08-03-2004, 12:04 PM
FYI for all us Mac users out there. I just read this at the MacDirectory website:
Apple CEO Steve Jobs Has Cancer Surgery
Steve Jobs appears to be engaged in a new battle that is far more important than any software or hardware war. This battle is for his health. Reports have just surfaced that Jobs, age 49, is recovering from surgery due to a rare form of pancreatic cancer. According to reports, Jobs wrote an email from his hospital bed informing his Apple employees of his status on Sunday.
Jobs wrote, "This weekend I underwent a successful surgery to remove a cancerous tumor from my pancreas. I had a very rare form of pancreatic cancer called an islet cell neuroendocrine tumor, which represents about 1 percent of the total cases of pancreatic cancer diagnosed each year, and can be cured by surgical removal if diagnosed in time (mine was). [I] will not require any chemotherapy or radiation treatments."
Jobs is expected to return to work at Apple Computer some time in September.
He has my thoughts and prayers.
08-03-2004, 01:52 PM
Background: Pancreatic islet cells are part of the diffuse neuroendocrine system of the gut and pancreatic endocrine system. Islet cells commonly are referred to as APUD cells, a name derived from their high amine content and capacity for amine precursor uptake with decarboxylation.
Tumors of pancreatic islet cells are uncommon. They may manifest as sporadic tumors or as part of syndromes including multiple endocrine neoplasia (MEN type-I) and Von Hippel-Lindau disease (VHL). Islet cell tumors may be functional or nonfunctional; although nonfunctional islet cell tumors are not uncommon at autopsy, most islet cell tumors with clinical manifestations are functional.
Functioning tumors produce a clinical syndrome from their excessive hormone production. Clinical features of the syndrome depend on tumor cell type. Pancreatic islet cell tumors may secrete two or more polypeptide hormones. Functioning tumors usually are small at presentation, and localizing these tumors can be challenging to the radiologist. Hormonal and biochemical parameters are invaluable for skillful interpretation of the imaging and clinical features and to arrive at a specific diagnosis. Nonfunctioning tumors usually are larger and present as a result of effects from their size or metastatic spread.
Prognosis for patients with MEN type-I is usually poor. Islet cell tumors in this group are often multiple and malignant. In patients with MEN type-I and Zollinger-Ellison (ZE) syndrome, surgical cure is usually not possible. However, surgical cure can be achieved in patients with MEN type-I and insulinomas, although recurrences are frequent.
Imaging is used to localize primary and metastatic lesions and to determine resectability or alternative palliative and curative treatment options. This chapter reviews the role of imaging in the management of islet cell tumors.
Pathophysiology: Tumors arising from APUD cells are termed APUDomas. Pearse initially suggested that APUD cells were derived from neural crest cells, although now researchers generally recognize that gastroenteropancreatic APUD cells (including pancreatic islets) probably arise from endoderm. APUD cells contain the enzyme neuron-specific enolase, which is the universal marker for hyperplasia and neoplasia of such cells. Pancreatic islet cell tumors are capable of secreting more than one type of hormone and, as a response to excessive production of a particular hormone, regulatory hypersecretion of other hormones may occur.
Approximately 15-25% of patients with pancreatic APUDomas have MEN type-I syndrome. Good correlation exists between the type of islet cell tumor and the type of hormone produced in excess, although little correlation appears among tumor size, hormone production, and severity of clinical symptoms.
Immunohistochemical staining generally does not allow differentiation between benign and malignant tumors. Recent studies of CD44s have shown some promising results. Endocrine pancreatic tumors express CD44s and isoforms differentially. Imam and coworkers have shown that expressions of two isoforms of CD44s (v6 and v9) seem to be related more to the benign form of the tumor and may serve as a predictor of good prognosis. A recent report on the role of telomerase activity in pancreatic endocrine tumors may be useful to distinguish benign from malignant tumors. The presence of telomerase activation in the tumor predicts malignancy in islet cell tumors.
In the US: Persons with islet cell carcinomas have a better prognosis than those with pancreatic exocrine adenocarcinomas and account for less than 2% of pancreatic cancers in the United States.
Internationally: Sporadic islet cell tumors are more common than islet cell tumors as a part of MEN type-I syndrome. Worldwide prevalence of these tumors is approxi