There have been an increasing number of reports of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas since its first report by Ohhasi et al. in 1982. Most IPMNs arise from Wirsung's duct or its branches, whereas IPMNs arising from Santorini's duct are rare. Pancreas divisum is a common congenital anatomical anomaly characterized by the lack of fusion of the ventral and dorsal parts of the pancreas during the eighth week of fetal development. Although clinical significance of pancreas divisum has been the subject of debate for many years, there seems to be little doubt that in certain patients there is a causal relation between pancreas divisum and pancreatitis. Also, it is occasionally accompanied by a pancreatic tumor. Herein, we report a case of IPMN arising from Santorini's duct in patient with complete type of pancreas divisum.
Adenocarcinoma, Mucinous/*diagnosis/etiology ; Aged ; Carcinoma, Pancreatic Ductal/*diagnosis/etiology ; Carcinoma, Papillary/*diagnosis/etiology ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Diagnosis, Differential ; Female ; Humans ; Pancreatic Ducts/abnormalities/*surgery ; Pancreatic Neoplasms/*diagnosis/etiology

In rare instances, stroke may precede a diagnosis of cancer and be the first clinical evidence of an underlying malignancy.Cerebral infarction mostly complicates lymphomas, carcinomas, and solid tumors. Malignancy-related thromboembolism can present as acute cerebral infarction, nonbacterial thrombotic endocarditis and migratory thrombophlebitis. It is generally attributed to a cancer-related hypercoagulable period, chronic disseminated intravascular coagulopathy (DIC), or tumor embolism. We reported a case of malignancy-related thromboembolism from an undiagnosed pancreatic adenocarcinoma in a 54-year-old man, who presented with recurrent ischemic stroke due to chronic DIC. He died of the underlying malignancy despite the appropriate institution of anticoagulation therapy.This case emphasizes that cerebral infarction may be the first manifestation of an undiagnosed cancer. If there is laboratory or clinical evidence associated with DIC, patients with a cerebral infarct of an unknown etiology should be investigated for a malignant process. The optimal method of anticoagulation in cancer patients with thromboembolic disease (TED) remains unclear.
Adenocarcinoma ; complications ; diagnosis ; physiopathology ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms ; complications ; diagnosis ; physiopathology ; Stroke ; diagnosis ; etiology ; Thrombosis ; diagnosis ; etiology

Mucinous (colloid) carcinoma is defined as pools of stromal extracellular mucin containing scanty, floating carcinoma cells. It is a well-defined entity in breast or large bowel. However, mucinous noncystic carcinoma of the pancreas (MNCC) is uncommon, comprising between 1% and 3% of all carcinomas of the pancreas. In the past, MNCC generally had been categorized together with ordinary ductal adenocarcinoma or misdiagnosed as mucinous cystadenocarcinoma or signet-ring cell carcinoma. The new WHO classification lists MNCC as a variant of ductal adenocarcinoma. Herein, we report a 32-year-old woman with incidentally found pancreatic body mass who underwent subtotal pancreatectomy. She was diagnosed as MNCC histologically.
Adenocarcinoma, Mucinous/*diagnosis/etiology/pathology ; Adult ; Breast Neoplasms/diagnosis ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology ; Diagnosis, Differential ; Female ; Humans ; Pancreatic Neoplasms/*diagnosis/pathology ; Tomography, X-Ray Computed

Pancreatic cancer is currently the major leading cause of cancer-related deaths in the Western countries with an overall 5-year survival rate of less than 3. The key aim of investigation is to identify the cellular population in which some of the earliest molecular events occur, presumably the ultimate target for carcinogenic insult. Advances in pathological classification and genetics have improved our descriptive understanding of this disease. However, important aspects of pancreatic cancer biology remain poorly understood. Factors associated with the increased risk of pancreatic cancer include smoking, chronic pancreatitis, diabetes, prior gastric surgery, and exposure to radiation or chemicals. A number of syndromes have been identified with the increased incidence of pancreatic cancer, including familial atypical multiple-mole melanoma syndrome, hereditary nonpolyposis colorectal cancer, and hereditary pancreatitis, etc. Recently, there have been growing evidences that stem cell biology could provide new insights into the understanding of cancer biology. Three postulates regarding the relationship between stem and tumor cells have been proposed. First, the similarities in the mechanims that regulate self-renewal of normal stem cells and cancer cells. Second, the possibility that tumor cells might arise from normal stem cells and third, the notion that tumors might contain 'cancer stem cells' - rare cells with indefinite proliferative potential which drive the formation and growth of tumors. New insights for the cancer stem cells and their possible markers in pancreatic cancer have been suggested recently. Further observations of molecular and cellular events in the early stage of pancreatic carcinogenesis may have important implications regarding the cellular lineage responsible for pancreatic ductal metaplasia and neoplasia, and provide further support for the presence of stem cell capabilities within mature pancreatic epithelium.
Carcinoma, Pancreatic Ductal/*etiology/genetics/pathology ; Disease Progression ; Humans ; Mutation ; Neoplasm Proteins/genetics ; Neoplastic Syndromes, Hereditary/genetics ; Oncogenes ; Pancreatic Neoplasms/diagnosis/*etiology/genetics ; Risk Factors ; Tumor Markers, Biological

Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery.
Adenocarcinoma, Mucinous/diagnosis/surgery ; Aged ; Female ; Humans ; Male ; Mesenteric Veins/radiography ; Pancreas/abnormalities ; Pancreatic Diseases/*diagnosis/therapy ; Pancreatic Fistula/etiology ; Pancreatic Neoplasms/diagnosis/surgery ; Pancreaticoduodenectomy/adverse effects ; Portal Vein/radiography ; Splenic Vein/radiography ; Tomography, X-Ray Computed

No abstract availble.
Duodenoscopy ; Esophageal and Gastric Varices/*diagnosis/etiology/pathology ; Gastrointestinal Hemorrhage/*diagnosis/etiology/pathology ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/*complications ; Tomography, X-Ray Computed

We present a case of intrapancreatic accessory splenic infarction in a 28-year-old woman. It was discovered during a workup for an acute right epigastric pain. Computed tomography imaging of abdomen demonstrated a hemorrhagic high attenuation with enhancing solid portion in the tail of pancreas. The clinical and radiological differential diagnosis included pancreatic mucinous cystic neoplasm, pancreatic endocrine neoplasm, solid pseudopapillary tumor, ductal adenocarcinoma, and metastasis. A distal pancreatectomy was completed. The microscopic examination revealed heterotopic splenic tissue with infarction and her abdominal pain disappeared. In this case report, we first describe a symptomatic accessory splenic infarction which presented as a hemorrhagic mass in the tail of pancreas mimicking pancreatic neoplasm.
Adult ; Diagnosis, Differential ; Female ; Hemorrhage/etiology ; Humans ; Pancreas/pathology/surgery ; Pancreatectomy ; Pancreatic Diseases/*diagnosis/pathology/surgery ; Pancreatic Neoplasms/diagnosis ; Spleen/pathology ; Splenic Infarction/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

No abstract available.
Abscess/complications/*diagnosis ; Adenocarcinoma/complications/*diagnosis ; Adult ; Diabetes Mellitus, Type 2/complications ; Diabetic Ketoacidosis/*etiology ; Fatal Outcome ; Female ; Humans ; Pancreatic Neoplasms/complications/*diagnosis

The most common finding related to nonalcoholic steatohepatitis is obesity, but a status of severe malnutrition can also induce the steatohepatitis. The authors report a rare case of steatohepatitis leading to hepatic decompensation caused by malnutrition after pancreaticoduodenectomy. A 68-year-old female patient who had been previously diagnosed with pancreatic cancer and had undergone pancreaticoduodenectomy 5 months previously presented with abdominal distension. Routine CT performed 3 months after the surgery revealed severe fatty liver without evidence of tumor recurrence. After undergoing pancreaticoduodenectomy her food intake had reduced, and as a result she had lost 7 kg of body weight over 2 months. At this admission, CT revealed moderate amounts of ascites without tumor recurrence. Furthermore, her albumin and lipid profile levels were markedly decreased, and she had a flapping tremor and slurred speech suggestive of hepatic encephalopathy. Her liver biopsy findings were consistent with steatohepatitis and disclosed macrovesicular steatosis without definite fibrosis. After careful nutritional control, her symptoms disappeared and her laboratory findings improved.
Aged ; Ascites/etiology ; Fatty Liver/*diagnosis/etiology/pathology ; Female ; Humans ; Liver Function Tests ; Malnutrition/*complications ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy ; Tomography, X-Ray Computed

OBJECTIVETo compare the findings of pancreaticobiliary duct dilation due to pancreatic carcinoma and chronic pancreatitis by magnetic resonance cholangiopancreatography (MRCP).

METHODSMRCP findings in 28 cases of pancreatic carcinoma and 42 cases of chronic pancreatitis were retrospectively analyzed. Both plain MR and MRCP examinations were performed in all the cases after oral Gd-DTPA dilution.

RESULTSMRCP in the patients with pancreatic carcinoma displayed dilated pancreatic duct with smooth and regular caliber (n=16, 72.7%), dilated common biliary duct with abrupt rupture in most cases (n=18, 90%) and intra- and extra-hepatic cholangiectasis (n=12, 42.8%), and the double-duct sign (n=19, 86.5%). In the patients with chronic pancreatitis, MRCP identified irregular dilation of the pancreatic duct across the whole segment of the lesion (n= 20, 60.6%), taper of the dilated common bile duct (n=8, 80%), stones within the pancreatic duct (n=5, 11.9%), and pancreatic pseudocsyt within the pancreatic duct (n=21, 50%).

CONCLUSIONCholangiopancreatographic findings of pancreaticobiliary duct dilation are of great value in distinguishing pancreatic carcinoma from chronic pancreatitis.

Adult ; Aged ; Aged, 80 and over ; Cholangiopancreatography, Magnetic Resonance ; methods ; Chronic Disease ; Common Bile Duct ; pathology ; Diagnosis, Differential ; Dilatation, Pathologic ; etiology ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Ducts ; pathology ; Pancreatic Neoplasms ; complications ; diagnosis ; Pancreatitis ; complications ; diagnosis ; Reproducibility of Results ; Sensitivity and Specificity