Imaging Characteristics and Prevalence of Pancreatic Carcinoma in Kosovo During 2011-2015 - Diagnostic Method as Choice

Abstract

Introduction: Pancreatic cancer is the 10(th)most common malignancy and the 4(th)largest cancer killer in adults.

Aim: The purpose of this paper is to evaluate the number of cases presented with pancreatic carcinoma during the years 2011-2015, our experience of the imaging characteristics of pancreatic carcinoma. We evaluated prevalence of the pancreatic cancers, distant metastases and other local infiltration signs among the total cases of the pancreatic cancers diagnosed in the University Clinical Center of Kosovo, with the aim to compare these research findings to similar studies made in the developed countries. This is a retrospective research study done during the period of 2011-2015.

Materials and methodology: This retrospective research study includes 362 patients recently diagnosed with pancreatic cancer, examined in the period of 2011-2015 at the University Clinical Center of Kosovo. The imaging diagnostics are performed with MSCT Sensation 64 Siemens, MSCT Emotion 6 Siemens, and 1.5T MRI Symphony Siemens, biopsy guide with MSCT Sensation 64 Siemens in the Radiologic Clinic of UCCK; while the histopathology diagnostics has been performed in Clinic of Pathology at UCCK and prevalence is taken from the number of cases Reported at the Institute of Oncology Institute of Statistics and NIPH (National Institute of Public Health of Kosovo).

Results: Out of a total of the 362 patients diagnosed with pancreas cancer, results is female 39.5% (n=143) and male 61.5% (n=219), report M: F (1: 1.6), 286 cases resulted in head and neck 79 % (n=286), 76 cases resulted in body and tail cancers (21%), distant metastases in first imaging modality were found in(n=155) patients 43 %, local infiltration was found in patients: gastric infiltration 15 % (n=54), duodenal and papilla infiltration 26% (n=94), local infiltration spleen 16% (n=57), local infiltration mesentery 43 % (n= 155), dilated biliary tree 34 % (n=123), regional lymph node infiltration 83 % (n= 300). Out of a total of the 362 patients diagnosed with pancreas cancer, 346 cases resulted > 2 cm and 16 cases resulted < 2 cm and with component cystic was 41.2 % (n = 149), solid with component cystic - necrotic 33% (n= 119), solid 25.7% (n= 93). The prevalence is 19.9: 100,000 inhabitants.

Conclusions: Prevalence of carcinoma of the pancreas for 5 years in Kosovo has proved to be prevalence is 19.9: 100,000 inhabitants. Seventy-four percent (74 %, n= 268) of all cancers are found in Stage III and IV. From an imaging point of view, these cancers were presented in an advanced stage, mainly due to their late clinical symptoms and limited access to imaging methods in our country.

Keywords: Distant Metastasis; Kosovo; Local Infiltration; MRI; MSCT; Pancreatic Cancer; Prevalence; UCCK Pristina.

Figure. 1

NCE MSCT (a, b), CE MSCT (c, d) scan of pancreas axial and coronal plane: Expansive process of tail and body of pancreas solid mass with cystic- necrotic component.

Figure. 2

CE MRI of upper abdomen axial plane (a, b): Pancreas tail neoplasm with infiltration of spleen and liver metastases.

Figure. 3

CE MRI of upper abdomen axial plane (a, b, d), tumoral mass lesion body part of pancreas, one satellite lesion is noted laterally in body part, invasion beyond pancreatic capsule, especially posterior-inferiorly and anteriorly. There is impression for splenic vein encasement. Metastases in liver.

Figure. 4

CE MRI of upper abdomen axial plane (a, b, d), tumoral mass lesion head of pancreas extracapsullar. MRCP (d) dilatation of the bile ductus pronounced proximal intrahepatike and liver. DCB obstruction distal level.

Figure 5

CE MRI of upper abdomen axial plane (a),coronal plane (b): The largest tumor lesion in the central structure includes paraaortik region and lies in order intraperitoneal and retroperitoneal. Heterogeneous lesion. Vases blood infiltration of the aorta and proximal part of the VCI. CE MRI of upper abdomen axial plane (c), liver multifocalis metastases with hepatomegali and multiple nodular lesions in the lower lobes of the lung–metastatic shared (d).

Figure. 6

CE MRI of upper abdomen axial plane (a, b): There is tumoral mass lesion located in pancreatic head-body junction level, T2-hyperintense masses lesion in posterior inferior segment of right liver lobe and caudate lobe in lateral segment of liver lobe–metastasis. Pancreatic duct is totally obstructed at pancreatic head level with marked distal dilatation. CBD is coursing just lateral mass lesion and there is no remarkable invasion at this stage. There is extra pancreatic invasion involving superior mesenteric arterial root.

Figure. 7

Percutaneous biopsy of the pancreas MSCT: Axial plane (a) dhe Sagital plane (b): Pancreas body and tail neoplasm with local infiltration of adjacent blood vessel, gastric infiltration and liver metastases. Axial plane (c) dhe Sagital plane (d): Pancreas head and neck neoplasm with local infiltration of adjacent blood vessel, gastric infiltration and liver metastases.

Figure. 8

Histopathological preparations (a, b, c, d) – Histopathologic findings show erythrocyte domination and many clusters of malign epithelial cells. In some microscopic fields tumor cells show lumen obliterations (verified the sample taken for ductal adenocarcinoma).