International journal of pancreatology : official journal of the International Association of Pancreatology最新文献

Background: The bcl-2 and p53 gene deregulation is frequently involved in several types of malignancies. The purpose of this study was to evaluate the expression of bcl-2 and p53 genes in various types of pancreatic intraepithelial proliferation and in pancreatic cancer and to answer the question of whether they interact in the process of intraductal epithelial proliferation.

Methods: Immunohistochemical staining for p53 and bcl-2 was performed on paraffin embedded sections from 56 patients operated on for pancreatic carcinoma, chronic pancreatitis, and other conditions.

Results: Pancreatic cancer in 100% of cases showed p53 expression and in 27.7% bcl-2 expression. The p53 gene was expressed already in pancreatic intraductal neoplasia and its frequency was significantly rising with an increasing degree of hyperplasia. Normal epithelium of pancreatic ducts and ductules showed a high expression of bcl-2, which was decreasing in the process of intraductal proliferation.

Conclusions: Pancreatic cancer is characterized by a high expression of p53 and a low expression of bcl-2. In pancreatic cancers and pancreatic intraepithelial neoplasia, there is an inverse relationship between the expression of bcl-2 and p53. Malignant behavior of pancreatic cancer may be associated with the phenotype bcl-2-/p53+.

We report a case of acute pancreatitis complicating Salmonella enteritis. A 43-yr-old woman who was admitted to our department because of Salmonella enteritis developed clinical acute pancreatitis with laboratory and radiographic signs on the fourth hospital day. She was free from symptoms on the eighth hospital day, but her elevated serum amylase and lipase levels persisted for more than 2 m.o. In this case, clinical acute pancreatitis was a complication of bacterial enteritis caused by Salmonella enteritidis, and it was characterized by onset a few days after the onset of enteritis and by sustained elevation of serum pancreatic enzyme levels.

A 56-yr-old man with complaint of abdominal pain and body weight loss was admitted to our hospital. Contrast-enhanced computed tomography on admission revealed a pancreatic tumor. Contrast-enhanced computed tomography 1 m.o. after admission revealed rapid growth of this tumor. We performed exploratory laparotomy with only a needle biopsy of the unresectable tumor because of extensive spread, including liver metastases. Further histological and immunohistochemical examination revealed that both the pancreatic tumor and the hepatic metastases featured malignant spindle-shaped cells. Despite radiotherapy, the patient died 40 d after laparotomy.

A case of intraductal papillary mucinous tumor (IPMT) of the pancreas resected 27 yr after onset is presented. In March of 1997, a 71-yr-old man was admitted to our hospital with a complaint of severe epigastric pain. He had initially undergone endoscopic retrograde pancreatography (ERP) in April 1971 in our hospital and the patient had been followed up for pancreatografic changes for 26 yr. Dilatation of the main pancreatic duct gradually progressed during follow-up, and the filling defect owing to the tumor became demonstrable. On admission, ERP revealed diffuse dilatation of the main pancreatic duct, which was 20 mm in diameter, and the filling defect of 35 mm in diameter. We diagnosed this patient as having an IPMT of the pancreas. Considering his general condition, pancreatic segmentectomy was carried out, and the postoperative course was favorable. Histological findings were compatible with those of noninvasive papillary adenocarcinoma. This is a precious case for studying the natural history of intraductal papillary tumor of the pancreas and to evaluate the application of surgery, because the biologic behavior of this tumor is much less aggressive than that of pancreatic ductal cell carcinoma.

Background: The aim of the study was to define the prognostic role of etiology in the course of acute pancreatitis.

Methods: The study involved 208 consecutive patients with a first attack of acute pancreatitis. Etiology was biliary in 81 (39%) patients and alcohol abuse in 69 (33%); other etiologies were present in 16 (8%), and etiology remained unknown in 42 (20%). Etiology was correlated with the following parameters of severity of the disease: days in an intensive care unit (ICU); total hospital stay (THS); Ranson, Imrie, and Balthazar scores (contrast-enhanced computed tomography [CT] within 72 h of admission); indication of artificial ventilation, dialysis, or surgery; development of pancreatic pseudocysts; mortality.

Results: Alcoholic etiology correlated significantly more frequently than other subgroups with necrotizing pancreatitis, need for artificial ventilation, and development of pancreatic pseudocysts. For the other parameters, there were no significant differences between the etiologies.

Conclusion: Patients with alcohol-induced acute pancreatitis should be given special attention because of the higher incidence of necrotizing pancreatitis and necessity for artificial ventilation. Whether the pronounced frequency of pseudocysts in alcoholics suggests progression to chronic pancreatitis has to be clarified in follow-up studies.

Background: Adenosquamous carcinoma of the pancreas most probably represents squamous metaplasia of an adenocarcinoma. Metastases are typically an admixture of both elements, but more frequently, adenocarcinoma.

Methods: A review of 102 pancreaticoduodenectomies for masses of the head of the pancreas done between 1994 and 1998 revealed two patients with adenosquamous carcinoma of the pancreas.

Results: Both patients underwent successful pancreaticoduodenctomy, but were found to have nodal metastasis. One patient lived 13 mo and the other lived 14 mo with both dying from metastatic disease.

Conclusion: Adenosquamous carcinoma of the pancreas is a rare tumor, and because its presentation, clinical features, and course are identical to adenocarcinoma of the pancreas, it should be considered in the differential diagnosis for any mass of the head of the pancreas. Survival is poor for these patients. In this series, it was 13 and 14 mo, respectively.

Background: A considerable amount of evidence collected from several experimental systems and clinical studies with nonsteroidal Anti-inflammatory drugs (NSAIDs) indicates that Cox-2 may play a major role in colorectal tumorigenesis, but little information about Cox-2 expression in pancreatic tumors is available. In this study, we investigated Cox-2 expression by means of both immunohistochemical analysis and immunoblot analysis in pancreatic tumors.

Methods: Fifty invasive ductal adenocarcinomas and 26 intraductal papillary-mucinous tumors (IPMTs) were used for immunohistochemical analysis, and five pancreatic cancer tissues and five pancreatic cancer cell lines for immunoblot analysis.

Results: Cox-2 was expressed in 72% of the invasive ductal adenocarcinomas, 31% of intraductal papillary-mucinous adenocarcinomas, and none of intraductal papillary-mucinous adenomas. The expression rate of Cox-2 in intraductal papillary-mucinous adenocarcinomas was significantly higher than that in intraductal papillary-mucinous adenomas, and that in invasive ductal adenocarcinomas was significantly higher than that in intraductal papillary-mucinous carcinomas. However, there was no significant correlation between Cox-2 expression and the prognosis and clinicopathological factors. Immunoblot analysis identified Cox-2 in all of pancreatic cancer tissues and 60% of cell lines.

Conclusion: The biological role of cyclooxygenase-2 (Cox-2) in carcinoma cells should be investigated with reference to the cancer progression of the pancreas.

Background: Substantial numbers of studies have revealed the close correlation between chronic pancreatitis and cirrhosis in human. However, the situation with regard to pancreatic enzyme secretion is less clear.

Aim: The aim of the study was to investigate pancreatic exocrine function in rats with carbon tetrachloride-induced liver cirrhosis in rats.

Methods: Pancreatic exocrine function and morphology in Sprague-Dawley rats with carbon tetrachloride-induced liver cirrhosis were investigated. Pancreatic exocrine functions stimulated by cholecystokinin-8 and other secretagogs were assessed in isolated pancreatic acini, and in vivo and morphological changes were studied by routine histological examination and electron microscopy.

Results: The basal and cholecystokinin-8-stimulated amylase releases from acini and acinar amylase content were significantly lower in the cirrhotic rats than the control. None of the secretagogs induced the some amount of amylase release in cirrhotic as in control rats. Volume of the pancreatic juice and outputs of amylase and protein were significantly decreased under basal and cholecystokinin-8-stimulated conditions in vivo. Electron microscopy revealed most of the rough-surfaced endoplasmic reticulum accompanying less numbers of ribosomes to be dilated and some mitochondria to be swollen in cirrhotic rats.

Conclusion: Pancreatic exocrine functions are decreased in cirrhotic rats owing to alterations at the electron microscopic levels, reflecting an impaired acinar intracellular messenger system.

Background: Precise preoperative assessment of diagnosis and prognosis in patients with pancreatic tumors would facilitate improvement of treatment strategies. In this context, we evaluated the significance of the proliferative index and of static DNA cytophotometry in the diagnosis and prognosis of pancreatic tumors.

Methods: Consecutive surgical specimens from 26 patients with ductal pancreatic cancers and eight patients with chronic pancreatitis were investigated by: 1. Staging; 2. Conventional histological and cytological grading; 3. MIB-1 (Ki-67 labeling) proliferating index; and 4. Static DNA cytophotometry.

Results: All patients with chronic pancreatitis had a normal MIB-1 labeling index and a euploid DNA content. In contrast, patients with pancreatic cancers rarely had a normal labeling index (1 of 26 patients) or a euploid DNA content (6 of 26 patients). Staging significantly correlated with survival time. However, it did not correlate with cytological criteria. Cytological criteria, such as conventional grading, MIB-1 proliferating index, and DNA ploidy, were not significantly correlated with survival time. Conventional grading was significantly correlated (p < 0.02) with proliferating index, but not with DNA ploidy.

Conclusion: Proliferating index and DNA ploidy are relevant cytological markers that can help to discriminate between chronic pancreatitis and pancreatic cancer. The prognostic significance of these markers in pancreatic cancer patients, however, seems to be less relevant than tumor stage and of limited relevance for the individual cancer patient.