- Email: [email protected]
Clinical features of serous cystic neoplasm of the pancreas: Report of 7 cases
Abstracts / Pancreatology 16 (2016) S1eS192
S103
P-030.
P-032.
Clinical features of serous cystic neoplasm of the pancreas: Report of 7 cases
Solid pseudopapillary neoplasms of the pancreas: An experience of nine cases from a single institution
Naoya Imamura, Yuki Tsuchimochi, Takeomi Hamada, Koichi Yano, Masahide Hiyoshi, Jiro Ohuchida, Yoshiro Fujii, Atsushi Nanashima
Takuya Mizumoto, Hirochika Toyama, Yoshihide Nanno, Jun Ishida, Sachio Terai, Tadahiro Goto, Sadaki Asari, Masahiro Kido, Tetuo Ajiki, Takumi Fukumoto, Yonson Ku
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, University of Miyazaki Faculty of Medicine, Japan Background: Serous cystic neoplasm (SCN) of the pancreas is a rare benign tumor. In case the compatible imaging findings of SCN were observed, we intended to perform the follow up and did not undergo surgical treatments. However, in some cases, surgical resection was considered. The aim of this study is clarify the clinical features of resectable SCN. Method: By the retrospective review, 7 patients with SCN, who underwent resection and was histrogically diagnosed in our series between 2004 and 2015, were examined. Result: Four patients were female (57%), and three were male. Median age of the patients was 62 y.o. (range; 36-72 y.o.). Presence of symptoms as abdominal or back pain was observed in 3 patients (43%). The median sizes of the tumors was 42 mm (range; 32-60mm). The location of tumor was in head of pancreas is two, body in one, and tail in four (57%). Gross imaging findings were solid type in three, macrocystic type in two, and mixed type with honeycomb features in two. Although the mixed type of two patients were typically diagnosed as SCN before operation, it was difficult to preoperatively diagnose in others because the imaging findings of macrocystic type of 2 patients resembled the intraductal papillary mucinous neoplasm, and solid type of 3 patients resembled the neuroendocrine tumor. The reasons of surgical resection were in increase of tumor size in one, presence of symptom in three, and to difficulties of differential diagnosis with neuroendocrine tumor in three. Pancreaticoduodenectomy was performed in two patients, spleen preserving distal pancreatectomy in two, and distal pancreatectomy with splenectomy in three. All SCNs were diagnosed as adenoma histologically, and all patients were alive. Conclusion: It should pay further attention to distinguish between solid type SCN and neuroendocrine tumor by the various preoperative examination.
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University, Japan Introduction: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor of low malignant potential. The aim of this study is to report our experience with nine cases of surgically resected SPN of the pancreas. Methods: Medical records of all nine patients who underwent surgery for a pathologically confirmed SPN from 2006 to 2015 in our institution were retrospectively analyzed. Result: There were eight females and one male with median age of 34 (17-67). The median tumor size was 4.3cm (1.4-150 cm). Liver metastases were present in one patient who had history of pancreatic tumor resection 24 years before presentation. Recurrence due to tumor dissemination was suspected because she had multiple peritoneal tumors nearby pancreatic head. Pancreaticoduodenectomy was performed in four patients, distal pancreatectomy, tumor enucleation were performed in two patients, respectively. Middle pancreatectomy was performed in one patient. Synchronous liver resection was performed for the patient who had liver metastasis at the time of presentation. All nine patients achieved complete tumor resection. Portal vein resection was performed in three patients, but there were no portal venous invasion proven in the pathological evaluation. All nine tumors were negative for lymph node metastasis. After a median follow-up of 31 (2-109) months, eight patients remained tumor free, but one patient arose multiple liver metastases 5 years after resection. She was treated with transcatheter arterial chemoembolization (TACE) and remains alive 5 years after recurrence. Conclusion: SPN is locally less invasive tumor in many cases and lymph node metastasis is rare, but often arises liver metastasis. Procedures which may cause tumor seeding must be avoided considering a risk of tumor dissemination. Aggressive surgical procedure may be permitted to avoid tumor remnant. Long term follow-up should be carried out to detect remote period recurrence.
P-031. A case of mucinous cystic neoplasm of pancreas with melena Gaku Ota, Atsushi Miki, Kazuhiro Endo, Masaru Koizumi, Hideki Sasanuma, Yasunaru Sakuma, Hisanaga Horie, Yoshinori Hosoya, Joji Kitayama, Naohiro Sata Department of Surgery, Jichi Medical University, Japan The patient is a 46-year-old female with melena following epigastralgia and nausea. Endoscopy showed bleeding from papilla vater. Enhanced computed tomography (CT) showed a cystic lesion with enhancement at pancreas tail. She was referred to our department. On physical examination, vital signs showed no abnormalities. She has no medical history. Dynamic CT revealed the cystic lesion 70mm in diameter adjacent to splenic artery and an entry of blood flow into the cyst from a pseudoaneurism of splenic artery. Thereafter she underwent embolization of the pseudoaneurism with interventional radiology. Endoscopic ultrasonography showed a unilocular cyst at pancreas tail. Preoperative MRI showed no change of the cyst. There was no findings related to the cause of the cystic lesion. She underwent distal pancreatectomy. Surgical findings revealed fibrotic adhesion around the cystic lesion especially between with splenic artery without inflammation. Postoperative course was uneventful. She was discharged 5 days after surgery. The cyst included a partition in a part of the wall without communication with pancreatic duct and nodule. Histopathological findings showed ovarian-type stroma in a part of the cyst wall. The cystic lesion was diagnosed with pancreas mucinous cystic neoplasm with mild dysplasia. We report a rare case of pancreas mucinous cystic neoplasm with melena.
P-033. Activities of an educational program for patients with pancreatic cancer and their caregivers Yasunari Sakamoto 1, Chikako Doutani 2, Satoshi Shiba 1, Takuji Okusaka 1 1 Department of Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Japan 2 Department of Psycho-Oncology Division, National Cancer Center Hospital, Japan
What is an educational program?: We first introduced an educational program for patients with advanced pancreatic or biliary cancer and their caregivers in 2007, which was delivered in a classroom environment. The class aimed to provide life-enhancing information. Classes were held every two months. Physicians, pharmacists, nurses, psychotherapists, dietitians, and medical social workers attended and talked about their specialties. After classes, time was allowed for interaction with participants. Problems: It was difficult to evaluate the effect of the classes, so we used a check list to try to measure the participant's understanding following classes. Another problem was the different needs between participants, requiring differing content for different groups. Therefore, we only recruit patients with pancreatic or biliary cancer within six months of starting cancer treatment. Current state: Classes included 16-27 participants (patients and caregivers) in 2015, and 96%-100% of these were “satisfied” with the classes. Occasionally receiving a gratitude letter from participants is an outcome.
S103
P-030.
P-032.
Clinical features of serous cystic neoplasm of the pancreas: Report of 7 cases
Solid pseudopapillary neoplasms of the pancreas: An experience of nine cases from a single institution
Naoya Imamura, Yuki Tsuchimochi, Takeomi Hamada, Koichi Yano, Masahide Hiyoshi, Jiro Ohuchida, Yoshiro Fujii, Atsushi Nanashima
Takuya Mizumoto, Hirochika Toyama, Yoshihide Nanno, Jun Ishida, Sachio Terai, Tadahiro Goto, Sadaki Asari, Masahiro Kido, Tetuo Ajiki, Takumi Fukumoto, Yonson Ku
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, University of Miyazaki Faculty of Medicine, Japan Background: Serous cystic neoplasm (SCN) of the pancreas is a rare benign tumor. In case the compatible imaging findings of SCN were observed, we intended to perform the follow up and did not undergo surgical treatments. However, in some cases, surgical resection was considered. The aim of this study is clarify the clinical features of resectable SCN. Method: By the retrospective review, 7 patients with SCN, who underwent resection and was histrogically diagnosed in our series between 2004 and 2015, were examined. Result: Four patients were female (57%), and three were male. Median age of the patients was 62 y.o. (range; 36-72 y.o.). Presence of symptoms as abdominal or back pain was observed in 3 patients (43%). The median sizes of the tumors was 42 mm (range; 32-60mm). The location of tumor was in head of pancreas is two, body in one, and tail in four (57%). Gross imaging findings were solid type in three, macrocystic type in two, and mixed type with honeycomb features in two. Although the mixed type of two patients were typically diagnosed as SCN before operation, it was difficult to preoperatively diagnose in others because the imaging findings of macrocystic type of 2 patients resembled the intraductal papillary mucinous neoplasm, and solid type of 3 patients resembled the neuroendocrine tumor. The reasons of surgical resection were in increase of tumor size in one, presence of symptom in three, and to difficulties of differential diagnosis with neuroendocrine tumor in three. Pancreaticoduodenectomy was performed in two patients, spleen preserving distal pancreatectomy in two, and distal pancreatectomy with splenectomy in three. All SCNs were diagnosed as adenoma histologically, and all patients were alive. Conclusion: It should pay further attention to distinguish between solid type SCN and neuroendocrine tumor by the various preoperative examination.
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University, Japan Introduction: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare tumor of low malignant potential. The aim of this study is to report our experience with nine cases of surgically resected SPN of the pancreas. Methods: Medical records of all nine patients who underwent surgery for a pathologically confirmed SPN from 2006 to 2015 in our institution were retrospectively analyzed. Result: There were eight females and one male with median age of 34 (17-67). The median tumor size was 4.3cm (1.4-150 cm). Liver metastases were present in one patient who had history of pancreatic tumor resection 24 years before presentation. Recurrence due to tumor dissemination was suspected because she had multiple peritoneal tumors nearby pancreatic head. Pancreaticoduodenectomy was performed in four patients, distal pancreatectomy, tumor enucleation were performed in two patients, respectively. Middle pancreatectomy was performed in one patient. Synchronous liver resection was performed for the patient who had liver metastasis at the time of presentation. All nine patients achieved complete tumor resection. Portal vein resection was performed in three patients, but there were no portal venous invasion proven in the pathological evaluation. All nine tumors were negative for lymph node metastasis. After a median follow-up of 31 (2-109) months, eight patients remained tumor free, but one patient arose multiple liver metastases 5 years after resection. She was treated with transcatheter arterial chemoembolization (TACE) and remains alive 5 years after recurrence. Conclusion: SPN is locally less invasive tumor in many cases and lymph node metastasis is rare, but often arises liver metastasis. Procedures which may cause tumor seeding must be avoided considering a risk of tumor dissemination. Aggressive surgical procedure may be permitted to avoid tumor remnant. Long term follow-up should be carried out to detect remote period recurrence.
P-031. A case of mucinous cystic neoplasm of pancreas with melena Gaku Ota, Atsushi Miki, Kazuhiro Endo, Masaru Koizumi, Hideki Sasanuma, Yasunaru Sakuma, Hisanaga Horie, Yoshinori Hosoya, Joji Kitayama, Naohiro Sata Department of Surgery, Jichi Medical University, Japan The patient is a 46-year-old female with melena following epigastralgia and nausea. Endoscopy showed bleeding from papilla vater. Enhanced computed tomography (CT) showed a cystic lesion with enhancement at pancreas tail. She was referred to our department. On physical examination, vital signs showed no abnormalities. She has no medical history. Dynamic CT revealed the cystic lesion 70mm in diameter adjacent to splenic artery and an entry of blood flow into the cyst from a pseudoaneurism of splenic artery. Thereafter she underwent embolization of the pseudoaneurism with interventional radiology. Endoscopic ultrasonography showed a unilocular cyst at pancreas tail. Preoperative MRI showed no change of the cyst. There was no findings related to the cause of the cystic lesion. She underwent distal pancreatectomy. Surgical findings revealed fibrotic adhesion around the cystic lesion especially between with splenic artery without inflammation. Postoperative course was uneventful. She was discharged 5 days after surgery. The cyst included a partition in a part of the wall without communication with pancreatic duct and nodule. Histopathological findings showed ovarian-type stroma in a part of the cyst wall. The cystic lesion was diagnosed with pancreas mucinous cystic neoplasm with mild dysplasia. We report a rare case of pancreas mucinous cystic neoplasm with melena.
P-033. Activities of an educational program for patients with pancreatic cancer and their caregivers Yasunari Sakamoto 1, Chikako Doutani 2, Satoshi Shiba 1, Takuji Okusaka 1 1 Department of Hepatobiliary and Pancreatic Oncology Division, National Cancer Center Hospital, Japan 2 Department of Psycho-Oncology Division, National Cancer Center Hospital, Japan
What is an educational program?: We first introduced an educational program for patients with advanced pancreatic or biliary cancer and their caregivers in 2007, which was delivered in a classroom environment. The class aimed to provide life-enhancing information. Classes were held every two months. Physicians, pharmacists, nurses, psychotherapists, dietitians, and medical social workers attended and talked about their specialties. After classes, time was allowed for interaction with participants. Problems: It was difficult to evaluate the effect of the classes, so we used a check list to try to measure the participant's understanding following classes. Another problem was the different needs between participants, requiring differing content for different groups. Therefore, we only recruit patients with pancreatic or biliary cancer within six months of starting cancer treatment. Current state: Classes included 16-27 participants (patients and caregivers) in 2015, and 96%-100% of these were “satisfied” with the classes. Occasionally receiving a gratitude letter from participants is an outcome.