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Pancreatic Neoplasms: HELP
Articles by Philippe Ruszniewski
Based on 78 articles published since 2010
(Why 78 articles?)
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Between 2010 and 2020, P. Ruszniewski wrote the following 78 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4
51 Article Pattern and clinical predictors of lymph node involvement in nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs). 2013

Partelli, Stefano / Gaujoux, Sebastien / Boninsegna, Letizia / Cherif, Rim / Crippa, Stefano / Couvelard, Anne / Scarpa, Aldo / Ruszniewski, Philippe / Sauvanet, Alain / Falconi, Massimo. ·Departments of Surgery and Pathology, University of Verona, Verona, Italy. ·JAMA Surg · Pubmed #23986355.

ABSTRACT: IMPORTANCE: Nonfunctioning pancreatic neuroendocrine tumors (NF-PanNETs) are often indolent neoplasms without lymph node (LN) metastasis at diagnosis. Therefore, in patients with low risk of LN metastasis, the extent of surgery and lymphadenectomy could be limited and follow-up adjusted to the very low risk of relapse. OBJECTIVE: To construct a predicting model to assess the risk of pN+ prior to surgical resection for NF-PanNETs using preoperative retrievable variables. DESIGN: Retrospective review using multiple logistic regression analysis to construct predictive model of pN+ based on preoperatively available data. SETTING: The combined prospective databases of the Surgical Departments of the University of Verona, Verona, Italy, and Beaujon Hospital, Clichy, France, were queried for clinical and pathological data. PARTICIPANTS: All patients with resected (R0 or R1), pathologically confirmed NF-PanNETs between January 1, 1993 and December 31, 2009. MAIN OUTCOME AND MEASURE: Risk of lymph node metastases in patients with pancreatic neuroendocrine tumors. RESULTS: Among 181 patients, nodal metastases were reported in 55 patients (30%) and were associated with decreased 5-year disease-free survival (70% vs 97%, P < .001). Multivariable analysis showed that independent factors associated with nodal metastasis were radiological nodal status (rN) (odds ratio [OR], 5.58; P < .001) and tumor grade (NET-G2 vs NET-G1: OR, 4.87; P < .001) (first model). When the tumor grade was excluded, rN (OR, 4.73; P = .001) and radiological tumor size larger than 4 cm (OR, 2.67; P = .03) were independent predictors of nodal metastasis (second model). The area under the receiver operating characteristic curve for the first and second models were 80% and 74%, respectively. CONCLUSIONS AND RELEVANCE: Patients with NF-PanNET-G1 have a very low risk of pN+ in the absence of radiological signs of node involvement. When preoperative grading assessment is not achieved, the radiological size of the lesion is a powerful alternative predictor of pN+. The risk of pathological nodal involvement in patients with NF-PanNETs can be accurately estimated by a clinical predictive model.

52 Article Hand-assisted laparoscopic total pancreatectomy: a report of two cases. 2013

Dokmak, Safi / Aussilhou, Béatrice / Sauvanet, Alain / Ruszniewski, Philippe / Levy, Philippe / Belghiti, Jacques. ·Department of Hepatobiliary and Pancreatic Surgery, Beaujon Hospital, Clichy, France. safi.dokmak@bjn.aphp.fr ·J Laparoendosc Adv Surg Tech A · Pubmed #23551033.

ABSTRACT: BACKGROUND: Because of improvement in surgical technique and endocrine and exocrine insufficiency management, total pancreatectomy is being frequently performed, especially for benign or low-potential malignant diseases. The laparoscopic approach is rarely performed. SUBJECTS AND METHODS: Our aim is to report two cases operated by the assisted laparoscopic approach and to describe a standardized surgical technique. RESULTS: Two patients underwent laparoscopic total pancreatectomy with assisted minilaparotomy or the hand-assisted technique for degenerated intraductal papillary mucinous neoplasms (IPMNs) and neuroendocrine tumors with operative times of 270 and 360 minutes, estimated blood loss of 200 and 300 mL, and a hospital stay of 12 and 18 days, respectively. One patient was re-operated on postoperative Day 10 for bleeding from the hepaticojejunostomy probably related to an inadequate dose of antiproton inhibitors, necessitating refection of the anastomosis with an uneventful course. Pathological examination revealed degenerated IPMNs (T3N1R0) and well-differentiated neuroendocrine tumors (T2NOR0) with complete resection. After 6-10 months of follow-up, the diabetes is well controlled with insignificant episodes of hypoglycemia in 1 patient without any evidence of tumor relapse. CONCLUSIONS: In selected patients laparoscopic total pancreatectomy appears safe and had many advantages over the open and other laparoscopic pancreatic resection approaches, including first laparoscopic abdominal exploration and no pancreatic anastomosis. Oncological rules can be respected, but further larger studies are needed before drawing conclusions.

53 Article Efficacy of everolimus in patients with metastatic insulinoma and refractory hypoglycemia. 2013

Bernard, Valérie / Lombard-Bohas, Catherine / Taquet, Marie-Caroline / Caroli-Bosc, François-Xavier / Ruszniewski, Philippe / Niccoli, Patricia / Guimbaud, Rosine / Chougnet, Cécile N / Goichot, Bernard / Rohmer, Vincent / Borson-Chazot, Françoise / Baudin, Eric / Anonymous4440749. ·Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Institute, University Paris Sud-XI, Villejuif, France. ·Eur J Endocrinol · Pubmed #23392213.

ABSTRACT: BACKGROUND: Refractory hypoglycemia in patients with metastatic insulinoma is an important cause of morbidity and mortality. Everolimus could be a new therapeutic option. METHODS: Within the French Group, we conducted a retrospective, multicentric study of endocrine tumors to evaluate the time to the first recurrence of symptomatic hypoglycemia, after everolimus initiation, in patients with metastatic insulinoma and refractory hypoglycemia. Ongoing hyperglycemic medical options, tumor response, and safety information were recorded. RESULTS: Twelve patients with metastatic insulinoma and refractory hypoglycemia who were treated with everolimus between May 2007 and June 2011 were reviewed. Everolimus (starting dose, 10 mg/day, except in one patient, 5 mg/day) was given after a median of four previous therapeutic lines. Medication aimed at normalizing blood glucose levels in 11 patients. After a median duration of 6.5 months (range 1-35+ months), median time to the first recurrence of symptomatic hypoglycemia was 6.5 months (range 0 to 35+ months). Three patients discontinued everolimus because of cardiac and/or pulmonary adverse events at 1, 1.5, and 7 months after initiation, which led to two deaths. Three patients discontinued everolimus because of tumor progression at 2, 3, and 10 months after initiation, without recurrence of hypoglycemia. CONCLUSION: Everolimus appears to be a new effective treatment for patients with metastatic insulinoma and refractory hypoglycemia. Tolerance should be carefully monitored.

54 Article Tumoral epithelial and stromal expression of SMAD proteins in pancreatic ductal adenocarcinomas. 2013

Handra-Luca, Adriana / Hammel, Pascal / Sauvanet, Alain / Ruszniewski, Philippe / Couvelard, Anne. ·APHP Hôpital Avicenne, Service d'Anatomie Pathologique, Paris, France. adriana.handra-luca@avc.aphp.fr ·J Hepatobiliary Pancreat Sci · Pubmed #22581056.

ABSTRACT: BACKGROUND: SMAD proteins, intracellular mediators of the transforming growth factor (TGF)-beta pathway, function within two axes, the SMAD1/5/8 and SMAD2/3, connected to TGF-beta and bone morphogenetic protein (BMP) ligands. The SMAD proteins of these two axes dimerize with SMAD4 and translocate to the nucleus. SMAD signaling is characterized by a dichotomic functioning, with tumor-suppressive functions and with loss of normal growth inhibitory responses, depending on the carcinogenesis stage. SMAD proteins also have pro-tumor effects including abnormal extracellular matrix production. Among tumors, pancreatic cancers harbor SMAD4 inactivation the most frequently and the SMAD proteins are considered to be key factors in pancreatic carcinogenesis. METHODS: Our aims were to study the expression patterns of the different types of SMAD proteins in pancreatic ductal adenocarcinomas treated by surgical resection (without neoadjuvant treatment) and their correlations with morphological and clinical characteristics. We examined the immunohistochemical expression of SMAD4, SMAD1/5/8, and SMAD2/3 in 99 pancreatic ductal adenocarcinomas. Antibodies directed against the activated, phosphorylated forms of proteins were used when appropriate (SMAD1/5/8, SMAD2/3). Protein expression in the epithelial tumor cells and in stromal fibroblasts was analyzed with regard to morphological and clinical data. RESULTS: Epithelial tumor cells showed SMAD1/5/8, SMAD2/3, and, SMAD4 expression in 13, 93, and 45 tumors, respectively, and stromal fibroblast expression in 5, 11, and 22 tumors, respectively. Epithelial SMAD4 was associated with a low, T1 or T2, TNM stage, and with the presence of an abundant stroma (p = 0.05 and <0.01, respectively). Activated stromal fibroblast SMAD2/3 expression was correlated with the presence of a fibrotic focus (p = 0.01), whereas fibroblast SMAD4 was related to a tendency for shorter postsurgical overall survival (p = 0.07). The relationship of stromal, fibroblast SMAD4 to a worse outcome attained statistical significance in the group of patients with T1 and with N1 stage tumors (p < 0.01 and p = 0.04, respectively). CONCLUSION: In pancreatic ductal adenocarcinomas, SMAD protein expression in epithelial tumor cells or in stromal fibroblasts was related to stromal features and to a shorter postsurgical overall survival. Our results point out that the SMAD proteins play a role in the microenvironment of this highly fibrotic tumor type.

55 Article FOLFIRI regimen in metastatic pancreatic adenocarcinoma resistant to gemcitabine and platinum-salts. 2012

Neuzillet, Cindy / Hentic, Olivia / Rousseau, Benoît / Rebours, Vinciane / Bengrine-Lefèvre, Léïla / Bonnetain, Franck / Lévy, Philippe / Raymond, Eric / Ruszniewski, Philippe / Louvet, Christophe / Hammel, Pascal. ·Service de Gastroentérologie-Pancréatologie, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy La Garenne, AP-HP, France. ·World J Gastroenterol · Pubmed #22969226.

ABSTRACT: AIM: To evaluate the efficacy and safety of the FOLFIRI regimen in patients with metastatic pancreatic adenocarcinoma (PAC) after the failure of gemcitabine and platinum salts. METHODS: All consecutive patients with histologically confirmed, metastatic PAC and World Health Organization performance status (PS) ≤ 2 received FOLFIRI-1 [irinotecan 180 mg/m(2) on day 1 and leucovorin 400 mg/m(2) followed by 5-fluorouracil (5-FU) 400 mg/m(2) bolus, then 5-FU 2400 mg/m(2) as a 46-h infusion, biweekly] or FOLFIRI-3 (irinotecan 100 mg/m(2) on day 1 and leucovorin 400 mg/m(2), then 5-FU 2400 mg/m(2) as a 46-h infusion and irinotecan 100 mg/m(2) repeated on day 3, biweekly) after failure of gemcitabine and platinum-based chemotherapies as a systematic policy in two institutions between January 2005 and May 2010. Tumor response, time to progression (TTP), overall survival rate (OS) and grade 3-4 toxicities were retrospectively studied. Subgroup analyses were performed to search for prognostic factors. RESULTS: Sixty-three patients (52.4% male, median age 59 years) were analyzed. Among them, 42.9% were PS 0, 38.1% were PS 1 and 19.0% were PS 2. Fifty one patients (81.0%) had liver metastases. Before the FOLFIRI regimen, patients had received 1 line (n = 19), 2 lines (n = 39) or 3 lines (n = 5) of chemotherapy. Median TTP obtained with the line before FOLFIRI was 3.9 mo (95% CI: 3.4-5.3 mo). A total of 480 cycles was completed (median: 6 cycles, range: 1-51 cycles). The main reason for discontinuing FOLFIRI was tumor progression (90.3%). Tumor control was achieved in 25 patients (39.7%) (partial response: n = 5, stable disease: n = 20) with FOLFIRI. Median TTP was 3.0 mo (95% CI: 2.1-3.9 mo) and median OS was 6.6 mo (95% CI: 5.3-8.1 mo). Dose adaptation was required in 36 patients (57.1%). Fifteen patients (23.8%) had grade 3-4 toxicities, mainly hematological (n = 11) or digestive (n = 4). Febrile neutropenia occurred in 3 patients. There was no toxic death. PS 2 was significantly associated with poor TTP [hazard ratio (HR): 16.036, P < 0.0001] and OS (HR: 4.003, P = 0.004). CONCLUSION: The FOLFIRI regimen had an acceptable toxicity and an interesting efficacy in our study, limited to patients in good condition (PS 0-1).

56 Article FOLFIRI regimen: an effective second-line chemotherapy after failure of etoposide-platinum combination in patients with neuroendocrine carcinomas grade 3. 2012

Hentic, O / Hammel, P / Couvelard, A / Rebours, V / Zappa, M / Palazzo, M / Maire, F / Goujon, G / Gillet, A / Lévy, P / Ruszniewski, P. ·Pôle des Maladies de L'appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hôpital Beaujon, Clichy, France. olivia.hentic@bjn.aphp.fr ·Endocr Relat Cancer · Pubmed #22940375.

ABSTRACT: Patients with neuroendocrine carcinomas (NECs) grade 3 have a poor prognosis. Etoposide-platinum combination is the standard chemotherapy but the role of a second-line therapy remains unknown. Irinotecan alone or in combination has shown some efficacy in patients treated for small cell lung cancer which had pathological similarities with neuroendocine tumors. The aim of this study is to determine safety and efficacy of the FOLFIRI regimen in patients with NECs grade 3 after failure of etoposide-platinum combination. This study was retrospective, including patients with NECs grade 3 and treated with the FOLFIRI regimen after progression or toxicity of etoposide-platinum combination in first-line. Patients with Eastern Cooperative Oncology Group (ECOG) performance status ≥3 and/or serum alkaline phosphatase ≥5×upper limit of normal value (ULN) and/or bilirubin ≥1.5×ULN were excluded. Among 39 patients who failed etoposide-platinum combination, 19 (49%; 12 women, median age 53 (29-78) years) received the FOLFIRI regimen with a median number of 6 (1-16) courses. Six patients (31%) had at least one episode of grades 3-4 toxicity (neutropenia, n=3; diarrhea, n=3) without toxic death. Six patients (31%) had objective response, 6 (31%) stable disease, and 7 (38%) tumor progression. Median progression-free survival under FOLFIRI was 4 months. Overall survival was 18 vs 6.8 months in noneligible patients. FOLFIRI regimen is a safe and potentially efficient chemotherapy given as second-line in patients with NECs grade 3 who remain in good condition and with correct liver tests after failure of etoposide-platinum combination. These results should be confirmed in a future prospective study.

57 Article Parenchyma-sparing resections for pancreatic neuroendocrine tumors. 2012

Cherif, Rim / Gaujoux, Sébastien / Couvelard, Anne / Dokmak, Safi / Vuillerme, Marie-Pierre / Ruszniewski, Philippe / Belghiti, Jacques / Sauvanet, Alain. ·Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), AP-HP, hôpital Beaujon, 100, Bd du Général Leclerc, Clichy 92110, France. ·J Gastrointest Surg · Pubmed #22911124.

ABSTRACT: BACKGROUND: Parenchyma-sparing pancreatectomy (PSP), including enucleation and central pancreatectomy, has been investigated as an alternative to standard resection for pancreatic endocrine neoplasm, but the benefit/risk of these procedures remains little known. METHODS: From 1998 to 2010, among 197 patients operated for well-differentiated pancreatic neuroendocrine tumors, 67 underwent PSP (45 enucleations and 22 central pancreatectomies) and 66 standard resections (35 pancreaticoduodenectomies and 31 distal pancreatectomies) for a tumor below 4 cm, without synchronous distant metastasis. Groups were compared regarding postoperative morbidity, mortality, long-term pancreatic function, and survival calculated using the Kaplan-Meier method. RESULTS: Tumors operated by PSP had a median size of 15 mm, were mainly incidentally diagnosed (n = 46, 69 %), and nonfunctioning (n = 55, 82 %). Overall morbidity rate was higher after PSP than standard resection (SR) (76 vs 58 %, p = 0.0028), including more frequent pancreatic fistulas (69 vs 42 %, p = 0.003). Postoperative diabetes was less frequent following PSP than pancreaticoduodenectomy (5 vs 21 %; p = 0.022) but equivalent to the one observed after distal pancreatectomy (4 %, p = 1). Exocrine insufficiency was significantly less frequent after PSP than SR (3 vs 32 %; p < 0.0001). The overall and recurrence-free 5-year survival after PSP for nonfunctioning tumors was 96 and 98 %, respectively. CONCLUSION: In selected patients, with small and low-grade tumors, PSP are associated with excellent overall and recurrence-free survivals. These procedures are associated with an increased postoperative morbidity but an excellent postoperative pancreatic function. Therefore, they should be considered as a valid therapeutic option in selected well-differentiated pancreatic neuroendocrine tumors.

58 Article The long term risk of malignancy in patients with branch duct intraductal papillary mucinous neoplasms of the pancreas. 2012

Khannoussi, Wafaa / Vullierme, Marie Pierre / Rebours, Vinciane / Maire, Frédérique / Hentic, Olivia / Aubert, Alain / Sauvanet, Alain / Dokmak, Safi / Couvelard, Anne / Hammel, Pascal / Ruszniewski, Philippe / Lévy, Philippe. ·Service de Pancréatologie-Gastroentérologie, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, 92118 Clichy Cedex, France. ·Pancreatology · Pubmed #22687372.

ABSTRACT: PATIENTS AND METHODS: Prospective study in consecutive patients (pts) with BD-IPMN and follow-up (F/U) ≥60 months to assess long term risk of malignant progression. All computed tomographies and magnetic resonance cholangiopancreatographies performed every 1 or 2 years (depending on the maximum size of cyst) were read by the same radiologist. EUS was performed in case of occurrence of main pancreatic duct (MPD) dilation or mural nodule >5 mm. Size increase was considered significant if >5 mm. Size variation, criteria suggestive of malignancy, operative therapy and pathology were recorded. RESULTS: 53 pts were included (median age at diagnosis: 61 years, median F/U: 84 months (range: 60-132) including 5 F/U >120 months). Lesions were stable in 38 pts (72%). Size increased in 8 pts (15%) (median increase : 11 (5-33) mm) without mural nodule (MN). One of those was operated on (low-grade dysplasia). A MN appeared in 5 pts (9%). ≥5 mm in 2 pts (5 and 15 mm) who were operated on (intermediate-grade dysplasia in both). The 3 remaining pts (MN < 5 mm) were carefully followed-up. Invasive advanced carcinoma occurred in 2 pts, both after 84 months F/U. In one of these, no imaging changes were noted 12 months before diagnosis of malignancy. CONCLUSION: In BD-IPMN, the risk of malignant evolution persists after 60 months F/U including invasive carcinomas. F/U imaging surveillance is still necessary beyond this delay in patients fit for potential surgery.

59 Article TNM staging of neoplasms of the endocrine pancreas: results from a large international cohort study. 2012

Rindi, G / Falconi, M / Klersy, C / Albarello, L / Boninsegna, L / Buchler, M W / Capella, C / Caplin, M / Couvelard, A / Doglioni, C / Delle Fave, G / Fischer, L / Fusai, G / de Herder, W W / Jann, H / Komminoth, P / de Krijger, R R / La Rosa, S / Luong, T V / Pape, U / Perren, A / Ruszniewski, P / Scarpa, A / Schmitt, A / Solcia, E / Wiedenmann, B. ·Institute of Anatomic Pathology, Università Cattolica del Sacro Cuore, Histopathology and Cytodiagnosis Unit, Policlinico Gemelli, Largo A. Gemelli, 8, Roma I-00168, Italy. guido.rindi@rm.unicatt.it ·J Natl Cancer Inst · Pubmed #22525418.

ABSTRACT: BACKGROUND: Both the European Neuroendocrine Tumor Society (ENETS) and the International Union for Cancer Control/American Joint Cancer Committee/World Health Organization (UICC/AJCC/WHO) have proposed TNM staging systems for pancreatic neuroendocrine neoplasms. This study aims to identify the most accurate and useful TNM system for pancreatic neuroendocrine neoplasms. METHODS: The study included 1072 patients who had undergone previous surgery for their cancer and for which at least 2 years of follow-up from 1990 to 2007 was available. Data on 28 variables were collected, and the performance of the two TNM staging systems was compared by Cox regression analysis and multivariable analyses. All statistical tests were two-sided. RESULTS: Differences in distribution of sex and age were observed for the ENETS TNM staging system. At Cox regression analysis, only the ENETS TNM staging system perfectly allocated patients into four statistically significantly different and equally populated risk groups (with stage I as the reference; stage II hazard ratio [HR] of death = 16.23, 95% confidence interval [CI] = 2.14 to 123, P = .007; stage III HR of death = 51.81, 95% CI = 7.11 to 377, P < .001; and stage IV HR of death = 160, 95% CI = 22.30 to 1143, P < .001). However, the UICC/AJCC/WHO 2010 TNM staging system compressed the disease into three differently populated classes, with most patients in stage I, and with the patients being equally distributed into stages II-III (statistically similar) and IV (with stage I as the reference; stage II HR of death = 9.57, 95% CI = 4.62 to 19.88, P < .001; stage III HR of death = 9.32, 95% CI = 3.69 to 23.53, P = .94; and stage IV HR of death = 30.84, 95% CI = 15.62 to 60.87, P < .001). Multivariable modeling indicated curative surgery, TNM staging, and grading were effective predictors of death, and grading was the second most effective independent predictor of survival in the absence of staging information. Though both TNM staging systems were independent predictors of survival, the UICC/AJCC/WHO 2010 TNM stages showed very large 95% confidence intervals for each stage, indicating an inaccurate predictive ability. CONCLUSION: Our data suggest the ENETS TNM staging system is superior to the UICC/AJCC/WHO 2010 TNM staging system and supports its use in clinical practice.

60 Article Gene expression signature of advanced pancreatic ductal adenocarcinoma using low density array on endoscopic ultrasound-guided fine needle aspiration samples. 2012

Bournet, B / Pointreau, A / Souque, A / Oumouhou, N / Muscari, F / Lepage, B / Senesse, P / Barthet, M / Lesavre, N / Hammel, P / Levy, P / Ruszniewski, P / Cordelier, P / Buscail, L. ·INSERM UMR1037, Cancer Research Center of Toulouse, CHU Rangueil, 1 avenue Jean Poulhès, Bât. L3, BP 84225, 31432 Toulouse Cedex 4, France3 ·Pancreatology · Pubmed #22487470.

ABSTRACT: AIMS: The purpose of this study was to investigate the clinical feasibility and utility of low-density array analysis on samples obtained from endoscopic ultrasound-guided fine needle aspiration biopsy in locally advanced and/or metastatic pancreatic ductal adenocarcinoma and chronic pancreatitis. PATIENTS AND METHODS: In this prospective multicenter study, we quantified candidate gene expression in biopsies sampled from 44 locally advanced and/or metastatic pancreatic carcinoma and from 17 pseudotumoural chronic pancreatitis using dedicated low-density array microfluidic plates. RESULTS: We first demonstrated that 18S gene expression is stable and comparable in normal pancreas and pancreatic cancer tissues. Next, we found that eight genes (S100P, PLAT, PLAU, MSLN, MMP-11, MMP-7, KRT7, KRT17) were significantly over expressed in pancreatic cancer samples when compared to pseudotumoural chronic pancreatitis (p value ranging from 0.0007 to 0.0215): Linear discriminative analysis identified S100P, PLAT, MSLN, MMP-7, KRT7 as highly explicative variables. The area under receiver operating curve establishes the clinical validity of the potential diagnostic markers identified in this study (values ranging from 0.69 to 0.76). In addition, combination of S100P and KRT7 gave better diagnosis performances (Area Under Receiver Operating Curve 0.81, sensitivity 81%, specificity 77%). CONCLUSION: We demonstrate that molecular studies on EUS-guided FNA material are feasible for the identification and quantification of markers in PDAC patients diagnosed with non-resectable tumours. Using low-density array, we isolated a molecular signature of advanced pancreatic carcinoma including mostly cancer invasion-related genes. This work stems for the use of novel biomarkers for the molecular diagnosis of patient with solid pancreatic masses.

61 Article Molecular profiling of pancreatic neuroendocrine tumors in sporadic and Von Hippel-Lindau patients. 2012

Speisky, Daniela / Duces, Aurélie / Bièche, Ivan / Rebours, Vinciane / Hammel, Pascal / Sauvanet, Alain / Richard, Stéphane / Bedossa, Pierre / Vidaud, Michel / Murat, Arnaud / Niccoli, Patricia / Scoazec, Jean-Yves / Ruszniewski, Philippe / Couvelard, Anne / Anonymous1570722. ·Service d'Anatomie Pathologique, Service de Gastroentérologie-Pancréatologie, Service de Chirurgie Hépatique et Pancréatique, AP-HP, Hôpital Beaujon, Clichy, France. ·Clin Cancer Res · Pubmed #22461457.

ABSTRACT: PURPOSE: Von Hippel-Lindau (VHL) disease is an inherited syndrome caused by germline mutations in the VHL tumor suppressor gene, predisposing to a variety of neoplasms including pancreatic neuroendocrine tumors (PanNET). In VHL disease, PanNET probably progress according to a specific pathway of carcinogenesis. Our aim was to characterize by molecular quantitative analysis a panel of molecules implicated in the VHL pathway and in tumor progression in the PanNET of patients with VHL. EXPERIMENTAL DESIGN: The expression of 52 genes was studied by quantitative reverse transcriptase PCR in 18 patients with VHL operated on for PanNET and compared with 16 non-VHL PanNET. The VHL and non-VHL tumors were matched according to their size and cell proliferation. For some genes, we looked for differences in the protein expression in VHL PanNET (n = 31), microadenomas (n = 22), and non-VHL PanNET (n = 16), included in tissue microarray blocks. RESULTS: Nineteen (36%) genes were significantly upregulated and three (6%) downregulated in VHL PanNET. The upregulated genes were related to (i) hypoxia-inducible factor (HIF) molecules (CA9, HIF2A, and GLUT1), (ii) angiogenesis (CDH5, VEGFR1, EDNRA, ANGPT2, CD34, VEGFR2, VEGFA, and ANGPT1), (iii) the processes of epithelial-mesenchymal transition (VIM) and/or metastasis (LAMA4 and CXCR4), (iv) growth factors and receptors (PDGFB, IRS1, and ERBB1), or (v) cell cycle (CCND1 and CDKN2A). The downregulated genes were related to (i) EMT (OCLN) and (ii) signaling pathways (RPS6KB1 and GADD45B). CONCLUSION: This study shows that the progression of PanNET in patients with VHL tumors follows a specific pathway and supports that targeting molecules specifically involved may be of therapeutic importance.

62 Article Recurrence after surgical resection of gastrinoma: who, when, where and why? 2012

Maire, Frédérique / Sauvanet, Alain / Couvelard, Anne / Rebours, Vinciane / Vullierme, Marie-Pierre / Lebtahi, Rachida / Hentic, Olivia / Belghiti, Jacques / Hammel, Pascal / Lévy, Philippe / Ruszniewski, Philippe. ·Department of Gastroenterology and Pancreatology, Beaujon University Hospital, AP-HP, Clichy, France. frederique.maire@bjn.aphp.fr ·Eur J Gastroenterol Hepatol · Pubmed #22410712.

ABSTRACT: BACKGROUND: Surgery prolongs survival in patients with gastrinomas, but postoperative recurrences are frequent and controversies still exist about the optimal surgical procedures. AIM: The aim of this study is to analyze biological and morphological recurrences and to search for risk factors. PATIENTS AND METHODS: Between 1990 and 2008, 22 patients (five with multiple endocrine neoplasia type 1) who underwent curative resection for gastrinoma were evaluated every 6 months for biological and morphological recurrences. All patients were disease-free postresection. RESULTS: The median postoperative follow-up was 37 months (range, 7-204 months). A biological recurrence was observed in 59% of cases, after a median time of 16.5 months (range, 7-90 months). A morphological recurrence was reported in 32% of cases, in the liver (86%) or lymph nodes (43%), after a median time of 21 months (range, 8-91 months). The median delay between biological and morphological recurrence was 3 months (range, 0-69 months). At recurrence, all patients were offered a second treatment (surgical resection in 71% of cases). One and 5 year overall survival were 100 and 76%, respectively. One and 5 year biological disease-free survival (DFS) were 76 and 27%, respectively. One and 5 year morphological DFS were 90 and 62%, respectively. Tumor size of at least 20 mm (P=0.008) and pancreatic location (P=0.04) of the primary tumor had significant effect on morphological DFS. Overall survival was significantly lower in patients with primary tumor of at least 20 mm (P=0.01). CONCLUSION: (a) Recurrence occurs in nearly two out of three patients operated upon for gastrinoma, most often detected through biological tests; (b) lymph nodes and liver are the most frequent sites of relapse and patients benefit from second treatment; (c) risk factors for recurrences are as follows: size of at least 20 mm; and the pancreatic location of the primary tumor.

63 Article Biological and prognostic relevance of mitogen-activated protein kinases in pancreatic adenocarcinoma. 2012

Handra-Luca, Adriana / Lesty, Claude / Hammel, Pascal / Sauvanet, Alain / Rebours, Vinciane / Martin, Antoine / Fagard, Remi / Fléjou, Jean-François / Faivre, Sandrine / Bédossa, Pierre / Ruszniewski, Philippe / Couvelard, Anne. ·Service d'Anatomie Pathologique, APHP Groupe Hospitalier Universitaire Nord, Bobigny, France. adriana.handra-luca@avc.aphp.fr ·Pancreas · Pubmed #22158075.

ABSTRACT: OBJECTIVES: The aims of this study were to study the biological and clinical significance of 3 main proteins of the mitogen-activated protein kinase (MAPK) signaling pathway, ERK1/2, P38, and MKK4, in a series of patients having pancreatic adenocarcinomas treated by surgery. METHODS: We examined the immunohistochemical expression of 3 MAPK proteins, ERK1/2, P38, and MKK4 in 99 surgically resected pancreatic ductal adenocarcinomas. Tumor protein expression was studied with regard to pathological characteristics and to postsurgical recurrence-free and overall survivals. RESULTS: MKK4 expression was related to tumor cell proliferation, evaluated by the Ki67 index (P < 0.01). ERK1/2 expression was related to a shorter recurrence-free survival on both univariate and multivariate analysis (P < 0.01; odds ratio, 8.39; 95% confidence interval, 2.68-26.26) independently of lymph node metastases and tumor size, and to a shorter overall survival (P = 0.01) on univariate analysis. In patients without postsurgical treatment, both ERK1/2 and P38 tumor expression correlated with a shorter recurrence-free survival (P < 0.01 and P = 0.02, respectively). CONCLUSIONS: The results of our study suggest that in pancreatic ductal adenocarcinomas, the MKK4 protein was directly related to high cell proliferation, and that tumor ERK1/2 and P38 expression correlated to shorter postsurgical recurrence-free and overall survivals.

64 Article Magnetic resonance imaging versus endoscopic ultrasonography for the detection of pancreatic tumours in multiple endocrine neoplasia type 1. 2012

Barbe, Coralie / Murat, Arnaud / Dupas, Benoit / Ruszniewski, Philippe / Tabarin, Antoine / Vullierme, Marie-Pierre / Penfornis, Alfred / Rohmer, Vincent / Baudin, Eric / Le Rhun, Marc / Gaye, Delphine / Marcus, Claude / Cadiot, Guillaume / Anonymous2780710. ·Clinical Research Coordination Unit, Robert Debré Hospital, University Hospital of Reims, Reims, France. cbarbe@chu-reims.fr ·Dig Liver Dis · Pubmed #22078814.

ABSTRACT: OBJECTIVE: In multiple endocrine neoplasia type 1, the main risk factor for metastases is pancreatic tumour size. We and others recommend limiting surgery to non-functioning pancreatic tumors ≥20 mm or growing, based on their size measured with endoscopic ultrasonography. Because endoscopic ultrasonography is invasive, we compared endoscopic ultrasonography (EUS) to non-invasive magnetic resonance imaging (MRI) for the detection of pancreatic tumours ≥10 mm in multiple endocrine neoplasia type 1 patients. METHODS: A prospective study was performed in nine participating centres; 90 patients with multiple endocrine neoplasia type 1 underwent EUS and MRI with gadolinium infusion. Gastroenterologists and radiologists were blinded to the results, magnetic resonance images were reviewed centrally. RESULTS: EUS detected 86 tumours ≥10 mm, and 48 (53.3%) patients had at least one tumour ≥10 mm. MRI detected 67 tumours ≥10 mm, and 46 (51.1%) patients had at least one tumour ≥10 mm. EUS and MRI agreement was moderate for detection of tumours ≥10 mm (Kappa coefficient=0.49), and for selection of patients with tumours ≥10 mm (Kappa coefficient=0.55). EUS and MRI missed 11/24 and 4/24 lesions ≥20 mm, respectively. EUS failed to identify 9/57 (15.7%) patients with pancreatic tumours ≥10 mm, and MRI failed to identify 11/57 (19.3%) patients with pancreatic tumours ≥10 mm. CONCLUSIONS: EUS and MRI are complementary and should be performed at initial evaluation in multiple endocrine neoplasia type 1 patients. Whether follow-up should be based on either technique or both, requires further evaluation.

65 Article Proteomic assessment of markers for malignancy in the mucus of intraductal papillary mucinous neoplasms of the pancreas. 2012

Corcos, Olivier / Couvelard, Anne / Dargère, Delphine / Sauvanet, Alain / Hammel, Pascal / Paradis, Valérie / Lévy, Philippe / Ruszniewski, Philippe / Bedossa, Pierre. ·Service de Gastroentérologie et d'Assistance Nutritive, Hôpital Beaujon, France. olivier.corcos@bjn.aphp.fr ·Pancreas · Pubmed #22076567.

ABSTRACT: OBJECTIVES: Intraductal papillary mucinous neoplasms (IPMN) of the pancreas evolve from dysplasia to invasive adenocarcinoma. The aims of this study were to look for candidate protein profiles in IPMN mucus according to histological grade, using a differential proteomic technique, and to highlight protein peaks associated with malignant transformation. METHODS: Forty-three mucus samples obtained from surgically resected IPMN and categorized as benign (low/moderate dysplasia) or malignant (severe dysplasia/invasive adenocarcinoma) in 21 and 22 patients, respectively. A surface-enhanced laser desorption ionization time-of-flight mass spectrometry was used to determine candidate protein expression profiles. Protein peaks that significantly differed between benign/malignant IPMN (area under curve > 0.88; P < 10; high intensity) were identified using adapted software. RESULTS: Among 952 protein peaks, 31 were differentially expressed in benign/malignant IPMN (P < 0.001). Among them, 5 candidate proteins of interest (mass-to-charge ratio [m/z]: 5217, 6326, 6719, 10,453, and 10,849 d) were selected by their high diagnostic accuracy and ability to distinguish between malignant and benign tumors. No correlation was found between peak profiles and duct involvement. CONCLUSIONS: Carcinogenic process in IPMN is associated with changes in mucus proteome with characteristic peaks that could be potential candidate biomarkers of malignancy. ABBREVIATIONS: IPMN - intraductal papillary mucinous neoplasm, EPC - extrapancreatic cancer, MRI - magnetic resonance imaging, ERCP - endoscopic retrograde cholangiopancreatography.

66 Article Familial intraductal papillary mucinous neoplasms of the pancreas. 2012

Rebours, Vinciane / Couvelard, Anne / Peyroux, Jean-Luc / Sauvanet, Alain / Hammel, Pascal / Ruszniewski, Philippe / Lévy, Philippe. ·Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie - Pancréatologie, Hôpital Beaujon, APHP, Université Denis Diderot-Paris VII, 100, boulevard du général Leclerc, 92118 Clichy, France. vinciane.rebours@bjn.aphp.fr ·Dig Liver Dis · Pubmed #21824831.

ABSTRACT: METHODS: Three families (8 patients) with intraductal papillary mucinous neoplasms familial forms were described. Diagnosis was made according to radiological criteria and was confirmed by pathological data. Genetic predisposing factors of pancreatic cancer were searched for. RESULTS: Symptoms related to intraductal papillary mucinous neoplasms were recurrent acute pancreatitis (n=3) or fortuitous discovery (n=5). Number of cystic lesions was ≤3 (n=4) or >3 (n=4). Intraductal papillary mucinous neoplasms involved branch ducts (n=7) or both main pancreatic duct and branch duct (n=1). Severe and moderate dysplasia was found on surgical specimens. No genetic alteration was found (BRCA2, p16 or CDKN2A genes). CONCLUSION: A familial form of intraductal papillary mucinous neoplasms was found in three families. No pancreatic cancer was found in relatives but an attentive survey has to be proposed.

67 Article Mucinous cystic neoplasms of the pancreas: definition of preoperative imaging criteria for high-risk lesions. 2011

Le Baleur, Yann / Couvelard, Anne / Vullierme, Marie Pierre / Sauvanet, Alain / Hammel, Pascal / Rebours, Vinciane / Maire, Frédérique / Hentic, Olivia / Aubert, Alain / Ruszniewski, Philippe / Lévy, Philippe. ·Service de Pancréatologie-Gastroentérologie, Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Clichy, France. ·Pancreatology · Pubmed #22042244.

ABSTRACT: BACKGROUND/AIM: Pancreatic mucinous cystic neoplasms (MCN) are premalignant lesions whose natural history is poorly known. Whether the dysplasia grade might be determined with precision by preoperative clinical and imaging criteria is not known. We aimed to determine if CT scan data might be useful to predict the grade of dysplasia in a series of 60 histologically proven MCN. METHODS: All consecutive patients who were operated on with pathological confirmation of MCN were included. Careful CT scan evaluation was reviewed without knowledge of pathological results. Imaging and pathological results were correlated. RESULTS: Sixty patients (59 females) were included. Low- and intermediate-grade dysplasias were identified in 47 and 3 patients (benign MCN), respectively, and high-grade dysplasia and invasive carcinoma in 7 and 3 patients (malignant MCN), respectively. Patients with benign lesions were significantly younger. None of the studied clinical data were statistically different to distinguish benign and malignant MCN, except age (42 vs. 48 years, p < 0.05). Only maximal diameter and mural nodules on CT scan were significantly more frequent in the malignant group. No malignant MCN had a maximal diameter <40 mm. At a 40-mm threshold, the sensitivity and specificity of the maximal diameter to diagnose malignant MCN were 100 and 54%, respectively. Mural nodules seen on CT scan were confirmed in all cases but one upon pathological examination of the surgical specimen. The sensitivity and specificity of the presence of a mural nodule seen on CT scan for the diagnosis of a malignant lesion were 100 and 98%, respectively. CONCLUSION: Preoperative CT scan detection of a mural nodule within a cystic pancreatic neoplasm suggestive of MCN strongly suggests malignancy. A diameter <40 mm is associated with no risk of malignancy.

68 Article Gemcitabine in elderly patients with advanced pancreatic cancer. 2011

Hentic, Olivia / Dreyer, Chantal / Rebours, Vinciane / Zappa, Magaly / Lévy, Philippe / Raymond, Eric / Ruszniewski, Philippe / Hammel, Pascal. ·Pôle des Maladies de l'Appareil Digestif, Service de Pancréatologie, Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy, France. ·World J Gastroenterol · Pubmed #21941416.

ABSTRACT: AIM: To assess feasibility, tolerability and efficacy of gemcitabine-based chemotherapy in patients ≥ 75 years old with advanced pancreatic cancer. METHODS: All consecutive patients ≥ 75 years old with advanced pancreatic adenocarcinoma were included in this retrospective study. Necessary criteria to receive chemotherapy were: performance status 0-2, adequate biological parameters and no serious comorbidities. Other patients received best supportive care (BSC). RESULTS: Thirty-eight patients (53% women, median age 78 years, range 75-84) with pancreatic cancer (metastatic: n = 20, locally advanced: n = 18) were studied. Among them, 30 (79%) were able to receive chemotherapy [median number: 9 infusions (1-45)]. Six patients (23%) had at least one episode of grade 3 neutropenia and one patient developed a grade 3 hemolytic-uremic syndrome. No toxic death occurred. Three patients (11%) had a partial tumor response, 13 (46%) had a stable disease and 12 (43%) had a tumor progression. Median survival was 9.1 mo (metastatic: 6.9 mo, locally advanced: 11.4 mo). CONCLUSION: Tolerance and efficacy of gemcitabine-based chemotherapy is acceptable in elderly patients in good condition, with similar results to younger patients.

69 Article Chromogranin A measurement in metastatic well-differentiated gastroenteropancreatic neuroendocrine carcinoma: screening for false positives and a prospective follow-up study. 2011

Vezzosi, Delphine / Walter, Thomas / Laplanche, Agnès / Raoul, Jean Luc / Dromain, Clarisse / Ruszniewski, Philippe / d'Herbomez, Michèle / Guigay, Joël / Mitry, Emmanuel / Cadiot, Guillaume / Leboulleux, Sophie / Lombard-Bohas, Catherine / Borson-Chazot, Françoise / Ducreux, Michel / Baudin, Eric. ·Institut Gustave Roussy, Villejuif - France. ·Int J Biol Markers · Pubmed #21574156.

ABSTRACT: BACKGROUND: Multiple causes of false-positive chromogranin A (CgA) measurement have been reported that may affect its impact as a surrogate marker of RECIST progression in well-differentiated gastroenteropancreatic neuroendocrine tumors (WDGEPNET). ? AIMS: 1) To evaluate the frequency of false-positive CgA results. 2) To prospectively compare CgA variations with RECIST morphological changes in patients without known causes of false-positive CgA measurements.? METHODS: First, the conditions responsible for potentially false-positive CgA measurements were screened in 184 consecutive patients with metastatic WDGEPNET. Secondly, a variation in CgA at a 6-month interval was compared to RECIST results at 6 months in 46 patients.? RESULTS: Among 184 patients, elevated CgA was found in 130 cases (71%) including 99 patients with at least one cause of a false-positive result. Impaired kidney function as well as medication with proton pump inhibitors were found to be the 2 major causes of false-positive results. The sensitivity and specificity of CgA measurements compared with morphological tumor changes according to the RECIST criteria were 71% and 50%, respectively, at 6 months.? CONCLUSION: Routine screening for the causes of false-positive CgA measurements is mandatory in WDGEPNET patients. Our study does not validate the use of CgA as a surrogate marker of tumor progression.

70 Article Gender-related differences in MEN1 lesion occurrence and diagnosis: a cohort study of 734 cases from the Groupe d'etude des Tumeurs Endocrines. 2011

Goudet, P / Bonithon-Kopp, C / Murat, A / Ruszniewski, P / Niccoli, P / Ménégaux, F / Chabrier, G / Borson-Chazot, F / Tabarin, A / Bouchard, P / Cadiot, G / Beckers, A / Guilhem, I / Chabre, O / Caron, P / Du Boullay, H / Verges, B / Cardot-Bauters, C. ·Centre Hospitalier Universitaire de Dijon, Service de Chirurgie Endocrinienne, Dijon, France. pierre.goudet@chu-dijon.fr ·Eur J Endocrinol · Pubmed #21551167.

ABSTRACT: CONTEXT: Multiple endocrine neoplasia type 1 (MEN1) disease is an autosomal dominant syndrome that is believed to equally affect men and women. This assumption has never been confirmed. OBJECTIVE: The aims of this study were to evaluate the impact of gender on the prevalence of MEN1 lesions, on their lifetime probability of occurrence, and on the diagnosis of MEN1. DESIGN: Data regarding a study of 734 cases of MEN1 from the multicenter 'Groupe d'étude des Tumeurs Endocrines' were analyzed. RESULTS: There were 57.8% females. The prevalence and probability of pancreatic tumors were higher in males than in females (P=0.06, P=0.0004). This difference was due to gastrinomas. The prevalence and probability of developing pituitary tumors were significantly greater in females (P<0.001, P<0.0001). Thymic tumors were exclusively found in men. There were no significant gender differences in the prevalence and the probability of developing hyperparathyroidism, or adrenal and bronchial tumors, or in the proportion of positive genetic tests. A family history of MEN1 was more frequently found in men than in women at the time of diagnosis (P=0.02). In the case of pituitary tumor, the proportion of patients diagnosed with MEN1 at the time of the first lesion was lower in women (44.2%) than in men (67.3%). CONCLUSION: The phenotype expression of the MEN1 disease gene was different in males and females. In female patients, the possibility of MEN1 is not sufficiently taken into account. Any patient presenting a lesion that belongs to the MEN1 spectrum, such as a pituitary tumor, should be closely questioned about their family history and should be tested for hypercalcemia.

71 Article Molecular markers associated with response to chemotherapy in gastro-entero-pancreatic neuroendocrine tumors. 2010

O'Toole, Dermot / Couvelard, Anne / Rebours, Vinciane / Zappa, Magali / Hentic, Olivia / Hammel, Pascal / Levy, Philippe / Bedossa, Pierre / Raymond, Eric / Ruszniewski, Philippe. ·Department of Clinical Medicine and Gastroenterology, St James's Hospital and Trinity College Dublin, James's Street, Dublin 8, Ireland. dermot.otoole@tcd.ie ·Endocr Relat Cancer · Pubmed #20570957.

ABSTRACT: Response rates to cytotoxics in gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs) vary; recent trials demonstrated lack of objective response rates in up to 70% of patients. Identification of predictive therapeutic biomarkers would be beneficial in the treatment of GEP. Selected markers with known or suspected capability of predicting response to cytotoxics or prognosis (Ki-67, p53, multidrug resistance protein-1 (MDR1), Akt, thymidylate synthase (TS), phosphatase and tensin homolog (PTEN), CA9, cluster of differentiation 34 (CD34), vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF)-1, mismatch repair gene - human mutL homolog 1 (hLMH1), and Bcl-2) were analyzed using immunohistochemisrtry in 60 treatment-naive patients receiving chemotherapy (n=46) or chemoembolization (n=14) for inoperable advanced and/or metastatic GEP and correlated with prognosis (survival and response rates). Therapy included systemic chemotherapy with streptozotocin (n=28), doxorubicin (n=14), 5-fluorouracil (n=18), and etoposide/cisplatinum (n=16), or chemoembolization (streptozotocin, 9; doxorubicin, 5). Factors associated with overall survival in the entire cohort were Ki-67, P<0.001; tumor grade, P<0.001; tumor differentiation, P<0.001; CA9, P=0.004; Akt, P=0.01; HIF-1, P<0.001; p53, P<0.0001; and hMLH1, P=0.005. Markers associated with treatment response included overall group: Akt and PTEN (P=0.05 and 0.05 respectively); streptozotocin: Akt (P=0.07), TS (P=0.02), and PTEN (P=0.017); doxorubicin: Ki-67 (P=0.05), Akt (P=0.06), and CA9 (P=0.02). At multivariate analysis, Akt was significantly associated with a nonresponse to therapy (objective response (OR): 0.2 (0.05-0.8)). For patients receiving only systemic chemotherapy (n=46), PTEN (0.04) and hLMH1 (0.03) were correlated with treatment response and for individual molecules were streptozotocin: PTEN (P=0.008) and hLMH1 (0.07); doxorubicin: Akt (P=0.09), CA9 (P=0.09), and hLMH1 (P=0.09). These results demonstrate a number of new prognostic biomarkers in GEP-NET, and in addition, response to chemotherapy was correlated with a simple panel of selected markers (such as CA9, Akt, PTEN, TS, and hLMH1).

72 Article Acute pancreatitis in patients operated on for intraductal papillary mucinous neoplasms of the pancreas: frequency, severity, and clinicopathologic correlations. 2010

Pelletier, Anne-Laure / Hammel, Pascal / Rebours, Vinciane / Couvelard, Anne / Vullierme, Marie-Pierre / Maire, Frédérique / Hentic, Olivia / Aubert, Alain / Sauvanet, Alain / Lévy, Philippe / Ruszniewski, Philippe. ·Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hôpital Beaujon, AP-HP, Clichy, France. ·Pancreas · Pubmed #20173669.

ABSTRACT: OBJECTIVES: Acute pancreatitis (AP) may reveal intraductal papillary mucinous neoplasms of the pancreas (IPMN). The aims were to describe the characteristics of AP associated with IPMN and to compare patients with AP with those without AP. METHODS: All patients who underwent surgery for IPMN between 1995 and 2006 were retrospectively studied. Clinical, imaging, and histological data were collected. The clinical and radiological severity of AP, the number of episodes, and recurrence after surgery were assessed. RESULTS: One hundred eighty-five patients were included. Sixty-four (34.6%) had at least 1 AP (median, 2; range, 1-10). The median Balthazar score was 1 (0-6). Imaging analysis showed no difference between the 2 groups except for the presence of a mass. Branch duct IPMNs were more frequent in the AP group (74.4% vs 45.3%, P = 0.001), whereas combined IPMNs were more frequent in the non-AP group (45.3% vs 21.5%, P = 0.001). There was no difference in the grade of dysplasia between AP and non-AP groups: carcinoma, 45.3% versus 56.2%; benign IPMN, 54.7% versus 43.8% (P = NS), respectively. CONCLUSIONS: Acute pancreatitis occurs in 34.6% of patients with IPMNs. Acute pancreatitis is not severe and often recurs. Histology showed no difference between the 2 groups.

73 Article Difficult diagnosis of atypical cystic pancreatic lesions in von Hippel-Lindau disease. 2010

Neuzillet, Cindy / Vullierme, Marie-Pierre / Couvelard, Anne / Sauvanet, Alain / Levy, Philippe / Richard, Stéphane / Ruszniewski, Philippe / Hammel, Pascal. ·Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, Clichy, France. ·J Comput Assist Tomogr · Pubmed #20118737.

ABSTRACT: von Hippel-Lindau disease is a progressive, autosomal dominant disorder with multiorgan involvement. There are 2 types of pancreatic lesions from von Hippel-Lindau disease: cystic lesions and endocrine pancreatic tumors. Only the latter type is potentially malignant and may justify pancreatic resection. The differential diagnosis between these 2 types of lesions can be difficult. We report 3 patients with atypical cystic pancreatic lesions who underwent surgery for suspected malignant tumors. The pathological-radiological correlations and the diagnostic and management strategies are discussed.

74 Minor High risk of myelodysplastic syndrome and acute myeloid leukemia after 177Lu-octreotate PRRT in NET patients heavily pretreated with alkylating chemotherapy. 2016

Brieau, Bertrand / Hentic, Olivia / Lebtahi, Rachida / Palazzo, Maxime / Ben Reguiga, Makrem / Rebours, Vinciane / Maire, Frederique / Hammel, Pascal / Ruszniewski, Philippe / Fenaux, Pierre. ·Service de gastro-entérologie et pancréatologieHôpital Beaujon, AP-HP, Université Paris Diderot, Clichy, France. · Service de médecine nucléaireHôpital Beaujon, AP-HP, Université Paris Diderot, Clichy, France. · Département de pharmacieHôpital Beaujon, AP-HP, Université Paris Diderot, Clichy, France. · Service d'hématologieHôpital Saint Louis, AP-HP, Université Paris Diderot, Paris, France pierre.fenaux@aphp.fr. ·Endocr Relat Cancer · Pubmed #26932783.

ABSTRACT: -- No abstract --

75 Minor Somatostatin receptor subtype 2 expression and somatostatin receptor scintigraphy positivity in pancreatic serous cystadenomas. 2015

Poté, Nicolas / Lebtahi, Rachida / Hentic, Olivia / Speisky, Daniela / Sauvanet, Alain / Vullierme, Marie-Pierre / Bedossa, Pierre / Ruszniewski, Philippe / Couvelard, Anne. ·Département de Pathologie, Hôpital Beaujon DHU UNITY, AP-HP, Clichy, France Sorbonne Paris Cité, Université Paris Diderot Paris, France Nicolaspotedoc@yahoo.fr Sorbonne Paris Cité, Université Paris Diderot Paris, France Département de Médecine Nucléaire Hôpital Beaujon, DHU UNITY AP-HP, Clichy, France Département de Gastroentérologie-Pancréatologie, Hôpital Beaujon DHU UNITY, AP-HP, Clichy, France Département de Pathologie, Hôpital Beaujon DHU UNITY, AP-HP, Clichy, France Sorbonne Paris Cité, Université Paris Diderot Paris, France Département de Chirurgie Pancréaticobiliaire et Hépatique, Hôpital Beaujon DHU UNITY, AP-HP, Clichy, France Département de Radiologie, Hôpital Beaujon DHU UNITY, AP-HP, Clichy, France Département de Pathologie, Hôpital Beaujon DHU UNITY, AP-HP, Clichy, France Sorbonne Paris Cité, Université Paris Diderot Paris, France Sorbonne Paris Cité, Université Paris Diderot Paris, France Département de Gastroentérologie-Pancréatologie, Hôpital Beaujon DHU UNITY, AP-HP, Clichy, France Sorbonne Paris Cité, Université Paris Diderot Paris, France Département de Pathologie, Hôpital Bichat DHU UNITY, AP-HP, Paris, France. ·Pancreas · Pubmed #25872132.

ABSTRACT: -- No abstract --

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