Case reports in pancreatic cancer最新文献

Background: Recurrent pancreatic cancer may represent a true local recurrence or a second intrapancreatic primary. Resection of recurrent pancreatic cancer is uncommon. Case Presentation: A 68-year-old woman underwent a distal pancreatectomy/splenectomy for pancreatic adenocarcinoma after presenting with acute pancreatitis. She received 6 months of adjuvant gemcitabine. Nearly 5 years later, she presented with acute pancreatitis. Endoscopic ultrasonography suggested malignant degeneration of an uncinate intraductal papillary mucinous neoplasm (IPMN), but the cytology was negative. She subsequently underwent a completion pancreaticoduodenectomy for what proved to be a second pancreatic adenocarcinoma. Conclusion: Although uncommon, repeat resection for a second pancreatic cancer may be appropriate in select patients. Careful attention to the remnant pancreas must be maintained on surveillance imaging.

Background: Colloid carcinoma of the pancreas is a rare type of pancreatic cancer that has a more indolent course and superior long-term survival compared to ductal adenocarcinoma. There is a dearth of literature describing this diagnosis due to its rarity and its only recent recognition as a distinct clinical entity. We present two cases of patients with colloid carcinoma and discuss the presentation and management of this disease. Case Presentation: A 58-year-old man with repeated bouts of pancreatitis and a 72-year-old woman with symptoms of pancreatic exocrine and endocrine insufficiency were both found to have cystic masses in the head of the pancreas. Both were identified as having at least mixed main duct/side branch intraductal papillary mucinous neoplasms (IPMNs) on appropriate workup with additional imaging and endoscopy. Pancreaticoduodenectomy was recommended. Both patients, however, were noted to have high-grade dysplasia at the resection margin intraoperatively on frozen section, and thus, total pancreatectomies were performed. Final pathology in each case demonstrated colloid carcinoma with no nodal spread of disease. The patients recovered well. Adjuvant chemotherapy was recommended. Conclusion: Colloid carcinoma of the pancreas is a rare pathologic diagnosis and is frequently associated with IPMN. Colloid carcinomas tend to present at earlier stages than do ductal adenocarcinomas and are known to have improved long-term survival. Surgical and systemic options for treatment parallel that of ductal adenocarcinoma due to the rarity of the diagnosis and the lack of trials assessing therapy for this specific diagnosis.

Background: In the literature, pancreatic cancer is not frequently acknowledged among the tumors that are considered a part of Lynch Syndrome. Case Presentation: Our case is one of a young man who was found, very early in life, to have pancreatic cancer. His tumor demonstrated germline microsatellite instability, and hence by definition the patient has Lynch syndrome. He responded well to treatment, which included surgery and adjuvant chemotherapy. To date he remains in remission from pancreatic cancer. Conclusion: The rare instances in this case report include: (a) The patient had pancreatic cancer that fulfilled the histopathological and clinical criteria for Lynch syndrome. (b) Pancreatic cancer was diagnosed earlier in our patient than is expected in patients who suffer from pancreatic cancer as a part of Lynch syndrome. (c) Our patient had an excellent response to chemotherapy. He remains in remission to date from pancreatic cancer and is 5 years since his last treatment for this disease.

Background: Pancreatic adenocarcinoma is associated with a very poor prognosis, with a 5 year survival of ∼7.2%. Vitamin D has long been evaluated for benefit as a protective agent and treatment for malignancies. Although cancer incidence and outcomes have been tied to vitamin D levels, there is no clear evidence that supplementation of vitamin D improves outcome in pancreatic cancer to date. Case Presentation: We present a patient who errantly took supratherapeutic doses of vitamin D 50,000 U daily, achieving a serum 25(OH)D level of more than 150 mg/mL, with no appreciable side effects. Conclusion: Her disease was stable for 8 months off of conventional treatment, although it is unclear whether this was related to vitamin D supplementation.

Background: Duodenal masses are rare entities and symptomatic presentation generally is due to abdominal pain or the presence of gastrointestinal bleeding. A number of published case reports in the literature have detailed various neoplasms that have caused an intussusception isolated to the duodenum. This is a particularly unusual phenomenon due to the location and fixation of this portion of the proximal small bowel to the retroperitoneum. We present here a case of duodeno-duodenal intussusception secondary to a leiomyoma. Case: A 65-year-old Caucasian male presented with intermittent bloody stools and syncope over a 9-month period secondary to a duodenal leiomyoma causing intussusception, which was treated through a pancreaticoduodenectomy. Conclusion: Intussusception of the duodenum is an uncommon entity and the diagnosis of a leiomyoma should be considered in the setting of a potential mass in the small intestine.

Background: A solid pseudopapillary tumor (SPT) of the pancreas is a rare neoplasm with low malignancy, constituting about 2% of pancreatic tumors, which mainly occurs in young women. Case Presentation: We herein report a case of a small SPT arising from the head of the pancreas in an asymptomatic 50-year-old man. This patient was admitted to our department at Henan Provincial People's Hospital for the evaluation of a pancreatic mass and a pancreatic resection was performed. Histology revealed the lesion to be an SPT of the pancreas, with the characteristic pseudopapilla formation, central degeneration, and capsule formation. The tumor was positive for vimentin, CD10, α1-antichymotrypsin, α1-antitrypsin, β-catenin, neuron-specific enolase, synaptophysin, and progesterone receptor. Conclusion: We diagnosed an SPT in the patient based on these histological findings and immunophenotype.

Background: Malignancy-associated bleeding can pose diagnostic dilemmas. We report a unique case of paraneoplastic acquired hemophilia A (AHA), immune thrombocytopenia (ITP), and immune neutropenia in a patient with pancreatic adenocarcinoma. Case Presentation: A 66-year-old male with newly diagnosed pancreatic cancer and normal preoperative hematological evaluation was taken to the operating room for pancreaticoduodenectomy. The operation was aborted due to empyema of the gall bladder, cholangitis, and local extent of disease. Postoperatively, the patient developed bleeding diatheses with mucocutaneous and intra-abdominal bleeding and a prolonged activated partial thromboplastin time. Evaluation revealed high-titer factor VIII inhibitor confirming AHA. Management with bypassing agents such as recombinant activated factor VII, factor VIII inhibitor bypassing activity, and immunosuppression with steroids, cyclophosphamide, and rituximab achieved remission in 2 months. ITP developed after achieving normal factor VIII levels, which was managed with intravenous immunoglobulin. Neutropenia was detected before initiation of chemotherapy and was managed with granulocyte-colony stimulating factor. Conclusion: These unique challenges posed by paraneoplastic hematological syndromes warrant the need for astute clinical judgment and multidisciplinary collaboration for effective management.

Background: Acinar cell cystadenoma is a rare pancreatic cyst that has been described in several case reports. This lesion may be incidental or asymptomatic, occurs predominately in females, and has a mean age of onset in the fourth decade. Case Presentation: A previously healthy 14-year-old male presented with abdominal pain. He was found to have a pancreatic cystic lesion on ultrasound and cross-sectional imaging. His diagnosis remained uncertain despite additional analysis, including endoscopic ultrasound with fine-needle aspiration. The patient underwent successful laparoscopic excision for definitive diagnosis and management with an unremarkable postoperative course. He was diagnosed with a multilocular acinar cell cystadenoma. Conclusion: Acinar cell cystadenoma is a rare pancreatic cyst whose true malignant potential is unknown. Although there are no formal recommendations for post-operative monitoring and the true risk of recurrence is unknown, we recommended every other year magnetic resonance imaging/magnetic resonance cholangiopancreatography for postresection surveillance for this patient due to the theoretical risk of recurrence with malignant transformation.

Background: Gastrointestinal malrotation arises from intrauterine events that occur early in the first trimester of gestation, and can result in a midgut volvulus that classically presents in the neonatal period with bilious emesis. Gastrointestinal malrotation can present clinically with symptoms such as chronic abdominal pain or bowel obstruction, or remain completely asymptomatic only to be discovered as an incidental finding much later in life during surgical exploration for other diseases. We sought to identify the prevalence of gastrointestinal malrotation in patients undergoing surgical exploration for hepatopancreatobiliary (HPB) malignancy and describe the operative considerations of these cases. Case Presentation: We performed a retrospective review of our prospectively acquired HPB surgery database from January 1, 2006, to December 1, 2013. We identified three cases of gastrointestinal malrotation out of a total of 1220 HPB cases reviewed, which represents 0.2%. We found two cases of gastrointestinal malrotation in the setting of pancreatic ductal adenocarcinoma and one case in the setting of cholangiocarcinoma. All three patients underwent exploratory laparotomy with resection of their respective primary tumors. We searched the English literature for cases of HPB malignancy in the setting of gastrointestinal malrotation. Conclusion: Our case series and review of the literature underscore the rarity and complexity of these cases.