Analysis Of Diagnosis And Treatment Of 22 Cases Of Common Pancreatic Malignant Tumors In Children

Background and Objective Pancreatic malignancies are rare in children and adolescents.Over the past 30 years,a total of 228 people have been admitted to the National Cancer Center in pediatric hospitals in the United States.In the past 30 years,the British National Medical Statistics Agency registered a total of 41 cases of pediatric pancreatic malignancies.And over the past 10 years,the Italian Clinical Rare Tumor Statistics Project(TREP)has registered a total of 21 patients with pancreatic malignancies under the age of 18.Although pancreatic malignant tumors in children are rare,they are classified into various types,including exocrine epithelial tumors and endocrine epithelial tumors,as well as non epithelial tumors as well as other malignant tumors.The malignant tumor of the pancreas in children and adolescents is mainly composed of pancreatic tumor,pancreatic acinar cell carcinoma,solid pseudopapillary tumor of pancreas,pancreatic endocrine tumor and pancreatic leiomyosarcoma.Due to the extremely low incidence of disease,single disease analysis is less than the number of cases and can not get their common characteristics,it is suggested by foreign research institutions that need international cooperation to learn more about the information of children with pancreatic cancer.At present,there are few reports of pancreatic malignant tumors in children,and the research is also far behind the malignant tumors of the pancreas in adults.Therefore,most of the clinical departments are lack of knowledge about this kind of disease,which is easy to be misdiagnosed.In this study,the history,physical signs,laboratory and imaging examinations,surgical methods and pathological results of 22 cases were reviewed and analyzed.To sum up the experience to improve the understanding of pancreatic cancer.Methods In this paper,by collecting and retrospectively analyzing the clinical data of 22 children with pancreatic malignancy in the pediatric surgery and hepatobiliary surgery of the First Affiliated Hospital of Zhengzhou University from January 2007 to January 2017,The clinical data of the children and adolescents in the Department of pediatric surgery and Department of hepatobiliary surgery in the First Affiliated Hospital of were collected and analyzed retrospectively.These data include hepatobiliary renal ultrasonography,abdominal CT scan,tumor markers,blood routine examination,C-reactive protein,liver and kidney function,blood coagulation and infectious disease screening tests,and the characteristics of the disease,the age of onset,location,surgical procedure,postoperative chemotherapy etc.The 22 cases of children and adolescents after the completion of the examination were performed in parallel with pathological examination,the diagnosis was clear.Postoperative follow-up by outpatient visits,telephone counseling and other means to review the request: in the first year after surgery in every 2 months by 1 times of abdominal ultrasound and tumor markers,every 3 months by 1 times enhanced abdominal CT;if the indicators of the first year are no exception,then second years time to check every 4 months the 1 time ultrasound and tumor markers,every half year review of 1 abdominal enhanced CT,three years without abnormal change of annual review 1.The main understanding of children with or without special discomfort,to understand whether there is recurrence and complications.The data of 22 cases of pediatric and adolescent pancreatic malignancies were classified according to sex,age,tumor location,morbidity,peripheral tissue infiltration,chemotherapy,operation and malignancy.The data were analyzed by SPSS21.0,The difference of survival rate between different groups was tested by Fisher exact test,and the Cox proportional hazards regression model was used to analyze the difference between the two groups.The difference was statistically significant(P <0.05).Results There are 9 cases of teenagers of the 22 patients(41%)suffering from pancreatic solid pseudopapillary tumor(SPPN),6 cases(27.3%)had pancreatoblastoma(PBL),2 cases(9.1%)suffering from pancreatic acinar cell carcinoma(PAAC),2 cases(9.1%)suffering from pancreatic endocrine tumors(insulinoma and the gastrin tumor),1 cases(4.5%)suffered from pancreatic transverse sarcoma(PLMS),1 cases(4.5%)suffered from pancreatic mucinous cystadenoma(MCN),1 cases(4.5%)suffering from pancreatic lymphoma(PPL).Of the 22 children,age ranged from months to 17 years(mean age of 9.13± 4.95).The location of the tumor was in 7 cases of pancreatic head,in the body of pancreas in 1 cases,in the body and tail of pancreas in 7 cases,in the tail of pancreas in 6 cases,in the presence of multiple lesions in the pancreatic neck and tail of pancreas(n = 1).Among the 22 cases,11 cases with abdominal mass were found,5 cases of children in the hospital with symptoms of abdominal pain,4 cases of children in the hospital were fatigue symptoms,2 cases of children admitted to hospital with symptoms of anemia,3 cases of children admitted to hospital with jaundice.Perfect the relevant examination after admission,imaging examination showed abdominal mass,tumor sizes,shapes,mostly round or oval,maximum diameter between 25mm-160 mm,multiple cystic,solid areas visible slow enhancement,visible calcification.The quality is hard,the surface is not smooth,the activity is low,and the incision is more cystic.After examination of 5 patients with invasive tissue surrounding the tumor,5 cases underwent resection(3 cases of pancreatic tail tumor and spleen resection,1 cases underwent extended pancreaticoduodenectomy(not pylorus preserving pancreatic tail tumor),1 cases underwent splenectomy and left kidney),1 cases of pancreatic twelve rectum excision and peripheral adipose tissue removal;the remaining 17 cases had no obvious infiltration,5 cases underwent pancreaticoduodenectomy,12 cases underwent tumor resection.The postoperative routine pathological examination,diagnosis of solid pseudopapillary tumor of the pancreas in 9 cases,6 cases of pancreatic tumor,2 cases of pancreatic acinar cell carcinoma,2 cases of pancreatic endocrine tumors,1 cases of pancreatic mucinous cystadenoma,1 cases of pancreatic rhabdomyosarcoma,1 cases of pancreatic T lymphoblastoid cell tumor.Among them,7 cases were treated with chemotherapy.Of the 22 patients were followed up to 20 cases of effective information,the follow-up rate was 91%.The follow-up time from January to 108 months,the average follow-up(29.27 ±3.56)months,evil group 7 cases died,3 cases survived,1 cases of low malignant metastasis;1 cases died,1 cases were lost,10 patients survived,including 1 cases of recurrence,1 cases of postoperative pancreatic fistula,1 cases of postoperative pancreatic pseudocyst formation.To summarize the above indexes,the five-year survival rates were analyzed from the age,the site of onset,the symptoms of the disease,the presence or absence of infiltration of the surrounding tissue,the mode of operation,the presence or absence of chemotherapy,and the following results: 1.The five-year survival rate of adolescent children(?12 years)was statistically significant compared with the five-year survival rate of other patients,and the 5-year survival rate was 87.5% for patients younger than 12 years old,higher than others Group of patients;2.Female pancreatic malignancy accounted for 63.6% of children,male accounted for 36.4%,female mortality accounted for 42.9%,male mortality accounted for 62.5%;3.According to pathological results suggest that the degree of malignancy classification.The 5-year survival rates were 0% and 91.7% in the highly malignant group and the low-grade group,the difference was statistically significant(p <0.05).The five-year survival rate of children with malignant group was lower than that of low-grade children.4.The 5-year survival rate was 0% in the chemotherapy group and 73.3% in the non-chemotherapy group.The five-year survival rate of the chemotherapy group was lower than that of the chemotherapy group The difference was statistically significant(p <0.05).This result may be associated with a high degree of malignancy and chemotherapy and other side effects of drug and other factors;5.There were no significant differences in the five-year survival rate of different parts,different symptoms,infiltration and different surgical methods,indicating that the prognosis of children with pancreatic tumors was not affected by such factors.Conclusion 1.Age can be used to determine the degree of malignancy and prognosis of children with adolescent pancreatic malignancy: the younger(? 6 years old),the greater the risk of high risk of malignant tumors,poor prognosis;older(? 12 years old,? 18 years),Suffering from low risk of malignant tumors,the prognosis is good.2.Pancreatic cancer in children with high incidence of pancreaticoblastoma;adolescent pancreatic cancer patients prone to Solid pseudopapillary tumor.3.Pediatric and adolescent pancreatic malignancies,the incidence of women is high,but the 5-year survival rate higher than men;4.There were no significant differences in the five-year survival rate between different symptoms and different parts and different surgical methods in pediatric and adolescent pancreatic malignancies.