Pancreatic adenocarcinomas are known to have a high incidence of K- ras gene mutations. Differential diagnosis of pancreatic cancer and chronic pancreatitis sometimes presents a clinical dilemma. We recently developed a highly sensitive and specific polymerase chain reaction capable of detecting 3–30 copies of mutant K- ras genes harboring codon 12 single base changes in the presence of 300,000 normal copies. Mutant ras genes were detected in DNA purified from pancreatic juice from all 6 cases of pancreatic adenocarcinoma and 1 case of intraductal papillary neoplasms of the pancreas. In 2 of 6 other cases with pancreatic adenocarcinoma, circulating metastatic cells were detected in DNA purified from peripheral blood. Activated ras genes were not found in pancreatic juice of three control cases (chronic pancreatitis and choledocholithiasis) or in the peripheral blood of two patients with insulinomas. Notable conclusions of this study are that there can be significant levels of shed tumor cells in peripheral blood and an even higher number in pancreatic juice. In addition, two different K- ras mutations were found in some patients.

https://cancerres.aacrjournals.org/content/canres/53/11/2472.full.pdf

Detection of ras Gene Mutations in Pancreatic Juice and Peripheral Blood of Patients with Pancreatic Adenocarcinoma

We have reviewed the natural history, reliability of diagnosis, and survivorship of 100 patients with adenocarcinoma of the pancreas, in the context of a thorough review of the literature on survival after therapy for adenocarcinoma of the pancreas. There is 40-62.5% error in the histologic confirmation of the diagnosis of pancreatic cancer. The error by inspection and palpation alone at the time of surgery may be as great as 25%. The absolute 5 year survival rate calculated from 61 clinical studies representing approximately 15,000 patients is 0.4%. The best series in the current literature has only 3% 5 year rate based upon the total population of pancreatic cancer patients. 12.3% of 5 year survivors from the world literature did not have curative surgery. This study shows the necessity for standardization of reporting methods. The same patients and survivors should not be used repeatedly in different reports. Some authors who claim the most effective palliation by pancreatic resection have the highest mortality rates. Cancer 42:2494–2506, 1978.

Cancer of the pancreas: diagnostic accuracy and survival statistics.

In 70 patients suspected of having pancreatic cancer, we prospectively compared results of seven diagnostic tests. Subsequent exploration (of 68) and liver biopsy (of two) demonstrated pancreatic cancer in 30, pancreatitis in seven, nonpancreatic neoplasms in nine and nonpancreatic non-neoplastic disease (or no disease) in 24. For detection of pancreatic disease, the best tests were the pancreatic-function test (cholecystokinin-stimulated enzyme outputs) and ultrasonography. The pancreatic scan was nonspecific (P<0.001), and thermography was insensitive (P<0.001). Endoscopic retrograde pancreatography and arteriography were significantly more sensitive than cytologic study in diagnosis of pancreatic cancer (P<0.001). Therefore, when pancreatic cancer is suspected, abdominal ultrasound should be performed first, and if it is negative, a pancreatic-function test next. A positive result from either test warrants an endoscopic retrograde pancreatography for a definitive diagnosis. This sequence ident...

A Prospective Comparison of Current Diagnostic Tests for Pancreatic Cancer

Our experience with laparoscopy in the diagnosis and staging of 23 cases of pancreatic cancer is reported. This endoscopic procedure has proved useful in the diagnosis of the disease, in the assessment of operability, and in the retrieval of material for histological and cytological confirmation of pancreatic cancer. An infra-gastric laparoscopic method for inspection of the body and tail of the pancreas is described and the technique may allow the earlier detection of neoplasms in this region.

https://gut.bmj.com/content/gutjnl/19/7/672.full.pdf

Value of laparoscopy in the diagnosis and management of pancreatic carcinoma.

Background. Mutations in the K-ras oncogene at codon 12 are detected at a remarkably high frequency in pancreatic carcinomas and are believed to be a critical event in oncogenesis. The authors attempted to detect K-ras mutations in DNA obtained from pure pancreatic juice collected endoscopically, as a novel diagnostic approach to pancreatic carcinoma.



Methods. K-ras mutations were examined using the two-step polymerase chain reaction (PCR) combined with restriction enzyme digestion, followed by nonra-dioisotopic single-strand conformation polymorphism (SSCP) analysis.



Results. Specific mutations of the K-ras gene at codon 12 were found in six of nine (67%) duct cell carcinomas, all of which were negative by cytodiagnosis of the same pure pancreatic juice. K-ras mutations were not detected in the pancreatic juice from 14 healthy control subjects, 10 patients with chronic pancreatitis, or 3 patients with islet cell tumors.



Conclusions. Detection of K-ras mutation at codon 12 in pancreatic juice is highly specific for diagnosing pancreatic duct cell carcinoma and may be a valuable diagnostic modality for pancreatic carcinoma and for differentiating chronic pancreatitis from carcinoma. Cancer 1994; 73:1589–94.

Detection of point mutations in the K-ras oncogene at codon 12 in pure pancreatic juice for diagnosis of pancreatic carcinoma

Cytodiagnosis of pancreatic malignant tumors by aspiration, under direct vision, using a duodenal fiberscope.

A case of small intestinal carcinoma diagnosed by jejunal fiberscope

https://www.jstage.jst.go.jp/article/gee1973b/25/2/25_2_229/_pdf

Endoscopic findings of severe ulcerative colitis

This is a report of a case of prevertebral abscess with Lemierre’s syndrome, which was difficult to differentiate from a retropharyngeal abscess and calcific tendinitis of the longus colli muscle. 

A Case of Prevertebral Abscess with Lemierre’s Syndrome Which was Difficult to Differentiate from Retropharyngeal Abscess and Calcific Tendinitis of the Longus Colli Muscle

Yoshihiko Endo

Papers

Cytodiagnosis of pancreatic malignant tumors by aspiration, under direct vision, using a duodenal fiberscope.

A case of small intestinal carcinoma diagnosed by jejunal fiberscope

Endoscopic findings of severe ulcerative colitis

A Case of Prevertebral Abscess with Lemierre’s Syndrome Which was Difficult to Differentiate from Retropharyngeal Abscess and Calcific Tendinitis of the Longus Colli Muscle