Elevated Erythropoietin and Multicystic Neoplasm of the Pancreas

Cystic lesions of the pancreas are more frequently recognized due to the widespread use of improved imaging techniques. There are a variety of pancreatic cystic lesions with different clinical presentations and malignant potentials, and their management depends on the type of the cysts. Although the early recognition of a cystic neoplasm with malignant potential provides an opportunity of early surgical treatment, the precise diagnosis of the cystic neoplasm can be a challenge, largely due to the lack of reliable biomarkers of malignant transformation. We report a case of a large, multicystic neoplasm within the body and tail of the pancreas complicated by elevated erythropoietin, which is likely related to the malignant transformation of the pancreatic neoplasm.

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Rare Pseudopapillary Neoplasm of the Pancreas: A 10-Year Experience

Surgery Research and Practice ◽

10.1155/2021/7377991 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Suvendu Sekhar Jena ◽

Samrat Ray ◽

Sri Aurobindo Prasad Das ◽

Naimish N Mehta ◽

Amitabh Yadav ◽

...

Keyword(s):

Imaging Techniques ◽

Pancreatic Neoplasm ◽

Clinical Manifestations ◽

Malignant Tumour ◽

The Body ◽

Low Grade ◽

Borderline Resectable ◽

Pancreatic Tumours ◽

Common Location ◽

The Mean

Introduction. The solid pseudopapillary epithelial neoplasm (SPN) is a rare form of pancreatic neoplasm with an incidence of 2-3% of all pancreatic tumours. The recent increase in incidence is attributed to the increasing use of imaging techniques for nonspecific abdominal complaints. We report our institutional experience in the management of this tumour over the last decade. Method. We retrospectively analyzed from a prospectively maintained database of patients from January 2011 to December 2020 who were operated upon for SPN. All the patients were followed till date. Results. Of 479 patients operated on for various types of pancreatic tumours during this period, 15 (3.1%) had SPN. The mean age of presentation was 28 years with a female preponderance (12/15, 80%). The most common location was the body and tail of the pancreas (66%), and the mean size was 6.4 cm (2–15 cm). The tumour extent was defined as ‘borderline resectable’ in 20% of cases. Distal pancreatectomy was done in 11 patients with spleen preservation in 3. R0, R1, and R2 resection were done in 12, 2, and 1 patient(s), respectively. The operative mortality was 6.7%. All the patients are doing well on follow-up. Conclusion. SPN is a low-grade malignant tumour with a strong female predilection. Clinical manifestations have no specificity, imaging examination only contributes tumour location, and the final diagnosis rests on pathology. Surgery is the main modality of treatment and carries a good prognosis.

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Pancreatic Cysts: Pathologic Classification, Differential Diagnosis, and Clinical Implications

Archives of Pathology & Laboratory Medicine ◽

10.5858/133.3.423 ◽

2009 ◽

Vol 133 (3) ◽

pp. 423-438 ◽

Cited By ~ 26

Author(s):

Olca Basturk ◽

Ipek Coban ◽

N. Volkan Adsay

Keyword(s):

Differential Diagnosis ◽

Malignant Potential ◽

Common Finding ◽

Pancreatic Cysts ◽

Pancreatic Ducts ◽

Low Grade ◽

Cystic Lesions ◽

Dismal Prognosis ◽

Cystic Tumors ◽

Pathologic Classification

Abstract Context.—Cystic lesions of the pancreas are being recognized with increasing frequency and have become a more common finding in clinical practice because of the widespread use of advanced imaging modalities and the sharp drop in the mortality rate of pancreatic surgery. Consequently, in the past 2 decades, the nature of many cystic tumors in this organ has been better characterized, and significant developments have taken place in the classification and in our understanding of pancreatic cystic lesions. Objective.—To provide an overview of the current concepts in classification, differential diagnosis, and clinical/biologic behavior of pancreatic cystic tumors. Data Sources.—The authors' personal experience, based on institutional and consultation materials, combined with an analysis of the literature. Conclusions.—In contrast to solid tumors, most of which are invasive ductal adenocarcinomas with dismal prognosis, cystic lesions of the pancreas are often either benign or low-grade indolent neoplasia. However, those that are mucinous, namely, intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, constitute an important category because they have well-established malignant potential, representing an adenoma-carcinoma sequence. Those that are nonmucinous such as serous tumors, congenital cysts, lymphoepithelial cysts, and squamoid cyst of pancreatic ducts have no malignant potential. Only rare nonmucinous cystic tumors that occur as a result of degenerative/necrotic changes in otherwise solid neoplasia, such as cystic ductal adenocarcinomas, cystic pancreatic endocrine neoplasia, and solid-pseudopapillary neoplasm, are also malignant and have variable degrees of aggressiveness.

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Transforming growth factor β1 selectively regulates ferritin gene expression in malignant H-ras-transformed fibrosarcoma cell lines

Biochemistry and Cell Biology ◽

10.1139/o00-062 ◽

2000 ◽

Vol 78 (4) ◽

pp. 527-535 ◽

Cited By ~ 3

Author(s):

James Lo ◽

Robert AR Hurta

Keyword(s):

Gene Expression ◽

Cell Proliferation ◽

Growth Factor ◽

Malignant Transformation ◽

Cell Lines ◽

Transforming Growth Factor ◽

Malignant Potential ◽

Transformed Cells ◽

Protein Synthesis Inhibitor ◽

Ferritin Gene

Transforming growth factor β1 is an important growth regulator in many cell types, usually exerting a negative effect on cellular growth. Inhibition of DNA synthesis and cell proliferation is frequently lost during malignant transformation, and in some cases, tumor cell proliferation is actually stimulated by TGF-β1. The present study demonstrates a novel link between alterations in TGF-β1 regulation during malignant conversion, and the expression of ferritin, an important activity involved in a number of biological functions including iron homeostasis and cell-growth control. A series of H-ras-transformed mouse 10 T 1/2 cell lines, exhibiting increasing malignant potential, was investigated for possible TGF-β1-mediated changes in ferritin gene expression. Selective induction of gene expression was observed, since only H-ras-transformed cells with malignant potential exhibited marked elevations in ferritin gene expression, in particular, alterations in H-ferritin gene expression. The regulation of H-ferritin gene expression in response to TGF-β 1 did not involve alterations in transcription, but occurred through mechanisms of post-transcriptional stabilization of the H-ferritin mRNA. Additionally, evidence was obtained for a cycloheximide-sensitive regulator of H-ferritin gene expression, since the presence of this protein synthesis inhibitor increased H-ferritin message levels, and in combination with TGF-β1, cooperated in an additive manner to augment H-ferritin gene expression. These results show for the first time that TGF-β1 can regulate ferritin gene expression in malignant H-ras transformed cells, and suggest a mechanism for growth factor stimulation of malignant cells, in which early alterations in the control of H-ferritin gene expression are important.Key words: TGF-β1, ferritin gene expression, malignant transformation.

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Cd5+ Diffuse Large B Cell Lymphoma of the Liver Presenting as Cholestatic Transaminitis.

10.21203/rs.3.rs-580354/v1 ◽

2021 ◽

Author(s):

Taroob Jawad Latef ◽

Muhammad Bilal ◽

Sudeep Siddappa Malleshappa ◽

Chandravathi Loke

Keyword(s):

B Cell ◽

Viral Infections ◽

Cell Lymphoma ◽

Early Recognition ◽

Specific Treatment ◽

B Cell Lymphoma ◽

The Body ◽

Large B Cell Lymphoma ◽

High Index Of Suspicion ◽

Large B Cell

Abstract A 72-year-old male with nonspecific symptoms was found to have pancytopenia and transaminitis. The pancytopenia began to improve early in the hospital course without specific treatment. A liver biopsy, obtained later to determine the etiology of the transaminitis, eventually confirmed CD5+ diffuse large B cell lymphoma (DLBCL). DLBCL typically presents with painless lymphadenopathy and constitutional symptoms although it may also present as a rapidly enlarging mass in any part of the body. However, in rarer cases its presentation can be misleading. Conditions such as HLH or viral infections, can confound a patient’s presentation and delay the diagnosis. High index of suspicion is warranted for the diagnosis of DLBCL in atypical cases to prevent mortality associated with late diagnosis. Early recognition and biopsy of involved organ, in the absence of clear etiology, is vital for timely diagnosis and prompt treatment to achieve a favorable cure rate. CD5+ DLBCL may have unusual involvement of extra nodal organs such as the liver and may need further investigations.

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Cervical intradural extramedullay vascular schwannoma in a thirty eight year old male

International Surgery Journal ◽

10.18203/2349-2902.isj20193012 ◽

2019 ◽

Vol 6 (7) ◽

pp. 2634

Author(s):

Shipra Singhal ◽

Sufian Zaheer ◽

Rashmi Arora

Keyword(s):

Peripheral Nerve ◽

Peripheral Nerves ◽

Neck Region ◽

The Body ◽

Vascular Changes ◽

Vascular Tissues ◽

Clinical Presentations ◽

Cervical Swelling ◽

Head Neck

Schwannomas are benign peripheral nerve sheet tumours that may arise almost anywhere in the body but are commonly seen in the head, neck region and in the extremities. They may be associated with variable clinical presentations depending on their location. The peripheral nerves are closely related to vascular tissues morphologically and physiologically and therefore schwannomas may be associated with vascular changes like vascular hyperplasia and vascular dilation. Here authors represent one such case where a 38-year-old patient presented with a cervical swelling which on histopathology was diagnosed as vascular schwannoma.

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Addressing adenomyosis: Implications beyond we actually know

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193790 ◽

2019 ◽

Vol 8 (9) ◽

pp. 3644

Author(s):

Ganesh Kumar ◽

Purnima Pachori

Keyword(s):

Recurrent Pregnancy Loss ◽

Imaging Techniques ◽

Abnormal Uterine Bleeding ◽

Uterine Bleeding ◽

Age Group ◽

Adherent Placenta ◽

Clinical Presentations ◽

Number Of Patients ◽

Retrospective Comparative Study ◽

Clinical Records

Background: Hysterectomy is one of the commonest gynecological surgeries being performed in India for various pelvic pathologies like fibroid uterus, endometrial hyperplasia, dysfunctional uterine bleeding, etc. But pre-operative diagnosis of adenomyosis and making it an indication for hysterectomy is not as common as pathologists find it in histo-pathology of hysterectomized specimens. The aim of the study was to study the frequency of adenomyosis in comparison to leiomyoma as a uterine pathology in hysterectomized specimens and correlate them clinically.Methods: A retrospective comparative study was carried out on 1646 hysterectomy specimens, during January 2014 to December 2016, which showed either adenomyosis or leiomyoma or both. Clinical records of these cases were retrieved and histo-pathology was correlated to clinical presentations and pre-operative ultrasonography.Results: Of the 1646 specimens taken for comparision between adenomyosis and leiomyoma, 49% showed only adenomyosis, 37% only leiomyoma and 14% had dual pathology showing findings of both. The peri-menopausal age group (45-54 years) accounted for the maximum number of patients undergoing hysterectomy (37.12%). But adenomyosis was found maximum in 35 - 44 years age group (38.04%). The clinical presentations for these two pathologies were similar and maximum patients presented with abnormal uterine bleeding and pelvic pain. Ultrasonography was able to diagnose only 32% cases of adenomyosis pre-operatively whereas this figure was 87% for fibroids.Conclusions: Adenomyosis and leiomyoma both account for the most frequent findings in hysterectomy specimens. Fibroids are easily diagnosed pre-operatively, but adenomyosis needs to be diagnosed pre-operatively by high index of clinical suspicion and imaging techniques. Adenomyosis is not just a disease of middle age, it needs to be addressed for infertility, recurrent pregnancy loss (RPL), bad obstetric history, IVF failures and adherent placenta as well.

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Clinical and radiological features that predict malignant transformation in cystic lesions of the pancreas: a retrospective case note review

AMRC Open Research ◽

10.12688/amrcopenres.12860.1 ◽

2019 ◽

Vol 1 ◽

pp. 4

Author(s):

Margaret G. Keane ◽

Hannah R. Dadds ◽

Ghassan El Sayed ◽

Tu Vinh Luong ◽

Brian R. Davidson ◽

...

Keyword(s):

High Risk ◽

Malignant Transformation ◽

Cystic Lesions ◽

Retrospective Case ◽

Radiological Features ◽

Multidisciplinary Meeting ◽

Mucinous Neoplasms ◽

Low Incidence ◽

Immediate Surgery

Background: Pancreatic cystic lesions (PCL) are being detected with increasing frequency. Current methods of stratifying risk of malignant transformation are imperfect. This study aimed to determine the frequency of pancreatic malignancy in patients with PCL and define clinical and radiological features that predict malignant transformation in patients managed by surgery and/or surveillance. Methods: A retrospective cohort of adults who were evaluated in a tertiary hepatopancreaticobiliary centre between January 2000 - December 2013 with a confirmed PCL and followed up for at least 5 years. All cystic lesions were discussed at a weekly multidisciplinary meeting. Results: Of the 1,090 patients diagnosed with a PCL, 768 patients were included in the study: 141 patients were referred for immediate pancreatic resection, 570 entered surveillance while 57 had a malignant PCL which was unresectable at diagnosis (n=47) or were unfit for surgery (n=10). In those who were resected following presentation, malignancy was present in 38%. During follow-up 2% of those entering a surveillance programme underwent malignant transformation. Clinical and radiological features associated with a high-risk PCL included older age, symptoms, associated solid component or dilated main pancreatic duct. In intraductal papillary mucinous neoplasms, larger size was not a feature of malignant transformation (benign vs. malignant 30mm vs. 23mm; P= 0.012). Conclusion: The sensitivity of standard diagnostic tests leading to immediate surgery for high-risk PCL (malignant or mucinous) was 92% but with a specificity of just 5%. Surveillance of PCL without high-risk features within a multidisciplinary meeting was associated with a low incidence of cancer development, supporting the use of worrisome clinical and radiological features in the initial stratification of PCL.

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The application of digital imaging techniques in the in vivo estimation of the body composition of pigs: a review

Livestock Production Science ◽

10.1016/s0301-6226(99)00050-0 ◽

1999 ◽

Vol 60 (1) ◽

pp. 1-11 ◽

Cited By ~ 47

Author(s):

Cs. Szabo ◽

L. Babinszky ◽

M.W.A. Verstegen ◽

O. Vangen ◽

A.J.M. Jansman ◽

...

Keyword(s):

Body Composition ◽

Digital Imaging ◽

Imaging Techniques ◽

The Body

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Non-Tumor Cystic Lesions of the Adrenal Gland

PRILOZI ◽

10.1515/prilozi-2015-0078 ◽

2015 ◽

Vol 36 (3) ◽

pp. 51-59 ◽

Cited By ~ 3

Author(s):

Vesna Janevska ◽

Vlado Janevski ◽

Oliver Stankov ◽

Liljana Spasevska ◽

Slavica Kostadinova-Kunovska ◽

...

Keyword(s):

Imaging Techniques ◽

Cystic Lesions ◽

Pathological Features ◽

Radiological Findings ◽

Tissue Sections ◽

Male Ratio ◽

Radiologic Imaging ◽

Vascular Origin ◽

The Mean ◽

Material Standard

Abstract Adrenal cystic lesions are uncommon but due to the improved radiologic imaging techniques their appearance seems to increase. Material and Methods: We analyzed the clinical and radiological findings of 10 patients with adrenal cysts and the pathological features of the operative material. Standard dissection procedure and paraffin embedded tissue sections were made, stained by HE and immunohistochemically with CD34, CD 31, Factor 8, Podoplanin, CKWS and AE1/AE3 Results: The mean age of the patients was 40.6 years; female to male ratio was 2.3:1. All the cysts were diagnosed as cystic lesions radiologically except one. The most present clinical symptom was abdominal pain. The diameter of the cysts measured from 2 to 7 cm. Four of the cysts were diagnosed as pseudocysts and six as endothelial. Six cysts were lined by CD34+ and CD31+ cells, four were lined by Factor 8+ and podoplanin+ cells and four had no lining. Conclusion: Endothelial cysts were more common cysts in our study and the immunohistochemical results suggested common vascular origin to all endothelial cysts and supported additional separation of angiomatous and lymphangiomathous adrenal vascular cysts.

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