Pancreatic ductal adenocarcinoma with inferior vena cava invasion: a report of three resected cases

Abstract

Background

Pancreatic ductal adenocarcinoma (PDAC) often infiltrates to the adjacent major vasculatures; however, direct invasion of PDAC to the inferior vena cava (IVC) is uncommon.

Case presentation

We report our experience with three cases of PDAC directly invading the IVC wall. All three patients underwent pancreatoduodenectomy along with wedge resection of the IVC wall without severe postoperative complications. Histopathological studies revealed tumor infiltration to the adventitia of the IVC. All patients achieved negative surgical margins. One patient was still alive 26 months after surgery without tumor recurrence. Two patients experienced recurrence; one patient experienced liver metastasis but was still alive and in a stable condition without further tumor progression 12 months after surgery. Another patient experienced multiple liver metastasis 10 months after surgery and died 26 months after surgery.

Conclusions

Pancreatoduodenectomy along with wedge resection of the IVC wall for patients with PDAC directly invading the adventitia of the IVC can be performed safely. Further accumulation of cases is needed to elucidate the prognostic impact of IVC invasion.

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Usefulness of PET/CT for early detection of internal malignancies in patients with Muir–Torre syndrome: report of two cases

Abstract

Background

Muir–Torre syndrome (MTS) is a rare autosomal dominant genodermatosis caused by mutations in mismatch repair genes. It is characterized by the presence of at least one sebaceous skin tumor associated with internal malignancies. Whether positron emission tomography/computed tomography (PET/CT) is useful for the detection of malignancies in patients with MTS has not been determined. We herein report two cases in which PET/CT was useful for the diagnosis and follow-up of internal malignancies in patients with MTS.

Case presentation

In case 1, a 57-year-old woman underwent excision of a sebaceous carcinoma on the left upper eyelid. She underwent follow-up PET/CT once yearly thereafter. Forty-two months after the eyelid surgery, PET/CT showed intense tracer uptake in the right lower abdomen. An ascending colon tumor was identified, and examination of a biopsy specimen showed adenocarcinoma. In case 2, a 77-year-old man presented for evaluation of three continuous papules with telangiectasia on his right cheek. Examination of a skin biopsy specimen of the cheek papule revealed a sebaceous carcinoma. He underwent PET/CT to detect other malignancies. PET/CT showed intense tracer uptake in the sigmoid colon. A sigmoid colon tumor was identified, and examination of a biopsy specimen showed adenocarcinoma. Both patients underwent resection of their tumors, and both were still free of recurrence of the sebaceous and colon carcinomas at the time of this writing.

Conclusion

PET/CT is a reliable imaging modality for the detection of internal malignancies and is useful for the diagnosis and follow-up of MTS.

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Reply to Piperno et al.: It is too soon to argue for localized, short-term human impacts in interfluvial Amazonia [Social Sciences]

We welcome the debate opened by Piperno et al. (1) in response to our recent article (2), and thank the editors of PNAS for the opportunity to reply. Although acknowledging that we detected localized human impacts in our study area, Piperno et al. (1) downplay the increases in palms observed...

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Reply to Candel et al.: Evidence for evolutionary conservation of folding kinetics in the thioredoxin protein family [Biological Sciences]

The letter by Candel et al. (1) does not address a potential problem with their own experimental set-up. In particular, the use of guanidinium hydrochloride (GdnHCl) is not the best choice of denaturant for studying a folding reaction. There is an ample amount of evidence to suggest that the variations...

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Further evidence for localized, short-term anthropogenic forest alterations across pre-Columbian Amazonia [Social Sciences]

By generating soil phytolith and charcoal data from a region of geoglyph construction in southwest Amazonia, Watling et al. (1) provide important evidence on a current debate over the scale and intensity of pre-Columbian modification of Amazonia (e.g., refs. 2–6). The clear evidence for human activity in their study region...

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Fast folding and slow unfolding of a resurrected Precambrian protein [Biological Sciences]

Tzul et al. (1) report different unfolding rates and similar folding rates for a number of thioredoxins. The authors interpret this result as evidence of the principle of minimal frustration. Their study includes several resurrected Precambrian thioredoxins that we have previously prepared and characterized (2–5). We agree that the principle...

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The wisdom of crowds for visual search [Psychological and Cognitive Sciences]

Decision-making accuracy typically increases through collective integration of people’s judgments into group decisions, a phenomenon known as the wisdom of crowds. For simple perceptual laboratory tasks, classic signal detection theory specifies the upper limit for collective integration benefits obtained by weighted averaging of people’s confidences, and simple majority voting can...

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