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The liver, gallbladder and pancreas
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Dina G. Tiniakos, Alastair D. Burt
The prognosis in carcinoma of the pancreas is extremely poor, with 90% of patients not surviving more than 6 months. The most important factor for prognosis is resectability. However, even if successfully resected, most ductal adenocarcinomas recur within 2 years, mostly locally or in the liver, and less frequently in the peritoneal cavity or the lymph nodes. One of the strongest prognostic factors for survival after surgical resection is the ratio of the number of lymph nodes with metastasis to the total number of examined lymph nodes. Histological features, such as tumour differentiation, number of mitoses, and density of intratumoral regulatory T cell infiltration are less significant prognostic factors. Adjuvant chemotherapy may slightly prolong patient survival. Patients with carcinoma in the immediate region of the ampulla often present relatively early with obstructive jaundice. Survival after surgery in these patients is usually better than that after surgery for carcinoma of the head of pancreas, but even here the 5-year survival rate is only approximately 25%.
Liver and biliary system, pancreas and spleen
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The most common type of pancreatic carcinoma is adenocarcinoma and the majority of cases are located in the head of pancreas (Fig. 6.24c). Masses are usually hypoechoic (darker than the surrounding tissue), irregular in outline, with increased vascularity demonstrated with colour or power Doppler. If the mass is at the head of the pancreas it can cause obstruction, which may lead to dilatation of the pancreatic duct (>2 mm), CBD (>6 mm), intrahepatic bile ducts and the gallbladder.
Hepatobiliary Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
Presentation➢ Carcinoma head of pancreas most commonly presents with obstructive jaundice. Gall bladder is typically palpable. (courvoisier’s law: in case of obstructive jaundice, if gallbladder is palpable it is unlikely to be due to stones).➢ Epigastric or left upper quadrant pain.➢ Nausea, vomiting, anorexia and weight loss could be feature of malignancy.➢ Rarely it can present for the first time with an episode of acute pancreatitis or thrombophlebitis migrans.➢ Metastatic disease can cause hepatomegaly and intractable back pain due to invasion of celiac plexus.
A rare case of intraductal tubulopapillary neoplasm of the pancreas – case report (with video)
Published in Postgraduate Medicine, 2020
Ankit Dalal, Gaurav Patil, Amol Vadgaonkar, Amit Maydeo
The lesion at the head of pancreas causes ductal obstruction which leads to repeated attacks of pancreatitis. CEA levels were done as the lesion resembled IPMN morphologically during EUS. However, HPE proved otherwise. ITPN are premalignant and have demonstrated its potential for progression to invasive carcinoma. The first case was recognized in 1990s, named as intraductal tubular carcinoma in 2002, renamed as ITPN in 2009 [6]. There is no gender predominance and is equally seen among males and females. The mean age at diagnosis is 61 years (range 35–78 years) [7]. Two-thirds of patients usually exhibit nonspecific symptoms including abdominal pain, weight loss, vomiting, exacerbation of diabetes, jaundice, and fever. While the remaining one-third are often asymptomatic. Nearly half of these neoplasms are located in the head of pancreas. However, it has been seen in other parts as well including head and body, body and tail with diffuse involvement [7]. They grow slowly and become large at the time of diagnosis. Size of the tumor varies and can range approximately from 1 to 15 cm (average of 3 cm). Laboratory investigations are often negative including tumor-specific antigens. Surgery is the treatment option in most cases with the commonly performed being pylorus preserving pancreatoduodenectomy and distal pancreatectomy.
Outcome after Surgical Treatment of Gastrointestinal Stromal Tumors in the Second Part of Duodenum: Is Localized Resection Appropriate?
Published in Journal of Investigative Surgery, 2022
Hany M. El-Haddad, Mohammed I. Kassem, Gihan A. Shehata, Islam A. El-Sayes
Specifically, the D2 was studied as it is the most common part to be involved with GISTs and, at the same time, the most surgically challenging part. Tumors situated in this part should be carefully approached owing to the close proximity to the head of pancreas. Most studies found that the D2 is the most common site for DGIST [3,7,9]. In the report of Chung et al. [10] on a small number of patients (n = 21), the D1 was the most common part involved. Manifestations of GI blood loss were the most common presentation (19 patients, 35.2%). Moreover, Zhou et al. [3] found that bleeding was the most common presentation in 60.4% of their cases. Nevertheless, Duffaud et al. [11] reported abdominal pain as the most common presentation in their patients.
Comparison of Image-Guided Iodine-125 Seed Interstitial Brachytherapy and Local Chemotherapy Perfusion in Treatment of Advanced Pancreatic Cancer
Published in Journal of Investigative Surgery, 2022
Li Zhou, Hui Yang, Linjun Xie, Jiantong Sun, Jun Qian, Lifei Zhu
The study included 84 cases in iodine-125 group and 81 cases in chemotherapy perfusion group. No patient quit or lost to follow-up. The follow-up duration was 2–12 months. Among all patients, the mean age was 58.69 ± 14.90, mean tumor diameter was 4.47 ± 1.69. The tumor position was at the head of pancreas in 88 cases (53.33%), at body of pancreas in 53 cases (32.12%), and at tail of pancreasin 24 cases (14.55%). No significant difference was found in all indices (Table 1).