1/86. Solid-pseudopapillary tumor of the pancreas--a rare and frequently misdiagnosed neoplasm.INTRODUCTION: We describe a young woman with an unusual pancreatic tumor. FINDINGS AND DISCUSSION: Intraoperatively, a smoothly demarcated and encapsulated tumor was exposed. It was large (5 cmx4 cm) and of solid consistency, with a small stalk attached to the uncinate process. The tumor was partially surrounded by the pancreatic head. The macroscopic appearance suggested a benign tumor. frozen sections revealed a benign pancreatic tumor, most likely of endocrine nature. Based on these findings, tumor enucleation was performed. The patient recovered rapidly from the intervention and was discharged from hospital after 2 weeks. One year after surgical treatment, the patient is without recurrence. The final diagnosis of the tumor was a solid pseudo-papillary tumor.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/86. cholecystitis caused by hemocholecyst from underlying malignancy.Massive hemobilia is a well recognized clinical entity, particularly when it presents with jaundice, GI bleeding, and biliary pain. However, occult hemobilia is more difficult to diagnose and has seldom been reported because of its clinically silent nature. In fact, this is usually overlooked until complications arise. Hemocholecyst or clot within the gallbladder may rarely occur in this setting, leading to cystic duct obstruction and cholecystitis. Most previous reports describe cholecystitis resulting from hemocholecyst after iatrogenic trauma. We describe two cases in which hemocholecyst occurred from underlying malignancies, both resulting in cholecystitis (acute or chronic).- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/86. Pitfall of the accessory spleen.Two patients, one with insulinoma and one with Cushing's syndrome, are presented. Biochemical evaluation readily suggested the correct diagnosis. During radiologic imaging, the anatomic abnormality giving rise to these diseases, i.e. a pancreatic islet cell tumor, and an adrenal adenoma, at first were mistakenly interpreted as an accessory spleen on the basis of specific computed tomography and magnetic resonance imaging appearances. The insulinoma was identified as such during laparotomy, whereas additional jodo-cholesterol scintigraphy revealed the real nature of the lesion in the patient with Cushing's syndrome. Both patients were operated successfully.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/86. Pancreatic vasoactive intestinal polypeptide-oma as a cause of secretory diarrhoea.A 42-year-old woman presented with a 4-year history of worsening diarrhoea that was watery, profuse and confirmed to be secretory in nature. She had tested positive for phenolphthalein on urinary laxative screening but continued to deny laxative usage. Her vasoactive intestinal polypeptide (VIP) level was subsequently found to be markedly elevated. Despite a normal abdominal ultrasound, a computed tomography scan revealed a 5-cm pancreatic tail mass. octreotide scanning was used to exclude metastatic disease and she went on to have surgical removal of a localized pancreatic vasoactive intestinal polypeptide-oma which resulted in the complete resolution of her diarrhoea.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/86. Intraoperative cytodiagnosis of metastatic brain tumors confused clinically with brain abscess. A report of three cases.BACKGROUND: Cystic lesions of the brain may have diverse etiologies, ranging from true cysts to malignant tumors with cystic degeneration. Preoperative determination of the exact nature of them as well as intraoperative diagnosis may be sometimes difficult or even impossible. sensitivity and specificity of diagnosis will be improved by introducing new methods or combining traditional procedures. CASES: Three metastatic brain carcinomas with primary sites of breast, pancreas and prostate presented as cystic lesions and were confused clinically with abscess. Intraoperative frozen section was not revealing. Cytologic study of sediments of aspirated fluid uncovered malignant cells. CONCLUSION: When combined with frozen section, intraoperative cytologic studies in the form of crush preparation, fine needle aspiration or evaluation of aspirated fluid in cystic lesions (as in our cases) can improve diagnostic accuracy by detecting important diagnostic features that otherwise may be missed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/86. FNAC of papillary and solid epithelial neoplasm of pancreas--a case report.A case of solid papillary epithelial neoplasm (PSEN) of pancreas in a young woman is reported in which the nature of tumour was recognised pre-operatively by ultrasound guided Fine needle aspiration. The pre-operative cytologic diagnosis enabled prompt and appropriate surgical treatment. FNAC revealed large cell clumps in the aspirate showing branching papillary appearance in which multiple layers of tumour cells surrounded central vascular stalks. The above was confirmed on histopathological examination of the excised tumour tissue.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/86. Lessons to be learned: a case study approach: ascites and elevated serum CA 125 due to a pancreatic carcinoma. A diagnostic dilemma.A 72 year-old lady with unrecognised cancer of the body of the pancreas presented with a 4-month history of progressive loss of weight and ascites. The results of laboratory investigations were either negative or within normal limits--apart from a raised serum CA 125 level; no tumour mass was detected on diagnostic imaging. She underwent exploratory laparotomy for a suspected ovarian tumour, but this proved not to be the correct diagnosis. A serum CA 19-9 level was subsequently requested and found to be significantly raised; a second contrast CT scan then showed the presence of ill-defined peri-aortic tissue. A further exploratory laparotomy was carried out in order to establish the true nature of the problem; a large pancreatic carcinoma was revealed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/86. CT halo sign in pulmonary metastases from mucinous adenocarcinoma of the pancreas.The CT halo sign was first described in immunocompromised patients with invasive pulmonary aspergillosis. Although the halo sign was originally thought to be specific for invasive pulmonary aspergillosis, it has been reported in a wide variety of pulmonary abnormalities in both immununocompromised and immunocompetent patients. We report a case of mucinous adenocarcinoma of the pancreas metastatic to the lungs in which there were multiple pulmonary nodules showing the halo sign. This case further illustrates the nonspecific nature of the CT halo sign and the need to consider malignancy as a cause in immunocompetent patients.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/86. insulinoma of the pancreas with insular-ductular differentiation in its liver metastasis--indication of a common stem-cell origin of the exocrine and endocrine components.We describe an insulinoma of the pancreas in a 56-year-old patient, which showed insular-ductular differentiation in its liver metastasis. Although the primary tumor was uniformly endocrine in nature with insulin production, the metastasis contained two distinct cell types in organoid arrangement. One cell type was insulin-positive and was arranged in islet-like structures; the other was insulin-negative but distinctly pan-cytokeratin and cytokeratin 7 positive and arranged in ducts. In the primary tumor and the metastasis, the tumor cells were surrounded by a desmoplastic stroma. As to the histogenesis of the tumor and its metastasis, we discuss the following possibilities: (1) the tumor cells might derive from a common stem cell that matures into two phenotypically different cell lines, resembling the situation in embryogenesis and (2) one tumor cell type originates from the other by transdifferentiation (metaplasia). We conclude that the parallel occurrence of endocrine and ductal differentiation supports the concept that, under certain conditions, islet cells and ductular cells may also originate from islets and that mixed endocrine/exocrine pancreatic tumors do not necessarily arise from totipotent duct cells but might also have a primary endocrine cell origin.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/86. Functioning acinar cell pancreatic carcinoma: diagnosis on mangafodipir trisodium (Mn-DPDP)-enhanced MRI.We describe the imaging findings of a functional pancreatic acinar cell carcinoma in a patient who presented with weight loss, hyperlipasemia, and multiple foci of subcutaneous fat necrosis. The tumor invaded the adjacent splenic and portal vein, causing isolated left-sided portal hypertension. At MRI, the tumor showed marked enhancement following administration of the hepatobiliary-specific contrast agent mangafodipir trisodium (Mn-DPDP), thereby demonstrating the functional nature of the tumor. Avid uptake of Mn-DPDP by a functioning pancreatic tumor has not been reported in the radiology literature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
| | Next -> |