Suizo
Online ISSN : 1881-2805
Print ISSN : 0913-0071
ISSN-L : 0913-0071
Volume 28, Issue 6
Displaying 1-9 of 9 articles from this issue
Special Editions
  • [in Japanese]
    2013 Volume 28 Issue 6 Pages 683
    Published: 2013
    Released on J-STAGE: January 18, 2014
    JOURNAL FREE ACCESS
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  • Masayuki IMAMURA
    2013 Volume 28 Issue 6 Pages 684-690
    Published: 2013
    Released on J-STAGE: January 18, 2014
    JOURNAL FREE ACCESS
    In Japan there have been a number of great scholars in the field of neuroendocrine science. However, we have failed to maintain our clinical treatment system for patients with pNET up to the international standard level. Therefore we have an urgent need to introduce a few important treatment tools for NET. To address this issue, we have recently begun hard work to produce Japanese guidelines for the treatment of pNET based on Japanese clinical studies.
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  • Hisato IGARASHI, Lingaku LEE, Yusuke NIINA, Masayuki HIJIOKA, Yuichi T ...
    2013 Volume 28 Issue 6 Pages 691-698
    Published: 2013
    Released on J-STAGE: January 18, 2014
    JOURNAL FREE ACCESS
    Pancreatic neuroendocrine tumors (pNETs) are relatively rare, however, they have recently garnered attention. pNETs consist of functioning and non-functioning tumors. Unfortunately, many patients present with metastasis at initial diagnosis. At this point tumor have a high malignant potential, so toward determining the therapeutic strategy, correct diagnosis (disease existence, tumor localization and histopathological diagnosis) is extremely important. Inherited syndromes such as multiple endocrine neoplasia type 1 are associated with the development pNETs and have to be examined before starting treatment. Measuring the serum levels of the chromogranin A and localizing tumors using somatostatin receptor scintigraphy is useful for the diagnosis of pNET, however these procedures are not covered by health insurance in Japan. Therefore establishing an algorithm to develop a diagnostic system to address pNETs would be future issue in Japan.
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  • Ryuichiro DOI, Yusuke ABE, Naoto NAKAMURA, Takashi ITO, Akitada YOGO, ...
    2013 Volume 28 Issue 6 Pages 699-706
    Published: 2013
    Released on J-STAGE: January 18, 2014
    JOURNAL FREE ACCESS
    Pancreatic neuroendocrine tumors (pNET) exhibit a variety of symptoms at the clinical setting depending on the hormone that is secreted by the tumor. Accordingly, a wide range of tumor types exist for pNETs, but it is assumed that enterochromaffin cells in the neuroendocrine tissue are the origin of all tumors. Diagnostic methods cannot be standardized because the symptoms are different for each type of tumor. On the other hand, an indication for surgical resection should be always considered if a pNET is encountered. Risks of metastasis and recurrence are very high in tumors other than insulinomas; therefore lymph node dissection is necessary. Even if the tumor is accompanied by liver metastasis, one should consider whether a liver resection would provide a clinical benefit or not. Molecular targeted therapy for pNET is recently available in Japan. Because it is not always possible to achieve curative surgical resection, combined modality therapy should be considered.
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  • Chigusa MORIZANE, Takuji OKUSAKA
    2013 Volume 28 Issue 6 Pages 707-713
    Published: 2013
    Released on J-STAGE: January 18, 2014
    JOURNAL FREE ACCESS
    The most common cytotoxic agent for the treatment of pNETs is streptozocin. Two kinds of molecular targeted agents, everolimus and sunitinib have been recently assessed in phase III placebo-controlled trials, producing a significant benefit, with improvement in progression-free survival. Regarding the somatostatin analogue, the PROMID trial demonstrated an improvement in time to tumor progression by octreotide LAR in neuroendocrine tumors of the midgut. Additionally, the CLARINET study comparing lanreotide autogel to placebo in patients with non-functioning pancreatic or intestinal neuroendocrine tumors demonstrated an improvement in progression-free survival. Tumour-targeted radiolabelled somatostatin analogues have been used during the past few years with some encouraging results. In treating advanced NEC, guidelines recommend chemotherapy regimens, which are suitable for small-cell lung carcinoma.
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Guideline
Case Reports
  • Yasuyuki MIZUTANI, Hiroyuki OTSUKA, Hiromasa MORISHIMA, Yoshinori FUJI ...
    2013 Volume 28 Issue 6 Pages 785-791
    Published: 2013
    Released on J-STAGE: January 18, 2014
    JOURNAL FREE ACCESS
    A 65 year-old-man presented with pancreatic-duct distention and received a medical examination at our department. A pancreatic mass was not detected by US enhanced CT. A four millimeter expansion of the pancreatic duct was observed in the body and tail of the pancreases and low echo domain that had an indistinct and irregular border was identified on the head side by EUS. We took carcinoma in situ into consideration and performed ERCP. The pancreatic duct showed localized stenosis at the head body shift region, and the distal pancreatic duct showed beaded appearance. The cytodiagnosis of the pancreatic juice was negative, and classification of the mass was difficult, but we doubted it was pancreatic cancer based on observations from pancreatic duct imaging and the pancreatoduodenectomy. The pathological findings showed a transition of increased papillosity in the pancreatic duct epithelium. A substitution-related increase of atypical epithelium was equivalent to PanIN3 from PanIN1. Permeation was not apparent.
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  • Chihiro KAWAGUCHI, Masayuki SHO, Takahiro AKAHORI, Shoichi KINOSHITA, ...
    2013 Volume 28 Issue 6 Pages 792-799
    Published: 2013
    Released on J-STAGE: January 18, 2014
    JOURNAL FREE ACCESS
    We here report a rare case of synchronous pancreatic metastasis of soft tissue tumor. A 39-year-old man was referred to our hospital for further examination and treatment of a pancreatic tumor. CT and MRI demonstrated a mass in the pancreatic body, a different tumor on the left buttock, and multiple bone masses. Although biopsies of the pancreatic and buttock tumors were performed, a definitive diagnosis was not reached. He underwent distal pancreatectomy and resection of the buttock mass. The pathological diagnosis was primary extraskeletal mesenchymal chondrosarcoma (EMCS) of the right buttock and pancreatic metastasis. The patient received chemotherapy and radiation thereafter. He died 2 years and 10 months after surgery. Pancreatic metastases derived from soft tissue tumors are rare and this case was considered as the first synchronous pancreatic metastasis of EMCS.
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  • Akira YASUDA, Takashi ARIKAWA, Hiroyuki FUJISAKI, Keiichi ANDO, Hirosh ...
    2013 Volume 28 Issue 6 Pages 800-805
    Published: 2013
    Released on J-STAGE: January 18, 2014
    JOURNAL FREE ACCESS
    A 45-year-old woman was referred to our hospital because of epigastralgia and back pain. Contrast-enhanced CT, revealed a cystic lesion in the pancreatic head, and the main pancreatic duct of the body and tail was distended. EUS showed multiple cystic lesions in the pancreatic head. There was no nodule in the cystic wall. Relatively smooth stenosis was identified in the main pancreatic duct of pancreatic head in ERCP. Brushing cytology of the stenosis was pseudopositive. Based on these results, we diagnosed it as IPMN. Subtotal stomach preserved pancreaticoduodenectomy was performed because we could not rule out the possibility of malignancy. Small and large cysts were recognized in cut surface and the pathological diagnosis was serous cystadenoma. The stenosis of main pancreatic duct was induced by the oppression of the tumor. Stenosis of main pancreatic duct due to serous cystadenoma is rare. Serous cystadenoma is typically benign, and surgery is not needed if it is diagnosed definitely. In our case, a surgical procedure was performed due to the symptoms and the suspicion of malignancy.
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