Isolated obstruction of the splenic vein leads to segmental portal hypertension, which is mainly originated from pancreatic disease, such as chronic pancreatitis, pancreatic pseudocyst, pancreatic cancer. The clinical manifestation are devoid of ascites and encephalopathy, but presented with gastric variceal bleeding. We experienced 27-year-old male patient who complained of hematochezia and melena. After work-up with CT and angiography, we performed operation with the impression of pancreatic tumor associated with splenic vein occlusion. It resulted nonfunctioning pancreatic endocrine tumor. Often called islet cell tumor, pancreatic endocrine tumor has various names according to secreted hormones, such as insulinoma, Zollinger-Ellison syndrome and glucagonoma. It was classified as nonfunctioning tumor if there were any evidence of hormone secretion by radioimmunoassay and immunohistochemistry. Surgical excision and adjuvant medical therapy is the mainstay of therapy. We performed tumor resection and splenectomy for control of gastric variceal bleeding due to splenic vein occlusion.
Adenoma, Islet Cell ; Adult ; Angiography ; Ascites ; Esophageal and Gastric Varices* ; Gastrointestinal Hemorrhage ; Glucagonoma ; Humans ; Hypertension, Portal ; Immunohistochemistry ; Insulinoma ; Male ; Melena ; Pancreas* ; Pancreatic Diseases ; Pancreatic Neoplasms ; Pancreatic Pseudocyst ; Pancreatitis, Chronic ; Radioimmunoassay ; Splenectomy ; Splenic Vein ; Zollinger-Ellison Syndrome

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 neuroendocrine tumors (PNETs), a group of endocrine tumors arising in the pancreas, are among the most common neuroendocrine tumors. The genetic causes of familial and sporadic PNETs are somewhat understood, but their molecular pathogenesis remains unknown. Most PNETs are indolent but have malignant potential. The biological behavior of an individual PNET is unpredictable; higher tumor grade, lymph node and liver metastasis, and larger tumor size generally indicate a less favorable prognosis. Endocrine testing, imaging, and histological evidence are necessary to accurately diagnose PNETs. A 4-pronged aggressive treatment approach consisting of surgery, locoregional therapy, systemic therapy, and complication control has become popular in academic centers around the world. The optimal application of the multiple systemic therapeutic modalities is under development; efficacy, safety, availability, and cost should be considered when treating a specific patient. The clinical presentation, diagnosis, and treatment of specific types of PNETs and familial PNET syndromes, including the novel Mahvash disease, are summarized.
Combined Modality Therapy ; Gastrinoma ; diagnosis ; therapy ; Glucagonoma ; diagnosis ; therapy ; Humans ; Insulinoma ; diagnosis ; therapy ; Multiple Endocrine Neoplasia Type 1 ; diagnosis ; therapy ; Neuroendocrine Tumors ; classification ; diagnosis ; therapy ; Pancreatic Neoplasms ; classification ; diagnosis ; therapy ; Vipoma ; diagnosis ; therapy ; von Hippel-Lindau Disease ; complications

Pancreatic fistulae follows pancreatic duct disruption and may develop as a complication of pancreatic disease or injury. The escaping fluid may be walled off by the surrounding viscera to form a pseudocyst or an abscess. Fistulae may drain spontaneously into adjacent hollow viscera or communicate with the body surface externally. Although internal pancreatic fistulas that communicate with adjacent internal organs are much less common, vascular communication with the pancreatic ductal system is especially unusual and generally represents a serious clinical situation. We experienced one case of pancreatic duct-portal vein fistula in a patient with pancreatic cancer. Endoscopic retrograde cholangiopancreatography revealed a large vascular structure representing the portal vein filled at the time of the contrast injection, indicating the presence of a pancreatic duct-portal vein fistulae.
Abscess ; Cholangiopancreatography, Endoscopic Retrograde ; Fistula* ; Humans ; Pancreatic Diseases ; Pancreatic Ducts ; Pancreatic Fistula ; Pancreatic Neoplasms* ; Portal Vein ; United Nations ; Veins* ; Viscera

The most common pancreatic cystic lesion is pancreatic pseudocyst which represents about 85%. Primary cystic neoplasms represent about 10 to 15% of the lesion. Pathologically cystic neoplasms can be classified into serous cystadenoma, mucinous cystadenoma and papillary cystic neoplasm by epithelial lining-cell, whereas pseudocyst is characterized by fibrotic capsules. Mucinous form is known to be premalignant or malignant and serous cystadenoma was known to be benign in the past, but recently 4 cases of malignant transformation have been reported. Serous cystadenoma is described under a variety of names, including microcystic adenoma and glycogen-rich cystadenoma but recently macroqystic variants have been reported. Serous cystadenoma is most commonly seen in middle aged women with symptoms of vague upper abdominal pain or palpable mass. It is sometimes associated with extra- pancreatic diseases such as gallstones, diabetes mellitus, hypertension, duodenal ulcers, sterility, obesity and thymic dysfunction, but coexisting papillary thyroid cancer have been reported in only 2 cases to our knowledge. The pathogenesis of associated diseases is unknown and appears to be due to function of age of the patients or incidental occurrence. Herein, we report a patient who had a pancreatic serous cystadenoma coexisting with papillary thyroid cancer. Since pancreatic serous cystadenoma can occur in association with papaillary thyroid cancer, examination of thyroid seems to be advisable when pancreatic serous cystadenoma is found.
Abdominal Pain ; Adenoma ; Capsules ; Cystadenoma ; Cystadenoma, Mucinous ; Cystadenoma, Serous* ; Diabetes Mellitus ; Duodenal Ulcer ; Female ; Gallstones ; Humans ; Hypertension ; Infertility ; Middle Aged ; Mucins ; Obesity ; Pancreatic Cyst ; Pancreatic Diseases ; Pancreatic Pseudocyst ; Thyroid Gland* ; Thyroid Neoplasms*

BACKGROUND: The aims of this study were to evaluate the diagnostic value of pancreatic elastase-1(PE-1) in patients with pancreatic diseases and compare the significance of PE-1 with that of pancreatic exocrine function test by pure pancreatic juice (PPJ) collection. METHODS: For evaluation of PE-1, seventy nine patients with pancreatic diseases were examined. For evaluation of exocrine pancreatic function by PPJ, twenty three patients with Chronic pancreatitis(CP) were examined. PPJ was collected by endoscopic cannulation of main pancreatic duct under the intravenous bolus injection of secretin (0.25 CU/kg body weight) and cholecystokinin (CCK, 40 ng/kg body weight). RESULTS: Pancreatic exocrine functions were significantly decreased in patients with CP showing moderate and severe ductal changes on pancreatogram. The mean concentration of fecal PE-1 was significantly decreased in patients with CP and pancreatic cancer, but not in patients with acute pancreatitis. When we analyzed the PE-1 concentration according to Cambridge classification, the concentration of fecal PE-1 was significantly decreased only in patients with moderate and severe CP. With a cut off of 200 ug fecal PE-1/g, the sensitivity of PE-1 was 25%, 60%, and 100%, respectively, for mild, moderate and severe CP, and the specificity was 88.1%. The mean concentration of serum PE-1 was increased both in patients with acute and chronic pancreatitis, but there was no difference between both group. CONCLUSION: Fecal PE-1 is useful for diagnosis of pancreatic exocrine insufficiency in patients with CP, especially in moderate and severe grade of pancreatic exocrine insufficiency. The diagnostic value of fecal PE-1 was also similar to secretin-CCK test in pancreatic exocrine insufficiency.
Catheterization ; Cholecystokinin ; Classification ; Diagnosis ; Humans ; Pancreatic Diseases* ; Pancreatic Ducts ; Pancreatic Juice ; Pancreatic Neoplasms ; Pancreatitis ; Pancreatitis, Chronic ; Secretin ; Sensitivity and Specificity

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

Serous cystadenoma of the pancreas is a rare disease and is usually benign. Mucinous cystadenoma, another cystic neoplasm of the pancreas, has a malignant potential. Serous cystadenoma is usually composed of many small cysts lined by small, cuboidal or flattened cells containing abundant glycogen. With the finding of endoscopic retrograde pancreatography, a communication between the cyst and pancreatic duct is observed occasionally in the mucinous cystadenoma, but rarely in the case of serous cystadenoma of the pancreas. We experienced a case of serous cystadenoma of the pancreas that had a communication between a cyst and the pancreatic duct.
Adult ; Cystadenoma, Serous/*complications ; Digestive System Fistula/*complications ; Female ; Humans ; Pancreatic Diseases/complications ; *Pancreatic Ducts ; Pancreatic Neoplasms/*complications

A comparative descriptive study was carried out on 80 patients diagnosed as pancrea head tumors. Ultrasound results were evaluated through operated and histopathological outcomes. Ultrasound diagnosis reached 96.1% of sensivity and 92.5% of accurracy, concerning the localization of the tumors the accuracy was 68%. Ultrasound sensitivity in the identification of the signs of infiltration in the neighbour tissues, in blood vessels, in gland was 12.5%, 11.8% and 8.8% respectively.
neoplasms ; Pancreatic Diseases ; Pancreatic Neoplasms ; ultrasonography ; diagnosis

PURPOSE: To classify perivascular change in the celiac trunk and SMA occurring in pancreatic disease and toevaluate its significance in differential diagnosis. MATERIALS AND METHODS: In 73 patients with pancreaticdisease (42, acute pancreatitis; 14, chronic pancreatitis; 17, panreatic cancer) abdominal CT findings wereretrospectively reviewed. We defined " infiltration" as linear or irregular density and "thickening" as presenceof a soft tissue mantle surrounding the vessel, and statistically evaluated the usefulness of these factors forthe differential diagnosis of pancreatic diseases. RESULTS: In 13/42 cases of acute pancreatitis (31%), 4/14 ofchronic pancreatitis (28.6%), and 6/17 of pancreatic cancer (35.3%), periceliac infiltration was observed; thefrequencies were not statistically significant (p=0.916). Peri-SMA infiltration was demonstrated in 9/42 of acutepancreatitis (21.4%), 4/14 of chronic pancreatitis (28.6%), and 5/17 of pancreatic cancer (29.4%); again, thesefrequencies were not statistically significant (p=0.758). Thickening of the celiac trunk and SMA was observed onlyin pancreatic cancer, in 3/17 (17.6%) and 7/17(41.2%) cases, respectively, with statistical significance (p<0.05). CONCLUSION: Thickening of the celiac trunk and SMA is a valuable finding in the differential diagnosis ofpancreatic inflammatory disease and pancreatic cancer. When applied to the differential diagnosis of pancreaticdisease, perivaseular change should be classified as either infiltration or thickening.
Diagnosis, Differential* ; Humans ; Mesenteric Arteries* ; Pancreatic Diseases* ; Pancreatic Neoplasms ; Pancreatitis ; Pancreatitis, Chronic ; Tomography, X-Ray Computed