Dramatic Pancreatic Duct Strictures Secondary to Small Endocrine Neoplasms: A Manifestation of Serotonin Production?
C Shi, SS Siegelman, S Kawamoto, CL Wolfgang, RD Schulick, A Maitra, RH Hruban. Johns Hopkins School of Medicine, Baltimore, MD
Background: We observed six pancreatic endocrine neoplasms (PENs) associated with stenosis of the pancreatic duct out of proportion to the size of the tumors on computed tomography (CT). In this study, we attempted to elucidate if serotonin production by PENs is associated with this pattern of pancreatic duct stenosis.
Design: Clinical presentations and radiographic findings of these six patients were reviewed. Gross findings and histology of the resected pancreata were also assessed. Formalin-fixed, paraffin-embedded tumor sections were immunolabeled with an antibody to serotonin. Tissue microarrays constructed from 47 PENs in our bank were used as control. Histology and serotonin immunoreactivity were compared between the two groups.
Results: Four of 6 PENs with associated pancreatic duct stricture had prominent stromal fibrosis. Serotonin immunoreactivity was present in 5 cases (5/6, 83%), and this labeling was very strong and diffuse in the 4 cases with prominent fibrosis. By contrast, stromal fibrosis was minimal in the non-immunoreactive case. Only 3 of 47 control PENs (6%) were immunoreactive for serotonin (P<0.01, X2 test).
Conclusions: These data suggests that serotonin produced by PENs may be associated with local fibrosis and stenosis of the pancreatic duct. Clinicians should be aware that small PENs can produce pancreatic duct stenosis resulting in dramatic ductal dilatation and/or upstream pancreatic atrophy out of proportion to the size of the tumor.
Category: Liver & Pancreas
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 216, Tuesday Afternoon