus, this case is considered an inflammatory subtype of PEComa. It has a distinctive morphology that is not typical of PEComa. This histological phenotype should be widely recognized.
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  • 文章类型: Meta-Analysis
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  • 文章类型: Journal Article
    胰腺实性假乳头状瘤(SPN)是一种罕见的胰腺外分泌肿瘤。我们的研究目的是总结SPN的临床特征并分析恶性SPN的危险因素。
    对2013年5月至2022年9月经病理证实为SPN的患者进行回顾性分析。人口统计数据,临床和病理特征,收集并分析随访数据.探讨影响SPN良恶性的因素,我们采用逻辑回归。此外,我们利用Kaplan-Meier曲线来描述和分析总体预后.
    共纳入195名患者,其中163人为女性,所有患者的平均年龄为31.7岁。在195名患者中,101例(51.8%)无明显临床症状,常规检查发现胰腺病变。主要症状为腹痛和腹胀64例(32.8%)。SPN肿瘤最大直径1~17cm,平均6.19cm。43例(22.1%)患者发生了48例术后并发症。在中位随访时间为44.5个月后,5年总生存率为98.8%,复发率为1.5%.此外,我们观察到良性和恶性SPN之间肿瘤包膜完整性的统计学差异。
    在我们的大样本队列中,SPN与手术后良好的长期生存率相关。对于恶性SPN,肿瘤包膜不完整是一个独立的危险因素。
    UNASSIGNED: Solid pseudopapillary neoplasm of the pancreas (SPN) is a rare exocrine tumor of the pancreas. The aim of our study is to summarize the clinical features of SPN and to analyze the risk factors for malignant SPN.
    UNASSIGNED: From May 2013 to September 2022, patients who were pathologically confirmed to have SPN were retrospectively reviewed. Demographic data, clinical and pathological features, follow-up data were collected and analyzed. To investigate the factors influencing the benign or malignant nature of SPN, we employed logistic regression. Additionally, we utilized Kaplan-Meier curves to depict and analyze the overall prognosis.
    UNASSIGNED: A total of 195 patients were included, 163 of whom were female and the average age of all patients was 31.7 years old. Among 195 patients, 101 patients (51.8%) had no obvious clinical symptoms and their pancreatic lesions were detected during routine examination. The primary symptom was abdominal pain and distension in 64 cases (32.8%). The maximum diameter of SPN tumors ranged from 1-17 cm (mean 6.19 cm). Forty-eight postoperative complications developed in 43 (22.1%) patients. After a median follow-up duration of 44.5 months, the overall 5-year survival rate was 98.8% and the recurrence rate was 1.5%. Furthermore, we observed a statistically significant difference in the completeness of the tumor capsule between benign and malignant SPN.
    UNASSIGNED: SPN is associated with a favorable long-term survival after surgery in our large sample size cohort. For malignant SPN, tumor capsule incompleteness is an independent risk factor.
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  • 文章类型: Case Reports
    黄色肉芽肿性炎症是一种慢性炎症反应,显微镜下表现为泡沫组织细胞聚集,纤维组织,和各种炎症细胞的浸润。与胆囊或肾脏的黄色肉芽肿性炎症相反,黄色肉芽肿性胰腺炎罕见。我们在此介绍了一例在术前怀疑胰腺假性囊肿或胰腺肿瘤的情况下接受远端胰腺切除术和脾切除术的患者的黄色肉芽肿性胰腺炎。一名77岁女性,有1个月的上腹痛病史,厌食症,一般疲劳入院。对比增强计算机断层扫描显示囊性肿块,胰腺尾部边缘不明确,并伴有脾脓肿。对比增强内镜超声检查发现胰腺尾部有高回声囊性病变,内部回声不均匀,部分囊内含量被造影剂增强。内镜逆行胰胆管造影术显示胰腺尾部有囊性病变,持续进入主胰管,囊性病变下游的主胰管略微变窄。胰液细胞学检查发现可疑细胞,导致导管内乳头状黏液癌的可能性。行胰体切除术和脾切除术,组织病理学诊断为黄色肉芽肿性胰腺炎,无恶性发现。
    Xanthogranulomatous inflammation is a chronic inflammatory reaction microscopically characterized by aggregation of foamy histiocytes, fibrous tissue, and infiltration of various inflammatory cells. In contrast to xanthogranulomatous inflammation in the gallbladder or kidney, xanthogranulomatous pancreatitis is rare. We herein present a case of xanthogranulomatous pancreatitis in a patient who underwent distal pancreatectomy with splenectomy under preoperative suspicion of a pancreatic pseudocyst or pancreatic tumor. A 77-year-old woman with a 1 month history of epigastric pain, anorexia, and general fatigue was admitted to our hospital. Contrast-enhanced computed tomography revealed a cystic mass with ill-defined margins at the pancreatic tail together with a splenic abscess. Contrast-enhanced endoscopic ultrasound detected a hyperechoic cystic lesion at the tail of the pancreas with heterogeneous internal echogenicity, and part of the intra-cystic content was enhanced by the contrast agent. Endoscopic retrograde cholangiopancreatography showed a cystic lesion at the tail of the pancreas that continued into the main pancreatic duct, and the main pancreatic duct was slightly narrowed downstream of the cystic lesion. Pancreatic juice cytology revealed suspicious cells, leading to the possibility of intraductal papillary mucinous carcinoma. Distal pancreatectomy with splenectomy was performed, and the histopathological diagnosis was xanthogranulomatous pancreatitis with no malignant findings.
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