glucagonoma is a rare islet alpha-cell tumor. We report a case of glucagonoma in a 55-year-old male patient with such clinical findings of necrolytic migratory erythema, diabetes mellitus, body weight loss, and anemia. CT examination found a space-occupying lesion in the pancreas, and an elevated serum glucagon level indicate the diagnosis of glucagonoma, which was confirmed postoperatively by pathological examination of the tumor tissue. A definite diagnosis of glucagonoma relies on pathological report, and so far no standard treatment strategy has been available for this tumor. Surgical resection is an effective means for treatment of glucagonoma.
Glucagonoma ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Pancreatectomy ; Pancreatic Neoplasms ; diagnosis ; pathology ; surgery

Solid and papillary neoplasms of the pancreas, a rare tumor usually found in young female patients, seldom presents with metastasis since it is a tumor with low potential for malignancy. The prognosis for this lesion is much more favorable than that for other pancreatic neoplasms. In an attempt to understand the characteristics and prognosis of this lesion, we reviewed twenty cases treated at the Department of Surgery, Severance Hospital, Yonsei University from 1985 to 1994. The mean age of the patients was 25.6 years (range: 13 to 39 years), and 19 (95%) were women. Chief complaints were palpable mass (50%), pain (45%), and indigestion(5%). In laboratory studies, tumor markers, including CEA, CA125, CA19-9, and aFP were studied in eight patients, and found negative. Other laboratory findings were also nonspecific. These tumors may occur anywhere in the pancreas. In our studies, the tumor was most often located in the tail (45%), and the head (40%) of the pancreas. These were treated by distal pancreatectomy and splenectomy (55%), Whipple's operation (20%), pylorus preserving pancreatoduodenectomy (10%), enucleation (10%) or excision (5%). Significant morbidity or mortality was not observed during hospitalization, and no recurrence or malignant degeneration occurred during the mean follow-up period of 4 years (range: 1 month to 9 years). In conclusion, this study has suggested that the patients with a solid and papillary neoplasm of the pancreas have a good prognosis for successful treatment, if the disease is diagnosed early and the tumor is completely resected. A higher index of suspicion, and more aggressive diagnostic workups are needed in dealing with this disease entity.
Adolescent ; Adult ; Carcinoma, Papillary/diagnosis/*pathology/surgery ; Female ; Follow-Up Studies ; Human ; Male ; Pancreatic Neoplasms/diagnosis/*pathology/surgery

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a unique disease entity that is characterized by predominant intraductal growth of mucinous cells, copious mucin production, and subsequent cystic dilatation of pancreatic ducts. IPMN shows a spectrum of histologic and imaging findings and possesses as the potential for malignant transformation arising from adenoma to invasive carcinoma. It is important to determine the type, extent of duct involvement, and presence of malignant transformation, and to assess tumor grading prior to surgical resection. Thus, it would be helpful for physicians managing patients with IPMN of the pancreas to have a guideline for the diagnosis and treatment of IPMN. In this review, a role of radiological evaluation for diagnosis and preoperative assessment is described as well as presentation of the guideline for patient management.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Carcinoma, Papillary/*diagnosis/pathology/surgery ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Preoperative Care ; Prognosis ; Tomography, X-Ray Computed

Carcinoma, Intraductal, Noninfiltrating ; diagnosis ; pathology ; surgery ; Carcinoma, Pancreatic Ductal ; pathology ; Diagnosis, Differential ; Humans ; Male ; Prostate ; pathology ; Prostatic Intraepithelial Neoplasia ; pathology ; Prostatic Neoplasms ; diagnosis ; pathology ; surgery

With increasing indence and peculiar clinico-pathological features, intraductal papillary mucinous neoplasm (IPMN) of the pancreas has been a major interest in the field of pancreatology. Although pathologic and clinical diversities make difficulty in decision of treatment of IPMN in some circumstances, surgical treatment is generally indicated for main duct IPMN and branch duct IPMN with suspected malignancy (tumor size >or=30 mm, mural nodules, dilated main pancreatic duct, or positive cytology) or prominent symptoms. IPMN has a favorable prognosis after the resection. However, invasive IPMN shows poor prognosis comparable to stage-matched pancreatic ductal adenocarcinoma. Conventional pancreatic resection is recommended in case of highly suspected malignant cases, and organ preserving pancreatectomy or minimal invasive surgery could be used, especially in benign looking branch duct IPMN. Before the surgical resection, clinician should consider patient's general and social condition as well as risk of malignancy to select proper type and extent of surgery.
Adenocarcinoma, Mucinous/diagnosis/pathology/*surgery ; Carcinoma, Pancreatic Ductal/diagnosis/pathology/*surgery ; Carcinoma, Papillary/diagnosis/pathology/*surgery ; Humans ; *Pancreatectomy ; Pancreatic Neoplasms/diagnosis/pathology/*surgery ; Preoperative Care ; Survival Analysis ; Treatment Outcome

BACKGROUND/AIMS: Intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms are included in mucin-producing pancreatic tumors. The reports about IPMN are not uncommon but those about the mucinous cystic neoplasms are relatively few. The aims of this study were to define the natural history of resected mucinous cystic neoplasms of the pancreas and to identify the findings which suggest malignancy. METHODS: The authors retrospectively evaluated the clinical outcomes of 41 patients with mucinous cystic neoplasms who were surgically resected at Asan Medical Center between 1995 and 2004. RESULTS: Women (n=33) were more frequently affected than men (n=8). Thirty three patients (80.6%) had adenoma, 1 (2.4%) borderline malignancy, 1 (2.4%) carcinoma in situ, and 6 (14.6%) invasive mucinous cystadenocarcinoma. The most frequent symptom was abdominal pain (39%). About half of the enrolled patients were asymptomatic. Unilocular type (79%) was more frequent than the multilocular type (21%) on gross morphology. The tumor size of invasive mucinous cystic neopolasms was larger than that of non-invasive mucinous cystic neoplalsms (p=0.01). Abdominal pain was more frequent in invasive mucinous cystic neoplasms (p=0.026). On gross morphology, mural nodules were detected in 4 of 6 patients with invasive mucinous cystic neoplasms. However, they were not detected in any patients with non-invasive mucinous cystic neoplasms. Recurrence developed in none of the 35 patients with non-invasive mucinous cystic neoplasms, however 2 of the 6 patients with invasive mucinous cystic neoplasms died within 5 years. CONCLUSIONS: Clinical predictors of invasive mucinous cystic neoplasms are suggested to be tumor size and abdominal pain. The prognosis of the non-invasive mucinous cystic neoplasms is excellent when curative resection is performed.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Adult ; Aged ; Carcinoma, Pancreatic Ductal/diagnosis/pathology/surgery ; Cystadenocarcinoma, Mucinous/diagnosis/pathology ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Retrospective Studies ; Survival Analysis

OBJECTIVETo study the diagnosis and treatment of solid-pseudopapillary tumor of the pancreas (SPTP).

METHODSThe clinical course, surgical treatment, and pathological findings of 13 patients with SPTP were analyzed.

RESULTSSPTP has no specific clinical symptoms. The patients mostly have abdominal pain and space occupying symptoms. Laboratory investigations of some patients showed decreased pancreatic exocrine function and elevated CA242 of tumor markers. Ultrasonography and CT revealed large solid cystic tumor of pancreas. Digital subtraction angiography (DSA) showed lacked-blood-supply space occupying lesion. All tumors were resected successfully. The histological findings showed a large encapsulated tumor and the section of tumor surrounded by hemorrhagic and necrotic areas. The solid areas are composed of small and medium size tumor cells, which had no obvious atypia. Psudopapillary structures were found in the cystic degeneration areas. Immunohistochemically, most of the tumors were positive for alpha-antitrypsin (alpha-AT) and vimentin and negative for chromogrannin. No patients recurrence during the follow-up.

CONCLUSIONSMost of SPTP can be removed successfully after diagnosis. The tumor and local infiltration tissue should be removed completely, and the long-term prognosis of SPTP is good.

Adolescent ; Adult ; Carcinoma, Papillary ; diagnosis ; pathology ; surgery ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pancreas ; pathology ; surgery ; Pancreatic Neoplasms ; diagnosis ; pathology ; surgery ; Retrospective Studies

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.
Adenocarcinoma, Mucinous/diagnosis/pathology ; Adenocarcinoma, Papillary/diagnosis/pathology ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Mucin-1/analysis ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

Compared with other types of cancers, pancreatic cancer is one of the most dreadful malignancies and is fifth leading cause of cancer-related death in Korea. It is difficult to expect early diagnosis or improvement in prognosis due to lack of specific early symptoms and effective diagnostic methods. Whereas cystic neoplasm of the pancreas is a rare type of pancreatic tumor, surgical resection provides good prognosis because of its low possibility of local invasion or distant metastasis. In case of pancreatic cystic tumor, radiologic differentiation between benign and malignant lesions is crucial for the selection of appropriate treatment and the prediction of prognosis. And ductal adenocarcinoma of pancreas presenting in cystic form is an uncommon type of cystic tumor, making it extremely rare among all pancreatic malignancies. We report two cases of atypical pancreatic ductal adenocarcinoma presenting as solid pseudopapillary tumor and intraductal papillary mucinous neoplasm, respectively.
Adenocarcinoma, Mucinous/*diagnosis/surgery ; Adenocarcinoma, Papillary/*diagnosis/surgery ; Adult ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreatectomy ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed