Pancreatic neuroendocrine tumor trapped in a cyst

Pancreatic neuroendocrine tumor (Pan NET) accounts for only 1–2% of pancreatic neoplasms and <1% of tumors present as cystic lesions. A diagnosis of cystic tumor in the pancreas can be very challenging and confusing. Endoscopic ultrasound (USG) and fine needle aspiration (FNA) of these cystic lesions can help the clinician to narrow down the differential diagnosis. A multidisciplinary approach is warranted for a definitive diagnosis and optimal treatment. Here, we present to you a very rare case of Pan NET presenting as a cystic mass. A 65-year-old man was admitted with a history of abdominal pain. Laboratory tests showed increased levels of serum amylase, and other biochemical tests were normal. The patient underwent transabdominal USG and computed tomography (CT). CT showed well-defined cystic lesion in the proximal body of the pancreas. Endoscopic guided FNA (EUS-FNA) using 22 gauges was done. Cytological examination demonstrated clusters and sheets of plasmacytoid cells. EUS core needle biopsy was done which showed loose clusters of cells with fine uniformly distributed chromatin that stained positively for insulinoma associated protein-1 which was suggestive of a Pan NET. The differential diagnosis of cystic lesions in the pancreas is very difficult with conventional radiology such as CT and magnetic resonance imaging. Cytology is helpful for a pre-operative diagnosis of cystic Pan NET. A diagnosis of Pan NET in a pancreatic biopsy or FNA with limited and suboptimal material is often challenging. This unusual case highlights the importance of pre-operative workup of EUS followed by FNAC in cystic pancreatic lesions.

Focal IgG4-related autoimmune pancreatitis with distal choledochal adenocarcinoma: a rare case report

Background Autoimmune pancreatitis (AIP) is a rare disease that manifests as pancreatic involvement in systemic IgG4-related disease (IgG4-RD), a special type of chronic pancreatitis caused by autoimmune abnormalities. The main imaging manifestations of IgG4-related AIP consist of diffuse or localized pancreatic enlargement and irregular pancreatic duct narrowing. The diagnosis of AIP is challenging because it can present with focal lesions, similar to radiologically bile duct cancer or pancreatic cancer. Case presentation A 55-year-old male patient was admitted with painless jaundice and multiple radiographic findings of pancreatic head mass, as well as intrahepatic and extrahepatic bile duct dilatation. Various imaging methods indicated pancreatic cancer. However, the endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) and a laparoscopic pancreatic biopsy suggested an IgG4-related AIP. After one month, magnetic resonance imaging showed that the lesion had slightly grown. Combined with CA19-9 and other indexes, the possibility of malignancy was high and there were still surgical indications. The pathological analysis following a pancreaticoduodenectomy revealed poorly differentiated adenocarcinoma in the distal common bile duct. Conclusion To date, few reports have described pancreatic or extrapancreatic malignancies in AIP patients, and no association between AIP and bile duct adenocarcinoma has been previously confirmed. This case discuss the differentiation between AIP and malignancy, recent research progress, and the correlation between the two diseases, highlights the importance of carefully evaluating patients with AIP to rule out potential tumors, as well as the critical need for follow up treatment.

Clinical use of cytomedin in patients with prostate diseases

Introduction. The use of extracts of the prostate of animals is one of the main directions in the treatment of patients with diseases of the prostate. Most studies describe the experience of using these drugs in a small number of patients for a limited time period. The aim of this work was to summarize the long-term experience of using drugs of the cytomedin group in the treatment of a large number of patients with chronic prostatitis (CP) and benign prostatic hyperplasia (BPH). Materials and methods. Cytomedins were used in 487 patients with CP / BPH from January 2015 to December 2018. Indications: rehabilitation of patients after pancreatic biopsy (63 patients, 13%), cystoscopy and other endoscopic surgical interventions (189 patients, 39%), as well as conservative therapy of chronic inflammation associated with BPH (235 patients, 48%). If an infectious-inflammatory process was suspected, the following scheme was used: Vitaprost Plus 1 candle 1 time per day for 20 days, in the presence of irritative complaints, Vitaprost Forte was used 1 candle 1 time per day for 20 days, in other cases Vitaprost was prescribed 1 candle 1 time per day for 20 days ... The second component of the complex treatment was the use of the Vitaprost tablet form for 20 days, 1 ton 2 times a day. Before and after the appointment of therapy, the quality of life was monitored according to the data of the visual analogue scale (VAS), ultrasound examination of the pancreas (ultrasound) and laboratory parameters. The results of therapy were assessed as successful with an improvement in the quality of life, a decrease in the level of leukocytes, and a decrease in the volume of the pancreas by more than 10% from the initial level. Results. The total efficacy of cytomedin therapy was 39%. The greatest effectiveness of therapy was with the initial VAS less than 60 points out of 100; with more severe pain syndrome, the effectiveness was statistically significantly reduced to 32%. The initial detection of an inflammatory component with an increase in the level of leukocytes in laboratory tests statistically significantly increased the effectiveness of therapy 48 versus 24%. Cytomedin therapy was equally effective regardless of the prostate volume (36% versus 42% versus 38%, p> 0.05). A survey was conducted in 102 patients after Vitaprost-Forte / Vitaprost therapy, the results of which revealed a decrease in the I-PSS score from 18 ± 6.4 points to 12 ± 4 points (p> 0.05), in the group with combination therapy with alpha adrenergic blockers – 8 ± 3.2 points, p <0.05. A control examination of 51 patients with the development of erectile dysfunction against the background of chronic intake of 5-ARI showed that the cancellation of 5-ARI inhibitors followed by the appointment of Vitaprost in the form of suppositories and tablets led to an increase in the IIEF-5 indicator by 5 points, the average indicator during the control examination was 23 ± 4.2 points (p> 0.05) versus 18 ± 3.4 points before treatment. Conclusions. the following prognostic criteria for the effectiveness of cytomedin therapy were determined: the level of the visual analogue scale is less than 60 out of 100 and the presence of a confirmed inflammatory component according to laboratory tests.

Gastric metastasis from pancreatic cancer characterized by mucosal erosion: a case report and literature review

Pancreatic cancer with gastrointestinal tract metastasis is a fairly rare occurrence, and gastric metastasis in such cases has been seldom reported. We herein present a case of gastric involvement secondary to pancreatic cancer in a 74-year-old woman in whom the metastatic lesion only presented as mucosal erosion in the stomach. The patient had a 1-month history of progressive right upper quadrant pain before admission. Computed tomography and endoscopic examinations revealed a solid and hypo-enhancing mass in the head of the pancreas. The patient underwent conventional upper endoscopy before pancreatic biopsy, and mucosal erosion was observed in the gastric pylorus. We obtained gastric and pancreatic biopsies by gastroscopy and endoscopic ultrasound-guided fine needle aspiration, respectively. Pathologically, the biopsies taken from the area of gastric erosion showed poorly differentiated invasive adenocarcinoma that was morphologically consistent with the pancreatic specimens. Moreover, the gastric section showed tumor thrombi within the vessels. Hence, the suspected diagnosis was unresectable pancreatic cancer with gastric metastasis. The patient immediately underwent two courses of chemotherapy, but her condition rapidly deteriorated and she died 2 months later.

A Diabetic Patient Complicated With Pancreatic Cancer After Using Liraglutide: A Case Report

BackgroundDiabetes and cancer are both multifactorial diseases, and epidemiologic evidence indicates that diabetes may be associated with the incidence of certain types of cancer. In diabetes the risk of pancreatic cancer is increased significantly. However, whether certain diabetes treatment being related with the risk of pancreatic cancer remains unclear. In this report, we presented a case of pancreatic ductal adenocarcinoma in a diabetic patient in China after being treated with liraglutide, a novel glucagon-like peptide-1 (GLP-1) analog.Case reportA 71-year-old Han Chinese man who had had a type 2 diabetes for 25 years presented at the endocrinology department with discomfort in the left upper quadrant of abdomen for 10 days. The patient’s vital signs and laboratory findings were unremarkable except for the elevated level of carbohydrate antigen (CA19-9). The upper abdomen routine enhanced computed tomography (CT) scan showed low density of the pancreatic body and tail, and the histopathological result of the pancreatic biopsy samples was pancreatic ductal adenocarcinoma with regional lymph node metastasis. We reviewed his former medical records and found that liraglutide was added to his hypoglycemic treatment regimen 20 months ago. At that time, the level of tumor biomarkers and upper abdomen routine CT were unremarkable. We estimated the causality between liraglutide and pancreatic cancer by the Naranjo Adverse Drug Reaction Probability scale and WHO-Uppsala Monitoring Centre (WHO-UMC) system, and the causality turned out to be possible.ConclusionOur report suggests that liraglutide may be related with the genesis and development of pancreatic cancer and also highlights the importance of regular checkups in diabetic patients treated with liraglutide. However, our report has some notable limitations, and further longer-term follow-up trials with larger sample should be conducted in future to assess the causality between liraglutide and pancreatic cancer.

Adolescent Type 2 Autoimmune Pancreatitis

There are two forms of autoimmune pancreatitis (AIP). Type 1 is associated with immunoglobulin G4 (IgG4)-related systemic fibro- inflammatory disease, whereas type 2 AIP is localized to the pancreas and not associated with IgG4. The number of children presenting with type 2 AIP has recently increased. Here, we report a case of type 2 AIP in a 16-year-old adolescent who presented with clinical acute pancreatitis and associated pancreatic masses. He was diagnosed with type 2 AIP based on pancreatic biopsy results showing granulocytic epithelial lesions and supportive radiological imaging and steroid responsiveness.