gastrins and Carcinoma--Pancreatic-Ductal

Pancreatic tumors are chemoresistant and malignant, and there are very few therapeutic options for pancreatic cancer, as the disease is normally diagnosed at an advanced stage. Although attempts have been made to develop vaccine therapies for pancreatic cancer for a couple of decades, none of the resultant protocols or regimens have succeeded in improving the clinical outcomes of patients. We herein review vaccines tested within the past few years, including peptide, biological and multiple vaccines, and describe the three sets of criteria used to evaluate the therapeutic activity of vaccines in solid tumors.

Topics: Bacterial Vaccines; Cancer Vaccines; Carcinoembryonic Antigen; Carcinoma, Pancreatic Ductal; Clinical Trials as Topic; Fowlpox virus; Gastrins; Genes, ras; Heat-Shock Proteins; Inhibitor of Apoptosis Proteins; Kinesins; Listeria monocytogenes; Mucin-1; Mutation; Pancreatic Neoplasms; Peptides; Survivin; Telomerase; Vaccines, Attenuated; Vascular Endothelial Growth Factor Receptor-2; Viral Vaccines; WT1 Proteins

Neoplasms of the pancreas usually show ductal, acinar or endocrine differentiation. Tumors with mixed exocrine and endocrine components are unusual. We herein describe a case of a mixed ductal-endocrine tumor.. A 65-year-old woman was referred to our department with a diagnosis of carcinoma of the tail of the pancreas. The patient had a short history of upper abdominal pain, nausea and melena. Upper gastrointestinal endoscopy revealed gastric fundus varices and CT scan demonstrated an inhomogeneous tumor located in the tail of the pancreas infiltrating the spleen and the splenic vein. The patient underwent distal pancreatectomy and splenectomy, and had an uneventful recovery. Pathological examination revealed a mixed ductal-endocrine tumor. The endocrine component was immunoreactive for glucagon, gastrin and somatostatin, and non-reactive for insulin.. Because of the rarity and unpredictable biologic behavior of these tumors, the need for adjuvant therapy has not yet been well-defined. The patient has had a follow-up CT scan every six months, and one and a half years later remains disease free.

Topics: Aged; Carcinoma, Islet Cell; Carcinoma, Pancreatic Ductal; Chromogranins; Female; Gastrins; Glucagon; Humans; Immunohistochemistry; Mixed Tumor, Malignant; Pancreatic Neoplasms; Phosphopyruvate Hydratase; Somatostatin

Duct cell adenocarcinomas may produce neuroendocrine markers such as pancreatic polypeptide, gastrin and gastrin releasing hormones. A 53 year old patient, with a history of insulin dependent diabetes, was found to have a pancreatic mass which was later pathologically demonstrated to be a duct cell adenocarcinoma. The tumor produced elevated circulating neuroendocrine markers specifically gastrin and pancreatic polypeptides. An 111In Octreotide imaging showed definite uptake of Octreotide by the tumor. The patient was subsequently treated with Somatostatin analog which resulted in the reduction of some of the circulating endocrine markers. The patient had essentially six months of asymptomatic clinical remission but then she relapsed. Octreotide scanning could be useful for selected patients with pathologic diagnosis of duct cell adenocarcinoma, because some tumors may have neuroendocrine features and can be imaged, and might even respond to Somatostatin analog therapy.

Topics: Adenosarcoma; Carcinoma, Pancreatic Ductal; Diagnosis, Differential; Female; Follow-Up Studies; Gastrins; Humans; Indium Radioisotopes; Middle Aged; Octreotide; Pancreatic Neoplasms; Pancreatic Polypeptide; Radionuclide Imaging