A case of breast cancer metastatic to the head of the pancreas

A case of breast cancer that metastasized to the head of the pancreas 6 years and 8 months after mastectomy is reported. The pancreas head metastasis was associated with general fatigue and obstructive jaundice. The serum levels of CEA, CA15-3 and NCC-ST-439, tumor markers of breast cancer, were within normal limits, but CA15-3 was immunohistochemically demonstrated in the resected metastatic lesion, in a manner similar to lobular carcinoma of the breast.     

Primary lymphoma of the head of the pancreas

Primary and isolated lymphoma of the head of pancreas with secondary involvement of the lungs and obstructive jaundice, in a 31-year-old postpartum woman, is described. The histological diagnosis was diffuse histiocytic lymphoma. Chemotherapeutic treatment resulted in complete remission of the tumor. During therapy a pseudocyst of the pancreas developed and a gastrocystostomy was performed. This is the second reported case of primary pancreatic lymphoma in the English medical literature.     

178例胰头癌的诊治分析

目的：分析胰头癌的临床表现,诊治方法,提高胰头癌的诊治水平。方法：用回顾性方法研究178例胰头癌的临床表现,诊治方法及治疗效果。:结果：178例患者主要临床表现有上腹部疼痛及不适,占69．7％;梗阻性黄疸,占74．2％,这两各症状1、Ⅱ期与Ⅲ、Ⅳ期之间差异均有显著性（P＜0．001）,伴腰背部疼痛者占17．9％,其中IV期占81．3％,对胰头肿瘤检出率B超为74．2％,CT为87．3％,MRI为85．5％,全组行根治性胰十二指肠切除术18例（10．1％）,术后1,3,5,年生存率分别为67．5％,36．0％和5．6％,胆汁内引流术115例。肿瘤未切除而行放、化疗者,中位生存期为7个月,结论：上腹疼痛不适及梗阻性黄疸为胰头癌的常见症状,高血糖为多发合并症,腰背疼痛常为晚月。结论：上腹疼痛不适及梗阻性黄为胰头癌的常见症状,高血糖为多发 合并症,腰背疼痛为晚期表现,CT是最重要的影像学诊断方法,B超,CT和（或）MRI联合检查可提高诊断率（达96．6％）,目前,胰十二指肠切除术是胰头癌唯一有效的治疗方法,胆汁内引流是重要的姑息治疗方法。     

Portal hypertension as an early manifestation of carcinoma of the pancreas

Massive hematemesis followed by 48 hours the onset of obstructive jaundice in a previously asymptomatic 38-year-old male patient. Splenomegaly was the only abnormal physical finding. Esophagoscopy visualized bleeding varices. The liver scan was normal. Dilated intra- and extrahepatic bile ducts and a possible retroperitoneal mass were demonstrated by ultrasonography. Laparotomy disclosed the presence of a carcinoma of the head and body of the pancreas that obstructed the common bile duct and the portal vein. This case report should draw attention to the vast spectrum of rare presentations of pancreas carcinoma.     

Pancreatic head melanoma producing obstructive jaundice: Magnetic resonance characteristics aiding differentiation from adenocarcinoma

A case is reported of malignant melanoma presenting as a mass in the head of the pancreas producing obstructive jaundice. On MR imaging the mass displayed signal characteristics not typical of adenocarcinoma but instead exhibited a low signal on T2‐weighted images and early phase dynamic enhancement, the combination of which should suggest the possibility of melanoma.     

Adenosquamous cell carcinoma arising from the papilla major

A 47-year-old man was admitted to hospital with complaint of general fatigue. Shortly before the admission a suspected obstructive jaundice was diagnosed at a local hospital. On admission, the physical examination was significant for jaundice; total bilirubin was 6.43 mg/dl. The tumor marker CA19-9 was 2056 U/ml. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and showed dilatation of common bile duct and main pancreatic duct, accompanied with an endoscopic naso-biliary drainage (ENBD) in order to reduce the jaundice. The duodenoscopy showed enlarged and deformed papilla. Hypotonic duodenography showed a filling defect at the medial side of the second portion of the duodenum. Ultrasonography (US) showed a hyperechoic lesion, sized 15 mm in diameter, at the pancreas head with dilatation of biliary tract and main pancreatic duct. An abdominal enhanced CT scan showed a mass sized 15 mm at the lower edge of the common bile duct. A selective hepatic arteriography showed no special finding. We performed a pancreatoduodenectomy with dissection of the lymph nodes. The tumor, sized 22x15x20 mm, was white colored and solid on the papilla. Histopathological inspection of the specimen showed an adenosquamous cell carcinoma of the bile duct in the papilla. The tumor was found to infiltrate the neighboring pancreas and to contain metastasis in lymph nodes in the hepatoduodenal ligament, post pancreaticoduodenal and para-aortic lymph nodes. This is the first report on a case of adenosquamous carcinoma of the papilla major.     

Obstructive jaundice. An unusual presentation of granulocytic sarcoma

A 36-year-old woman presented with obstructive jaundice, found at laparotomy to be due to a granulocytic sarcoma in the head of the pancreas. Six months later she developed lymphadenopathy in the left supraclavicular fossa. In spite of chemotherapy containing cytarabine and vincristine, she developed acute myeloid leukaemia (French-American-British [FAB] type M4) 16 months after the onset of her illness.     

A patient with obstructive jaundice due to recurrence after gastric cancer surgery responding remarkably to FLP combination therapy

The patient was a 67-year-old man who had undergone distal gastrectomy because of early gastric cancer without lymph node metastasis two years earlier. The postoperative course was uneventful, but he was admitted again to our hospital because of abrupt jaundice. A CT scan of the abdomen showed obstructive jaundice due to the enlargement of the lymph nodes around the hepatoduodenal ligament, pancreas head, portal vein, and celiac axis. After percutaneous transhepatic cholangio-drainage (PTCD), 5 cycles of FLP combination therapy (5-fluorouracil, leucovorin, cisplatin) were performed. Consequently, the tumor marker level returned to the normal range and the shrinkage of the metastatic lymph nodes was remarkable. A reopening of the biliary tract was attained, so the PTCD tube could be removed. As an outpatient without recurrence he has received oral administration of uracil plus tegafur. The FLP combination therapy was effective for obstructive jaundice due to intraperitoneal lymph node recurrence of the gastric cancer.     

Metachronous multiple adenocarcinomas of the pancreas

We report a rare case of metachronous multiple adenocarcinoma of the pancreas. A 59-year-old Japanese man visited our institute for a routine workup as a hepatitis C virus carrier, resulting in detection of a 3-cm tumor in the pancreatic body by screening echogram. Results from several imaging modalities were consistent with pancreatic carcinoma. Distal pancreatectomy along with dissection of partial gastrectomy, transverse colectomy, and lymph node dissection were performed in November 2003. Histological examination confirmed a pancreatic ductal adenocarcinoma with a clear surgical margin and negative lymph node metastases. Gemcitabine was administered for 5 years, then suspended because no recurrent signs were found. The patient returned to our hospital in March 2009, with obstructive jaundice along with a 2-cm tumor in the head of the remnant pancreas. The condition of the patient was carefully investigated and extra-pancreatic metastatic lesions were not found; a pancreaticoduodenectomy was then carried out. Histological examination revealed a diagnosis of pancreatic adenocarcinoma arising from the remnant pancreas gland.     

Obstructive jaundice in a metastatic tumor of the pancreas from breast cancer: a case report

Metastatic pancreas tumors from breast cancer are comparatively uncommon and patients with this tumor usually remain asymptomatic during their life. A 55-year-old woman presented with obstructive jaundice following mastectomy for invasive ductal carcinoma. We diagnosed obstructive jaundice due to a pancreatic tumor demonstrated on computed tomography and performed percutaneous transhepatic cholangio-drainage. Although the patient recovered from the jaundice, she had exacerbation of pneumonia from which she died. At autopsy, invasive ductal carcinoma was found in the pancreas tumor. Immunohistochemical staining was performed to confirm whether the pancreatic tumor was primary or secondary. Human milk fat globules 1 and 2 and gross cystic disease fluid protein-15, which characteristically exist in normal breast tissue or breast carcinoma, were expressed both in the primary breast tumor and the pancreatic tumor. In contrast, both the anti-estrogen receptor and anti-progesterone receptor antibodies stained positively in the primary breast cancer; however, neither of them was positive in the metastatic pancreatic tumor. We report a rare case of a patient who presented with obstructive jaundice from a pancreatic tumor metastasizing from breast cancer and in whom immunohistochemical staining using the antibodies unique to the mammary gland was effective for the diagnosis of this secondary tumor.     

An autopsy case of malignant lymphoma of the pancreas

Case reports of malignant lymphoma of the pancreas are extremely rare. We experienced a 36-year-old man with malignant lymphoma involving the pancreas associated with obstructive jaundice, confirmed by autopsy. It is very difficult to differentiate between pancreatic carcinoma and pancreatic malignant lymphoma. Age, icterus, diffuse pancreatic enlargement, pathological findings and tumor markers may be useful in suggesting lymphoma. Trials of positive biopsy, appropriate radiotherapy and chemotherapy are necessary in patients who may have malignant lymphoma of the pancreas.     

Seminoma metastases mimicking primary pancreatic cancer

BACKGROUND: A case of seminoma clinical stage III, arising from the right testis and mimicking a primary pancreatic malignancy is reported. CASE REPORT: A 57-year-old male patient presented with obstructive jaundice. He suffered from recurrent abdominal pain and significant weight loss over the past 4 months. Abdominal CT scan showed a tumor in the head of the pancreas and multiple pathologically enlarged peripancreatic lymph nodes. In the laboratory findings there were signs of cholestasis and infection. A laparoscopic biopsy out of a suspicious lesion of the head of the pancreas and a surrounding lymph node was done. Histopathological examination reported metastasis of seminoma in a lymph node. Further laboratory findings showed an elevation of the human placental alkaline phosphatase (HPLAP) and urological examination revealed a suspect right testis. The patient underwent castration of the right testis and histopathological examination confirmed a seminoma. 4 cycles of chemotherapy including cisplatinum, etoposide and bleomycin led into complete response that is still ongoing. CONCLUSION: This case shows a seminoma with metastases at retroperitoneal site, mimicking a primary pancreatic neoplasm. It provides an example of the possibility of an uncommon clinical appearance of seminoma metastases and again underlines the importance of exact radiological and histopathological examination to distinguish between curable and incurable tumor.     

Ultrasound in the Investigation of Biliary Tract Disease

88 patients with non-opacification of the gallbladder were examined by Ultrasound of the right upper quadrant of the abdomen. Criteria for the diagnosis of gallstones are described. Employing such criteria we have had no false positive results in the diagnosis of calculi. Our overall accuracy rate has been 90% and we feel that this has been improved in examinations after this analysis was completed by expanding our criteria to include stones and their acoustic “shadow”, even when the gallbladder itself cannot be demonstrated. Thirty-three patients with jaundice were examined by Ultrasonography as an initial procedure, not only because of its accuracy, as shown by our figures, but also because it is a safe, noninvasive technique. Criteria for the diagnosis of obstructive jaundice are described. In those patients with obstructive jaundice caused by pancreatic disease, enlargement of the pancreas was successfully shown. In patients with hepatocellular jaundice, causes such as liver metastases, cirrhosis and Congestive Heart Failure were accurately diagnosed.     

Ampullary somatostatinoma associated with von Recklinghausen's neurofibromatosis presenting as obstructive jaundice

A case of von Recklinghausen's disease associated with a somatostatinoma of the pancreas causing obstructive jaundice is described. Discussion on the association of von Recklinghausen's disease with somatostatinoma is presented.     

An autopsy report of pancreatic carcinoma following the achievement of significant prolongation of survival, despite the lack of a definitive diagnosis

A 56-year-old female presented with chief complaints of epigastric discomfort and jaundice. Various examinations led to a differential diagnosis of carcinoma of she pancreas vs. malignant lymphoma. Chemotherapy and radiotherapy achieved a 50% reduction of the tumor mass and the disappearance of her jaundice. The patient survived for twenty-seven months following initial presentation. On post-mortem examination, she was found to have had carcinoma of the head of the pancreas. We studied the relationship between chemotherapy and the survival time in histologically diagnosed, unresectable pancreatic cancer at this hospital over the last ten years.     

Squamous cell carcinoma-A rare pancreatic exocrine malignancy

A 65-year-old Caucasian female presented with abdominal symptoms and obstructive jaundice. She reported a significant pancreatic cancer history in her family. Her CT of the abdomen and pelvis showed 3.9 × 3.5 cm centrally necrotic mass within the pancreatic head, occluding the superior mesenteric and splenic veins; peripancreatic lymph nodes were enlarged, and there were many hepatic lesions. She underwent biopsy of the hepatic lesions showing metastatic tumor cells, arranged in the form of nests, with enlarged and hyperchromatic irregular nuclei with some nucleoli and moderate eosinophilic cytoplasm. Immunohistochemical staining on cancer cells was positive for CK7, P40, GATA3. These findings were concerning for poorly differentiated metastatic squamous cell carcinoma (SCC). PET-CT showed no other hypermetabolic lesions, suggestive of another primary except pancreatic head with SUV of 17.8, hepatic metastasis and 1 cm right retroperitoneal lymph node. The patient was diagnosed with metastatic SCC of the pancreas. Contrary to the well-known genetic mutations of pancreatic adenocarcinoma, the data on pancreatic SCC-related mutations is limited; however, one such mutation is BRCA-2 exon 15 germline mutation reported in a locally advanced SCC of the pancreas. The index patient is one of those rare cases in which a significant family history of pancreatic cancer was reported. We believe that some familial mutation could be responsible for this finding, i.e., occurrence of pancreatic cancer in multiple family members. Further research is necessary to explore such association.     

Obstructive jaundice due to a rare periampullary tumor

Gangliocytic paraganglioma is a rare neuroendocrine tumor predominantly arising in the second part of the duodenum with rare local recurrence or metastasis to regional lymph nodes.A 92-year-old female presented with obstructive jaundice.On exam she had pale conjunctiva and icteric sclera.Abdominal examination revealed tenderness in the upper abdomen.Laboratory data was consistent with obstructive jaundice.Computed tomography of the abdomen revealed a dilated gall bladder and a common bile duct(CBD)with no evidence of liver lesions or pancreatic head mass.Endoscopic ultrasonography revealed a 1 cm isoechoic submucosal nodule at the periampullary area,dilated CBD(9 mm),a prominent pancreatic duct(4.1 mm)and a hydropic gall bladder with no stones.Endoscopic retrograde cholangiopancreaticography was performed to relieve obstruction and showed a 1 cm periampullary mass which underwent an en-bloc snare resection.Histopathology analyses with immunohistochemical stains were positive for cytokeratin,synaptophysin,S-100 protein,neuron specific enolase and negative for actin and desmin consistent with periampullary gangliocytic paraganglioma.Periampullary gangliocytic paraganglioma is a rare benign tumor of the small bowel.Common presentation includes abdominal pain and obstructive jaundice which should be included in differential diagnosis of obstructive jaundice.Endoscopic resection is a curative therapy in the absence of local invasion or distant metastasis.     

Twelve-year survival after the diagnosis of locally advanced carcinoma of the pancreas: A case report

The long-term survival rate of patients with carcinoma of the pancreas is low. Even more so, long-term survival of patients with metastatic pancreatic carcinoma is extremely rare. In this case report, we describe a patient with an unusual course of disease. This patient was diagnosed with locoregional carcinoma of the pancreas and therefore underwent gastroenterostomy and cholecystojeojenostomy without resection of the primary tumor. Later he was treated with radiotherapy and chemotherapy and survived 12 years, during 11 of which he had no evidence of disease. He died 12 years after the initial diagnosis from peritoneal dissemination of poorly differentiated carcinoma complicated with obstructive jaundice and sepsis. To our knowledge, this patient had the longest reported survival with locally advanced pancreas carcinoma that was not resected. The case is presented and discussed in this article.     

Complete response of anaplastic pancreatic carcinoma to paclitaxel treatment selected by chemosensitivity testing

A 58-year-old woman was admitted to our institute in June 2007 because of obstructive jaundice. A mass in the pancreatic head and multiple swollen lymph nodes surrounding the common hepatic artery were identified using computed tomography (CT). Subsequently, endoscopic ultrasonography-guided fine-needle aspiration biopsy (EUS-FNA) was done. Histopathologic results revealed anaplastic carcinoma of the pancreas. Using specimens obtained with EUS-FNA, chemosensitivity testing with adenosine triphosphate assay was performed. Testing indicated high chemosensitivity to paclitaxel (PTX). According to this result, chemotherapy using PTX was performed, and the primary lesion and lymph node metastases disappeared completely on CT. The patient has been doing well with no recurrence for 1 year and 11 months since initial chemotherapy.     

Solitary malignant schwannoma of the pancreas: report of a case and ultrastructural examination

Primary malignant schwannoma of the pancreas is rare. The reported patient, a 40-year-old white female, presented with obstructive jaundice and a large palpable mass in the upper abdomen. A Whipple procedure was performed. Electron microscopic examination of the tumor established the Schwann cell origin of the neoplasm by demonstrating basement membranes, junctional complexes, and interdigitating cytoplasmic extensions infested with basal lamina, dense neurosecretory-like granules, and axon-like structures. The inadequacy of light microscopic examination alone for establishing the diagnosis with certainty is discussed. Review of the literature revealed only one case of a malignant schwannoma of the pancreas that was not resected. This is the first report confirmed by ultrastructural examination.