Catalytic efficiency of expressed aromatase following site-directed mutagenesis

A solid and cystic tumor (SCT) of the pancreas occurring in a 35-yr-old male is reported. Cut sections of the specimen revealed a solid, ill-defined mass measuring 2.5 x 2.3 x 2.0 cm, without cystic or necrotic changes. Histologically, the solid tumor consisted of small, round acidophilic cells invading the surrounding pancreatic parenchyma. The tumor cells were positive for alpha-1-antitrypsin and neuron-specific-enolase. Ultrastructural studies revealed clear nuclei with no zymogen, but immature secretory granules in the cytoplasm of the tumor cells, which had a junctional complex-like structure. These findings were consistent with the so-called solid and cystic tumor of the pancreas. There was neither a capsule surrounding the tumor nor a papillary structure, known to be characteristic findings of the SCT tumor. The small tumor reported in the present article might represent an early-stage SCT of the pancreas.     

Ultrasonographic findings of diseases in peripheral lung fields using transtracheobronchial endoscopic ultrasonography (TUS)

Cystic neoplasms of the pancreas constitute about 9% of all cystic lesions of the pancreas and less than 1% of all pancreatic neoplasms. The case of a 70 years-old woman with microcystic cystadenoma is reported. 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 ERCP showed cephalic symmetrical stenosis (diameter 3 mm) of the main pancreatic duct (MPD), mildly dilated in the remaining tract (diameter 6 mm). An intraoperative biopsy of the cystic wall was performed. Therefore, it was decided to proceed with a duodenum-preserving resection of the head of the pancreas (DPPHR), including the stenosis tract of the MPD in the surgical specimen. The reconstructive procedure consisted, by i.v. jejunal loop transposition, in 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, DPPHR is a highly effective surgical procedure with a low early and late morbidity and mortality due to limited surgical resection. This technique, introduced into surgical practice 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 be performed also in case of pancreatic benign tumors, as microcystic cystadenoma. Advantages of this technique makes DPPHR an attractive alternative to Pylorus-Preserving-Pancreatico-Duodenectomy (PPPD).     

Finite element stress analysis of stress distribution endodontic posts at shoulder

Pancreatic tuberculosis is rare and may present differential diagnostic problems, specially with cancer of the pancreas. An immunocompetent patient with a pancreatic tuberculous abscess whose clinical manifestations were epigastric pain and a toxic syndrome of one month of evolution is presented. A cystic mass was detected on computerized axial tomography in the tail of the pancreas suggestive of irresectable carcinoma because of vascular invasion with negative percutaneous cytologic puncture for malignant cells. The patient was surgically treated with no histologic confirmation of malignancy. A second laparotomy was performed at 6 months since spontaneous size reduction, external pancreatic fistula with miliary peritoneal dissemination and biopsy compatible with tuberculous granulomas was found. Staining for resistant acid-alcohol bacilli were always negative. Medical treatment achieved complete disappearance of the pancreatic tumor in one year.     

Mucinous biliary obstruction associated with a cystic adenocarcinoma of the pancreas

Obstruction of the biliary tree by large amounts of mucinous material is reported in a patient with a mucin-producing cystic adenocarcinoma of the pancreas invading the common bile duct. Although preoperative endoscopic retrograde cholangiography suggested bile duct invasion, mucinous obstruction, as in the previous cases in which it has been reported, was not suspected. Mucinous obstruction, although unusual, should be considered in patients with cystic carcinomas of the pancreas in the presence of jaundice or episodes of cholangitis.     

Acute myocardial infarction in a young woman with systemic lupus erythematosus

A 49-year-old diabetic patient with abdominal pain was found upon ultrasonography and computed tomography to have a cystic mass in the head of the pancreas with dilation of the main pancreatic duct. The head of the pancreas and duodenum were removed surgically. Examination of the operative specimen showed chronic pancreatitis, dilation of the main pancreatic duct, and impacted mucus in the secondary ducts with villous proliferation of the ductal epithelium, establishing the diagnosis of intraductal adenomatosis. There was no evidence of malignancy. The resection margin was involved, and consequently the remainder of the pancreas was removed six months after the initial surgical procedure. A review of the literature showed that intraductal adenomatosis tends to spread and carries a high risk of malignant transformation. Surgery is required because of the risk of pancreatic duct obstruction and pancreatic cancer. Intraductal adenomatosis of the pancreas shares many characteristics with other adenomatous proliferations of the gastrointestinal tract (colorectal villous adenoma, bile duct adenomatosis), including presence of villous structures with increased mucus production, a tendency to spread massively, and a high risk of malignant transformation.     

胰腺实性假乳头状瘤的CT征象分析

Objective: The aim of our study was to demonstrate the CT features of solid pseudopapillary tumor of the pancreas (SPTP) so as to improve the imaging diagnostic abilities. Methods: The CT materials of 10 cases with surgery andpathology proved SPTP were retrospectively analyzed, including 8 females and 2 males, their age ranged from 12 to 54years (average being 27.2 years). All of the 10 cases underwent spiral CT scan and also with contrast enhancement before surgery. Results: All of the 10 cases were isolated mass. They were located at the head (n = 5), tail (n = 4), and body (n =1) of the pancreas. Their shapes were round (n = 3), oval (n = 4), and irregular (n = 3). The long-axis diameter ranged from 2.1-8.6 cm (mean 6.5 cm). All of neoplasms consisted of solid and cystic components. Mostly solid components in 5 cases,nearly the same proportion of solid and cystic part in 3 cases, and mostly cystic components in 2 cases. After dynamic contrast-enhanced, the solid parts of the lesion showed progressive enhancement and the cystic parts of the lesion showed no enhancement. Calcification was noted in 5 cases, such as the spot, line-like, small nodules or patchy calcification. Fluiddebris level and "floating cloud" sign were noted in one case. In one case of mostly cystic components, patchy area of high attenuation were shown on CT imaging which then was proved as old hemorrhage by pathologic evaluation. Seven cases were completely encapsulated and made more remarkable on post-contrast images. Three cases had incomplete capsules,and adhesion to the surrounding tissues could be seen during operation, including one case in which invasion to the adjacent adipose tissues near the inferior vena cava and walls of the duodenum could be seen under the microscope. Pancreatic duct broadening or hepatic duct dilatation was caused by tumor each in 1 case. All of the 10 cases had no enlargement of the intra-abdominal lymph nodes or distant organ metastasis. Conclusion: SPTP occurs mainly in young women and has comparatively characteristic CT imaging features: a large solid and cystic tumor of pancreas, sharp edges, the solid parts of the lesion showed progressive enhancement, a few with hemorrhage and calcification.     

Diffuse plane xanthoma: clinicopathologic study of 8 cases

We report a 17-year-old woman who had two synchronous solid and cystic tumors of the pancreas (SCTP) detected by abdominal echography and computed tomography. There was a 6 x 5 cm mass in the pancreatic body and a 3 x 3 cm mass in the tail, with the two lesions being separate. No distal metastases were detected. The resected tumors consisted of solid and cystic components and both were well demarcated with fibrous capsules. The larger tumor was predominantly solid and the smaller one was mostly hemorrhagic. On microscopy, the tumor cells were small, eosinophilic, and arranged, in part, like pseudorosettes. The tumor cells were immunohistochemically positive for alpha-1 antitrypsin, neuron-specific enolase, and synaptophysin. The final diagnosis was SCTP arising synchronously and independently at two sites. As far as we know, only one case of multicentric SCTP has been reported previously. Local recurrence of SCTP suggests the possibility of multicentric occurrence, and we believe that reports of such cases may increase in the future with advances in echography and computed tomography.     

Benign retroperitoneal schwannoma mimicking a pancreatic cystic tumor: case report and literature review

A rare case of benign retroperitoneal schwannoma mimicking a pancreatic cystic tumor is reported herein. The tumor mass, based on a computed tomography scan and an abdominal echo examination, was initially suspected to be a mucinous cystadenoma or cystadenocarcinoma of the pancreas. However, the surgical and pathohistological findings made a final diagnosis of benign pancreatic schwannoma. The patient is doing well at a 2-year follow-up. The tumor, 18x17x15 cm in size, represented the largest among reported pancreatic schwannomas. Furthermore, a comprehensive review of reported cases of pancreatic schwannoma was carried out to summarize corresponding findings, including benign or malignant forms, adherence to other tissues, cystic change of the tumor, as well as relation to von Recklinghausen's neurofibromatosis.     

The schwannoma: an uncommon type of cystic lesion of the pancreas

Schwannomas of the pancreas are rare and their number is lower than is usually reported in the literature since some were probably neurofibromas. We report a further case characterized by cystic feature, clinically mimicking a pancreatic pseudocyst. Cystic lesions of the pancreas also comprise the schwannomas, both benign or malignant, as has been previously reported and is stressed by the present case. Cyst formation characterizes many diseases of the pancreas, both neoplastic and not. Difficulties in the differential diagnosis of cysts are fortunately reduced by the preponderance of pseudocysts (i.e. non-neoplastic cysts) and, among neoplastic ones, of cystadenomas and cystadenocarcinomas. As a consequence, uncommon cystic neoplasms are neglected and very often misdiagnosed. We reported a case of solitary schwannoma mimicking a pancreatic pseudocyst, interesting both because of its rarity and because of its cystic feature which was previously reported in the literature but not emphasized.     

Management of cystic lesions of the tail of the pancreas

OBJECTIVE: To emphasize that although cystic pancreatic neoplasms are stated to make up only 10% of pancreatic cysts, this number may be significantly higher if patients who are misdiagnosed with pseudocysts are considered. DESIGN: A small case series. SETTING: A tertiary-care centre. PATIENTS: A consecutive sample of three patients with cystic lesions of the tail of the pancreas seen between 1992 and 1994. All three were women ranging in age from 28 to 42 years. Two had been treated previously for pancreatic pseudocysts by cystenterostomy. None had a history of pancreatitis or alcohol abuse, and gallstones were not present on ultrasonography. INTERVENTIONS: Distal pancreactectomy and splenectomy. RESULTS: The excised specimens from the two patients treated initially elsewhere revealed mucinous cystadenoma with atypia in one and mucinous cystadenocarcinoma with invasion into stomach in the other. In the third patient, a cystic neuroendocrine tumour and two other intrapancreatic nodules of neuroendocrine tumour were found on pathological examination. CONCLUSIONS: Pancreatic neoplasms may be misdiagnosed as pancreatic pseudocysts. In patients without a history or risk factors for pancreatitis, a cystic pancreatic mass is not necessarily a pseudocyst, and such patients should be considered for pancreatic resection.     

Dermoid cyst of the pancreas: a rare cystic neoplasm

Dermoid cysts of the pancreas, also called cystic teratomas, are a rare entity and are included in the group of neoplasms with a germ cell origin. Only twelve cases have been described in the world literature. The symptomatology is due to tumor compression of the neighboring tissues. Ultrasonography and computed tomography may be helpful, but there are no pathognomonic data for their preoperative recognition. The differential diagnosis should include all other cystic tumors of the pancreas. Complete surgical removal is mandatory. We describe the diagnostic and surgical procedures in a 74 year-old man with a pre-operatively unsuspected dermoid cyst. We review the previously published cases and emphasize the appropriate therapeutical management.     

Clinical diagnosis of pancreato-biliary lesions by ultrasound angiography with intra-arterial infusion of carbon dioxide microbubbles

Ultrasound angiography (USAG), sonographic imaging of the blood flow with intra-arterial infusion of carbon dioxide (CO2) microbubbles, was applied to pancreato-biliary lesions. Hypervascular pattern was observed in all cases of gallbladder elevated lesions except for debris balls. However, the vascular pattern of CO2 inflow that many arterial vessels were branching off into the lesion was characteristic for gallbladder carcinomas. The hemodynamics of solid tumors of the pancreas with USAG were divided into three patterns. Most of hypovascular nodules were duct cell carcinomas, while inflammatory pancreatic masses always exhibited isovascular except for two cases of hypovascular pattern. Furthermore, islet cell tumors showed hypervascular. In cases of mucin-producing cystic tumors of the pancreas, excrescent nodules or thickened septa within the lesions were identified as hypervascular. Other cystic tumors of the pancreas also presented peculiar hemodynamics. Therefore USAG is potentially useful for detecting various vascular patterns of pancreato-biliary lesions, contributory as a diagnostic tool in this area.     

Lymphoepithelial cysts of the pancreas: demonstration of lipid component using CT and MRI

We present two cases of surgically proven lymphoepithelial cyst (LEC) of the pancreas that had a lipid component visualized by CT and MRI. Identification of this component in a pancreatic cystic lesion is a key to favor the diagnosis of LEC or splenic epidermoid cyst over other cystic lesions when the lesion is noted in an elderly patient.     

Use of post-column fluorescence derivatization to develop a liquid chromatographic assay for ranitidine and its metabolites in biological fluids

OBJECTIVE: To describe the cytologic features of solid and cystic tumor of the pancreas. STUDY DESIGN: Cytologic features of four cases of solid and cystic tumor of the pancreas (SCT) were reported and compared with those of three cases of islet cell tumor of the pancreas. RESULTS: Aspiration and imprint cytology of the tumor cells obtained from three cases of SCT showed papillary structures or rosette formations in part and demonstrated uniformly round to oval nuclei that contained finely granular chromatin, a fairly distinct nucleolus and a scant to moderate amount of granular or vesicular cytoplasm. Another case of SCT consisted of multinucleated giant cells with coherent chromatin as well as mononuclear cells with nuclear grooves. Islet cell tumor consisted mainly of clustered or isolated uniform mononuclear cells with rosette formations but without a papillary structure and occasional multinucleated giant cells in all cases. The nuclei of islet cell tumors had peculiar, fine chromatin aggregates with a "salt-and-pepper" appearance and slightly enlarged nucleoli. CONCLUSION: SCT is cytologically distinguishable from islet cell tumor in spite of having many cytologic features in common with it.     

Esophageal manometric studies in children with achalasia before and after operative treatment

A 68-year-old woman was found crouching in the kitchen with severe upper abdominal pain. She entered a state of shock at our emergency clinic. Abdominal computed tomography (CT) scan demonstrated a 3 cm cystic mass dorsal to the pancreas tail accompanied with a hematoma. On angiography, a bleeding from the left middle adrenal artery was identified and embolized for hemostasis. An operation was performed 3.5 months after embolization. Preoperative evaluation showed the tumor to be endocrinologically inactive. Metoclopramide stimulation test was negative, too. Left adrenalectomy was performed uneventfully without intraoperative increase in blood pressure. However, histopathological diagnosis was pheochromocytoma. Transarterial embolization is an effective treatment for adrenal bleeding. In our case, however, embolization might have caused the tumor to be falsely "endocrinologically inactive".     

First adult patient with fibrosing colonopathy

An adult patient with cystic fibrosis and chronic abdominal complaints developed symptomatic fibrosing colonopathy several months after the beginning of high dose pancreas enzyme therapy. Despite the absence of a stricture, surgical resection was performed. Since then the abdominal complaints have not recurred.     

Hyperthyroidism in early infancy: pathogenesis, clinical features and diagnosis with a focus on neonatal hyperthyroidism

We report here two rare cystic lesions, a lymphoepithelial cyst (LEC) and an epidermoid cyst of the accessory spleen (ECAS) occurring in the pancreas. Histologically, the LEC was lined by stratified squamous epithelium and surrounded by a layer of lymphoid tissue with germinal centers. The ECAS showed similar histologic features with scattered lymphoid tissue, but splenic pulp tissue was present in the wall. In both cysts, some small pancreatic islets and ducts were seen in the fibrous tissue surrounding the lymphoid layer or the splenic pulp, respectively. The lining epithelia of the LEC and the ECAS, as well as those of retention cysts of the pancreas and epidermoid cysts of the spleen used for comparison, were similarly positive with AE1/3, CAM5.2, CK7, CK13, and carcinoembryonic antigen. CA19-9 was also detected in the epithelial cells of the LEC, the ECAS, and the retention cyst of the pancreas, but not in those of the splenic epidermoid or branchial cleft cysts used for comparison. These findings indicate that LECs and ECASs might develop from the pancreatic ducts protruding into a lymph node or accessory spleen located in the pancreas, respectively. Some of both cysts might cause elevated levels of serum carcinoembryonic antigen and/or CA19-9 and should be distinguished from malignant cystic tumors.     

Solid cystic tumor of the head of the pancreas in a young woman

This a case report of a solid papillary tumor of the pancreas in a young woman of 18 years, who was referred to after having suffered for a period of 8 months with a rather vague symptomatology, characterized by dyspepsia, fatigue and, towards the end of the 8 month period, weight loss (approximately 2 kg). In the last week, as a consequence of a modest abdominal trauma, the patient was submitted to abdominal CT that showed a burden at the head of the pancreas, demonstrating a round neoformation about 6 cm in diameter with solid echogenicity slightly hypodense. Subsequently, she underwent an operation with the diagnosis of pseudocystis of the pancreas. During surgery, a big cystic formation of the head of the pancreas, into which a drain was introduced, was revealed. The histological postoperative examination was compatible with pancreatic tumor with a low grade of malignancy, cystic papillary or solid papillary type. Therefore, the patient came under our observation and underwent an operation of pancreatoduodenectomy. Two years after the operation, the patient had completely recovered. In this case, we discussed the problem of performing certain preoperative diagnoses despite the aid of modern diagnostic imaging, this being a very rare illness that almost exclusively plagues young women (median age 19 years). This diagnosis has an uncertain histological origin and is generally accompanied by a modest and vague symptomatology. The surgical procedure, given the low grade of malignancy of the neoplasm and the excellent long-term prognosis, must be, with respect to the oncological radicality, as conservative as possible.     

Cystic pancreatic neoplasms: report of a case and review of the literature

Cystic neoplasms of the pancreas are rare tumors. Because of very limited experience even in large medical centers, there is much debate regarding the evaluation and management of patients with these tumors. Recently, a patient presented to our community teaching hospital with an unusual complication of this rare tumor. She was found to have intra-abdominal hemorrhage from the erosion of a serous cystadenoma into the surrounding vasculature. In this report, we present this case and review the current literature with regard to the presentation, diagnosis, and management of cystic neoplasms of the pancreas.     

Association between pancreatic cystadenocarcinoma, malignant liver cysts, and polycystic disease of the kidney

Polycystic kidney disease is an autosomal dominant disease that may be associated with cystic disease of the liver. In women, the cysts may develop early and be more troublesome than in men. Cystadenocarcinoma of the pancreas is uncommon, comprising 1% of primary pancreatic malignancies. This case report is the first to describe a familial association between polycystic kidney disease and cystadenocarcinoma of the pancreas and liver in the English medical literature. A patient with autosomal dominant polycystic kidney disease (ADPKD) and multiple hepatic cysts developed cystadenocarcinoma of the pancreas with multiple malignant liver cysts. The patient's mother, sister, and niece had ADPKD, and the patient's sister also died of pancreatic cystadenocarcinoma. We believe that the development of these two disease entities in which the primary pathology is cyst formation has a genetic association.