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Clinicopathologic features and outcomes following surgery for pancreatic adenosquamous carcinoma.

Hsu JT, Chen HM, Wu RC, Yeh CN, Yeh TS, Hwang TL, Jan YY, Chen MF - World J Surg Oncol (2008)

Bottom Line: Patients with stage IIB pancreatic ASC had shorter median survival compared to those with adenocarcinoma.Aggressive surgical management does not appear effective in treating pancreatic ASC patients.Strategies involving non-surgical treatment such as chemotherapy, radiotherapy or target agents should be tested.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. hsujt2813@adm.cgmh.org.tw

ABSTRACT

Background: Pancreatic adenosquamous carcinoma (ASC) is a rare pancreatic malignancy subtype. We investigated the clinicopathological features and outcome of pancreatic ASC patients after surgery.

Methods: The medical records of 12 patients with pancreatic ASC undergoing surgical treatment (1993 to 2006) were retrospectively reviewed. Survival data of patients with stage IIB pancreatic adenocarcinoma and ASC undergoing surgical resection were compared.

Results: Symptoms included abdominal pain (91.7%), body weight loss (83.3%), anorexia (41.7%) and jaundice (25.0%). Tumors were located at pancreatic head in 5 (41.7%) patients, tail in 5 (41.7%), and body in 4 (33.3%). Median tumor size was 6.3 cm. Surgical resection was performed on 7 patients, bypass surgery on 3, and exploratory laparotomy with biopsy on 2. No surgical mortality was identified. Seven (58.3%) and 11 (91.7%) patients died within 6 and 12 months of operation, respectively. Median survival of 12 patients was 4.41 months. Seven patients receiving surgical resection had median survival of 6.51 months. Patients with stage IIB pancreatic ASC had shorter median survival compared to those with adenocarcinoma.

Conclusion: Aggressive surgical management does not appear effective in treating pancreatic ASC patients. Strategies involving non-surgical treatment such as chemotherapy, radiotherapy or target agents should be tested.

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Histopathology in a patient with pancreatic tumor shows glandular adenocarcinoma foci (black arrowheads) and nests of squamous cell carcinoma (upper middle part), consistent with adenosquamous carcinoma (Hematoxylin-Eosin stain, original magnification ×100).
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Figure 1: Histopathology in a patient with pancreatic tumor shows glandular adenocarcinoma foci (black arrowheads) and nests of squamous cell carcinoma (upper middle part), consistent with adenosquamous carcinoma (Hematoxylin-Eosin stain, original magnification ×100).

Mentions: Table 2 demonstrates the details of tumor characteristics, management and prognosis of 12 patients with pancreatic ASC. The tumors were located at pancreatic head in 5 (41.7%) patients, tail in 5 (41.7%), and body in 4 (33.3%). Tumor size ranged from 3.5 to 8 cm with a median of 6.3 cm. The lesions from the resected specimens were firm with light tan to yellowish colors and had merged imperceptibly with the surrounding pancreatic parenchyma. Histologically, tumors were a mixture component of adenocarcinoma and squamous cell carcinoma (Figure 1). The rates of squamous component in the tumor tissue ranged from 40 to 90% in patients undergoing surgical resection. Lymph node metastases were identified in 11 patients (91.7%). Encasement of superior mesenteric artery by the tumor was found during operation in 5 patients, and carcinomatosis in 1 patient. Surgical resection including pancreaticoduodenectomy (PD) and subtotal or distal pacreatectomy along with total gastrectomy or splenectomy was performed in 7 patients. R0 (radical) resection was identified in 5 patients and R1 resection in 2 (cases 9 and 11). Five patients underwent laparotomy followed by intra-operative biopsy of the pancreatic tumor and three received bypass surgery. Intraoperative irradiation and postoperative chemotherapy were carried out in 2 and 7 patients, respectively. Tumor stage was IIB in 7 patients, III in 4 and IV in 1.


Clinicopathologic features and outcomes following surgery for pancreatic adenosquamous carcinoma.

Hsu JT, Chen HM, Wu RC, Yeh CN, Yeh TS, Hwang TL, Jan YY, Chen MF - World J Surg Oncol (2008)

Histopathology in a patient with pancreatic tumor shows glandular adenocarcinoma foci (black arrowheads) and nests of squamous cell carcinoma (upper middle part), consistent with adenosquamous carcinoma (Hematoxylin-Eosin stain, original magnification ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2543014&req=5

Figure 1: Histopathology in a patient with pancreatic tumor shows glandular adenocarcinoma foci (black arrowheads) and nests of squamous cell carcinoma (upper middle part), consistent with adenosquamous carcinoma (Hematoxylin-Eosin stain, original magnification ×100).
Mentions: Table 2 demonstrates the details of tumor characteristics, management and prognosis of 12 patients with pancreatic ASC. The tumors were located at pancreatic head in 5 (41.7%) patients, tail in 5 (41.7%), and body in 4 (33.3%). Tumor size ranged from 3.5 to 8 cm with a median of 6.3 cm. The lesions from the resected specimens were firm with light tan to yellowish colors and had merged imperceptibly with the surrounding pancreatic parenchyma. Histologically, tumors were a mixture component of adenocarcinoma and squamous cell carcinoma (Figure 1). The rates of squamous component in the tumor tissue ranged from 40 to 90% in patients undergoing surgical resection. Lymph node metastases were identified in 11 patients (91.7%). Encasement of superior mesenteric artery by the tumor was found during operation in 5 patients, and carcinomatosis in 1 patient. Surgical resection including pancreaticoduodenectomy (PD) and subtotal or distal pacreatectomy along with total gastrectomy or splenectomy was performed in 7 patients. R0 (radical) resection was identified in 5 patients and R1 resection in 2 (cases 9 and 11). Five patients underwent laparotomy followed by intra-operative biopsy of the pancreatic tumor and three received bypass surgery. Intraoperative irradiation and postoperative chemotherapy were carried out in 2 and 7 patients, respectively. Tumor stage was IIB in 7 patients, III in 4 and IV in 1.

Bottom Line: Patients with stage IIB pancreatic ASC had shorter median survival compared to those with adenocarcinoma.Aggressive surgical management does not appear effective in treating pancreatic ASC patients.Strategies involving non-surgical treatment such as chemotherapy, radiotherapy or target agents should be tested.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. hsujt2813@adm.cgmh.org.tw

ABSTRACT

Background: Pancreatic adenosquamous carcinoma (ASC) is a rare pancreatic malignancy subtype. We investigated the clinicopathological features and outcome of pancreatic ASC patients after surgery.

Methods: The medical records of 12 patients with pancreatic ASC undergoing surgical treatment (1993 to 2006) were retrospectively reviewed. Survival data of patients with stage IIB pancreatic adenocarcinoma and ASC undergoing surgical resection were compared.

Results: Symptoms included abdominal pain (91.7%), body weight loss (83.3%), anorexia (41.7%) and jaundice (25.0%). Tumors were located at pancreatic head in 5 (41.7%) patients, tail in 5 (41.7%), and body in 4 (33.3%). Median tumor size was 6.3 cm. Surgical resection was performed on 7 patients, bypass surgery on 3, and exploratory laparotomy with biopsy on 2. No surgical mortality was identified. Seven (58.3%) and 11 (91.7%) patients died within 6 and 12 months of operation, respectively. Median survival of 12 patients was 4.41 months. Seven patients receiving surgical resection had median survival of 6.51 months. Patients with stage IIB pancreatic ASC had shorter median survival compared to those with adenocarcinoma.

Conclusion: Aggressive surgical management does not appear effective in treating pancreatic ASC patients. Strategies involving non-surgical treatment such as chemotherapy, radiotherapy or target agents should be tested.

Show MeSH
Related in: MedlinePlus