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A case of a suspected aneurysm of the pancreatic head
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Abstracts / Pancreatology 16 (2016) S1eS192
sites. (2) Pancreatic paragangliomas are rare and difficult to distinguished from another malignant tumour. The purpose of this article is to present a case of pancreatic paraganglioma in male patient that was surgically resected by Whipple surgery with vascular reconstruction. Case report: A 68-year-old male with history of intermitent abdominal pain. Physical examination showed a palpable mass in the right upper abdomen. Initial laboratory studies including tumour markers showed no abnormalities. An abdominal computed tomography scan showed a welldefined pancreatic tumour involving mesenteric vein, we made a preoperative diagnosis of a resecable pancreatic tumor. Pancreaticoduodenectomy was performed. The final pathology report pancreatic paraganglioma. Discussion: In the literature review have been reported 24 cases of pancreatic paraganglioma. (5) In these previous reports concluded that pancreatic paraganglioma usually not present any symptoms and often found incidentally. The mean age reported is 67 years. The imaging findings were generally characterized as a well-defined mass with frequent areas of hypoechogenicity on US, a well marginated, hypervascular tumor with cystic areas of low-attenuation on contrastenhanced CT. (4) Conclusion: Pancreatic paraganglioma is a rare entity with limited cases reported. The diagnosis pre-operatively is speculative and malignant tumor is a feasible differential diagnosis. Surgical resection is necessary for histological assessment. However, the risk of malignant transformation justifies aggressive management.
We herein report a case of aneurysm of the pancreatic head. A 44-year old woman was detected asymptomatic pancreatic cystic lesion, 40mm in size, by medical health check in 2007 and followed by magnetic resonance imaging (MRI) annually. In 2015, MRI detected the increase in size and wall thickness. Therefore, she was referred to our hospital for further examination and surgery. Computed tomography showed a 52mm cystic lesion, and the wall of cyst had increased contrast enhancement. Endoscopic retrograde cholangiopancreatography performed by previous doctor revealed the cyst had no communication with the main pancreatic duct. Endoscopic ultrasound identified a multilocular cystic lesion with suspected mural nodules. Under the preoperative diagnosis of mucinous cystic neoplasm, pancreatoduodenectomy was performed. Gross inspection of the resected specimen showed a cystic lesion with internal hemorrhage and serous fluid. Pathological examination showed there was no epithelial component on the inner surface of the cystic lesion, but there were collagen fiber, fibrous tissue and vascular structures communicated with gastroduodenal artery. Although it was difficult to conclude definitive diagnosis, the tumor was suspected as an aneurysm of the pancreatic head.
P-209. A case of lipomatous pseudohypertrophy of the pancreas diagnosed by endoscopic ultrasonography-fine-needle aspiration: without surgical resection
P-207. A case of primary pancreatic malignant lymphoma diagnosed by endoscopic ultrasound-guided fine needle aspiration Takumi Onoyama, Kazuya Matsumoto, Hiroki Koda, Hiroki Kurumi, Soichiro Kawata, Yohei Takeda, Kenichi Harada, Hajime Isomoto Department of Gastroenterology, Tottori University, Japan
Yoichi Sasaki 1, Shuji Ishii 1, Atsuo Inoue 1, Naoki Kawai 1, Yoshimichi Haruna 1, Kazuho Imanaka 1, Takuya Inoue 1, Noriko Hasegawa 1, Yuhei Wakahara 1, Satoshi Shigeno 1, Chiaki Torizumi 1, Toshihiro Imai 1, Sumiko Abe 1, Masahiko Tsujii 2, Kohsaku Onishi 2, Hiroaki Hushimi 3, Koki Shimazu 3 1 2 3
A 83-year-old man was admitted to our hospital with upper abdominal pain and anemia. Ultrasonography revealed a 78-mm hypoechoic mass in the head and body of the pancreas. Computed tomography showed a mass that was of lower contrast, and was penetrated by the celiac artery and superior mesenteric artery. On endoscopic ultrasonography, the surface was smooth, the margin was clear, internal echogenicity was heterogeneous, and there was no lateral shadow. Endoscopic retrograde pancreatography did not show stenosis or obstruction of the main pancreatic duct. The pancreatic juice cytology was negative. We performed endoscopic ultrasound-guided fine needle aspiration by using a 19-gauge needle. A hematoxylin and eosin staining showed that the tumor cells were large-sized atypical lymphocytes with diffuse proliferation. The immunohistological findings showed atypical lymphocytes that were positive for CD20, CD79a, Bcl-2, and MUM-1, negative for CD3, CD5, CD10, CD23, CD45RO, and cyclin D1, and positive or negative for Bcl-6. The final diagnosis was primary pancreatic diffuse large B-cell lymphoma, stage IE (Ann Arbor). Primary pancreatic malignant lymphoma is a rare disease among pancreatic tumors. We will report about a case of primary pancreatic malignant lymphoma diagnosed by endoscopic ultrasound-guided fine needle aspiration.
P-208. A case of a suspected aneurysm of the pancreatic head Takashi Miyata 1, Teiichi Sugiura 1, Yukiyasu Okamura 1, Takaaki Ito 1, Yusuke Yamamoto 1, Ryo Ashida 1, Sunao Uemura 1, Yoshiyasu Kato 1, Katsuhisa Ogi 1, Atsushi Kohga 1, Tsuneyuki Uchida 1, Syusei Sano 1, Keiko Sasaki 2, Katsuhiko Uesaka 1 1 Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan 2 Division of Diagnostic Pathology, Shizuoka Cancer Center, Japan
Gastroenterology, Osaka General Medical Center, Japan Gastroenterology, Osaka Rosai Hospital, Japan Patholorgy, Osaka General Medical Center, Japan
Context Lipomatous Pseudohypertrophy of the Pancreas is an extremely rare disease. The characteristics of this disease is the replacement of pancreatic acinar cells with adipose tissue, the pancreatic duct and islet cells are preserved. The patients often mark exocrine dysfunction. Endocrine function is preserved in many cases. To diagnose, typical imaging findings and serological data are important. Additionally, the diagnosis is strongly supported by pathological findings; resected specimens. We here in present a report of this case with Lipomatous Pseudohypertrophy of the Pancreas diagnosed by typical imaging findings, serological data, and pathological findings by endoscopic ultrasonography-fine-needle aspiration; without surgical resection. Case report: We report a case of a 74-year-old female who was undergoing treatment for urethral carcinoma at our hospital. Then she had no gastrointestinal symptoms.After resection of urethral carcinoma, she got an abdominal computed tomographic scan for the first time following, and it revealed marked fat replacement over the entire pancreas. In endoscopic ultrasonography, it was difficult to distinguish the pancreas with adipose tissue around the pancreas. With portal vein, splenic vein,and so on, it was able to make sure where the pancreas was. And serum levels of the pancreatic enzymes were considerably low, according to the data of the pancreatic exocrine function test (N-benzoyltyrosyl-p-aminobenzoic acid test), endocrine function was slightly low, of the 75g oral glucose tolerance test. Additionally, pathological findings showed the adipose tissue, glandular epithelium and the pancreatic acinar cells in samples gotten by endoscopic ultrasonography-fine-needle aspiration. Conclusion: Even though the diagnosis of the disease should be based on histological findings, this case indicated the possibility that cytological findings by endoscopic ultrasonography-fine-needle aspiration with typical imaging and serological findings may usefull to diagnose Lipomatous Pseudohypertrophy of the Pancreas.
Abstracts / Pancreatology 16 (2016) S1eS192
sites. (2) Pancreatic paragangliomas are rare and difficult to distinguished from another malignant tumour. The purpose of this article is to present a case of pancreatic paraganglioma in male patient that was surgically resected by Whipple surgery with vascular reconstruction. Case report: A 68-year-old male with history of intermitent abdominal pain. Physical examination showed a palpable mass in the right upper abdomen. Initial laboratory studies including tumour markers showed no abnormalities. An abdominal computed tomography scan showed a welldefined pancreatic tumour involving mesenteric vein, we made a preoperative diagnosis of a resecable pancreatic tumor. Pancreaticoduodenectomy was performed. The final pathology report pancreatic paraganglioma. Discussion: In the literature review have been reported 24 cases of pancreatic paraganglioma. (5) In these previous reports concluded that pancreatic paraganglioma usually not present any symptoms and often found incidentally. The mean age reported is 67 years. The imaging findings were generally characterized as a well-defined mass with frequent areas of hypoechogenicity on US, a well marginated, hypervascular tumor with cystic areas of low-attenuation on contrastenhanced CT. (4) Conclusion: Pancreatic paraganglioma is a rare entity with limited cases reported. The diagnosis pre-operatively is speculative and malignant tumor is a feasible differential diagnosis. Surgical resection is necessary for histological assessment. However, the risk of malignant transformation justifies aggressive management.
We herein report a case of aneurysm of the pancreatic head. A 44-year old woman was detected asymptomatic pancreatic cystic lesion, 40mm in size, by medical health check in 2007 and followed by magnetic resonance imaging (MRI) annually. In 2015, MRI detected the increase in size and wall thickness. Therefore, she was referred to our hospital for further examination and surgery. Computed tomography showed a 52mm cystic lesion, and the wall of cyst had increased contrast enhancement. Endoscopic retrograde cholangiopancreatography performed by previous doctor revealed the cyst had no communication with the main pancreatic duct. Endoscopic ultrasound identified a multilocular cystic lesion with suspected mural nodules. Under the preoperative diagnosis of mucinous cystic neoplasm, pancreatoduodenectomy was performed. Gross inspection of the resected specimen showed a cystic lesion with internal hemorrhage and serous fluid. Pathological examination showed there was no epithelial component on the inner surface of the cystic lesion, but there were collagen fiber, fibrous tissue and vascular structures communicated with gastroduodenal artery. Although it was difficult to conclude definitive diagnosis, the tumor was suspected as an aneurysm of the pancreatic head.
P-209. A case of lipomatous pseudohypertrophy of the pancreas diagnosed by endoscopic ultrasonography-fine-needle aspiration: without surgical resection
P-207. A case of primary pancreatic malignant lymphoma diagnosed by endoscopic ultrasound-guided fine needle aspiration Takumi Onoyama, Kazuya Matsumoto, Hiroki Koda, Hiroki Kurumi, Soichiro Kawata, Yohei Takeda, Kenichi Harada, Hajime Isomoto Department of Gastroenterology, Tottori University, Japan
Yoichi Sasaki 1, Shuji Ishii 1, Atsuo Inoue 1, Naoki Kawai 1, Yoshimichi Haruna 1, Kazuho Imanaka 1, Takuya Inoue 1, Noriko Hasegawa 1, Yuhei Wakahara 1, Satoshi Shigeno 1, Chiaki Torizumi 1, Toshihiro Imai 1, Sumiko Abe 1, Masahiko Tsujii 2, Kohsaku Onishi 2, Hiroaki Hushimi 3, Koki Shimazu 3 1 2 3
A 83-year-old man was admitted to our hospital with upper abdominal pain and anemia. Ultrasonography revealed a 78-mm hypoechoic mass in the head and body of the pancreas. Computed tomography showed a mass that was of lower contrast, and was penetrated by the celiac artery and superior mesenteric artery. On endoscopic ultrasonography, the surface was smooth, the margin was clear, internal echogenicity was heterogeneous, and there was no lateral shadow. Endoscopic retrograde pancreatography did not show stenosis or obstruction of the main pancreatic duct. The pancreatic juice cytology was negative. We performed endoscopic ultrasound-guided fine needle aspiration by using a 19-gauge needle. A hematoxylin and eosin staining showed that the tumor cells were large-sized atypical lymphocytes with diffuse proliferation. The immunohistological findings showed atypical lymphocytes that were positive for CD20, CD79a, Bcl-2, and MUM-1, negative for CD3, CD5, CD10, CD23, CD45RO, and cyclin D1, and positive or negative for Bcl-6. The final diagnosis was primary pancreatic diffuse large B-cell lymphoma, stage IE (Ann Arbor). Primary pancreatic malignant lymphoma is a rare disease among pancreatic tumors. We will report about a case of primary pancreatic malignant lymphoma diagnosed by endoscopic ultrasound-guided fine needle aspiration.
P-208. A case of a suspected aneurysm of the pancreatic head Takashi Miyata 1, Teiichi Sugiura 1, Yukiyasu Okamura 1, Takaaki Ito 1, Yusuke Yamamoto 1, Ryo Ashida 1, Sunao Uemura 1, Yoshiyasu Kato 1, Katsuhisa Ogi 1, Atsushi Kohga 1, Tsuneyuki Uchida 1, Syusei Sano 1, Keiko Sasaki 2, Katsuhiko Uesaka 1 1 Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan 2 Division of Diagnostic Pathology, Shizuoka Cancer Center, Japan
Gastroenterology, Osaka General Medical Center, Japan Gastroenterology, Osaka Rosai Hospital, Japan Patholorgy, Osaka General Medical Center, Japan
Context Lipomatous Pseudohypertrophy of the Pancreas is an extremely rare disease. The characteristics of this disease is the replacement of pancreatic acinar cells with adipose tissue, the pancreatic duct and islet cells are preserved. The patients often mark exocrine dysfunction. Endocrine function is preserved in many cases. To diagnose, typical imaging findings and serological data are important. Additionally, the diagnosis is strongly supported by pathological findings; resected specimens. We here in present a report of this case with Lipomatous Pseudohypertrophy of the Pancreas diagnosed by typical imaging findings, serological data, and pathological findings by endoscopic ultrasonography-fine-needle aspiration; without surgical resection. Case report: We report a case of a 74-year-old female who was undergoing treatment for urethral carcinoma at our hospital. Then she had no gastrointestinal symptoms.After resection of urethral carcinoma, she got an abdominal computed tomographic scan for the first time following, and it revealed marked fat replacement over the entire pancreas. In endoscopic ultrasonography, it was difficult to distinguish the pancreas with adipose tissue around the pancreas. With portal vein, splenic vein,and so on, it was able to make sure where the pancreas was. And serum levels of the pancreatic enzymes were considerably low, according to the data of the pancreatic exocrine function test (N-benzoyltyrosyl-p-aminobenzoic acid test), endocrine function was slightly low, of the 75g oral glucose tolerance test. Additionally, pathological findings showed the adipose tissue, glandular epithelium and the pancreatic acinar cells in samples gotten by endoscopic ultrasonography-fine-needle aspiration. Conclusion: Even though the diagnosis of the disease should be based on histological findings, this case indicated the possibility that cytological findings by endoscopic ultrasonography-fine-needle aspiration with typical imaging and serological findings may usefull to diagnose Lipomatous Pseudohypertrophy of the Pancreas.