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Association of aging and ARHGAP17 variation with pancreatic intraepithelial neoplasia
S14
Abstracts / Pancreatology 16 (2016) S1eS63
Rusults: WHO, ENETs, NANETs, NCCN, and Chinese consensus all recommended the patients should be resected primary and metastases neoplasms when all lesions can be removed. When they couldn't remove by operation lonely, radiofrequency ablation, frozen, microwave ablation, ethanol injection and others could be combined with it. If not for radical resection, more than 90% of resections should be required, especially for functional neoplasms. When patients are not suited for surgery, TACE, chemotherapy, molecular targeted, somatostain, liver transplantation could be chose. In first patient liver metastases from duodenal papilla neuroendocrine neoplasm was treated by four courses of TACE until the liver metastases completely disappeared. The patient then underwent pancreaticoduodenectomy to eradicate the primary tumor. The patient was followed up for 2 years and was doing well. In second patient, liver metastasis, noted four years after distal pumcreatectomy for a neuroendocrine tumor, was ignition, momaged by high dosage of octreotide and sunitinib. After these attempts failed, the patient received a liver transplantation four years ago and was followed up until March 1, 2015 wihout tumor recurrence. Conclusion: Liver metastasis of Gastroentero-pancreatic neuroendcorine neoplasms responds positively to liver transplant pretty good prognosis. Keywords: Gastroenteropancreatic neuroendcorine neoplasms; Liver metastases; Therapy
15185. Association of aging and ARHGAP17 variation with pancreatic intraepithelial neoplasia Y. Matsuda 1, M. Tanaka 2, A. Suzuki 1, A. Seki 1, K. Nonaka 1, M. Nishimura 3, T. Ishiwata 4, H. Yoshimura 5, N. Izumiyama 6, K. Nakamura 6, N. Ishikawa 6, J. Aida 6, K. Takubo 6, T. Arai 1 1 Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan 2 Department of Genomics for Longevity and Health, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan 3 Endoscopy, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan 4 Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan 5 Department of Applied Science, Nippon Veterinary and Life Science University, Tokyo, Japan 6 Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Background: Aging, obesity, smoking, alcohol consumption, diabetes, and pancreatitis have been reported to be the risk factors of pancreatic cancers. Approximately 70% of pancreatic cancer cases are unresectable because of distant metastasis or advanced local growth; therefore, examination of autopsy specimens may aid understanding of the characteristics of precancerous lesions. In the present study, we clarified the clinicopathological features of precancerous lesions of the pancreas. Methods: We analysed serial autopsy cases (men, 1351; women, 1107) of pancreatic intraepithelial neoplasia (PanIN), and performed comparisons based on the sex, age, and body mass index (BMI) of the patients. Single nucleotide polymorphisms (SNPs) were analysed using HumanExome BeadChip (Illumina). Results: The occurrence of PanIN increased with advanced age. Approximately 60% of the elderly patients showed low-grade PanIN. The occurrence of low-grade PanIN was correlated to the sex, age, and BMI of the patients. SNPs of the ARHGAP17 gene, p.G782D (rs28365822), were a risk factor of PanIN. Discussion: A high incidence of low-grade PanIN in the elderly might be related to the increased risk of pancreatic cancer in the elderly. Further study is needed to clarify the roles played by ARHGAP17 in the carcinogenesis of pancreatic cancer.
15205. Treatment of celiac artery stenosis using a coronary covered stent following pancreatoduodenectomy S.Y. Yao, A. Ikeda, T. Murakami, E. Tanaka, T. Okumoto, T. Harada Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan Introduction: Postoperative celiac artery stenosis (CAS) rarely occurs in the absence of vascular injury or pseudoaneurysm after pancreastoduodectomy (PD). The appropriate treatment is unknown because of few reported cases. Here, we show a case of CAS after PD. The purpose of this report is to describe this rare complication and its successful treatment. Case presentation: A 51eyear-old female underwent subtotal stomach-preserving PD with D2 lymphadenectomy and portal vein reconstruction for pancreatic cancer. No anatomical variations of celiac trunk or mesenteric vessels were found. During the course, the laboratory test showed abnormally elevated hepatic enzyme on postoperative day (POD) 2. The computed tomography (CT) revealed multiple liver and spleen infarctions. The CT angiography and celiac arteriography showed stenotic celiac arterial root with no pseudoaneurysm. To maintain hepatic arterial flow, a coronary covered stent was placed. No vascular adverse events were encountered during and after the procedure. The patient was discharged on POD 11 with no other complications. CT showed a patent stent graft and good arterial flow 2 years after placement. Now, she is taking aspirin for anticoagulation. Discussion: CAS can be caused by extrinsic or intrinsic factors. Although there was no apparent preoperative stenosis or intraoperative vascular injury in this case, postoperative CAS led to organ infarctions. Surgical procedures as lymphadenectomy of celiac region might result in tissue edema and exacerbate CAS. Latent median arcuate ligament syndrome might exist as underlying etiology. To keep the patency of arterial flow in this emergent situation, coronary covered stent can be applied safely. Conclusion: We experienced the first case of successful treatment of CAS after PD with coronary covered stent. Prompt management with coronary covered stent placement is safe and effective procedure as its treatment.
15208. Cystic lesion of pancreas e A rare presentation V. Shaw, S. Shah Department of GI, MIS and Bariatric Surgery, Rockland hospitals, New Delhi, India Introduction: Cystic lesion of pancreas is difficult to diagnose preoperatively despite modern diagnostic modalities. Surgical treatment is mainly based on clinico- radiological picture and intra operative findings may alter management. Case report: 69 year lady with history of chronic pain abdomen was clinicoradiologically diagnosed as infected pseudocyst pancreas with increased total leucocyte count and CT image showing air loculi in the 20x15x15 cm lesion. Tumour markers were negative. The operative findings were suggestive of pancreatic abscess with 2litre of foul smelling purulent fluid in the cyst cavity. In view of above; subtotal cyst wall excision biopsy and external drainage done. The biopsy report was borderline mucinous cystadenoma pancreas. Definitve resection was contemplated in post operative period which patient did not consent .At one year follow up the CT image shows residual cyst but the patient is asymptomatic
Abstracts / Pancreatology 16 (2016) S1eS63
Rusults: WHO, ENETs, NANETs, NCCN, and Chinese consensus all recommended the patients should be resected primary and metastases neoplasms when all lesions can be removed. When they couldn't remove by operation lonely, radiofrequency ablation, frozen, microwave ablation, ethanol injection and others could be combined with it. If not for radical resection, more than 90% of resections should be required, especially for functional neoplasms. When patients are not suited for surgery, TACE, chemotherapy, molecular targeted, somatostain, liver transplantation could be chose. In first patient liver metastases from duodenal papilla neuroendocrine neoplasm was treated by four courses of TACE until the liver metastases completely disappeared. The patient then underwent pancreaticoduodenectomy to eradicate the primary tumor. The patient was followed up for 2 years and was doing well. In second patient, liver metastasis, noted four years after distal pumcreatectomy for a neuroendocrine tumor, was ignition, momaged by high dosage of octreotide and sunitinib. After these attempts failed, the patient received a liver transplantation four years ago and was followed up until March 1, 2015 wihout tumor recurrence. Conclusion: Liver metastasis of Gastroentero-pancreatic neuroendcorine neoplasms responds positively to liver transplant pretty good prognosis. Keywords: Gastroenteropancreatic neuroendcorine neoplasms; Liver metastases; Therapy
15185. Association of aging and ARHGAP17 variation with pancreatic intraepithelial neoplasia Y. Matsuda 1, M. Tanaka 2, A. Suzuki 1, A. Seki 1, K. Nonaka 1, M. Nishimura 3, T. Ishiwata 4, H. Yoshimura 5, N. Izumiyama 6, K. Nakamura 6, N. Ishikawa 6, J. Aida 6, K. Takubo 6, T. Arai 1 1 Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan 2 Department of Genomics for Longevity and Health, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan 3 Endoscopy, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan 4 Department of Integrated Diagnostic Pathology, Nippon Medical School, Tokyo, Japan 5 Department of Applied Science, Nippon Veterinary and Life Science University, Tokyo, Japan 6 Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
Background: Aging, obesity, smoking, alcohol consumption, diabetes, and pancreatitis have been reported to be the risk factors of pancreatic cancers. Approximately 70% of pancreatic cancer cases are unresectable because of distant metastasis or advanced local growth; therefore, examination of autopsy specimens may aid understanding of the characteristics of precancerous lesions. In the present study, we clarified the clinicopathological features of precancerous lesions of the pancreas. Methods: We analysed serial autopsy cases (men, 1351; women, 1107) of pancreatic intraepithelial neoplasia (PanIN), and performed comparisons based on the sex, age, and body mass index (BMI) of the patients. Single nucleotide polymorphisms (SNPs) were analysed using HumanExome BeadChip (Illumina). Results: The occurrence of PanIN increased with advanced age. Approximately 60% of the elderly patients showed low-grade PanIN. The occurrence of low-grade PanIN was correlated to the sex, age, and BMI of the patients. SNPs of the ARHGAP17 gene, p.G782D (rs28365822), were a risk factor of PanIN. Discussion: A high incidence of low-grade PanIN in the elderly might be related to the increased risk of pancreatic cancer in the elderly. Further study is needed to clarify the roles played by ARHGAP17 in the carcinogenesis of pancreatic cancer.
15205. Treatment of celiac artery stenosis using a coronary covered stent following pancreatoduodenectomy S.Y. Yao, A. Ikeda, T. Murakami, E. Tanaka, T. Okumoto, T. Harada Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan Introduction: Postoperative celiac artery stenosis (CAS) rarely occurs in the absence of vascular injury or pseudoaneurysm after pancreastoduodectomy (PD). The appropriate treatment is unknown because of few reported cases. Here, we show a case of CAS after PD. The purpose of this report is to describe this rare complication and its successful treatment. Case presentation: A 51eyear-old female underwent subtotal stomach-preserving PD with D2 lymphadenectomy and portal vein reconstruction for pancreatic cancer. No anatomical variations of celiac trunk or mesenteric vessels were found. During the course, the laboratory test showed abnormally elevated hepatic enzyme on postoperative day (POD) 2. The computed tomography (CT) revealed multiple liver and spleen infarctions. The CT angiography and celiac arteriography showed stenotic celiac arterial root with no pseudoaneurysm. To maintain hepatic arterial flow, a coronary covered stent was placed. No vascular adverse events were encountered during and after the procedure. The patient was discharged on POD 11 with no other complications. CT showed a patent stent graft and good arterial flow 2 years after placement. Now, she is taking aspirin for anticoagulation. Discussion: CAS can be caused by extrinsic or intrinsic factors. Although there was no apparent preoperative stenosis or intraoperative vascular injury in this case, postoperative CAS led to organ infarctions. Surgical procedures as lymphadenectomy of celiac region might result in tissue edema and exacerbate CAS. Latent median arcuate ligament syndrome might exist as underlying etiology. To keep the patency of arterial flow in this emergent situation, coronary covered stent can be applied safely. Conclusion: We experienced the first case of successful treatment of CAS after PD with coronary covered stent. Prompt management with coronary covered stent placement is safe and effective procedure as its treatment.
15208. Cystic lesion of pancreas e A rare presentation V. Shaw, S. Shah Department of GI, MIS and Bariatric Surgery, Rockland hospitals, New Delhi, India Introduction: Cystic lesion of pancreas is difficult to diagnose preoperatively despite modern diagnostic modalities. Surgical treatment is mainly based on clinico- radiological picture and intra operative findings may alter management. Case report: 69 year lady with history of chronic pain abdomen was clinicoradiologically diagnosed as infected pseudocyst pancreas with increased total leucocyte count and CT image showing air loculi in the 20x15x15 cm lesion. Tumour markers were negative. The operative findings were suggestive of pancreatic abscess with 2litre of foul smelling purulent fluid in the cyst cavity. In view of above; subtotal cyst wall excision biopsy and external drainage done. The biopsy report was borderline mucinous cystadenoma pancreas. Definitve resection was contemplated in post operative period which patient did not consent .At one year follow up the CT image shows residual cyst but the patient is asymptomatic