Pancreatic Neoplasms

1. Universidad de Guadalajara
Noviembre 2011
PancreaticPancreatic
NeoplasmsNeoplasms
Centro Universitario Ciencias de la Salud
Clínicas Quirúrgicas
Mayra C. Silva Camarena
206558747
Dr. Benjamin Robles Mariscal
Dr. Héctor Manuel Virgen Ayala

2. Endocrine
Exocrine
Functional
No functional

3. Neoplasms of the
endocrine Pancreas

4. ++
Rare
Functional
Malignant
5/ 1000000/365
secreted peptide
products

5. Insulinoma
More frequent
90% solitarysolitary beningnos
10% malignant
Head = Body = Tail

6. Profound syncopal episode
 Palpitations
 Tremors
Sweating
Confusion
 Seizures
Personality changes
 Memory loss
 Unconsciousness
 Weight gain
Clinical Manifestations
ββ
Whipple's triad

7. Diagnosis
Demonstration
of fasting hypoglycemia with inappropriately
elevated insulin
0:3

8. Locate the tumor
TTreatment
CT 
Endoscopic ultrasound
Surgical treatment
Simple enucleation
Partial-pancreatomy
Pancreatoduodenectomy
Medical Treatment Diaxozido

9. 70-90% Passaro's triangle
25% NEM 1
50% solitary malformations
50% malignantmalignant
GGastrinomaastrinoma

10. α1         δ
Clinical Manifestations
Zollinger Ellison
syndrome
Gastrin
Abdominal pain
Peptic ulcer 
disease 
Severe esophagitis
Multiple ulcers 
Diarrhea

11. Serum gastrin(1000pg/ml)
Secretin stimulation
Diagnosis
Location
Somatostatin 
receptor scintigraphy + TAC
Endoscopic ultrasound

12. Simple enucleation
Pancreatomia
Selective vagotomyvagotomy
Resection of liver metastases
Chemotherapy
TTreatment

13. VIPoma
80% of tumors are 
solitary
50% of lesions are 
malignant
Average survival is one 
year

14. WDHA Syndrome
Clinical Manifestations
Watery diarrea
Hipokalemia
Aclorhidia
Metabolic acidosis
Hypercalcemia  
Extreme weakness

15. Serum concentrations of VIP
CT
Endoscopic ultrasound
Diagnosis

16. Preoperative
TTreatment
Somatostatin analogs
Fluids and electrolytes
SurgicalExtraction of the tumor
Streptozocin

17. GGlucagoma
20-70 years
25% benign lesions
α2

18. DDiabetes mellitus
Clinical Manifestations
Necrolytic 
migratory dermatitis
Weight loss
Stomatitis
Hipoaminoacidemia
Anemia

19. Serum concentrations of glucagon 
(500pg/ml)
CT
Diagnosis

20. Preoperative
TTreatment
Control of diabetes mellitus
Parenteral nutrition  
Octreotide
Surgical treatment Extraction of the tumor
Streptozocin

21. Somatostatinoma
Clinic: gallstones, diabetes  mellitus, steatorrhea, 
abdominal pain, jaundice and cholelithiasis. 
Diagnosis: somatostatin
serum (10ng/ml)

22. Treatment: 
Complete tumor excision and cholecystectomy.
50% cure
Streptozocin

23. No functional
They are found in the pancreatic head
Metastasis 80% of patients
Clinical: abdominal and
back pain, weight loss,
jaundice, palpable mass.

24. Diagnosis:  elevated levels of  
pancreatic polypeptide. CT.
Forecast: 5-year survival 15%

25. Neoplasms of the
exocrine Pancreas

26. 5th cause of death from cancer
Risk factors
Smoking
Diabetes
Chronic pancreatitis
Alcohol consumption
Coffee consumption,
Diet high in fat and
low in fiber
Family History

27. Ductal adenocarcinoma
40-60 years
75% Head
15% Body
10%Tail
CA 19-9

28. HEAD
Clinical Manifestations
Jaundice
-44kg
Abdominal pain
Hepatomegaly
Coourvoisier sign
BODY-TAIL
Abdominal pain
Weight loss
ALKALINE
PHOSPHATASE
BILIRUBIN

29. Dynamic helical CT
Positron emission 
tomography
Endoscopic ultrasonography
Tomor Criter Unresectable
-Invasion of the hepatic artery
-Invasion of the superior mesenteric artery
-Ascites
-Distant metastases (liver)
-Invasion to distant organs

30. Whipple procedure
Pancreatoduenoctomy
Cholecystojejunostomy
Percutaneous
endoprostheses
Gastroyeyunostonia
Chemotherapy

32. Adenoma and adenocarcinoma
Vater’s ampulla

33.  jaundice
 gastrointestinal 
bleeding
 weight loss
 pain
33% adenoma
66%  adenocarcinoma

34. DIAGNOSIS
ERCP
Pancreatoduodenectomy
Sphincterotomy

35. Pancreatiancreaticc
Injuries

36. 4% of abdominal injuries

Mortality
37%
36%%
26
%

37. Diagnosis
Abdominal pain
Peritoneal irritation
Serum amylase 
Ultrasound
Computed tomography
Helical CT
Endoscopic retrograde 
cholangiopancreatography cholangiopancreatography 
Thickening of the anterior renal
fascia, peripancreatic edema,
diffuse enlargement of the gland,
observation of the fracture,
hematoma or the presence of
pancreatic fluid separating the
splenic vein or pancreatic body

38. TTreatment
External drainage
simple 
Pancreatorrafia using 
nonabsorbable 
sutures
Resection of part of 
the gland
distal 
Pancreatectomy and 
splenectomy

39. Complications
35-40%
8 -18%
Pancreatic fistula
Peripancreatic abscesses
Pancreatitis