Laparoscopic approaches are increasingly used in pancreatic surgery. In the treatment of neuroendocrine tumors (NETs) of the pancreas, enucleation is one of the recommended surgery. Although many clinical experiences have reported the safety and efficacy of laparoscopic enucleation of functioning NETs, such as insulinomas, few reports have explored such treatment for non-functioning NETs. Here, we present a case of 70-year old female patient who underwent successful laparoscopic enucleation of a nonfunctioning NET located in the body of the pancreas.
Aged ; Female ; Humans ; *Laparoscopy ; Neuroendocrine Tumors/pathology/*surgery/ultrasonography ; Pancreatic Neoplasms/pathology/*surgery/ultrasonography

Most cases of accessory spleen show similar features as normal spleen in imaging studies. However, some accessory spleen has unusual scan feature which can be misdiagnosed. We present a case of intrapancreatic accessory spleen that was discovered incidentally during a workup for abdominal pain in a 47-year-old woman. CT and MRI revealed a different enhancing pattern from that of the spleen. Further evaluation with endoscopic ultrasonography failed to identify the pancreatic mass. Therefore, it was surgically removed and diagnosed pathologically as an accessory spleen.
Diagnostic Errors ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Pancreatectomy ; Pancreatic Neoplasms/radionuclide imaging/surgery/ultrasonography ; Spleen/*pathology/radionuclide imaging/surgery ; Tomography, X-Ray Computed

Pancreas acinar cell carcinoma (ACC) accounts for only 1-2% of pancreatic exocrine malignant tumor. The symptoms of patients with ACC are usually non-specific, for example the anorexia and weight loss. Patients may develop Schmid's triad including subcutaneous fat necrosis, polyarthritis, and eosinophilia. We reported a case of ACC which was manifested by subcutaneous nodule as initial clinical symptom. To our knowledge, this is the first reported case of ACC presenting as subcutaneous fat necrosis in Korea.
Carcinoma, Acinar Cell/*diagnosis/surgery/ultrasonography ; Fat Necrosis/pathology ; Humans ; Keratins/metabolism ; Male ; Middle Aged ; Pancreatic Neoplasms/*diagnosis/surgery/ultrasonography ; Subcutaneous Fat/*pathology ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

OBJECTIVETo evaluate prospectively the efficacy of ultrasonography (US), helical computed tomography (HCT), endoscopic ultrasonography (EUS) and magnetic resonance imaging (MRI) in the assessment of vascular invasion and lymph node metastasis in pancreatic carcinoma.

METHODSConsecutive 68 patients with pancreatic carcinoma were studied. Results of each imaging techniques regarding vascular invasion and lymph node metastasis were compared with the surgical and pathological findings.

RESULTS(1) US findings were confirmed moderately in accordance with surgical and pathological results in the evaluation of inferior cava vein, splenic artery and vein invasion of pancreatic carcinoma. HCT findings of evaluating superior mesenteric vein, portal vein, splenic vein were confirmed greatly in accordance with surgical and pathological results. The results of evaluating superior mesenteric artery, inferior cava vein, splenic artery, common hepatic artery, proper hepatic artery, celiac trunk, abdominal aorta were confirmed moderately in accordance with surgical and pathological results. MRI findings of evaluating superior mesenteric artery and vein, portal artery and vein were moderately in accordance with surgical and pathological results. EUS findings of evaluating splenic vein were confirmed greatly in accordance with surgical and pathological results, and moderately in accordance with surgical and pathological results in the evaluation of superior mesenteric vein. (2) EUS had the highest sensitivity (75.0%), accuracy (87.5%), and negative predictive values (91.7%) in the evaluation of lymph node metastasis. The sensitivity of HCT and MRI were 37.5% and 35.3%, which were significantly lower than that of EUS. The sensitivity of US was 18.7%, which was the lowest of all. In addition, the multivariate logistic regression analysis confirmed that EUS had an independent predictive value (OR: 34.50, 95%CI: 6.54 - 182.09).

CONCLUSIONHelical CT should be considered the most precise technique to evaluate vascular invasion. EUS had an independent predictive value with respect to tumor metastasis to regional lymph nodes.

Aged ; Blood Vessels ; diagnostic imaging ; pathology ; Endosonography ; methods ; Female ; Humans ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Neoplasm Invasiveness ; Pancreatic Neoplasms ; diagnostic imaging ; pathology ; surgery ; Prospective Studies ; Tomography, Spiral Computed ; methods ; Ultrasonography, Doppler, Color ; methods

Lung cancer metastases can occur in almost any organ. However, metastasis of small cell lung cancer to the pancreas is rare. Moreover, not all cases present with clinically diagnosed pancreatitis. We recently treated a patient with small cell lung carcinoma that invaded the pancreatic duct causing acute pancreatitis. Generally, the treatment for tumor-induced acute pancreatitis is initially supportive followed by aggressive chemotherapy or surgery. If the patient can tolerate the insertion of an endoscopic intrapancreatic stent, this is performed in addition to chemotherapy and surgery; this approach offers a safe and effective treatment modality for such patients.
Tomography, X-Ray Computed ; *Stents ; Prosthesis Implantation/*methods ; Pneumonectomy ; Pancreatitis/diagnosis/etiology/*surgery ; Pancreatic Neoplasms/*complications/secondary/therapy ; Pancreatic Ducts/radiography/*surgery/ultrasonography ; Middle Aged ; Lung Neoplasms/*pathology/therapy ; Humans ; Follow-Up Studies ; Female ; Endosonography ; Cholangiopancreatography, Endoscopic Retrograde ; Carcinoma, Small Cell/*complications/secondary/therapy ; Antineoplastic Agents/therapeutic use

OBJECTIVEPancreatic metastasis from renal cell carcinoma (RCC) is a rare event and has not been reported in our country. We report a series of 3 patients with metastatic RCC to the pancreas after radical nephrectomy at our institution. The published reports in the literature were reviewed, and the diagnosis, treatment as well as prognosis of this rare event were discussed.

METHODSThe data of 3 RCC patients with metastasis to the pancreas were reviewed retrospectively, including radical nephrectomy, metastatic interval, the second and third surgical removal. Survival of the three patients was analyzed and the reports in the literature were compared as well.

RESULTSThe average interval from radical nephrectectomy to the comfirmed pancreatic metastasis was 6.6 years (range, 1.2 to 12 years). The pathological stage revealed T2N0M0 (n = 2) or T3N0M0 (n = 1), with right-sided tumor in 2 patients and left side in 1. One patient was asymptomatic, while the other two cases were symptomatic at presentation, including upper abdominal pain, weight loss, slight xanthochromia of the skin and titillation, clay stool (n = 1); irregular fever, weight loss and jaundice (n = 1). All pancreatic metastases were hypervascular on arterial stage of CT imaging. One patient had only a solitary pancreatic metastasis (n = 1), the another showed two metastatic lesions (n = 1), the third one had multiple lesions (n = 1). Surgical removal was accomplished in 2 patients: including pylorus-preserving pancreaticoduodenectomy in one, and pylorus-preserving pancreaticoduodenectomy together with partial tail resection in another one. The third one only received interventional therapy due to widespread extrapancreatic metastasis, and died of disseminated disease 11 months after the therapy. One of the above two surgically treated patients underwent the second removal due to local recurrence 2.5 years after the first removal of pancreatic metastasis. These two patients were still alive after follow-up of 8.6 years and 16.1 years, respectively.

CONCLUSIONRenal cell carcinoma is an unpredictable tumor that may demonstrate very delayed metastasis even from early-stage of the disease. The pancreas is a rare site of metastasis from renal cell carcinoma. We advocate careful long-term follow-up of patients with a history of RCC. Aggressive surgical management of pancreatic metastatic lesions may provide a chance of long-term survival.

Aged ; Carcinoma, Renal Cell ; pathology ; surgery ; Chemotherapy, Cancer, Regional Perfusion ; Female ; Follow-Up Studies ; Humans ; Kidney Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Nephrectomy ; methods ; Pancreatic Neoplasms ; diagnosis ; drug therapy ; secondary ; surgery ; Pancreaticoduodenectomy ; methods ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Color