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Resectable pancreatic neuroendocrine neoplasms: Clinicopathological characteristics and immunohistochemical correlation
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Abstracts / Pancreatology 17 (2017) S1eS68
Aim: To evaluate the changes in PD morphology after injection of neostigmine in patients with recurrent pancreatitis. Method: Following a baseline CPRM, 7 patients received 0,5 mg of neostigmine i.m. A new CPRM was performed 40 minutes later to evaluate changes in PD diameter at the level of the head, body and tail. The means were compared using the t-student statistic for paired samples, and a p value <0.05 was considered statistically significant. Results: The mean caliber of the main pancreatic duct before and after administration of neostigmine was 1.9 and 3.6 mm in the head (p ¼ 0.0006), 1.3 and 2.5 mm in the body (P ¼ 0.0002) and 0.4 and 1.6 mm in the tail (p ¼ 0.0002). In two patients the diagnosis of pancreas divisum was performed. Conclusion: The administration of neostigmine in studied patients increased significantly the diameter of the pancreatic duct compared to the basal images. The diagnostic utility of this test should be checked with a greater number of patients.
0160. Pancreatic schwannoma s Lancelotti, Roberto Salgado, Valentina Sielecki, Nicolas Avellaneda, Toma Ricardo Oddi, Delfina Auza Hospital Universitario CEMIC, Argentina Introduction: We describe a rare case of an asymptomatic patient with pancreatic schwannoma. Less than 50 cases have been described to date. Background: Schwannomas are extremely rare tumors, formed by Schwann cells. Most frequently, tumors are located in legs and arms, head, neck, and less frequently retroperitoneal and pancreas. Method: A 59 year old female patient, with a medical history of hypercholesterolemia. During her routine check-up an ultrasound showed a wellcircumscribed hypoechogenic nodule in the body of the pancreas. An abdominal computerized tomography detected a contrast enhanced hypervascular lesion. She was asymptomatic and tumor markers were within normal range. A laparoscopic approach was decided and enucleation was successfully achieved with intraoperative frozen section showing a tumor compatible with a benign Schwannoma. Her postoperative course was uneventful and patient was discharged 2 days postop. Discussion: Pancreatic Schwannoma is a rare entity, mostly benign tumor, well-circumscribed nodule. Asymptomatic diagnoses are increasingly frequent due to medical advances in the imaging field. Pancreatic Schwannomas involve the head of the pancreas involve in the majority of the cases, followed by the body. Treatment and management remains controversial, and surgical technique varies from radical resections and enucleation. Both have shown good follow with no recurrence rate known to date. Conclusion: Although Pancreatic schwannomas are rare tumors, they should be considered in the differential diagnosis of cystic pancreatic masses.
0161. Resectable pancreatic neuroendocrine neoplasms: Clinicopathological characteristics and immunohistochemical correlation Carolin Nava 1, Renata Coudry 2, Marcell Machado 1, Marianne Castro Gonçalves 2, Luciana Mereilles 2, Jose Celso Ardengh 1 1 2
Hospial Nove de Julho, Brazil Hospital Sirio Libanes, Brazil
Introduction: The incidence rate of pancreatic neuroendocrine tumors (pNETs) has increased rapidly in recent years and represent nowadays 2e3 % of all pancreatic neoplasms. Aim: The aim of this study examined pNETs subtypes in correlation with the mean size, clinicopathological and immunohistochemical findings.
Background: The treatment and behavior of some of them is still a controversial point. The clinicopathological characteristics of pNETs are poorly understood. Method: Medical records of all patients pathologically diagnosed as pNETs were studied in a period from October 2013 to November 2016 in ^s Hospital. A retrospective and random set of resected speciSírio-Libane mens, radiologically diagnosed, were classified based on clinical findings, morphological features and immunohistochemical analysis defined by the current TNM and WHO criteria. Results: 28 patients (17 men), were included with a mean surgery age of 55 þ 10.7 years. 12 were asymptomatic (43%) and 9 (32%) had abdominal pain, 4 (14%) diarrhea and 3 (9.2%) hypoglycemia. 24 (86%) were nonfunctional pNETs (NF-pNETs), 2 insulinomas (7%), 1 nesidioblastosis (3.5%) and 1 Vipoma (3.5%). The mean tumor size was 2.9 cm þ 5.6 cm (range 0.8 e 9). The morphologic features were solid tumors in 22 (89%), solid-cystic in 4 (14%) and cystic in 2 (7%). Central necrosis was founded in 5 cases (17.5%). The TNM stages were I (67.8%), II (14.2%), III (10.7%) and IV (7.1%) (table 1). Based on WHO classification, pNETs were classified into Grades 1 [16/28; (57)], 2 [9/28; (32%)], and 3 [3/28; (11%)] (table 2). In the G1 (16) 87% had mean size of 1.1cm (range 0.8e2.8cm) and they were not associated to metastasis. G2 (9) showed a mean size of 4.3cm (1e9 cm) and was connecting to metastases in 2 (22%) cases. All G3 were associated with metastases and the mean size of these lesions were 4.3 cm (range 3-6 cm). The positive rates of chromogranin A, beta catenin, and synaptophysin staining were 100% (28/28), 61% (17/28) and 100% (28/28), respectively. The functional pNETS (F-pNETS) had larger tumor sizes, more advanced TNM staging, a higher Ki-67 index and a higher rate of liver metastasis (p < 0.05) in comparison with non-pNETs. The coexistence of the other pancreatic lesions was observed: 4 (14%) microadenomas (2 related to G1 and 2 to G2), 2 (7%) pancreatic intraepithelial neoplasia (PanIN), and 1 (3.5%) case pancreatobiliary type of intraductal papillary-mucinous tumor. Conclusion: The pNETs are heterogeneous tumors with varying clinical manifestations, diverse tumor biological characteristics and different prognoses. This study observed a higher prevalence of G1 tumors without association with metastasis, being the metastasis cases weakly associated to size. Considering this statement, we believe that a wait and watch approach could be proposed for this kind of patients. More randomized and prospective trials are need to confirm these findings.
0163. Sparing pancreatic resection for clear cell adenocarcinoma of pancreas Marcos Garcia Ejarque, Ariel Tcherkansky, Daniela Speisky, Mariano Bregante, Rafael Maurette, Diego Bogetti Hospital Britanico, Argentina Introduction: Total pancreatectomy it’s well established, if needed, for pancreatic resections for pancreatic cancer, nevertheless it is associated with impaired quality of life. Clear cell adenocarcinoma of pancreas it’s a rare type of pancreatic cancer originated in the acinar pancreatic cells. Unfortunately the incidence and prognoses are not well known. We present a case about a patient with 2 solid tumors of the pancreas, 1 in the head that cause jaundice, and one in the tail. Method: Case report. Results: A 66 years old man presented with a choledocal syndrome. On image of magnetic resonance we detected two pancreatic solid tumors of 23 and 33mm each, one in the head and one in the tail. Both tumors were well circumscribe and enhanced with contrast. With the suspect of two non functioning neuroendocrine tumors we decide a two times pancreatic resection trying to preserve pancreatic parenchyma. After the laparoscopic distal pancreatectomy, the hystopathologic analysis revealed a clear cell adenocarcinoma of pancreas. After debating in a multidisciplinary cancer team a duodenopancreatectomy was made two months later, preserving the body of the pancreas. Both resections were R0 and a total of 28 lymph nodes were resected, all negatives for
Abstracts / Pancreatology 17 (2017) S1eS68
Aim: To evaluate the changes in PD morphology after injection of neostigmine in patients with recurrent pancreatitis. Method: Following a baseline CPRM, 7 patients received 0,5 mg of neostigmine i.m. A new CPRM was performed 40 minutes later to evaluate changes in PD diameter at the level of the head, body and tail. The means were compared using the t-student statistic for paired samples, and a p value <0.05 was considered statistically significant. Results: The mean caliber of the main pancreatic duct before and after administration of neostigmine was 1.9 and 3.6 mm in the head (p ¼ 0.0006), 1.3 and 2.5 mm in the body (P ¼ 0.0002) and 0.4 and 1.6 mm in the tail (p ¼ 0.0002). In two patients the diagnosis of pancreas divisum was performed. Conclusion: The administration of neostigmine in studied patients increased significantly the diameter of the pancreatic duct compared to the basal images. The diagnostic utility of this test should be checked with a greater number of patients.
0160. Pancreatic schwannoma s Lancelotti, Roberto Salgado, Valentina Sielecki, Nicolas Avellaneda, Toma Ricardo Oddi, Delfina Auza Hospital Universitario CEMIC, Argentina Introduction: We describe a rare case of an asymptomatic patient with pancreatic schwannoma. Less than 50 cases have been described to date. Background: Schwannomas are extremely rare tumors, formed by Schwann cells. Most frequently, tumors are located in legs and arms, head, neck, and less frequently retroperitoneal and pancreas. Method: A 59 year old female patient, with a medical history of hypercholesterolemia. During her routine check-up an ultrasound showed a wellcircumscribed hypoechogenic nodule in the body of the pancreas. An abdominal computerized tomography detected a contrast enhanced hypervascular lesion. She was asymptomatic and tumor markers were within normal range. A laparoscopic approach was decided and enucleation was successfully achieved with intraoperative frozen section showing a tumor compatible with a benign Schwannoma. Her postoperative course was uneventful and patient was discharged 2 days postop. Discussion: Pancreatic Schwannoma is a rare entity, mostly benign tumor, well-circumscribed nodule. Asymptomatic diagnoses are increasingly frequent due to medical advances in the imaging field. Pancreatic Schwannomas involve the head of the pancreas involve in the majority of the cases, followed by the body. Treatment and management remains controversial, and surgical technique varies from radical resections and enucleation. Both have shown good follow with no recurrence rate known to date. Conclusion: Although Pancreatic schwannomas are rare tumors, they should be considered in the differential diagnosis of cystic pancreatic masses.
0161. Resectable pancreatic neuroendocrine neoplasms: Clinicopathological characteristics and immunohistochemical correlation Carolin Nava 1, Renata Coudry 2, Marcell Machado 1, Marianne Castro Gonçalves 2, Luciana Mereilles 2, Jose Celso Ardengh 1 1 2
Hospial Nove de Julho, Brazil Hospital Sirio Libanes, Brazil
Introduction: The incidence rate of pancreatic neuroendocrine tumors (pNETs) has increased rapidly in recent years and represent nowadays 2e3 % of all pancreatic neoplasms. Aim: The aim of this study examined pNETs subtypes in correlation with the mean size, clinicopathological and immunohistochemical findings.
Background: The treatment and behavior of some of them is still a controversial point. The clinicopathological characteristics of pNETs are poorly understood. Method: Medical records of all patients pathologically diagnosed as pNETs were studied in a period from October 2013 to November 2016 in ^s Hospital. A retrospective and random set of resected speciSírio-Libane mens, radiologically diagnosed, were classified based on clinical findings, morphological features and immunohistochemical analysis defined by the current TNM and WHO criteria. Results: 28 patients (17 men), were included with a mean surgery age of 55 þ 10.7 years. 12 were asymptomatic (43%) and 9 (32%) had abdominal pain, 4 (14%) diarrhea and 3 (9.2%) hypoglycemia. 24 (86%) were nonfunctional pNETs (NF-pNETs), 2 insulinomas (7%), 1 nesidioblastosis (3.5%) and 1 Vipoma (3.5%). The mean tumor size was 2.9 cm þ 5.6 cm (range 0.8 e 9). The morphologic features were solid tumors in 22 (89%), solid-cystic in 4 (14%) and cystic in 2 (7%). Central necrosis was founded in 5 cases (17.5%). The TNM stages were I (67.8%), II (14.2%), III (10.7%) and IV (7.1%) (table 1). Based on WHO classification, pNETs were classified into Grades 1 [16/28; (57)], 2 [9/28; (32%)], and 3 [3/28; (11%)] (table 2). In the G1 (16) 87% had mean size of 1.1cm (range 0.8e2.8cm) and they were not associated to metastasis. G2 (9) showed a mean size of 4.3cm (1e9 cm) and was connecting to metastases in 2 (22%) cases. All G3 were associated with metastases and the mean size of these lesions were 4.3 cm (range 3-6 cm). The positive rates of chromogranin A, beta catenin, and synaptophysin staining were 100% (28/28), 61% (17/28) and 100% (28/28), respectively. The functional pNETS (F-pNETS) had larger tumor sizes, more advanced TNM staging, a higher Ki-67 index and a higher rate of liver metastasis (p < 0.05) in comparison with non-pNETs. The coexistence of the other pancreatic lesions was observed: 4 (14%) microadenomas (2 related to G1 and 2 to G2), 2 (7%) pancreatic intraepithelial neoplasia (PanIN), and 1 (3.5%) case pancreatobiliary type of intraductal papillary-mucinous tumor. Conclusion: The pNETs are heterogeneous tumors with varying clinical manifestations, diverse tumor biological characteristics and different prognoses. This study observed a higher prevalence of G1 tumors without association with metastasis, being the metastasis cases weakly associated to size. Considering this statement, we believe that a wait and watch approach could be proposed for this kind of patients. More randomized and prospective trials are need to confirm these findings.
0163. Sparing pancreatic resection for clear cell adenocarcinoma of pancreas Marcos Garcia Ejarque, Ariel Tcherkansky, Daniela Speisky, Mariano Bregante, Rafael Maurette, Diego Bogetti Hospital Britanico, Argentina Introduction: Total pancreatectomy it’s well established, if needed, for pancreatic resections for pancreatic cancer, nevertheless it is associated with impaired quality of life. Clear cell adenocarcinoma of pancreas it’s a rare type of pancreatic cancer originated in the acinar pancreatic cells. Unfortunately the incidence and prognoses are not well known. We present a case about a patient with 2 solid tumors of the pancreas, 1 in the head that cause jaundice, and one in the tail. Method: Case report. Results: A 66 years old man presented with a choledocal syndrome. On image of magnetic resonance we detected two pancreatic solid tumors of 23 and 33mm each, one in the head and one in the tail. Both tumors were well circumscribe and enhanced with contrast. With the suspect of two non functioning neuroendocrine tumors we decide a two times pancreatic resection trying to preserve pancreatic parenchyma. After the laparoscopic distal pancreatectomy, the hystopathologic analysis revealed a clear cell adenocarcinoma of pancreas. After debating in a multidisciplinary cancer team a duodenopancreatectomy was made two months later, preserving the body of the pancreas. Both resections were R0 and a total of 28 lymph nodes were resected, all negatives for