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Pancreatic
tumors in children: radiologic-pathologic correlation.
Radiographics. 2006
Jul-Aug;26(4):1211-38.
Pancreatic
neoplasms are rare in children and have a different histologic
spectrum and prognosis than those in adults. In general, these
tumors are well demarcated with expansile rather than infiltrating
growth patterns. They may be quite large at diagnosis, and central
cystic necrosis is common. They infrequently cause biliary duct
obstruction. The imaging appearance of each neoplasm reflects its
pathologic features. Pancreatoblastoma is the most common pancreatic
neoplasm in young children. At imaging, pancreatoblastomas are
heterogeneous and often multilocular with hyperechoic and enhancing
septa. Solid-pseudopapillary tumor occurs in adolescent girls. It is
heterogeneous in internal architecture, with a mixture of solid and
cystic hemorrhagic and necrotic elements. This tumor is
distinguished by its fibrous capsule and hemorrhagic nature, which
are best shown at magnetic resonance imaging as a dark rim on T1- or
T2-weighted images and hyper-intense foci on T1-weighted images,
respectively. Islet cell tumors in children are insulinomas or
gastrinomas. These tumors manifest early due to hormonal syndromes
and are distinguished by their small size, homogeneous appearance,
and intense enhancement with intravenous contrast material. All
pancreatic neoplasms in children are capable of producing
metastases, usually to the liver and lymph nodes; however, on the
whole, these tumors have a better clinical outcome than most
pancreatic tumors in adults. Knowledge of the differential diagnosis
of pancreatic masses in children and their relatively good prognosis
may promote correct preoperative diagnosis and appropriate
treatment.
Laparoscopic
distal pancreatectomy in children: case report and review of the
literature. Ann
Surg Oncol. 2007 Mar;14(3):1065-9.
BACKGROUND:
Laparoscopic resection of benign tumors of the pancreas has been
reported in adults, but only four cases of partial laparoscopic
pancreatectomy in children have been described in the
English-language literature. METHODS: We describe the case of an
11-year-old girl with a solid pseudopapillary tumor who was treated
with a laparoscopic, spleen-preserving, distal pancreatectomy. The
specimen was extracted in an endoscopic bag retrieval system through
a Pfannenstiel incision. Operative time was 120 minutes, and minimal
blood loss occurred. The literature is reviewed. RESULTS: The
postoperative course was uneventful. Twenty-two months after the
operation, clinical follow-up (including assessment of exocrine and
endocrine pancreatic function) revealed nothing abnormal. The
functional and aesthetic results were satisfactory. CONCLUSIONS: The
technique used for our case is simple and reproducible, was
completed safely within a reasonable operative time, and yielded a
good result.
Pancreatic
tumors in children: report of three cases.Acta
Paediatr Taiwan. 1999
Sep-Oct;40(5):335-8.
From 1981 to
1996, we experienced 3 cases of pancreatic tumors in children--two
pancreatoblastomas (PB) and one solid and cystic tumor (SCT). The
ages were 1 month, 4 years, and 13 years of age respectively. The
two cases of pancreatoblastoma initially presented as chronic
diarrhea with failure to thrive, the other case presented with
abdominal mass. All of them were studied by laboratory examination,
ultrasonography, computed tomography and pathology. Increasing
alpha- fetoprotein (AFP) levels were found in the 2
pancreatoblastoma cases, however, the level in the SCT case was
normal. Abdominal sonography showed pancreatic masses with or
without calcification, and the echogenicity may be solid and/or
cystic. All patients underwent total excision of the tumors. We have
reviewed the literature and find no pancreatoblastoma with chronic
diarrhea was reported in young children, especially in neonate.
Therefore, we suggest that young children presenting with an
abdominal mass and/or weight loss should undergo imaging studies for
the possibility of pancreatic tumors.
A 20-year
review of pediatric pancreatic tumors.J
Pediatr Surg. 1992 Oct;27(10):1315-7.
Pancreatic
tumors are rare surgical problems in infants and children. A 20-year
audit (1971 to 1991) of this institution showed six patients ranging
in age from 3 weeks to 16 years who were operated on for pancreatic
neoplasms. Five of these tumors were malignant, bringing the
reported experience to 71 cases. This series of malignancies
included three solid cystic tumors, one insulin-secreting tumor, and
one pancreatoblastoma. The clinical presentations varied: three had
abdominal pain, one developed hypoglycemia, and one had an abdominal
mass with jaundice. In five of the six patients pancreatic pathology
was suspected preoperatively. All were treated primarily with
pancreatic resection including one pancreatoduodenectomy. No
radiotherapy or chemotherapy was used. The perioperative mortality
was 0% with a morbidity of 50%. The long-term results are
encouraging, with all patients alive after a mean follow-up of 7.8
years. These data suggest that aggressive surgical therapy is
warranted in the management of pediatric pancreatic tumors.
Malignant
pancreatic tumors in childhood and adolescence: The Memorial
Sloan-Kettering experience, 1967 to present.J
Pediatr Surg. 2002 Jun;37(6):887-92.
BACKGROUND:
Malignant tumors of the pancreas are uncommon in children and
adolescents and only recently have the most common tumor types been
well characterized. As a result, the treatment approach to these
patients has yet to be standardized, and much of the information
available in the literature, particularly with regard to the role of
chemotherapy and radiation, is anecdotal. METHODS: A retrospective
review was undertaken of all patients less than 21 years of age with
malignant pancreatic tumors who were cared for at Memorial
Sloan-Kettering since 1967. RESULTS: Seventeen patients were
identified. The pathologic types were pancreatoblastoma, 5; solid
pseudopapillary tumor, 7; acinar cell carcinoma, 1; nonfunctioning
pancreatic endocrine neoplasm, 1; malignant VIPoma, 1; and PNET, 2.
A complete resection of the primary tumor was achieved in 82%, and
12 of 15 are alive, 10 with no evidence of disease. Chemotherapy or
radiation were used in selected cases. CONCLUSIONS: Unlike malignant
pancreatic tumors in adults, tumors in children and adolescents
usually are resectable, and long-term survival is likely. However,
the risk of recurrence for pancreatoblastoma is high. The roles of
chemotherapy and radiation remain undefined.
Pancreatic
tumors in childhood: analysis of 13 cases.J
Pediatr Surg. 1990 Oct;25(10):1057-62.
Pancreatic
tumors are rare in children. Over a 20-year period we have treated
13 children with pancreatic neoplasms. There were eight boys and
five girls (age range, 4 months to 12 years). Seven tumors were
benign, including five insulinomas, and two cystadenomas. Six
lesions were malignant (rhabdomyosarcoma, 2; pancreatic carcinoma,
4). Children with insulinoma presented with hypoglycemia and
irrational behavior. Three had abnormal insulin:glucose ratios (
greater than 1.0). The tumor was detected by computed tomography
scan in three cases, at the time of surgery in one, and with
intraoperative ultrasound in one. Surgical treatment included tumor
enucleation in four cases and 80% pancreatectomy in one. Mucinous
cystadenomas were observed in two patients, ages 4 months and 10
months. Tha latter infant underwent cyst excision alone, resulting
in malignant recurrence at 18 months of age and death. The
4-month-old child had a distal pancreatectomy and is alive at 6
years. Two of the four children with pancreatic cancer had
unresectable tumors at diagnosis, and were treated by biopsy (ductal
adenocarcinoma), irradiation, and chemotherapy. Length of survival
was 6 months and 9 months. Two others (ages 4 and 12 years)
underwent 85% distal pancreatic resection for pancreatoblastoma and
a pancreatoduodenectomy for papillary carcinoma, respectively. The
latter is alive and tumor-free at 20 years of follow-up. The former
underwent hepatic lobectomy for a 3.0 x 3.0 cm solitary liver
metastases and is alive at 6 years with no evidence of disease. One
child with rhabdomyosarcoma died of progressive disease, the other
is alive with residual disease despite resection and chemotherapy.
Most insulinomas can be treated by enucleation.
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