Week 2 of Summer Immersion - Harry Peng

This week I have shadowed a PhD student from Dr. Rohit Chandwani's lab on mouse pancrease excision and a postdoc on mice pancreas ultrasound imaging. It was first difficult for me to recognize anything from the ultrasound images. However, after checking on a dozen of mice, I was able to recognize all the major abdominal organs (spleen, intestine, stomach, kidney, and of course the pancreas) and locate the tumor mass on the pancreas.

Same as last week, I also shadowed Dr. Chandwani on his clinics. One of the patients he just operated on 2 weeks ago came back for the followup appointment. He mainly checked on the patient's food and liquid intake and answered any questions from the patient and the family. Normally, the patient needs sometime to recover from the surgery before chemotherapy (about 6 weeks) because the chemotherapy will put more stress on the body and have a lot of adverse effects. From the lymph node smaples taken from the patient, only one out of 17 lymph nodes presented tumor metastasis, which is pretty promising. The tumor was 1 inch in diameter. Extra healthy tissue (1cm) was removed together with the tumor mass to make sure the margin is negative of tumor tissue. This is an interesting case because tumor mass was not seen in the scan. The location of the tumor was logically deduced from the dilated distal pancreatic duct causing pancreatitis. When part of the duct was dilated, it is highly likely that some mass is blocking the duct, which is also the location of the tumor.

Another patient came back for MRI on the pancreas cyst. The cyst has the possiblity of developing into IPMN (Intraductal Papillary Mucinous Neoplasm). IPMNs are important because some of them progress to invasive cancer if left untreated. Most IPMNs will never progress to a cancer, and it can be safe to observe (rather than treat) those IPMNs that don't progress. The challenge for clinicians is to determine which IPMNs need to be removed surgically and which IPMNs can be safely observed.

The cyst might also develop into PanIN. A PanIN is a microscopic (usually <5 mm) flat or papillary lesion arising in the small intralobular pancreatic ducts. The cyst will be removed depending on a series of factors, one of which is the size (>3cm). We need better mice model to study the progression and development of IPMN/PanIN into pancreatic cancer.

pancreatic ductal cell --> IPMN

pancreatic acinar cell --> PanIN

The last case is a hard case. The patient has a mass by the pancreas but hard to identify what it is. Neither biopsy nor imaging resutls suggests malignancy. Since it would still be removable even growing a bit larger, the patient was told to come back in 6 week for CT scans to check on the progress of the mass.

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