Recurrent Invasive Intraductal Papillary Mucinous Carcinoma of the Pancreas Mimicking Pott Disease: Review of the Literature
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, United States Pancreas
(Impact Factor: 2.96).
05/2006; 32(3):321-4. DOI: 10.1097/01.mpa.0000203957.86135.2e
Specific information regarding intraductal papillary mucinous neoplasm (IPMN) recurrence is limited because most series are small and the follow-up interval is short. We report an unusual case of cancer recurrence in an 86-year-old woman who had undergone a pancreaticoduodenectomy for a large IPMN in the head of the pancreas. Final pathological evaluation of the resected pancreas found a component of in situ and invasive ductal adenocarcinoma without lymph node involvement. The patient did not receive postoperative chemotherapy and was monitored with transaxial imaging at regular intervals. Nine years later, the patient developed a retroperitoneal psoas abscess that was misdiagnosed as tuberculous spondylitis (Pott disease) but was proven to be recurrent mucinous adenocarcinoma of pancreatic origin. In our review of published reports in patients who underwent resection of IPMN, we found a combined mean recurrence rate of approximately 20%.
Available from: Sang-Han Lee
- "Previously, several alkylated chalcones obtained from Angelica have been observed to inhibit influenza virus neuraminidase (12). Other preventive approaches against various degenerative diseases may ameliorate the opportunistic damage and/or causes (13,14). "
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ABSTRACT: In this study, to assess whether aqueous and ethanol fractions of Angelica keiskei induce acute skin irritation and phototoxicity, acute skin irritancy and phototoxicity tests were performed. The skin of rabbits or guinea pigs was treated with these fractions (100 mg/dose) and whether the animals sustained significant skin damage was determined. The data demonstrated that the aqueous and ethanol fractions of Angelica keiskei did not induce acute toxicity in the skin of the animals, as assessed by anatomical and pathological observations. The results from the present study suggest that these aqueous and ethanol fractions of Angelica keiskei have promising potential uses as cosmetic ingredients that do not induce significant levels of skin irritation or phototoxicity.
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ABSTRACT: We analyzed the clinical characteristics and patterns of recurrence of intraductal papillary mucinous neoplasms (IPMNs) from 100 consecutive surgical cases.
The average age was 62 +/- 12 years. The tumor was located in the head in 65 patients, body in 25 patients, and tail in 10 patients. Sixty-seven patients had benign IPMNs, and 33 patients had malignant IPMNs. Malignant IPMNs were observed more frequently in the head (42%) as compared with the body (20%) or tail (10%) (P < .05). During the follow-up period, 5 patients recurred and underwent second operation. In the first operation, 1 patient underwent pancreatoduodenectomy for the head tumor and the other 4 patients underwent distal pancreatectomy for the body and/or tail tumor.
Although histopathologic findings in the first operation were adenoma in 2 and carcinoma in 3 patients, all patients developed carcinoma by the time of the second operation. No hyperplasia developed recurrence. The overall recurrence rate for the head tumors was 1.5% (1 out of 65), whereas that for the body and tail tumors was 11.4% (4 out of 35) (P < .05). Metachronous multicentric recurrence was suspected in 4 cases.
These results indicate that adenomatous or carcinomatous IPMNs, especially originated from the body or tail, should be carefully observed even with a histologically negative surgical margin.
Available from: Fabio Madureira
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ABSTRACT: Required resection margins for noninvasive intraductal papillary mucinous neoplasms (IPMNs) are a controversial issue. Over a 10-year period we have resected IPMNs from the entire pancreatic gland with minimally invasive techniques and compared our survival and complication rates with open controls to see if any difference in resection margins and outcomes could be observed. Data were collected retrospectively, including our first cases of advanced laparoscopic resections. Five-year Kaplan-Meier curves were calculated and statistical analysis was performed using the log rank and Student's T test for continuous variables. Chi square and Fisher's exact tests were used for analyzing categorical variables. From March 1997 to February 2006, we operated on 22 patients with noninvasive IPMNs, of which 9 (41%) were operated on laparoscopically and 13 (59%) using open techniques. Three patients underwent laparoscopic duodenopancreatectomy, compared to five in the open group. All resection margins were negative, but two patients required total pancreatectomy, both of which were performed laparoscopically. One of these was converted to open (11%) because of difficulty in reconstructing the biliary anastomosis. The overall complication rates were 56% for the laparoscopic group and 85% for the open group. Twenty-two percent of the laparoscopic group required reoperation and 11% required percutaneous drainage, compared to 15 and 23% in the open group, respectively. All patients are alive after a mean of 20 months (range = 2-43) in the laparoscopic group and 37 months (range = 1-121) in the open one (p > 0.05). Laparoscopic resection of noninvasive IPMNs of the entire pancreatic gland has similar complication and survival rates as open procedures. As a result, the laparoscopic approach is appropriate for noninvasive IPMNs of the entire pancreatic gland; however, larger cohorts are needed to see if any approach has superior outcomes. Because of these favorable results, studies are currently underway to see if the minimally invasive approach is also appropriate for invasive IPMNs.
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