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Background/aims: Natural history of renal cell carcinoma includes metastases to the pancreas. The literature reports that selected patients may have benefits by pancreatic resection in terms of long term survival. We report patient outcome and considerations on immunotherapy approach., Methodology: From 2001 to 2010 eight patients underwent pancreatic resection for metastases from renal cancer. We reviewed surgical outcome and following treatment (conventional chemotherapy: 5FU-Vindesine; Immunotherapy: Interleukin 2 - Interferon - Dendritic cells) of these patients., Results: All patients underwent radical pancreatic resection (7 spleno-pancreatectomies; 1 segmental pancreatic resection) and were R0 after surgery. No postoperative mortality was reported. Morbidity was 37% (2 distal leakage; 1 pneumonitis). Two patients did not receive any further treatment; 2 patients received conventional chemotherapy; 2 patients received immunotherapy (interleukin2 + interferon); 2 patients received dendritic cells (DC) interleukin-2 infusion. Three years overall survival rate was 55%. Disease free survival after 3 years was 30%., Conclusions: Our data confirm that pancreatic resection should be offered to selected patients with no mortality and low morbidity. Long-term survival is achievable, but recurrence rate after surgery is high. Immunotherapy could be effective to control tumour progression especially in selected cases where DC may be used.

Background/aims: The aim of this prospective phase II study was to evaluate the effect of neoadjuvant GEMOX plus helical tomotherapy on the resectability of locally advanced pancreatic cancer., Methodology: Between November 2004 and July 2008, 33 enrolled patients received gemcitabine (GEM) 1000 mg/m2 on day 1, and oxaliplatin (OX) 100 mg/m2 on day 2, every two weeks for 3-4 cycles. This was followed by radiotherapy (25 Gy, 5 fractions), 15 days after completion of GEMOX. Patients then received a further 3-4 cycles of GEMOX, underwent restaging and were evaluated for surgery. Potentially resectable patients were submitted to surgery, while unresectable responders received further GEMOX and radiotherapy., Results: Toxicity to GEMOX was similar to that reported elsewhere and radiotherapy was also well tolerated. After treatment, one patient achieved a complete response, 14 had a partial response, 11 showed a stable disease, 6 progressed, and one was not evaluable. Eight patients (24%) underwent surgical laparotomy (7 radical pancreatic resections and one explorative laparotomy)., Conclusions: Our study shows the feasibility and potential efficacy of the GEMOX plus helical tomotherapy regimen in unresectable locally advanced pancreatic cancer.

Background/aims: Extra pleural solitary fibrous are very rare, but occasionally they appear in extraserosal soft tissues or parenchymatous organs, where their diagnosis is often a challenge. In this report we describe the case of a patient with a single primary solitary fibrous tumor of the pancreatic head with a review of the literature., Methods/results: A 62 years old woman underwent a Traverso-Longmire procedure in November 2004. Sixteen months after resection there is no evidence of recurrence. The tumour showed immunoreactivity for CD34, CD99, bcl-2, vimentin and smooth muscle actin. MIB-1 proliferating activity was < 5%., Conclusions: Extra pleural solitary fibrous tumor are often benign lesions. In the pancreas only 2 cases have been described so far. Other mesenchymal tumours that may occur in the pancreas include leiomyosarcoma, tumours of the peripheral nerve sheath, fibrous histiocytic tumours and rare vascular tumours. The differential diagnosis is mainly based on immunohistochemistry. The surgical approach is fundamental for the treatment of solitary fibrous tumour.