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Pancreatic Neoplasms: HELP
Articles by Juan Carlos Roa
Based on 5 articles published since 2010
(Why 5 articles?)

Between 2010 and 2020, Juan Carlos Roa wrote the following 5 articles about Pancreatic Neoplasms.
+ Citations + Abstracts
1 Guideline Pathologic Evaluation and Reporting of Intraductal Papillary Mucinous Neoplasms of the Pancreas and Other Tumoral Intraepithelial Neoplasms of Pancreatobiliary Tract: Recommendations of Verona Consensus Meeting. 2016

Adsay, Volkan / Mino-Kenudson, Mari / Furukawa, Toru / Basturk, Olca / Zamboni, Giuseppe / Marchegiani, Giovanni / Bassi, Claudio / Salvia, Roberto / Malleo, Giuseppe / Paiella, Salvatore / Wolfgang, Christopher L / Matthaei, Hanno / Offerhaus, G Johan / Adham, Mustapha / Bruno, Marco J / Reid, Michelle D / Krasinskas, Alyssa / Klöppel, Günter / Ohike, Nobuyuki / Tajiri, Takuma / Jang, Kee-Taek / Roa, Juan Carlos / Allen, Peter / Fernández-del Castillo, Carlos / Jang, Jin-Young / Klimstra, David S / Hruban, Ralph H / Anonymous6721124. ·*Department of Pathology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA †Department of Pathology, Massachusetts General Hospital, Boston, MA ‡Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan §Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY ¶Department of Pathology, University of Verona, Verona, Italy ||Department of Surgery, Massachusetts General Hospital, Boston, MA **Department of Surgery, University of Verona, Verona, Italy ††Department of Surgery, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD ‡‡Departments of Surgery, University of Bonn, Bonn, Germany §§Departments of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands ¶¶Department of Surgery, Edouard Herriot Hospital, HCL, Lyon, France ||||Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands ***Departments of Pathology, Technical University, Munich, Germany †††Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan ‡‡‡Department of Pathology, Tokai University Hachioji Hospital, Tokyo, Japan §§§Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea ¶¶¶Department of Pathology, Pontificia Universidad Católica de Chile, Santiago, Chile ||||||Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY ****Department of Surgery, Massachusetts General Hospital, Boston, MA ††††Department of Surgery, Seoul National University Hospital, Seoul, Korea ‡‡‡‡Department of Pathology, Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD. ·Ann Surg · Pubmed #25775066.

ABSTRACT: BACKGROUND: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs). DESIGN: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. RESULTS: (1) Crucial to rule out invasive carcinoma with extensive (if not complete) sampling. (2) Invasive component is to be documented in a full synoptic report including its size, type, grade, and stage. (3) The term "minimally invasive" should be avoided; instead, invasion size with stage and substaging of T1 (1a, b, c; ≤ 0.5, > 0.5-≤ 1, > 1 cm) is to be documented. (4) Largest diameter of the invasion, not the distance from the nearest duct, is to be used. (5) A category of "indeterminate/(suspicious) for invasion" is acceptable for rare cases. (6) The term "malignant" IPMN should be avoided. (7) The highest grade of dysplasia in the non-invasive component is to be documented separately. (8) Lesion size is to be correlated with imaging findings in cysts with rupture. (9) The main duct diameter and, if possible, its involvement are to be documented; however, it is not required to provide main versus branch duct classification in the resected tumor. (10) Subtyping as gastric/intestinal/pancreatobiliary/oncocytic/mixed is of value. (11) Frozen section is to be performed highly selectively, with appreciation of its shortcomings. (12) These principles also apply to other similar tumoral intraepithelial neoplasms (mucinous cystic neoplasms, intra-ampullary, and intra-biliary/cholecystic). CONCLUSIONS: These recommendations will ensure proper communication of salient tumor characteristics to the management teams, accurate comparison of data between analyses, and development of more effective management algorithms.

2 Review Pathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers: pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement. 2012

Adsay, N Volkan / Bagci, Pelin / Tajiri, Takuma / Oliva, Irma / Ohike, Nobuyuki / Balci, Serdar / Gonzalez, Raul S / Basturk, Olca / Jang, Kee-Taek / Roa, Juan Carlos. ·Department of Pathology, Emory University, School of Medicine, Atlanta, Georgia, USA. volkan.adsay@emory.edu ·Semin Diagn Pathol · Pubmed #23062420.

ABSTRACT: Tumors of the ampulla-pancreatobiliary tract are encountered increasingly; however, their staging can be highly challenging due to lack of familiarity. In this review article, the various issues encountered in staging of these tumors at the pathologic level are evaluated and possible solutions for daily practice as well as potential improvements for future staging protocols are discussed. While N-stage parameters have now been well established (the number of lymph nodes required in pancreatoduodenectomies is 12), the T-staging has several issues: for the pancreas, the discovery of small cancers arising in intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) necessitates the creation of substages of T1 (as T1a, b, and c); lack of proper definition of "peripancreatic soft tissue" and "common bile duct involvement" (as to which part is meant) makes T3 highly subjective. Increasing resectability of main vessels (portal vein) brings the need to redefine a "T" for such cases. For the ampulla, due to factors like anatomic complexity of the region and the under-appreciation of three-dimensional spread of the tumors in this area (in particular, the frequent extension into periduodenal soft tissues and duodenal serosa, which are not addressed in the current system and which require specific grossing approaches to document), the current T-staging lacks reproducibility and clinical relevance, and therefore, major revisions are needed. Recently proposed refined definition and site-specific subclassification of ampullary tumors highlight the areas for improvement. For the extrahepatic bile ducts, the staging schemes that use the depth of invasion may be more practical to circumvent the inconsistencies in the histologic layering of the ducts; better definition of terms like "periductal spread" is needed. For the gallbladder, since many gallbladder cancers are "unapparent" (found in clinically and grossly unsuspected cholecystectomies), establishing proper grossing protocols and adequate sampling are crucial. Since the gallbladder does not have the distinct layering of the other gastrointestinal organs, the definitions of Tis/T1a/T1b lack practicality, and therefore, "early gallbladder carcinoma" category proposed in high-risk regions may have to be recognized instead. Involvement of the Rokitansky-Aschoff sinuses should be a part of the evaluation and management of these early gallbladder cancers; for advanced cancers, documentation of hepatic versus serosal involvement is necessary. In summary, T-staging of ampulla-pancreatobiliary tract tumors has many challenges. Proper grossing and appreciation of histo-anatomic subtleties of this region are crucial in addressing these issues and achieving more applicable and clinically relevant staging systems in the future.

3 Article [Recommendations for the management of pancreatic cancer type adenocarcinoma: A consensus statement reached during the 2015 Latin American Symposium on Gastroenterological Oncology]. 2016

Caglevic, Christian / Gallardo, Jorge / de la Torre, Marcela / Mahave, Mauricio / Müller, Bettina / Solé, Sebastián / Moscoso, Yuri / De La Fuente, Hernán / Roa, Juan Carlos / Hoefler, Sebastián / Butte, Jean M / González M, Pablo / O'Connor, Juan Manuel / Torres, Javiera / Pérez Encalada, Verónica / Alarcón Cano, Daniel / Ubillos, Luis / Rolfo, Christian / Lingua, Alejo / Díaz Romero, Consuelo / Padilla Rosciano, Alejandro / Cuartero, Viviana / Calderillo Ruiz, Germán / Schwartsmann, Gilberto / Kon Jara, Xavier / Andrade G, Andrés / Mas López, Luis / Barajas, Olga / Carballido, Marcela / Lembach, Hanns / Morillas G, Lena / Roca, Enrique / Lobatón, José / Montenegro B, Paola / Yepes, Andrés / Marsiglia, Hugo. ·Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile, caglevicc@falp.org. · Fundación Chilena Desarrollo Oncología. · Centro Especializado en Terapia Radiante, Hospital Clínicas San José de San Martín, Universidad de Buenos Aires, Buenos Aires, Argentina. · Instituto Nacional del Cáncer, Santiago, Chile. · Oncología Radioterapia, Clínica IRAM, Santiago, Chile. · Unidad de Cuidados Paliativos, Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile. · Clínica Santa María, Santiago, Chile. · Pontificia Universidad Católica de Chile, Santiago, Chile. · Instituto Oncológico Fundación Arturo López Pérez, Santiago, Chile. · Clínica Reñaca, Viña del Mar, Chile. · Sección de Tumores Gastrointestinales, Instituto Alexander Fleming, Buenos Aires, Argentina. · Hospital Solón Espinosa Ayala - SOLCA, Ecuador. · Hospital Oncológico SOLCA, Manabí, Ecuador. · Servicio de Oncología Clínica, Hospital de Clínicas, Montevideo, Uruguay. · Unidad de Desarrollo Temprano de Drogas-Estudios Fase I, Hospital Universitario de Antwerp, Amberes, Bélgica. · Área Oncología Digestiva, Clínica Privada Universitaria Reina Fabiola, Córdoba, Argentina. · Unidad Funcional de Tumores Digestivos, Instituto Nacional de Cancerología, México, México. · Instituto de Cancerología,México, México. · Universidad de Buenos Aires,Buenos Aires,Argentina. · Universidad Federal de Río Grande do Sul,Porto Alegre,Brasil. · Hospital Solca,Cuenca,Ecuador. · Universidad Federal de Río Grande do Sul, Porto Alegre, Brasil. · Instituto Nacional de Enfermedades Neoplásicas,Lima,Perú. · Instituto Oncológico Fundación Arturo López Pérez,Santiago,Chile. · Hospital de Gastroenterologia Dr. Carlos Bonorino Udaondo,Buenos Aires,Argentina. · Universidad de Chile, Santiago,Chile. · Centro de Enfermedades Neoplásicas ONCOVIDA, La Paz, Bolivia. · Clínica IMAT, Monteria,Colombia. · Instituto Nacional de Enfermedades Neoplásicasa,Lima,Perú. · Fundación Colombiana de Cancerología, Medellín,Colombia. · nstituto Oncológico Fundación Arturo López Pérez,Santiago,Chile. ·Rev Med Chil · Pubmed #28074986.

ABSTRACT: Pancreatic cancer is a malignancy of great impact in developed countries and is having an increasing impact in Latin America. Incidence and mortality rates are similar for this cancer. This is an important reason to offer to the patients the best treatments available. During the Latin American Symposium of Gastroenterology Oncology (SLAGO) held in Viña del Mar, Chile, in April 2015, a multidisciplinary group of specialists in the field met to discuss about this disease. The main conclusions of this meeting, where practitioners from most of Latin American countries participated, are listed in this consensus that seek to serve as a guide for better decision making for patients with pancreatic cancer in Latin America.

4 Article Neoadjuvant chemoradiation therapy for borderline pancreatic adenocarcinoma: report of two cases. 2013

Galindo, José / Gabrielli, Mauricio / Guerra, Juan Francisco / Cassina, Juan Carlos / Garrido, Marcelo / Jarufe, Nicolás / Borghero, Yerko / Madrid, Jorge / Zoroquiain, Pablo / Roa, Juan Carlos / Martínez, Jorge. ·Department of Digestive Surgery, Hospital Clínico Pontificia Universidad Católica de Chile, Marcoleta 350, Santiago, Chile. ·World J Surg Oncol · Pubmed #23379413.

ABSTRACT: Pancreatic cancer remains as one of the most aggressive human neoplasms, with overall poor survival rates. Radical surgery of the primary lesion is the best option for treatment. Borderline resectable pancreatic tumors (BRPT), defined as partial involvement of peripancreatic vasculature, may benefit from neoadjuvant therapy. We report on the first two BRPT cases treated with neoadjuvant chemoradiation at our institution. Preoperative CT and MRI demonstrated pancreatic tumors encasing the porto-mesenteric confluence suggestive of BRPT. Patients received neoadjuvant chemotherapy (gemcitabine/cisplatin), followed by radiochemotherapy. After treatment, follow-up images demonstrated tumor downsize, allowing for the tumors to be considered then as resectable. They underwent partial pancreatoduodenectomies (Whipple procedure). In case 1, histopathology revealed a complete, margin-free resection, whereas in case 2 there was a complete pathological response, with no evidence of residual tumor. According to the literature, our initial experience using neoadjuvant chemoradiotherapy on BRPT allowed us to downsize the tumor and, subsequently, to perform a curative surgery.

5 Article Mucinous carcinomas of the gallbladder: clinicopathologic analysis of 15 cases identified in 606 carcinomas. 2012

Dursun, Nevra / Escalona, Oscar Tapia / Roa, Juan Carlos / Basturk, Olca / Bagci, Pelin / Cakir, Asli / Cheng, Jeanette / Sarmiento, Juan / Losada, Hector / Kong, So Yeon / Ducato, Leslie / Goodman, Michael / Adsay, N Volkan. ·Department of Pathology, Istanbul Education and Research Hospital, Istanbul, Turkey. ·Arch Pathol Lab Med · Pubmed #23106580.

ABSTRACT: CONTEXT: There are virtually no data in the literature regarding the incidence, patterns, and clinicopathologic characteristics of mucinous carcinomas (MCs) of the gallbladder (GB). OBJECTIVE: To determine the incidence of mucinous differentiation in invasive GB carcinomas and the clinicopathologic characteristics of those that qualify as MC. DESIGN: Primary invasive GB carcinomas (n  =  606) were reviewed for mucinous differentiation. Some degree of mucin production was identified in 40 cases (6.6%); however, only 15 (2.5%) were qualified for the World Health Organization definition of MC (stromal mucin deposition constituting >50% of the tumor). RESULTS: The mean age was 65 years, and the female to male ratio was 1.1 (versus 3.9 for conventional pancreatobiliary-type GB adenocarcinomas; P  =  .04). A significant proportion of the cases (8 of 12, 67%) presented with the clinical picture and intraoperative findings that were interpreted as acute cholecystitis. Mean and median tumor sizes were larger than those of conventional adenocarcinomas (4.8 and 3.4 cm versus 2.9 and 2.5 cm, respectively; P  =  .01). Most (13 of 15, 87%) cases presented with pT3 tumors (versus 48% for ordinary GB carcinomas; P  =  .01). Two cases had almost an exclusive colloid pattern (>90% composed of well-defined stromal mucin nodules that contained scanty carcinoma cells, most of which were floating within the mucin). Eight cases were of mixed-mucinous type, showing a mixture of colloid and noncolloid patterns. Five others had prominent signet-ring cells, both floating within the mucin (which constituted >50% of the tumor by definition) and infiltrating into the stroma as individual signet-ring cells in some areas. Immunohistochemical analysis performed on the 7 cases that had available tissue revealed CK7 in 4 of 7 (57%), CK20 in 2 of 7 (29%), MUC1 in 4 of 7 (57%), MUC2 in 6 of 7 (86%), CDX2 in 1 of 7 (14%), MUC5AC in 6 of 7 (86%), MUC6 in 0 of 7 (0%), and loss of E-cadherin in 6 of 7 (86%). The MLH1 and MSH2 were retained in 6 of 7 cases (100%). Follow-up information was available for 13 cases: 11 (85%) died of disease (1-37 months) and 2 (15%) were alive (23 months and 1 month). Overall survival of MCs was significantly worse than that of conventional adenocarcinomas (13 versus 26 months; P  =  .01); however, that did not seem to be independent of stage. CONCLUSIONS: Mucinous carcinomas constitute 2.5% of GB carcinomas. They present with an acute cholecystitis-type picture. Most MCs are a mixed-mucinous, not pure colloid, type. They are typically large and advanced tumors at the time of diagnosis and thus exhibit more-aggressive behavior than do ordinary GB carcinomas. Immunophenotypically, they differ from conventional GB adenocarcinomas by MUC2 positivity, from intestinal carcinomas by an often inverse CK7/20 profile, from pancreatic mucinous carcinomas by CDX2 negativity, and from mammary colloid carcinomas by a lack of MUC6. Unlike gastrointestinal MCs, they appear to be microsatellite stable.