1/466. A huge pancreatic cystic adenoma misdiagnosed as an ovarian cyst.pancreatic cyst mimicking an ovarian cyst ultrasonographically has not yet been reported. We report an elderly woman with such a huge pancreatic cyst whose initial presentation was low abdominal pain. Ultrasound showed a hypoechoic cyst measuring 13.6 x 13.2 x 11.8 cm occupying pelvic cavity. She received laparotomy under the impression of ovarian cyst. Interestingly, the cyst was found to have originated from the pancreas. Total cyst excision was performed and pathologic report was pancreatic microadenoma. The patient's postoperative course was unremarkable.- - - - - - - - - - ranking = 1keywords = abdominal pain, pain (Clic here for more details about this article) |
2/466. An unusual clinical presentation of pancreatic carcinoma: duodenal obstruction in the absence of jaundice.A case of pancreatic carcinoma, presenting with the uncommon initial manifestation of vomiting secondary to duodenal obstruction without jaundice, is reported. A review of 72 consecutive biopsy-proven cases of pancreatic carcinoma admitted to our institution in the past five years revealed an 8.3% incidence of this unusual primary complaint. Although infrequently reported previously, pancreatic carcinoma should be considered in the differential diagnosis of gastric outlet obstruction in the absence of jaundice. The classic triad of progressive jaundice, weight loss and abdominal pain suggests carcinoma of the head of the pancreas. Emesis, secondary to high grade duodenal obstruction in the absence of jaundice, is an infrequent clinical presentation. The case described is illustrative of widespread pancreatic carcinoma that remained silent until obstruction developed.- - - - - - - - - - ranking = 1keywords = abdominal pain, pain (Clic here for more details about this article) |
3/466. Sclerosing mesenteritis seen clinically as pancreatic pseudotumor: two cases and a review.Sclerosing mesenteritis is an uncommon nonneoplastic inflammatory process in the mesentery that is seen as a pseudotumor, usually involving the small bowel mesentery, the mesenteric fat, and less commonly, the mesentery of the large bowel. We report two cases of sclerosing mesenteritis and review the literature on this rare disease. Both patients had pain, profound weight loss, and a mass on computed tomography (CT) scan of the abdomen. The provisional diagnosis was pancreatic neoplasm on the basis of clinical presentation and imaging studies. The diagnosis of sclerosing mesenteritis was established by histologic findings in biopsy material obtained at laparotomy in both cases. Interval histologic studies in one patient who had a high CA 19-9 level, progressive biliary ductal and partial duodenal compression, revealed a transitional histologic pattern from predominant inflammation and fat necrosis to predominant fibrosis. This may explain the varied descriptive terms used in the literature to describe this entity.- - - - - - - - - - ranking = 0.11976059604791keywords = pain (Clic here for more details about this article) |
4/466. Resection of triple synchronous cancers: a case report.We herein present a case of synchronous triple cancer, which was successfully resected in a curative manner. These cancers consisted of primary duodenal, pancreatic and lung cancers, which were diagnosed in an asymptomatic 74 year-old male, who was referred to our department on December 14, 1996. On admission, his laboratory data showed no abnormality, including tumor markers (CEA 1.0, CA 19-9 1.0, AFP 8.1 U/ml), but he did show an impaired pulmonary function (FEV1.0: 57%). Upper gastrointestinal endoscopy showed a smooth surfaced duodenal tumor measuring 4 cm in size. The second tumor was found at the head of the pancreas by computed tomography (CT), showing a hypervascular mass measuring 3.0 cm, along with neighboring multiple cysts. In endoscopic retrograde cholangiopancreatography (ERCP), marked mucous secretion was observed through the papilla, while a filling defect was found in the dilated pancreatic duct. In a routine chest X-ray, a third tumor, which measured 1.5 cm in diameter, was recognized in the right upper lobe of the lung, and a moderately differentiated squamous cell carcinoma was also detected by a percutaneous CT guided biopsy. The pancreatic and duodenal tumors were surgically resected by a pancreatoduodenectomy (Stage I) in January 1997 and, 5 months later, a lung tumor underwent partial resection (Stage I). This patient tolerated these surgical procedures well and presently leads a normal, healthy life after discharge. In summary, a successful resection of synchronous triple cancers, which has never been previously reported in this specific combination, is described.- - - - - - - - - - ranking = 0.017286971209434keywords = upper, chest (Clic here for more details about this article) |
5/466. Benign pancreatic tumor treated with duodenum-preserving resection of the head of the pancreas. Case report.Cystic neoplasms of the pancreas constitute about 9% of all cystic lesions of the pancreas and less than 1% of all pancreatic neoplasms. Authors report the case of a 70 year-old woman with microcystic cystadenoma. Computed tomography (CT) scan of the abdomen diagnosed a 5 cm multilocular septated cyst, with calcifications in the context, localized in the head-uncinate process of the pancreas. The mass was well separated by a sharp cleavage plane with portal vein and superior mesenteric vessels. An endoscopic retrograde cholangiopancreatography (ERCP) showed cephalic symmetrical stenosis (diameter: 3 mm) of the main pancreatic duct (MPD), mildly dilated in the remaining tract (diameter: 6 mm). An intra-operative biopsy of the cystic wall had been performed. Therefore, it was decided to proceed with a duodenum-preserving resection of the head of the pancreas (DPPHR), including stenosis tract of the MPD in the surgical specimen. The reconstructive procedure consisted, by i.v. jejunal loop transposition, of a side-to-side pancreatico-jejunostomy, including in the anastomosis both corpocaudal stump and the resection cavity of the pancreatic head, and an end-to-side Roux-en-Y jejuno-jejunostomy. With respect to long-lasting pain relief and preservation of the endocrine and exocrine functions of the pancreas, duodenum-preserving resection of the head of the pancreas is a highly effective surgical procedure with low early and late morbidity and mortality due to limited surgical resections. This technique, introduced into surgical practice in 1972 by Beger, is indicated in patients with chronic pancreatitis with an inflammatory mass in the head of the pancreas. The authors conclude that this procedure can also be performed in cases of pancreatic benign tumors, such as microcystic cystadenoma. Advantages of this technique make DPPHR an attractive alternative to pylorus-preserving pancreatico-duodenectomy (PPPD).- - - - - - - - - - ranking = 0.11976059604791keywords = pain (Clic here for more details about this article) |
6/466. Pancreatic cystic neoplasms.Cystic neoplasms of the pancreas are relatively rare. This makes the evaluation and treatment of these tumors widely varied. The authors describe a patient who came to our hospital with complaints of abdominal pain, but no other related symptoms. Diagnostic evaluation of the patient yielded normal results, except for inspection and palpation of the abdominal areas, which revealed a large epigastric mass; this finding was confirmed subsequently by ultrasonographic examination and computed tomographic scanning. This article presents the case and reviews the literature, specifically related to diagnosis and current treatments.- - - - - - - - - - ranking = 1keywords = abdominal pain, pain (Clic here for more details about this article) |
7/466. Pancreatic head cystadenoma: a case report.An 18 year-old resident of Zagreb was admitted to our hospital with intermittent pain in the right subcostal region. On examination, a palpable resistance was found in the upper abdomen. After extensive clinical and laboratory tests, a tumor of the pancreatic head, 80-85 mm in diameter, was verified. Cytologically, a diagnosis of microcystic adenoma of the pancreas was established. The patient underwent a cephalic pancreatoduodenectomy with preservation of the pylorus. Six months later the patient was no longer on a diet and, at follow-up, 3 years after surgery, she is symptom-free and feeling well.- - - - - - - - - - ranking = 0.13613308091129keywords = pain, upper (Clic here for more details about this article) |
8/466. Clinical evaluation of three-dimensional MR-cholangiopancreatography using three-dimensional Fourier transform fast asymmetric spin echo method (3DFT-FASE): usefulness of observation by multi-planar reconstruction.MR-cholangiopancreatography (MRCP) is a new method that is non-invasive and permits volume data collection and three-dimensional expression. With the three-dimensional Fourier transform fast asymmetric spin echo (3DFT-FASE) method, a higher spatial resolution can be obtained both in-pain and in slice selecting direction. In this paper, the usefulness of this new technique is investigated in the clinical diagnosis of MIP images and MPR. The study was performed in 10 normal volunteers and 21 patients with abnormalities in the pancreas or bile-duct sustem. The study was done using a 1.5 Tesla super-conductive machine. The MRCP images were interpreted by three radiologists. In most cases good images were obtained. The additional clinical information provided by MPR was remarkably useful in cystic lesions, especially in mucinous cystic neoplasm of the pancreas. Even when the intestine overlapped the pancreas, it was possible to evaluate the pancreatic duct by MPR. Three-dimensional observation and clinically useful diagnosis were possible by utilizing the advantageds of the 3DFT-FASE method appears quite useful in clinical application.- - - - - - - - - - ranking = 0.11976059604791keywords = pain (Clic here for more details about this article) |
9/466. anxiety symptoms and panic attacks preceding pancreatic cancer diagnosis.Cancer of the pancreas is a highly malignant disease with a very poor prognosis. depression and anxiety occur more frequently in cancer of the pancreas than they do in other forms of intra-abdominal malignancies and other cancers in general. Yet, the etiology of psychiatric symptoms in patients with cancer of the pancreas may not be traced solely to poor prognosis, pain, or existential issues related to death and dying. In as many as half of patients that go on to be diagnosed with the disease, symptoms of depression and anxiety precede knowledge of the diagnosis. This observation has raised speculation that mood and anxiety syndromes are related to disruption in one of the physiologic functions of the pancreas. In this paper, we present a patient who had no prior psychiatric history and developed panic attacks just prior to diagnosis of her cancer. To our knowledge, this is the first report in the literature where panic attacks, not simply anxiety, presented prior to a pancreatic cancer diagnosis. Her symptoms resolved following resection of the tumor. Implications of such phenomena for the diagnosis and treatment of anxiety and depression in pancreas cancer are discussed.- - - - - - - - - - ranking = 0.11976059604791keywords = pain (Clic here for more details about this article) |
10/466. Squamous cell carcinoma and lipomatous pseudohypertrophy of the pancreas.A 68-year-old woman who had been treated for non-insulin-dependent diabetes mellitus for the past 20 years was admitted to hospital because of abdominal pain and weight loss. Radiological investigation revealed a tumour in the body of the pancreas and numerous intraductal calcifications in both the tail and the head of the pancreas. Left-sided pancreatectomy was performed to remove the tumour. The resection specimen showed fatty enlargement of the parenchyma and numerous intraductal calcifications in the tissue adjacent to the tumour, which was 7 cm in diameter and was found to be a primary squamous cell carcinoma with a spindle cell component. There was also lipomatous pseudohypertrophy.- - - - - - - - - - ranking = 1keywords = abdominal pain, pain (Clic here for more details about this article) |
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