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Multiple liver metastases of pancreatic solid pseudopapillary tumor treated with resection following chemotherapy and transcatheter arterial embolization: A case report.

Tajima H, Takamura H, Kitagawa H, Nakayama A, Shoji M, Watanabe T, Tsukada T, Nakanuma S, Okamoto K, Sakai S, Kinoshita J, Makino I, Nakamura K, Hayashi H, Oyama K, Inokuchi M, Nakagawara H, Miyashita T, Ninomiya I, Fushida S, Fujimura T, Wakayama T, Iseki S, Ikeda H, Ohta T - Oncol Lett (2015)

Bottom Line: Following 18 cycles, tumor sizes were reduced and 18-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) examination revealed obvious reduction of tumor FDG uptake.In the future, if the middle segment of the liver becomes enlarged, surgery for the residual right lobe tumor may be possible.If complete resection can be achieved, the majority of patients with SPT have a favorable prognosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.

ABSTRACT

A 33-year-old female was diagnosed with a solid pseudopapillary tumor (SPT) of the pancreas and multiple liver metastases at the Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital (Kanazawa, Japan). Distal pancreatectomy and postoperative systemic chemotherapy with gemcitabine (GEM) and S-1, an oral fluoropyrimidine derivative, was administered, however, liver metastases became enlarged and local recurrence occurred. Therefore, the patient was referred to the Department of Gastroenterologic Surgery at the Graduate School of Medicine (Kanazawa, Japan) for hepatic arterial infusion (HAI) chemotherapy. Oral S-1 (80 mg/m(2)) was administered as well as HAI chemotherapy with GEM (1,000 mg/standard liver volume). Following 18 cycles, tumor sizes were reduced and 18-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) examination revealed obvious reduction of tumor FDG uptake. Transarterial tumor embolization (TAE) was performed for the previously unresectable right subphrenic liver tumor, and the other tumors were surgically resected. The resected tumors were diagnosed as liver metastases and a local recurrence of SPT in the postoperative pathological examination, which revealed that the resected tumors were composed of sheets of bland cells, which were positive for CD10, CD56, vimentin, neuron-specific enolase and α-antitrypsin. The postoperative course was uneventful, and the patient is currently under observation at an outpatient clinic; postoperative adjuvant chemotherapy with oral S-1 has continued, and additional TAE is planned. In the future, if the middle segment of the liver becomes enlarged, surgery for the residual right lobe tumor may be possible. This case demonstrates one method of SPT treatment: Preoperative HAI chemotherapy with GEM, plus oral S-1 and TAE. If complete resection can be achieved, the majority of patients with SPT have a favorable prognosis. In patients with unresectable metastases from SPT, it is crucial to conduct systematic multimodal treatment to maximize treatment success.

No MeSH data available.


Related in: MedlinePlus

Electron microscopy: Dilated mitochondria and small vacuoles are seen. Large para-nuclear membrane-bound vacuoles and small vacuoles are observed.
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f5-ol-09-04-1733: Electron microscopy: Dilated mitochondria and small vacuoles are seen. Large para-nuclear membrane-bound vacuoles and small vacuoles are observed.

Mentions: The resected tumors were diagnosed as liver metastases and a local recurrence of SPT on postoperative pathological examination. The tumor specimen was a highly vascular lesion composed of sheets of bland cells with oval to round nuclei, moderate cytoplasm, ill-defined cell borders, and a focal pseudopapillary appearance (Fig. 4A). On immunohistochemical analysis, the tumor cells reacted positively for CD10, CD56, vimentin, NSE, and α-antitrypsin, however, the Ki-67 index was low (1–2%; Fig. 4B–H). Electron microscopy was performed to characterize the nature of the cytoplasmic vacuoles that appeared to be dilated or distended mitochondria; the remaining fractions appeared to be smooth endoplasmic reticulum, consistent with a previous report (Fig. 5). In a number of the small vacuoles, a few cristae could still be identified as mitochondrial, and a gradual transition from the normal mitochondria to those with attenuation of cristae was observed as well as loss of matrix.


Multiple liver metastases of pancreatic solid pseudopapillary tumor treated with resection following chemotherapy and transcatheter arterial embolization: A case report.

Tajima H, Takamura H, Kitagawa H, Nakayama A, Shoji M, Watanabe T, Tsukada T, Nakanuma S, Okamoto K, Sakai S, Kinoshita J, Makino I, Nakamura K, Hayashi H, Oyama K, Inokuchi M, Nakagawara H, Miyashita T, Ninomiya I, Fushida S, Fujimura T, Wakayama T, Iseki S, Ikeda H, Ohta T - Oncol Lett (2015)

Electron microscopy: Dilated mitochondria and small vacuoles are seen. Large para-nuclear membrane-bound vacuoles and small vacuoles are observed.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356297&req=5

f5-ol-09-04-1733: Electron microscopy: Dilated mitochondria and small vacuoles are seen. Large para-nuclear membrane-bound vacuoles and small vacuoles are observed.
Mentions: The resected tumors were diagnosed as liver metastases and a local recurrence of SPT on postoperative pathological examination. The tumor specimen was a highly vascular lesion composed of sheets of bland cells with oval to round nuclei, moderate cytoplasm, ill-defined cell borders, and a focal pseudopapillary appearance (Fig. 4A). On immunohistochemical analysis, the tumor cells reacted positively for CD10, CD56, vimentin, NSE, and α-antitrypsin, however, the Ki-67 index was low (1–2%; Fig. 4B–H). Electron microscopy was performed to characterize the nature of the cytoplasmic vacuoles that appeared to be dilated or distended mitochondria; the remaining fractions appeared to be smooth endoplasmic reticulum, consistent with a previous report (Fig. 5). In a number of the small vacuoles, a few cristae could still be identified as mitochondrial, and a gradual transition from the normal mitochondria to those with attenuation of cristae was observed as well as loss of matrix.

Bottom Line: Following 18 cycles, tumor sizes were reduced and 18-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) examination revealed obvious reduction of tumor FDG uptake.In the future, if the middle segment of the liver becomes enlarged, surgery for the residual right lobe tumor may be possible.If complete resection can be achieved, the majority of patients with SPT have a favorable prognosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterologic Surgery, Kanazawa University, Graduate School of Medical Science, Kanazawa 920-8641, Japan.

ABSTRACT

A 33-year-old female was diagnosed with a solid pseudopapillary tumor (SPT) of the pancreas and multiple liver metastases at the Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital (Kanazawa, Japan). Distal pancreatectomy and postoperative systemic chemotherapy with gemcitabine (GEM) and S-1, an oral fluoropyrimidine derivative, was administered, however, liver metastases became enlarged and local recurrence occurred. Therefore, the patient was referred to the Department of Gastroenterologic Surgery at the Graduate School of Medicine (Kanazawa, Japan) for hepatic arterial infusion (HAI) chemotherapy. Oral S-1 (80 mg/m(2)) was administered as well as HAI chemotherapy with GEM (1,000 mg/standard liver volume). Following 18 cycles, tumor sizes were reduced and 18-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) examination revealed obvious reduction of tumor FDG uptake. Transarterial tumor embolization (TAE) was performed for the previously unresectable right subphrenic liver tumor, and the other tumors were surgically resected. The resected tumors were diagnosed as liver metastases and a local recurrence of SPT in the postoperative pathological examination, which revealed that the resected tumors were composed of sheets of bland cells, which were positive for CD10, CD56, vimentin, neuron-specific enolase and α-antitrypsin. The postoperative course was uneventful, and the patient is currently under observation at an outpatient clinic; postoperative adjuvant chemotherapy with oral S-1 has continued, and additional TAE is planned. In the future, if the middle segment of the liver becomes enlarged, surgery for the residual right lobe tumor may be possible. This case demonstrates one method of SPT treatment: Preoperative HAI chemotherapy with GEM, plus oral S-1 and TAE. If complete resection can be achieved, the majority of patients with SPT have a favorable prognosis. In patients with unresectable metastases from SPT, it is crucial to conduct systematic multimodal treatment to maximize treatment success.

No MeSH data available.


Related in: MedlinePlus