Pancreatic tumor of mesenchymal origin--an unusual surgical finding.
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Abstract:
Recently, a patient with an unusual pancreatic tumor of smooth muscle origin, presented at the First Surgical Clinic, Charles University Hospital, Prague. Leiomyosarcoma, a malignant smooth muscle tumor, may arise almost anywhere in the body. Pancreatic localization is very unusual. A number of authors have surveyed the literature on pancreatic tumors of mesenchymal origin. As many as fifty cases have been reported in autopsy studies since 1882. Only six operated cases of pancreatic sarcomas were found in surgical series.Keywords:
Pancreatic tumor
Mesenchymal Tumor
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Recently, a patient with an unusual pancreatic tumor of smooth muscle origin, presented at the First Surgical Clinic, Charles University Hospital, Prague. Leiomyosarcoma, a malignant smooth muscle tumor, may arise almost anywhere in the body. Pancreatic localization is very unusual. A number of authors have surveyed the literature on pancreatic tumors of mesenchymal origin. As many as fifty cases have been reported in autopsy studies since 1882. Only six operated cases of pancreatic sarcomas were found in surgical series.
Pancreatic tumor
Mesenchymal Tumor
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An autopsy case of a 10‐day‐old newborn with generalized infection of Coxsackie virus B3 (CBV3) was reported. CBV3 was isolated from the blood before death. The patient died of cardiac failure. An immunofluorescent study was carried out on autopsy specimens fixed in formalin and embedded in paraffin. CBV3 antigen was detected in the heart, brain, kidney, lungs, spleen, thymus, and pancreas. In the pancreas CBV3 antigen was predominantly seen in the islet cells. No CBV3 antigen was found in the liver and adrenal glands. Electron microscopic examination revealed virion‐like particles, 20 nm in diameter, in the endothelial cells of the myocardium. ACTA PATHOL. JPN. 35:741‐748, 1985.
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A rare autopsy case of clear cell carcinoma of the pancreas developing in a 71-year-old Japanese male is described. He complained of epigastralgia and back pain and was clinically diagnosed as having primary pancreatic cancer. After death due to disseminated metastasis and cachexy, autopsy revealed pancreatic clear cell carcinoma metastasizing to various organs including the lungs (lymphoangiosis carcinomatosa). The tumor was almost entirely composed of clear cells with cytoplasm weakly positive for PAS and alcian blue, and negative for Sudan III stains. Histological differential diagnosis from the clear cell carcinoma of other organs, especially that of kidney, is also mentioned.
Clear cell carcinoma
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A case of leiomyosarcoma of the pancreas, occurring in a 44-year-old male, is reported. With a preoperative diagnosis of cystadenocarcinoma, the patient underwent surgical resection of a cystic tumor in the head of the pancreas. There were no metastases noted at the time. The resected specimen was diagnosed histologically as a smooth muscle tumor originating from the pancreas. It was seemingly benign on the basis of the mitotic counts and the degree of cellular atypism. However, the tumor proved to be malignant; the patient died with metastases to the liver. The tumor at autopsy also had few mitoses (0–1/10 hpf). The previously reported cases were reviewed and the limitations of histological diagnosis in assessing malignant potential of smooth muscle tumors are discussed.
Cystadenocarcinoma
Smooth Muscle Tumor
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Primary leiomyosarcoma of the pancreas is a very rare malignant tumor, with only 12 cases reported. A case of primary pancreatic leiomyosarcoma in a 55 year-old female with diabetes mellitus is described. US and CT demonstrated tumor masses in the head and tail of the pancreas. By angiography, abundant tumor vessels corresponding to the pancreatic tumor masses were revealed in the pancreas. The patient underwent surgical resection of the tumor in the tail of the pancreas, and then, microscopically it was diagnosed as leiomyosarcoma. The tumor in the head of the pancreas was not resected on account of the presence of diabetes mellitus and the possibility of poor prognosis. Macroscopically, it seemed to be the same as the tumor in the pancreatic tail. By operative findings, there was invasion from the pancreatic head to the duodenum and there was nothing to justify suspicion of the extra-ductal growing type of primary leiomyosarcoma of the duodenum. There were no metastases noted at the time.
Pancreatic tumor
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This chapter describes the mesenchymal tumors of the pancreas which are of rare occurrence. Mesenchymal tumors of the pancreas may be benign, of intermediate biological potential or malignant. The more commonly occurring mesenchymal tumors of the pancreas are described in this chapter along with their appropriate immunohistochemical workup and differential diagnoses.
Mesenchymal Tumor
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The mesenchymal components of tumors from 2 patients with ameloblastic fibrosarcoma were studied ultrastructurally. The mesenchymal components consisted predominantly of fibroblastic cells with a few histiocytie or fibrohistiocytic cells and myofibroblastic cells. In addition, a very small number of undifferentiated mesenchymal cells were found. We speculate that the mesenchymal components in this tumor may be derived from the undifferentiated mesenchymal cells.
Mesenchymal Tumor
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Solitary Fibrous Tumor
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Two autopsy cases of leiomyosarcoma of the liver in a 49‐year old female and 63‐year‐old male are reported. Both of the liver tumors showed electron microscopically dense patches in the cytoplasm and intermediate junctions between the tumor cells, suggesting a smooth muscle cell origin, irrespective of their different histological features. The nature of both tumors was confirmed by positive immunoreactivity for muscle‐specific actin in the tumor cells, whereas desmin immunoreactivity was labile in both cases, showing a higher diagnostic value of the former compared with the latter in these leiomyosarcomas. Both cases, showed extensive distant metastases in spite of an evident difference in their mitotic indices, indicating that this index is not reliable for judging the metastatic potential of these tumors. Acta Pathol Jpn 41: 461–465, 1991.
Desmin
Mitotic index
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