Pancreatic endocrine tumors (PET) are rare neoplasms of the pancreas and account for less than 5% of all primary pancreatic malignancies. Included in this group are insulinomas, gastrinomas, glucagonomas and somatostatinomas. Collectively, these neoplasms are classified as functional PETs. When a PET is not associated with a clinical syndrome due to hormone oversecretion, it is referred to as a non-functional PET. Non-functionalPETs are pancreatic tumors with endocrine differentiation but lack a clinical syndrome of hormone hypersecretion. Although a pancreatic carcinoma shows aggressive biological behavior, a cutaneous metastasis from a pancreas carcinoma is rare. We report a case of a case of a cutaneous metastasis from an endocrine pancreatic carcinoma in a 50-year-old female that clinically manifested as a painful firm nodule on the back.
Female ; Gastrinoma ; Glucagonoma ; Humans ; Insulinoma ; Middle Aged ; Neoplasm Metastasis ; Pancreas ; Pancreatic Neoplasms ; Somatostatinoma

Pancreatic endocrine tumors (PET) are rare neoplasms of the pancreas accounting for less than 5% of all primary pancreatic malignancies. Insulinomas, gastrinomas, glucagonomas and somatostatinomas is included in PET. PETs are usually classified into functioning and non-functioning tumors and presents with a range of benignity or malignancy. It is very important to accurate diagnose the PET location and to predict the benignity or malignancy of PET in terms of the treatment strategy, because PET have higher respectability, better response to chemotherapy and better prognosis compared to that of pancreatic adenocarcinoma. The utility and reliability of different imaging modalities depends on the characteristics of PETs, specifically their size. Functioning PET tend to be small (less than 2 cm), well circumscribed, homogeneous, and usually shown as strong enhancement on contrast enhanced CT or MR imaging. Non-functioning PET tend to be larger (4~10 cm), heterogeneous, and may contain the cystic areas of degeneration and necrosis. In this article, we present the various imaging findings of PET according to recent WHO classification.
Accounting ; Adenocarcinoma ; Gastrinoma ; Glucagonoma ; Insulinoma ; Magnetic Resonance Imaging ; Necrosis ; Pancreas ; Prognosis ; Somatostatinoma

OBJECTIVETo summarize our experience in the diagnosis and treatment of malignant pancreatic endocrine tumour.

METHODSWe retrospectively reviewed 36 cases of malignant pancreatic endocrine tumours in our hospital from July 1987 to April 2002, and summarized its clinical features.

RESULTSLiver metastasis was the main malignant manifestation of malignant pancreatic endocrine tumours (incidence rate 72.2%). Removals of primary lesion and isolated hepatic metastatic lesion were means of curative therapy. Interventional chemotherapy was an important adjuvant treatment.

CONCLUSIONComprehensive therapy plays an important role in improving the prognosis of malignant pancreatic endocrine tumour.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Islet Cell ; diagnosis ; pathology ; therapy ; Chemotherapy, Adjuvant ; Female ; Follow-Up Studies ; Gastrectomy ; Gastrinoma ; diagnosis ; pathology ; therapy ; Glucagonoma ; diagnosis ; pathology ; therapy ; Humans ; Insulinoma ; diagnosis ; pathology ; therapy ; Liver Neoplasms ; secondary ; therapy ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pancreas ; surgery ; Pancreatectomy ; Pancreatic Neoplasms ; diagnosis ; pathology ; therapy ; Retrospective Studies

PURPOSE: To analysis the radiologic characteristics of a pancreatic islet cell tumor, and to assess the usefulness of spiral CT scanning in the detection of a small tumor. MATERIALS AND METHODS: We retrospectively reviewed the clinical, pathologic, and imaging features of 12 cases of pathologically-proven islet cell tumors of the pancreas occurring between 1989 and 1995. Imaging study included conventional CT (n=9), spiral CT (n=3), ultrasonography (n=5), MRI (n=4), and angiography (n=6). RESULTS: Among 12 patients, eight (67%) were diagnosed as suffering from functioning islet cell tumor, and four (33%) as nonfunctioning tumors cases. Of the former, four were insulinoma and one was glucagonoma. Their average diameter was 2.4cm, whereas that of nonfunctioning tumors was 5cm. The average diameter of islet cell tumors was 1.3cm. Using conventional CT (4), spiral CT (3), ultrasonography (3), MRI (1), and angiography (3) preoperative localization was possible. Dynamic spiral CT scans with 5mm slice thickeness were performed in the three cases of smaller tumor (2cm) showded 100% sensitivity. CONCLUSION: Since nonfunctioning islet cell tumors tend to be large, it is usually possible to detect a tumor by using only ultrasonography or conventional CT scan. In the case of functioning islet cell tumors, however, localization of the lesion requires more complicated imaging studies. Our results show that thin slice spiral CT was valuable in the defection of small functioning tumors and can be the modality of choice for preoperative localization of a pancreatic islet cell tumor.
Adenoma, Islet Cell* ; Angiography ; Carcinoma ; Colitis ; Diagnosis, Differential ; Enteritis ; Glucagonoma ; Humans ; Inflammation ; Insulinoma ; Islets of Langerhans* ; Magnetic Resonance Imaging ; Mesentery ; Mucous Membrane ; Pancreas* ; Retrospective Studies ; Serous Membrane ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: The purpose of this study was to evaluate the CT features of target-like bowel wall thickenings and to correlate target layers with histopathologic layers. MATERIALS AND METHODS: We retrospectively analyzed 37 target-like bowel wall thickenings with inner high-, middle low- and outer high attenuated layers on CT scan. Bowel lesions included 15 cases of ischemic lesion, 12 of inflammation, four of carcinomatosis, four of trauma, and two of radiation enteritis. Target-like bowel wall thickenings were classified into three types : with inner most thickened high-attenuated layer(type I); with middle most thickened low-attenuted layer(type II), and with outer most thickened high-attenuated layer(type III). We analyzed the characteristic CT features of these bowel lesions and correlated target and histopathologic layers in resected bowel specimens. RESULTS: Target-like bowel wall thickening was type I in 18 cases(49%), type II in 13 cases(35%), and type III in 6 cases(16%). Type I ischemic bowel lesions and inflammations were most common, and were found in 60% and 67% of cases, retrospectively. All cases of trauma were type II and radiation colitis was type III. Histopathologic findings showed that each layer of target lesions did not exactly correlate with histopathologic layers. However, the inner high attenuated layer correlated with mucosa and some submucosa, the middle low-attenuated layer correlated with most submucosa and some muscularis, and the outer high-attenuated layer correlated with muscularis, serosa, and periserosal mesentery. CONCLUSION: CT features of target-like bowel wall thickenings showed type characteristics according to bowel lesions. Histopathologic comparison and analysis were considered helpful for the differential diagnosis of bowel lesions.
Adenoma, Islet Cell* ; Angiography ; Carcinoma ; Colitis ; Diagnosis, Differential ; Enteritis ; Glucagonoma ; Humans ; Inflammation ; Insulinoma ; Islets of Langerhans* ; Magnetic Resonance Imaging ; Mesentery ; Mucous Membrane ; Pancreas* ; Retrospective Studies ; Serous Membrane ; Tomography, Spiral Computed* ; Tomography, X-Ray Computed ; Ultrasonography

Neuroendocrine pancreatic tumors (NPTs) arise from the pancreatic islet cells and belong to the amine and precursor uptake and decarboxylation (APUD) system. These tumors are rare and account for only 1% to 5% of pancreatic tumor. The pancreas is an extremely uncommon site of neoplasia in children and adolescents. For this reason, our understanding of these tumors is still quite limited. Although the complete surgical resection is the key to successful management of all malignant adolescence pancreatic tumors, the information on the possible role of chemotherapy and radiation in recurrent, unresectable, or metastatic cases is purely anecdotal. The 17-year-old man transferred to our hospital with abnormal ultrasonographic findings. Result of abdominal ultrasonographic examination showed a mass in the upper abdomen. He presented with 6months history of intermittent abdominal pain and vomiting and diarrhea. A computed tomography (CT) scan and magnetic resonance showed a 4.5 x 6 cm mass in the head of the pancreas. An ultrasound-guided core biopsy confirmed an pancreatoblastoma or pancreas islet cell tumor. On operative findings, there was locally advanced, unresectable tumor within the pancreatic head. We report a 17-years-old man patient with non-functional panceratic islet cell carcinoma.
Abdomen ; Abdominal Pain ; Adenoma, Islet Cell ; Adolescent* ; Biopsy ; Carcinoma, Islet Cell ; Child ; Decarboxylation ; Diarrhea ; Drug Therapy ; Head ; Humans ; Islets of Langerhans* ; Pancreas ; Vomiting

BACKGROUND: Neuroendocrine tumors of the pancreas are classified according to the endocrine function as insulinomas gastrinomas somatostatinomas, or nonfunctioning tumors. However, the morphologic features are not different from each other. Therefore, we tried to compare correlations among the morphologic features, endocrine function, and the immunohistochemical reaction with specific monoclonal antibodies to the tumors. METHOD: We reviewed the medical records of seven patients with pancreatic neuroendocrine tumors retrospectively, and analysed the clinical manifestations, the methods of diagnosis, the pathological characteristics and the results of surgery. Additionally, we compared the correlation between the clinical manifestations and the expression of immunohistochemical staining by using six different kinds of monoclonal antibodies to each tumor. RESULTS: The seven pancreatic neuroendocrine tumor patients were treated by surgical excision. Four patients had benign insulinomas, two had nonfunctioning malignant tumor and one patient had a benign nonfunctioning tumor associated with stomach cancer. The pattern of immunohistochemical stain of each tumor was not correlate with the clinical manifestations. CONCLUSION: The morphologic study with H & E stain, even with immunohistochemical staining of pancreatic neuroendocrine tumor, cannot support differentiation of the functional diagnoses, such as insulinoma, gastrinoma, somatostatinoma, nonfunctional tumors and so forth.
Antibodies, Monoclonal ; Diagnosis ; Gastrinoma ; Humans ; Insulinoma ; Medical Records ; Neuroendocrine Tumors* ; Pancreas ; Retrospective Studies ; Somatostatinoma ; Stomach Neoplasms

Adenosquamous carcinoma of the pancreas is a rare tumor; its clinical features and radiologic findings are not well known, so the definite preoperative diagnosis of this tumor is quite difficult. We report a case of adenosquamous carcinoma of the pancreas. A 47-year-old woman was admitted on April 2005 to our hospital with a complaint of left upper quadrant pain. The serum CA 19-9 and CEA level were increased up to 4019.08 U/ml and 13.13 ng/ml, respectively. An abdominal computed tomographic (CT) revealed a 10x9 cm sized well-defined homogenous lobulated mass in the pancreas tail. Under the impression of solid-pseudopapillary neoplasm (SPN) or nonfunctioning islet cell tumor, distal pancreatectomy and splenectomy with wedge resection of stomach were performed. The specimen consisted of a huge pancreatic mass that was attached to the posterior wall of stomach. The cut surface of pancreatic mass revealed a huge whitish infiltrative mass. Microscopically, glandular elements of ductal adenocarcinoma were admixed with solid squamoid complexes or squamous cell carcinoma components. Although the origin of the adenosquamous carcinoma has not been well proven, the histopathological findings of our case support the theory of squamous metaplasia.
Adenocarcinoma ; Adenoma, Islet Cell ; Carcinoma, Adenosquamous* ; Carcinoma, Squamous Cell ; Diagnosis ; Female ; Humans ; Metaplasia ; Middle Aged ; Pancreas* ; Pancreatectomy ; Splenectomy ; Stomach

Neuroendocrine tumors originate from neuroendocrine cell, so called APUD (amine precursor uptake and decarboxylation). Most neuroendocrine tumors have typical histopathology, immunohistochemical findings, and can be diagnosed by specific electromicroscopic feature of dense core granules. Neuroendocrine tumors are a diverse group of neoplasms that include carcinoid tumors, islet cell tumors, neuroblastoma, and small cell carcinoma. Neuroendocrine carcinoma of thymus bears similarities to neuroendocrine carcinoma in other organs, but it is clinicopathologically distinct from other tumors of thymus. Rare reports have been seen about thymus neuroendocrine carcinoma. Authors experienced a case of neuroendocrine carcinoma of thymus which cannot be classified as carcinoid, atypical carcinoid, or small cell carcinoma. Herein, we report this case with a review of the literatures.
Adenoma, Islet Cell ; Carcinoid Tumor ; Carcinoma, Neuroendocrine* ; Carcinoma, Small Cell ; Neuroblastoma ; Neuroendocrine Cells ; Neuroendocrine Tumors ; Thymus Gland*

A blastoma is a type of cancer, which is common in children; it is caused by malignancies derived from in the precursor cells, often called blasts. Examples are nephroblastomas, retinoblastomas, pleuropulmonary blastomas, and pancreatoblastomas. Pancreatoblastomas are extremely rarely in adults. It is difficult preoperatively to distinguish this tumor from other pancreatic tumors including solid and papillary epithelial neoplasm of the pancreas (SPEN), acinar cell carcinoma, islet cell tumor, and ductal adenocarcinoma with cystic degeneration. To our knowledge, this case may be the second report of a pancreatoblastoma occurring in an adult in Korea. We report a case of a pancreatoblastoma that was confirmed by pathology, despite the radiologic finding that assumed it was a SPEN.
Adenocarcinoma ; Adenoma, Islet Cell ; Adult* ; Carcinoma, Acinar Cell ; Child ; Humans ; Korea ; Neoplasms, Glandular and Epithelial ; Pancreas ; Pathology ; Retinoblastoma ; Wilms Tumor