Ectodermal derivatives predominate in almost all cases of mature cystic teratoma. Organized neura... more Ectodermal derivatives predominate in almost all cases of mature cystic teratoma. Organized neural tissue is a common finding, and, although glial cells predominate, well-organized cerebrum, cerebellum, and choroid plexus may be found [1]. We recently studied a case of a mature cystic teratoma that exhibited an area of mature, well-formed cerebellum. To the best of our knowledge, there have been 12 cases of cerebellar tissue within an ovarian teratoma reported in the literature, 4 of which correspond to immature cerebellar tissue with the presence of an Obersteiner external granular layer. Our case represents the youngest patient reported, with mature and well-differentiated cerebellar tissue within a mature cystic teratoma.A 14 year-old Mexican girl was admitted to The American British Cowdray Medical Center (Mexico City, Mexico) for abdominal discomfort and abnormal uterine bleeding that characterized prolonged menstrual cycles and menorrhagia complicated by secondary anemia. She had ...
Background High platelet counts are associated with an adverse effect on survival in various neop... more Background High platelet counts are associated with an adverse effect on survival in various neoplastic entities. The prognostic relevance of preoperative platelet count in pancreatic cancer has not been clarified. Methods We performed a retrospective review of 205 patients with ductal adenocarcinoma who underwent surgical resection between 1990 and 2003. Demographic, surgical, and clinicopathologic variables were collected. A cutoff of 300,000/μl was used to define high platelet count. Results Of the 205 patients, 56 (27.4%) had a high platelet count, whereas 149 patients (72.6%) comprised the low platelet group. The overall median survival was 17 (2–178) months. The median survival of the high platelet group was 18 (2–137) months, and that of the low platelet group was 15 (2–178) months (p = 0.7). On multivariate analysis, lymph node metastasis, vascular invasion, positive margins, and CA 19–9 > 200 U/ml were all significantly associated with poor survival. Conclusions There is no evidence to support preoperative platelet count as either an adverse or favorable prognostic factor in pancreatic ductal adenocarcinoma. Use of 5-year actual survival data confirms that lymph node metastases, positive margins, vascular invasion, and CA 19–9 are predictors of poor survival in resected pancreatic cancer.
To describe the management and impact of pancreatic fistulas in a high-volume center. Retrospecti... more To describe the management and impact of pancreatic fistulas in a high-volume center. Retrospective case series. Tertiary academic center. Five hundred eighty-one consecutive patients who underwent pancreaticoduodenectomy from January 2001 through June 2006. Development of a pancreatic fistula (defined as > 30 mL of amylase-rich fluid from drains on or after postoperative day 7, or discharge with surgical drains in place, regardless of amount); the need for additional interventions or total parenteral nutrition; other morbidity; and mortality. Seventy-five patients (12.9%) developed a pancreatic fistula. Fistulas were managed with gradual withdrawal of surgical drains. This allowed for patient discharge and eventual closure at a mean of 18 days in 38.7% of cases; these were classified as low-impact fistulas. The remaining 46 patients (61.3%) had an associated abscess, required percutaneous drainage or total parenteral nutrition, or developed bleeding; these were classified as high-impact fistulas and closed a mean of 35 days after surgery. Standard 30-day in-hospital mortality was 1.9% for all pancreaticoduodenectomies and 6.7% for those who developed a pancreatic fistula. The overall fistula-related mortality was 9.3% (7 patients), all but 1 of which was related to major hemorrhage. More than one-third of pancreatic fistulas are clinically insignificant (low impact). The remaining 60% of fistulas have a high clinical impact and nearly an 8-fold increase in overall mortality.
Mucinous cystic neoplasms (MCNs) of the pancreas have often been confused with intraductal papill... more Mucinous cystic neoplasms (MCNs) of the pancreas have often been confused with intraductal papillary mucinous neoplasms. We evaluated the clinicopathologic characteristics, prevalence of cancer, and prognosis of a large series of well-characterized MCNs in 2 tertiary centers. Analysis of 163 patients with resected MCNs, defined by the presence of ovarian stroma and lack of communication with the main pancreatic duct. MCNs were seen mostly in women (95%) and in the distal pancreas (97%); 25% were incidentally discovered. Symptomatic patients typically had mild abdominal pain, but 9% presented with acute pancreatitis. One hundred eighteen patients (72%) had adenoma, 17 (10.5%) borderline tumors, 9 (5.5%) in situ carcinoma, and 19 (12%) invasive carcinoma. Patients with invasive carcinoma were significantly older than those with noninvasive neoplasms (55 vs. 44 years, P = 0.01). Findings associated with malignancy were presence of nodules (P = 0.0001) and diameter > or =60 mm (P = 0.0001). All neoplasms with cancer were either > or =40 mm in size or had nodules. There was no operative mortality and postoperative morbidity was 49%. Median follow-up was 57 months (range, 4-233); only patients with invasive carcinoma had recurrence. The 5-year disease-specific survival for noninvasive MCNs was 100%, and for those with invasive cancer, 57%. This series, the largest with MCNs defined by ovarian stroma, shows a prevalence of cancer of only 17.5%. Patients with invasive carcinoma are older, suggesting progression from adenoma to carcinoma. Although resection should be considered for all cases, in low-risk MCNs…
Background Nodal metastasis is considered a major prognostic factor in patients with ampulla of V... more Background Nodal metastasis is considered a major prognostic factor in patients with ampulla of Vater carcinoma (AVC). No study has investigated the significance of the ratio between metastatic and resected/examined lymph nodes (LNR) in patients with AVC. Methods Demographic, operative, and pathology data, including number of resected/evaluated nodes and LNR, were collected from patients who underwent pancreaticoduodenectomy with radical intent for invasive AVC from 1990 to 2005. Survival rates and recurrence patterns were evaluated and predictors were identified. Results In 90 evaluable patients (51 males, 39 females, median age 62.5 years), 5-year disease-specific survival (DSS) was 61%. The median number of resected/evaluated nodes was 16 (range: 5–47); 50% of the patients had nodal metastases. The 5-year DSS according to LNR was 75%, 49%, 38%, and 0% for LNR = 0, LNR >0 and ≤0.2, LNR >0.2, and ≤0.4, and LNR >0.4 (P = 0.002), respectively. The 5-year DSS was 81% in patients with >16 resected/evaluated nodes compared with 45% in those with ≤16 resected/evaluated nodes (P = 0.001). On multivariate analysis LNR and a number of resected/evaluated nodes >16 were significant predictors of survival; a number of resected/evaluated nodes >16 was also the only independent predictor of recurrence. Conclusions After curative resection for AVC, LNR and a cutoff of 16 resected/evaluated nodes are powerful prognostic factors. LNR might represent a major parameter for patient stratification in adjuvant treatment trials.
In pancreatic cancer patients, survival and palliation of symptoms should be balanced with social... more In pancreatic cancer patients, survival and palliation of symptoms should be balanced with social and functional impairment, and for this reason, health-related quality of life measurements could play an important role in the decision-making process. The aim of this work was to evaluate the quality of life and survival in 92 patients with different stages of pancreatic adenocarcinoma who underwent surgical and/or medical interventions. Patients were evaluated with the Functional Assessment of Cancer Therapy questionnaires at diagnosis and follow-up (3 and 6 months). At diagnosis, 28 patients (30.5%) had localized disease (group 1) and underwent surgical resection, 34 (37%) had locally advanced (group 2), and 30 (32.5%) metastatic disease (Group 3). Improvement in quality of life was found in group 1, while in group 3, it decreased at follow-up (p = 0.03). No changes in quality of life in group 2 were found. Chemotherapy/chemoradiation seems not to significantly modify quality of life in groups 2 and 3. Median survival time for the entire cohort was 9.8 months (range, 1–24). One-year survival was 74%, 30%, and 16% for groups 1, 2, and 3 respectively (p = 0.001). Pancreatic cancer prognosis is still dismal. In addition to long-term survival benefits, surgery impacts favorably quality of life.
Ectodermal derivatives predominate in almost all cases of mature cystic teratoma. Organized neura... more Ectodermal derivatives predominate in almost all cases of mature cystic teratoma. Organized neural tissue is a common finding, and, although glial cells predominate, well-organized cerebrum, cerebellum, and choroid plexus may be found [1]. We recently studied a case of a mature cystic teratoma that exhibited an area of mature, well-formed cerebellum. To the best of our knowledge, there have been 12 cases of cerebellar tissue within an ovarian teratoma reported in the literature, 4 of which correspond to immature cerebellar tissue with the presence of an Obersteiner external granular layer. Our case represents the youngest patient reported, with mature and well-differentiated cerebellar tissue within a mature cystic teratoma.A 14 year-old Mexican girl was admitted to The American British Cowdray Medical Center (Mexico City, Mexico) for abdominal discomfort and abnormal uterine bleeding that characterized prolonged menstrual cycles and menorrhagia complicated by secondary anemia. She had ...
Background High platelet counts are associated with an adverse effect on survival in various neop... more Background High platelet counts are associated with an adverse effect on survival in various neoplastic entities. The prognostic relevance of preoperative platelet count in pancreatic cancer has not been clarified. Methods We performed a retrospective review of 205 patients with ductal adenocarcinoma who underwent surgical resection between 1990 and 2003. Demographic, surgical, and clinicopathologic variables were collected. A cutoff of 300,000/μl was used to define high platelet count. Results Of the 205 patients, 56 (27.4%) had a high platelet count, whereas 149 patients (72.6%) comprised the low platelet group. The overall median survival was 17 (2–178) months. The median survival of the high platelet group was 18 (2–137) months, and that of the low platelet group was 15 (2–178) months (p = 0.7). On multivariate analysis, lymph node metastasis, vascular invasion, positive margins, and CA 19–9 > 200 U/ml were all significantly associated with poor survival. Conclusions There is no evidence to support preoperative platelet count as either an adverse or favorable prognostic factor in pancreatic ductal adenocarcinoma. Use of 5-year actual survival data confirms that lymph node metastases, positive margins, vascular invasion, and CA 19–9 are predictors of poor survival in resected pancreatic cancer.
To describe the management and impact of pancreatic fistulas in a high-volume center. Retrospecti... more To describe the management and impact of pancreatic fistulas in a high-volume center. Retrospective case series. Tertiary academic center. Five hundred eighty-one consecutive patients who underwent pancreaticoduodenectomy from January 2001 through June 2006. Development of a pancreatic fistula (defined as > 30 mL of amylase-rich fluid from drains on or after postoperative day 7, or discharge with surgical drains in place, regardless of amount); the need for additional interventions or total parenteral nutrition; other morbidity; and mortality. Seventy-five patients (12.9%) developed a pancreatic fistula. Fistulas were managed with gradual withdrawal of surgical drains. This allowed for patient discharge and eventual closure at a mean of 18 days in 38.7% of cases; these were classified as low-impact fistulas. The remaining 46 patients (61.3%) had an associated abscess, required percutaneous drainage or total parenteral nutrition, or developed bleeding; these were classified as high-impact fistulas and closed a mean of 35 days after surgery. Standard 30-day in-hospital mortality was 1.9% for all pancreaticoduodenectomies and 6.7% for those who developed a pancreatic fistula. The overall fistula-related mortality was 9.3% (7 patients), all but 1 of which was related to major hemorrhage. More than one-third of pancreatic fistulas are clinically insignificant (low impact). The remaining 60% of fistulas have a high clinical impact and nearly an 8-fold increase in overall mortality.
Mucinous cystic neoplasms (MCNs) of the pancreas have often been confused with intraductal papill... more Mucinous cystic neoplasms (MCNs) of the pancreas have often been confused with intraductal papillary mucinous neoplasms. We evaluated the clinicopathologic characteristics, prevalence of cancer, and prognosis of a large series of well-characterized MCNs in 2 tertiary centers. Analysis of 163 patients with resected MCNs, defined by the presence of ovarian stroma and lack of communication with the main pancreatic duct. MCNs were seen mostly in women (95%) and in the distal pancreas (97%); 25% were incidentally discovered. Symptomatic patients typically had mild abdominal pain, but 9% presented with acute pancreatitis. One hundred eighteen patients (72%) had adenoma, 17 (10.5%) borderline tumors, 9 (5.5%) in situ carcinoma, and 19 (12%) invasive carcinoma. Patients with invasive carcinoma were significantly older than those with noninvasive neoplasms (55 vs. 44 years, P = 0.01). Findings associated with malignancy were presence of nodules (P = 0.0001) and diameter > or =60 mm (P = 0.0001). All neoplasms with cancer were either > or =40 mm in size or had nodules. There was no operative mortality and postoperative morbidity was 49%. Median follow-up was 57 months (range, 4-233); only patients with invasive carcinoma had recurrence. The 5-year disease-specific survival for noninvasive MCNs was 100%, and for those with invasive cancer, 57%. This series, the largest with MCNs defined by ovarian stroma, shows a prevalence of cancer of only 17.5%. Patients with invasive carcinoma are older, suggesting progression from adenoma to carcinoma. Although resection should be considered for all cases, in low-risk MCNs…
Background Nodal metastasis is considered a major prognostic factor in patients with ampulla of V... more Background Nodal metastasis is considered a major prognostic factor in patients with ampulla of Vater carcinoma (AVC). No study has investigated the significance of the ratio between metastatic and resected/examined lymph nodes (LNR) in patients with AVC. Methods Demographic, operative, and pathology data, including number of resected/evaluated nodes and LNR, were collected from patients who underwent pancreaticoduodenectomy with radical intent for invasive AVC from 1990 to 2005. Survival rates and recurrence patterns were evaluated and predictors were identified. Results In 90 evaluable patients (51 males, 39 females, median age 62.5 years), 5-year disease-specific survival (DSS) was 61%. The median number of resected/evaluated nodes was 16 (range: 5–47); 50% of the patients had nodal metastases. The 5-year DSS according to LNR was 75%, 49%, 38%, and 0% for LNR = 0, LNR >0 and ≤0.2, LNR >0.2, and ≤0.4, and LNR >0.4 (P = 0.002), respectively. The 5-year DSS was 81% in patients with >16 resected/evaluated nodes compared with 45% in those with ≤16 resected/evaluated nodes (P = 0.001). On multivariate analysis LNR and a number of resected/evaluated nodes >16 were significant predictors of survival; a number of resected/evaluated nodes >16 was also the only independent predictor of recurrence. Conclusions After curative resection for AVC, LNR and a cutoff of 16 resected/evaluated nodes are powerful prognostic factors. LNR might represent a major parameter for patient stratification in adjuvant treatment trials.
In pancreatic cancer patients, survival and palliation of symptoms should be balanced with social... more In pancreatic cancer patients, survival and palliation of symptoms should be balanced with social and functional impairment, and for this reason, health-related quality of life measurements could play an important role in the decision-making process. The aim of this work was to evaluate the quality of life and survival in 92 patients with different stages of pancreatic adenocarcinoma who underwent surgical and/or medical interventions. Patients were evaluated with the Functional Assessment of Cancer Therapy questionnaires at diagnosis and follow-up (3 and 6 months). At diagnosis, 28 patients (30.5%) had localized disease (group 1) and underwent surgical resection, 34 (37%) had locally advanced (group 2), and 30 (32.5%) metastatic disease (Group 3). Improvement in quality of life was found in group 1, while in group 3, it decreased at follow-up (p = 0.03). No changes in quality of life in group 2 were found. Chemotherapy/chemoradiation seems not to significantly modify quality of life in groups 2 and 3. Median survival time for the entire cohort was 9.8 months (range, 1–24). One-year survival was 74%, 30%, and 16% for groups 1, 2, and 3 respectively (p = 0.001). Pancreatic cancer prognosis is still dismal. In addition to long-term survival benefits, surgery impacts favorably quality of life.
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