World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Review

Volume 1, Number 2, April 2010, pages 52-65

Tumors of the Pancreatic Body and Tail

**Table 1.** Classification of pancreatic tumors occurring in the body and tail
Exocrine
Malignant
duct cell carcinoma (90% of all cases)
acinar cell carcinoma
papillary mucinous carcinoma
signet ring carcinoma
adenosquamous carcinoma
undifferentiated carcinoma
mucinous carcinoma
giant cell carcinoma
mixed type (ductal-endocrine or acinar-endocrine)
small cell carcinoma
cystadenocarcinoma (serous and mucinous types)
unclassified
pancreatoblastoma
papillary-cystic neoplasm (this tumor has lower malignant potential, and may be cured with surgery alone)
Borderline
mucinous cystic tumor with dysplasia
intraductal papillary mucinous tumor with dysplasia
pseudopapillary solid tumor
Functioning Tumors
Insulinoma
Gastrinoma
VIPoma
Ghrelinoma
Somatostatinoma
Glucagonoma
GRFoma
PPoma
Carcinoids
Nonfunctioning Tumors

Table 1. Classification of pancreatic tumors occurring in the body and tail

Exocrine

Malignant

duct cell carcinoma (90% of all cases)

acinar cell carcinoma

papillary mucinous carcinoma

signet ring carcinoma

adenosquamous carcinoma

undifferentiated carcinoma

mucinous carcinoma

giant cell carcinoma

mixed type (ductal-endocrine or acinar-endocrine)

small cell carcinoma

cystadenocarcinoma (serous and mucinous types)

unclassified

pancreatoblastoma

papillary-cystic neoplasm (this tumor has lower malignant potential, and may be cured with surgery alone)

Borderline

mucinous cystic tumor with dysplasia

intraductal papillary mucinous tumor with dysplasia

pseudopapillary solid tumor

Endocrine

Functioning Tumors

Insulinoma

Gastrinoma

VIPoma

Ghrelinoma

Somatostatinoma

Glucagonoma

GRFoma

PPoma

Carcinoids

Nonfunctioning Tumors

**Table 2.** Summary of the genetic alterations in pancreatic tumors according to histopathological type
Adenocarcinoma	Pancreatic endocrine tumors	Intraductal papillary mucinous tumors
Sporadic
K – ras	Men-1	K-ras
P53	P16	P53
P16	P27	P16
DPC4	Cyclin D
	DPC4
Hereditary
PRSS1	Men-1
FAMM (p16)	Von Hippel Lindau (VHL)
STK11/LKB1	Von Recklinghausen’s
BRCA 2	disease (NF-1)
HNPCC	Tuberous Sclerosis
Li Fraumeni Syndrome (p53)	(TSC1, TSC2)

Table 2. Summary of the genetic alterations in pancreatic tumors according to histopathological type

Adenocarcinoma

Pancreatic endocrine tumors

Intraductal papillary mucinous tumors

Sporadic

K – ras

Men-1

K-ras

P53

P16

P53

P16

P27

P16

DPC4

Cyclin D

DPC4

Hereditary

PRSS1

Men-1

FAMM (p16)

Von Hippel Lindau (VHL)

STK11/LKB1

Von Recklinghausen’s

BRCA 2

disease (NF-1)

HNPCC

Tuberous Sclerosis

Li Fraumeni Syndrome (p53)

(TSC1, TSC2)

**Table 3.** CT criteria for vascular invasion
Arterial embedment in tumor mass or venous obliteration
Tumor involvement exceeding one-half circumference of the vessel
Vessel wall irregularity
Vessel calibre stenosis
Teardrop sign of the superior mesenteric vein

Table 3. CT criteria for vascular invasion

Arterial embedment in tumor mass or venous obliteration

Tumor involvement exceeding one-half circumference of the vessel

Vessel wall irregularity

Vessel calibre stenosis

Teardrop sign of the superior mesenteric vein

**Table 4.** Diagnostic tests for pancreatic endocrine tumors [12]
Tumor	Test
Insulinoma	Supervised 72hr fast, demonstrating Whipple’s triad and insulin/glucose ratio of >0.3 Selective arteriogram with intraarterial calcium injection and hepatic venous sampling Elevated c-peptide proinsulin levels
Gastrinoma	Elevated serum gastrin levels Elevated basal acid secretory rate Secretin stimulation test
Glucagonoma	Elevated glucagon levels
Somatostatinoma	Elevated fasting plasma somatostatin levels

Table 4. Diagnostic tests for pancreatic endocrine tumors [12]

Tumor

Test

Insulinoma

Supervised 72hr fast, demonstrating Whipple’s triad and insulin/glucose ratio of >0.3
Selective arteriogram with intraarterial calcium injection and hepatic venous sampling
Elevated c-peptide proinsulin levels

Gastrinoma

Elevated serum gastrin levels
Elevated basal acid secretory rate
Secretin stimulation test

Glucagonoma

Elevated glucagon levels

Somatostatinoma

Elevated fasting plasma somatostatin levels

**Table 5.** Chemotherapy in advanced / metastatic pancreatic adenocarcinoma (Saif MW – Online CME “Treatment of pancreatic cancer) [101-104]
Study	Gemcitabine regimen	Median Survival (months)	1-year survival
Burris et al [102]	30-minute infusion	5.7	18%
Tempero et al [103]	Fixed dose rate	7.8	24%
Louvet et al [104]	Gemcitabine and Oxaliplatin	9.2	36%

Table 5. Chemotherapy in advanced / metastatic pancreatic adenocarcinoma (Saif MW – Online CME “Treatment of pancreatic cancer) [101-104]

Study

Gemcitabine regimen

Median Survival (months)

1-year survival

Burris et al [102]

30-minute infusion

5.7

18%

Tempero et al [103]

Fixed dose rate

7.8

24%

Louvet et al [104]

Gemcitabine and Oxaliplatin

9.2

36%