We here provide a digest of the Pancreas Cancer Report 2007, a detailed analysis of 28655 cases with pancreatic neoplasms registered from 1981 to 2004 by the Japan Pancreas Society. This summary includes a new survival curve of IPMN according to the depth of cancer. We compared JPS and UICC classifications for the survival estimation not only for invasive cancer but also for IPMN, MCN, and endocrine tumors in various aspects. The survival of patients with pancreatic cancer improved especially in 2001-2004 cases compared to the cases in 1980s and 1990s. The JPS classification showed better survival estimation than the UICC classification, especially for patients with IPMN, MCN and endocrine tumor.

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After the identification and isolation of pancreatic stellate cells (PSCs), a number of studies on their functions have shown that PSCs play central roles in pancreatic fibrogenesis in patients with chronic pancreatitis. In chronic pancreatitis tissue, PSCs are activated, proliferate, and migrate to the injured regions of the pancreas, where they secrete various extracellular matrices resulting in pancreatic fibrosis. The specific molecules involved in these PSC functions have been identified. In this review, recent reports on the molecular mechanism of PSC functional controls and the possibility that these molecules can be the targets for the treatment of pancreatic fibrosis will be presented.

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Solid-pseudopapillary tumors (SPT) of the pancreas have been reported as rare lesions with "low malignant potential" occurring mainly in young women. SPT of the pancreas can be cured by complete surgical resection. To date, surgery is the main treatment for pancreatic SPT and the standard surgical procedure is enucleation of the tumor for benign SPT, whereas pancreatic resection is performed for malignant SPT. This study investigated the clinicopathological characteristics of these lesions and the effects of surgical intervention. We evaluated the clinical and pathological characteristics in 8 cases of pancreatic SPT that were resected in our hospital between 1988 and 2006. On preoperative imaging studies, none of the tumors demonstrated malignant features such as invasion of the surrounding structures, lymph node metastases, and distant metastases. Pancreatic resection with lymph node dissection was carried out in all patients. Four patients demonstrating a mass localized in the pancreatic head underwent pancreaticoduodenectomy; three patients demonstrating a mass localized in the pancreatic tail underwent distal pancreatectomy, and one patient demonstrating a mass localized in the pancreatic body underwent middle pancreatectomy. Among the 8 cases, four invaded the surrounding structures, and one presented with synchronous lymph node metastasis. Postoperatively, the patients were followed for 5 months to 18 years (median: 70.9 months). Since it is difficult to differentiate between benign and malignant SPT of the pancreas on preoperative imaging, pancreatic resection with lymph node dissection is considered a reasonable treatment for SPT of the pancreas.

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A 48 year-old man was seen by a doctor regularly for follow-up after surgery for occult atypical carcinoid of the right lung since 2003. He showed a gradual elevation of the CEA levels in 2006. He was asymptomatic and the results of the physical examinations were normal. PET-CT showed two hot spots, 3.7cm in diameter in segment 8 of the liver and 3.5cm in diameter in the tail of the pancreas. To diagnose whether these tumors were pancreatic ductal cancer or islet cell tumors, we obtained targeted biopsy specimen of the liver tumor that were positive for CD56, chromographin, NSE, and synaptophysin. Therefore, segmental tail pancreatectomy, spleenectomy and partial resection of the liver were performed under the diagnosis of endocrine tumor of the pancreas with liver metastasis. Histological examination revealed a pancreatic endocrine tumor that was positive for immunohistochemical staining of gulcagon and CEA.

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A 66-year-old woman was admitted to our hospital because of suspective acute pancreatitis with unknown etiology. Dynamic computed tomography scan of the pancreas showed a small cystic lesion measuring 5mm in diameter in the pancreatic body and endoscopic retrograde pancreatography demonstrated mucus outflow from the papilla Vater and mucus plugs in the main pancreatic duct. Furthermore, intraductal ultrasound sonography of the main pancreatic duct revealed a small nodule (1mm in diameter) in the cystic lesion. Accordingly, we diagnosed this lesion as intraductal papillary mucinous neoplasm. We did not choose surgical therapy due to its small size. We used bromhexine hydrochloride that suppresses sputum of the bronchus. This therapy decreased the stickiness of the pancreatic juice and resulted in decreased incidence of acute pancreatitis.

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We report a case of intra abdominal desmoid tumor that was preoperatively diagnosed as pancreatic tumor. The patient was a 23-year-old woman who was diagnosed as having a pancreatic tumor at the time of abdominal ultrasound, which revealed acute intestinal inflammation. Abdominal CT visualized a well-defined, ovoid tumor in the pancreatic body, which showed slight contrast enhancement. No invasion into the surrounding organs was noted. Multiple imaging studies failed to provide a definitive diagnosis and we performed a laparotomy. The tumor was located anterior to the pancreatic body, invading the vessels on the lesser curvature side and the stomach wall. Since these findings suggested a malignant tumor, we resected the pancreatic body and tail with splenectomy. The postoperative histopathological diagnosis was desmoid tumor. This patient underwent surgery under a diagnosis of pancreatic tumor; however, the tumor grew, apparently protruding from the pancreas, was well-defined, and had a diameter of about 3cm, with no influence on the pancreatic duct system. In such a case, an extrapancreatic lesion should be considered, and the differential diagnosis should include desmoid tumor, although it is rare.

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A 57-year-old man was admitted to our hospital with upper abdominal pain and fever up. One month previously, he had been diagnosed with alcoholic pancreatitis and received treatment with an oral protease inhibitor (camostat mesilate). CT showed swelling of the pancreas with inflammatory changes around the pancreas and a 2.5-cm-diameter cystic lesion on the pancreas head. Based on a diagnosis of malignant pancreatic cystic tumor, pylorus-preserving pancreatoduodenectomy was performed. Pathological findings showed xanthogranulomatous inflammation on the wall of cystic lesion without malignant findings. We report here a case of xanthogranulomatous pancreatitis difficult to differentiate from pancreatic cystic tumor.

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A 50-year-old man was admitted to our hospital because of body weight loss, upper abdominal fullness and back pain. Abdominal ultrasonography (US) and computed tomography (CT) revealed enlargement of the pancreas head. The levels of serum IgG and IgG4 were significantly elevated. ERCP revealed segmental narrowing of the main pancreatic duct with an irregular wall of the pancreas head and stenosis of the lower portion of the bile duct. Although US and CT revealed enlargement of the pancreas head, positron emission tomography (PET) showed diffuse uptake of 18F-fluorodeoxyglucose (FDG) in the entire pancreas. A diagnosis of autoimmune pancreatitis (AIP) was thereby established and we used steroid for therapy. The enlargement of the pancreas head markedly improved and the levels of IgG and IgG4 were decreased after starting the steroid therapy. The steroid dose was then gradually reduced.

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Pancreatic cancer is a rare cause of gastrointestinal bleeding, and it is extremely rare for hematemesis to be the initial manifestation of invasive pancreatic cancer. We report the case of a 62-year-old man with hematemesis who was found to have a profound ulcer on transverse duodenum by fiberscopy. CT scan showed an ill-defined low density mass on the transverse duodemum. Biopsy specimen revealed adenocarcimoma. Ten days after first hematemesis, the patient again suffered massive hematemesis causing hypovolemic shock and underwent emergency angiography revealing extravasation from the second jejunal artery to the transverse duodenum. Transcatheter arterial embolization (TAE) was performed and the bleeding was stopped. Twelve days after TAE, resection of the transverse duodenum was performed and microscopic examination revealed that pancreatic cancer originating from the uncus of the pancreas extended to the transverse duodemum and involved the superior mesenteric artery and jejunal arteries and, finally, the second jejunal artery ruptured to the duodenum.

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