MODERN METHODS OF DIAGNOSIS OF CYSTIC LESIONS OF PANCREAS

A.F. CHERNOUSOV, G.H. MUSAYEV, A.A. TAGAYEVA, A.B. BEKSHOKOV

The First Moscow State Medical University after I.M. Sechenov; Moscow, RUSSIA

Introduction: Accurate diagnosis of cystic nature of formations in the preoperative period is a particularly relevant problem of modern surgery and oncology. Therefore, it is necessary to select methods that are most informative and sufficient to deal with specific diagnostic problems, and as a consequence, to the choice of surgical approach.

The aim: To improve the diagnosis and differential diagnosis of pancreatic cystic tumors.

Materials and methods: The study included 46 patients with various cystic formations of pancreas. All patients underwent comprehensive examination with ultrasonography, CT with intravenous bolus contrast and preoperative needle biopsy with the study of the obtained material. The obtained liquid was subjected not only to a qualitative analysis and cytology, but were also investigated the level of tumor marker CA 19-9 and the level of immortalization of pool of cells obtained by puncture of cyst fluid.

Results: A prospective study of 20 patients and retrospective analysis of survey results of 26 patients with various cystic formations of pancreas were carried out.

In 28 patients was diagnosed postnecrotic cyst, in 2 patients - congenital cysts and in 3 patients - solid- psevdopapillar tumor. Cystadenoma was detected in 10 patients, cystadenocarcinoma - in 2 cases. Crucial in verifying the diagnosis were ultrasonigraphy and CT evaluation of cystic capsule, its blood flow and intracavitary inclusions; a qualitative analysis of the obtained liquid, determination of the level of tumor marker CA 19-9 level and immortalization of cells of cystic epithelia are also of great value. Analysis of the data of examination in all 18 observations has allowed a properly diagnose of cystic tumors.

Conclusion: Comprehensive examination of patients with cystic formations of pancreas, which includes ultrasonography and CT diagnosis, puncture of the cyst with the research of obtained material, allows making a diagnosis before surgery in the vast majority of observations. This algorithm allows differentiating indications and determining the optimal volume of surgical intervention for various morphological variants of cystic tumors of pancreas.

STUDY OF TELOMERASE ACTIVITY AS A UNIVERSAL MARKER OF MALIGNANT NEOPLASMS OF THE PANCREATIC GLAND

A.F. CHERNOUSOV, G.H. MUSAYEV, T.V. KHOROBRIKH, A.B. BEKSHOKOV, A.A. TAGAYEVA

Chair of Surgical Faculty No 1. named after N.N. Burdenko Medical Faculty of the I.M. Sechenov First Moscow State Medical University, Moscow,RUSSIA

Purpose: To study the telomerase activity as a universal tumor marker for the differential diagnosis of benign and malignant tumors of the pancreatic gland.

Materials and methods: The study included 16 patients with various tumors of the pancreas.

All patients carried out a comprehensive examination, preoperative biopsy of PG tumors under US-control and during the indications for surgical treatment. At the same time both the pre-operative material, and the tumor removed during surgery in addition to routine histological examination were subjected to determination of telomerase activity (TA, TRAP), reverse transcription and PCR (RT-PCR, expression of telomerase catalytic subunit gene, hTERT).

Identification of telomerase activity in extracts of tissues was performed by TRAP method with some modifications.

Analysis of mRNA expression of telomerase catalytic subunit (hTERT) was performed by the combined reactions of reverse transcription polymerase chain reaction (RT / PCR). Isolation of mRNA was carried out in accordance with the original method, with some modifications.

Results: In the study of tissue samples take by biopsy in 3 patients with benign lesions of the gland, telomerase activity and hTERT expression were not found in any follow-up, with a planned histological examination - a picture of chronic pancreatitis and pancreatic serous cystadenomy of the pancreatic gland.

In malignant lesions picture turned out to be quite different. Study of pancreatic tissue samples of eight patients showed that telomerase activity and hTERT expression were in all in observations which was confirmed by the planned histologic examination - in 3 patients moderately differentiated adenocarcinoma, 1 - intraduct papillary mucinous tumor head of the pancreas (IPMN), with mild dysplasia. Value of the method, is also expressed by the fact that even with carcinoma telomerase activity was increased - in a patient with highly differentiated carcinoid tumor of the duodenum there was identified TA and hTERT expression.

9 patients were deserved special attention in which during puncture biopsy tumors of the pancreas histology did not confirmed the diagnosis of malignancy, although clinical data and instrumental methods of examination with high probability showed malignant nature of the reasons of tumors.

Conclusion: For the first time in our country, there was conducted a study of telomerase activity and expression of its gene in tumor tissue in different neoplasms of the pancreas. The first results obtained in the study were encouraging. The data about significant correlation between the malignancy and presence of telomerase in tumor tissue was obtained.

Date: 2014-12-28; view: 801