Agenesia del páncreas dorsal: reporte de caso y revisión del tema / Agenesis of the dorsal pancreas: case report and topic review

Complete agenesis of the dorsal pancreas (ADP) is an exceedingly rare congenital anomaly, compatible with life. It may be asymptomatic and usually incidentally diagnosed. In symptomatic cases, the clinical manifestations vary from abdominal pain, pancreatitis and diabetes mellitus to exocrine insufficiency with steatorrhea. We present a case report of a 28 year old female with ADP, diagnosed incidentally during radiological evaluation for hyperglycemias in SARS COV2 concomitant affection. Magnetic resonance cholangiopancreatography confirmed the absence of, neck, body and tail of the pancreas. Knowing the pancreatic embryogenesis, the clinical presentation of their malformations and the main radiological characteristics is important for the proper diagnosis of these anomalies.

Clinical effect of minimally invasive duodenum preserving pancreatic head resection for benign and pre-malignant lesions of pancreatic head / 中华外科杂志

Objective: To examine the clinical effect of minimally invasive duodenum preserving pancreatic head resection(DPPHR) for benign and pre-malignant lesions of pancreatic head. Methods: The clinical data of patients with diagnosis of benign or pre-malignant pancreatic head tumor were retrospectively collected and analyzed,all of them underwent laparoscopic or robotic DPPHR between October 2015 and September 2021 at Division of Gastrointestinal and Pancreatic surgery,Zhejiang Provincial People's Hospital. Thirty-three patients were enrolled with 10 males and 23 females. The age(M(IQR)) was 54(32) years old(range: 11 to 77 years old) and the body mass index was 21.9(2.9)kg/m2(range: 18.1 to 30.1 kg/m2). The presenting symptoms included abdominal pain(n=12), Whipple triad(n=2), and asymptomatic(n=19). There were 7 patients with hypertension and 1 patient with diabetes mellitus. There were 19 patients who were diagnosed as American Society of Anesthesiologists class Ⅰ and 14 patients who were diagnosed as class Ⅱ. The student t test,U test, χ2 test or Fisher exact test was used to compare continuous data or categorized data,respectively. All the perioperative data and metabolic morbidity were analyzed and experiences on minimally invasive DPPHR were concluded. Results: Fourteen patients underwent laparoscopic DPPHR,while the rest of 19 patients received robotic DPPHR. Indocyanine green fluorescence imaging was used in 19 patients to guide operation. Five patients were performed pancreatico-gastrostomy and the rest 28 patients underwent pancreaticojejunostomy. Pathological outcomes confirmed 9 solid pseudo-papillary neoplasms, 9 intraductal papillary mucinous neoplasms, 7 serous cystic neoplasms, 6 pancreatic neuroendocrine tumors, 1 mucous cystic neoplasm, 1 chronic pancreatitis. The operative time was (309.4±50.3) minutes(range:180 to 420 minutes),and the blood loss was (97.9±48.3)ml(range:20 to 200 ml). Eighteen patients suffered from postoperative complications,including 3 patients experienced severe complications(Clavien-Dindo Grade ≥Ⅲ). Pancreatic fistula occurred in 16 patients,including 8 patients with biochemical leak,7 patients with grade B pancreatic fistula and 1 patient with grade C pancreatic fistula. No one suffered from the duodenal necrosis and none perioperative death was occurred. The length of hospital stay was 14(7) days (range:6 to 87 days). The follow-up was 22.6(24.5)months(range:2 to 74 months). None suffered from recurrence or metastasis. During the follow-up,all the patients were free of refractory cholangitis. Moreover,in the term of endocrine dysfunction,no postoperative new onset of diabetes mellitus were observed in the long-term follow-up. However,in the view of exocrine insufficiency,pancreatic exocrine insufficiency and non-alcoholic fatty liver disease (NAFLD) was complicated in 2 and 1 patient,respectively,with the supplement of pancreatic enzyme,steatorrhea and weight loss relieved,but NAFLD was awaited to be seen. Conclusions: Minimally invasive DPPHR is feasible and safe for benign or pre-malignant lesions of pancreatic head. Moreover,it is oncological equivalent to pancreaticoduodenectomy with preservation of metabolic function without refractory cholangitis.

Intraoperative anatomical observation of mesentery morphology of colonic splenic flexure / 中华胃肠外科杂志

Objective: At present, surgeons do not know enough about the mesenteric morphology of the colonic splenic flexure, resulting in many problems in the complete mesenteric resection of cancer around the splenic flexure. In this study, the morphology of the mesentery during the mobilization of the colonic splenic flexure was continuously observed in vivo, and from the embryological point of view, the unique mesenteric morphology of the colonic splenic flexure was reconstructed in three dimensions to help surgeons further understand the mesangial structure of the region. Methods: A total of 9 patients with left colon cancer who underwent laparoscopic radical resection with splenic flexure mobilization by the same group of surgeons in Union Hospital of Fujian Medical University from January 2018 to June 2019 were enrolled. The splenic flexure was mobilized using a "three-way approach" strategy based on a middle-lateral approach. During the process of splenic flexure mobilization, the morphology of the transverse mesocolon and descending mesocolon were observed and reconstructed from the embryological point of view. The lower margin of the pancreas was set as the axis, and 4 pictures for each patient (section 1-section 4) were taken during middle-lateral mobilization. Results: The median operation time of the splenic flexure mobilization procedure was 31 (12-55) minutes, and the median bleeding volume was 5 (2-30) ml. One patient suffered from lower splenic vessel injury during the operation and the bleeding was stopped successfully after hemostasis with an ultrasound scalpel. The transverse mesocolon root was observed in all 9 (100%) patients, locating under pancreas, whose inner side was more obvious and tough, and the structure gradually disappeared in the tail of the pancreatic body, replaced by smooth inter-transitional mesocolon and dorsal lobes of the descending colon. The mesenteric morphology of the splenic flexure was reconstructed by intraoperative observation. The transverse mesocolon was continuous with a fan-shaped descending mesocolon. During the embryonic stage, the medial part (section 1-section 2) of the transverse mesocolon and the descending mesocolon were pulled and folded by the superior mesenteric artery (SMA). Then, the transverse mesocolon root was formed by compression of the pancreas on the folding area of the transverse mesocolon and the descending mesocolon. The lateral side of the transverse mesocolon root (section 3-section 4) was distant from the mechanical traction of the SMA, and the corresponding folding area was not compressed by the tail of the pancreas. The posterior mesangial lobe of the transverse mesocolon and the descending mesocolon were continuous with each other, forming a smooth lobe. This smooth lobe laid flat on the corresponding membrane bed composed of the tail of pancreas, Gerota's fascia and inferior pole of the spleen. Conclusions: From an embryological point of view, this study reconstructs the mesenteric morphology of the splenic flexure and proposes a transverse mesocolon root structure that can be observed consistently intraopertively. Cutting the transverse mesocolon root at the level of Gerota's fascia can ensure the complete resection of the mesentery of the transverse colon.

Pancreatic damage control: the pancreas is simple don't complicate it / El control de daños en el páncreas es simple. No complique las cosas

Abstract Pancreatic trauma is a rare but potentially lethal injury because often it is associated with other abdominal organ or vascular injuries. Usually, it has a late clinical presentation which in turn complicates the management and overall prognosis. Due to the overall low prevalence of pancreatic injuries, there has been a significant lack of consensus among trauma surgeons worldwide on how to appropriately and efficiently diagnose and manage them. The accurate diagnosis of these injuries is difficult due to its anatomical location and the fact that signs of pancreatic damage are usually of delayed presentation. The current surgical trend has been moving towards organ preservation in order to avoid complications secondary to exocrine and endocrine function loss and/or potential implicit post-operative complications including leaks and fistulas. The aim of this paper is to propose a management algorithm of patients with pancreatic injuries via an expert consensus. Most pancreatic injuries can be managed with a combination of hemostatic maneuvers, pancreatic packing, parenchymal wound suturing and closed surgical drainage. Distal pancreatectomies with the inevitable loss of significant amounts of healthy pancreatic tissue must be avoided. General principles of damage control surgery must be applied when necessary followed by definitive surgical management when and only when appropriate physiological stabilization has been achieved. It is our experience that viable un-injured pancreatic tissue should be left alone when possible in all types of pancreatic injuries accompanied by adequate closed surgical drainage with the aim of preserving primary organ function and decreasing short and long term morbidity.

Resumen El trauma pancreático es un tipo de trauma poco común potencialmente fatal que está asociado con lesiones de órganos abdominales o vasculares. Usualmente, los signos clínicos son tardíos aumentado el riesgo de complicaciones respecto al manejo y al pronóstico general. Debido a la baja prevalencia de la lesión del trauma, no existe consenso entre los cirujanos alrededor del mundo sobre cómo se debe diagnosticar y tratar adecuadamente este desafío quirúrgico. La precisión en el diagnóstico es difícil por la localización anatómica y las manifestaciones clínicas tardías. El abordaje quirúrgico ha ido cambiando de dirección hacia la preservación del órgano para evitar complicaciones secundarias asociada a la perdida de la función exocrina y endocrina, o de potenciales complicaciones postquirúrgicas incluyendo las dehiscencias y fistulas. El objetivo de este artículo es proponer un algoritmo de manejo del trauma pancreático a través de un consenso de expertos. Las lesiones del páncreas pueden ser manejadas con una combinación de maniobras hemostáticas, empaquetamiento pancreático, sutura de la herida y drenaje quirúrgico cerrado. La pancreatectomía distal con la perdida de tejido vital pancreático debe ser evitadas. Los principios generales de la cirugía de control de daños deben ser aplicados cuando sea necesario para un manejo quirúrgico definitivo cuando y solo cuando la estabilización fisiológica haya sido lograda. En nuestra experiencia, el tejido pancreático sano debe preservarse cuando el trauma se asocia de un manejo mediante un drenaje quirúrgico cerrado con el objetivo de preservar la función primaria del órgano y disminuir a corto y largo tiempo las morbilidades.

Pancreatitis aguda. Artículo de revisión / Acute Pancreatitis. Review Article

La pancreatitis aguda (PA) se define como un proceso inflamatorio agudo del páncreas el cual puede comprometer otros órganos y tejidos. El diagnóstico requiere al menos 2 de las siguientes características: dolor abdominal de moderada a fuerte intensidad, acompañado de náuseas y vómito; evidencia bioquímica de pancreatitis y/o evidencia por imágenes a través de tomografía axial computarizada dinámica (TACD) y/o la resonancia magnética (RM) del páncreas. Es la enfermedad gastrointestinal aguda más común que requiere ingreso hospitalario, siendo la evolución favorable en la mayoría de los casos (80%). Sin embargo, la pancreatitis necrotizante puede desarrollarse en hasta el 20% de los pacientes y se asocia con tasas significativas de insuficiencia orgánica temprana (38%). Los trastornos metabólicos y el ayuno comprometen el estado nutricional lo que podría agravar el curso de la enfermedad, por ello la vía de administración de la terapia nutricional ha demostrado tener un impacto en la evolución de los pacientes. Ahora existe una mejor definición de cuales pacientes con PA necesitan una terapia nutricional agresiva y cuales son aquellos que probablemente se beneficiarán de una nutrición enteral temprana(AU)

Acute pancreatitis (AP) is defined as an acute inflammatory process of the pancreas which can compromise other organs and tissues. The diagnosis requires at least 2 of the following characteristics: moderate to severe abdominal pain, accompanied by nausea and vomiting; biochemical evidence of pancreatitis and/or imaging evidence through dynamic computed axial tomography (TACD) and/or magnetic resonance imaging (MRI) of the pancreas. It is the most common acute gastrointestinal disease that requires hospital admission, with a favorable evolution in most cases (80%). However, necrotizing pancreatitis can develop in up to 20% of patients and is associated with significant rates of early organ failure (38%). Metabolic disorders and fasting compromise the nutritional status which could aggravate the course of the disease, therefore the route of administration of nutritional therapy has been shown to have an impact on the evolution of patients. There is now a better definition of which AP patients need aggressive nutritional therapy and which are likely to benefit from early enteral nutrition(AU)

Endovascular treatment of acute gastrointestinal bleeding from a large splenic artery pseudoaneurysm: case report and literature review / Tratamento endovascular da hemorragia digestiva aguda por volumoso pseudoaneurisma esplênico: relato de caso e revisão da literatura

O pseudoaneurisma da artéria esplênica é uma entidade rara, com pouco mais de 150 casos descritos na literatura. A pancreatite é a etiologia mais comum, seguida do trauma. Em contraposição ao aneurisma verdadeiro, esse pseudoaneurisma é frequentemente sintomático, com risco de ruptura de 47% e mortalidade de 90%, quando não tratado. Descrevemos o caso de uma paciente de 48 anos que apresentou hemorragia gastrointestinal associada a pancreatite crônica agudizada. Durante investigação, a endoscopia evidenciou sinais de sangramento recente, e a angiorressonância de abdome observou volumoso pseudoaneurisma da artéria esplênica. Foi submetida a tratamento endovascular com embolização com micromolas, não apresentando novos episódios de sangramento. Atualmente, o tratamento endovascular é efetivo com baixa morbimortalidade e taxas de sucesso de 79-100%, sendo uma técnica viável para pacientes com processo inflamatório abdominal em franca atividade. Realizamos uma revisão das técnicas endovasculares e agentes embolizantes usados para o tratamento dessa patologia

Pseudoaneurysm of the splenic artery is a rare entity, with little more than 150 cases described in the literature. Pancreatitis is the most common etiology, followed by trauma. In contrast with true aneurysms, pseudoaneurysms are frequently symptomatic, with a 47% risk of rupture and 90% mortality if left untreated. We describe the case of a 48-year-old female patient who suffered a gastrointestinal hemorrhage associated with acute-on-chronic pancreatitis. During workup, endoscopy revealed signs of recent bleeding and magnetic resonance angiography of the abdomen showed a large pseudoaneurysm of the splenic artery. The patient underwent endovascular treatment with microcoil embolization and no further bleeding episodes occurred. Endovascular treatment is now an effective option with low morbidity and mortality and success rates in the range of 79-100%, making it a viable technique for patients with active abdominal inflammation. We conducted a review of endovascular techniques and embolization agents used to treat this pathology

Laparoscopic splenectomy: a new approach

OBJECTIVES: To introduce a new laparoscopic splenectomy (LS) approach. METHODS: Sixteen patients underwent LS with general anaesthesia and carbon dioxide pneumoperitoneum. The details of the surgery are as follows: 1. The omentum was incised along the greater curvature and retracted as much as possible to expose the pancreatic body and tail. 2. The right arteriovenous root in the gastric omentum was ligated to sufficiently expose the pancreatic body and tail. 3. The pancreatic capsula was opened along the inferior margin of the pancreatic tail, elevated and separated until the superior margin of the pancreas was grasped. The entire splenic pedicle was retracted using a string. The branching blood vessels in the splenic hilus were ligated using clamps and separated. The splenogastric and splenophrenic ligaments were transected proximally using an ultrasonic knife, and the thick short gastric blood vessels were clamped. This procedure allows complete exposure of the area above the pancreatic tail where the splenic hilus is located. The splenoportal vasculature was suspended using a 7-0 silk suture to easily manipulate this tissue. The splenic portal vessels were dissected using an ultrasonic knife, and the portal vessels were isolated individually using vascular clamps and transected. The splenogastric and lienorenal ligaments were also transected. The spleen was then placed into a bag, and the surgical port was slightly enlarged. Finally, the spleen was sectioned for removal. RESULTS: Fifteen surgeries were successfully performed from March 2015 to January 2016. One patient underwent laparotomy. No patients developed postoperative intra-abdominal haemorrhage or infection. One patient developed subcutaneous emphysema, and one developed a wound infection. No deaths occurred. CONCLUSIONS: Active exposure of the area dorsal to the pancreatic tail is a safe and simple splenectomy method.

Tumor sólido pseudopapilar de pâncreas: relato de caso de uma rara neoplasia / Solid pseudo papillary tumor of the pancreas: case report of a rare neoplasia

O tumor sólido pseudopapilar de pâncreas (TSPP) é uma neoplasia maligna de baixo grau, que acomete predominantemente mulheres jovens e corresponde a um processo tumoral ovoide pardo-avermelhado e de crescimento lento. Os autores relatam um caso incidental de TSPP, e discutem os achados anatomopatológicos e clínicos desta rara neoplasia. Paciente feminino, 45 anos, obesa mórbida, sem outras queixas clínicas, em avaliação para procedimento de cirurgia bariátrica, apresentou, nos exames de ultrassonografia e tomografia computadorizada do abdome, lesão tumoral sólido-cística na cauda do pâncreas, que mediu 7,1 cm no maior eixo. A paciente foi submetida à ressecção do processo. Aos cortes, foi identificada uma lesão tumoral ovoide, pardo-avermelhada, predominantemente sólida, circunscrita, que mediu 7,4 x 6,0 x 5,3 cm. Ao exame microscópico, identificou-se uma neoplasia de cé- lulas epitelioides monomórficas de tamanho intermediário, com citoplasma exibindo pequenos glóbulos hialinos, dispostas em áreas sólidas e císticas. O processo exibiu imunoexpressão positiva para pancitoqueratina, betacatenina, sinaptofisina, cromogranina A, CD56 e receptores de progesterona, e imunoexpressão negativa para E-caderina, CDX-2 e TTF-1. O diagnóstico de Tumor Sólido Pseudopapilar do Pâncreas foi então estabelecido. Após um seguimento de quatro meses, não foram encontradas evidências clínicas ou radiológicas de recidiva tumoral(AU)

The solid pseudopapillary tumor of the pancreas (SPTP) is a malignant neoplasm of low degree, which predominantly affects young women and corresponds to an ovoid reddish-brown tumor process of slow growth. The authors report an incidental case of SPTP and discuss the clinical and pathological findings of this rare neoplasm. A female patient, 45 years old, morbidly obese, with no other clinical complaints, in evaluation for bariatric surgery procedure, presented, in ultrasound examination and computed tomography of the abdomen, a solid-cystic tumor lesion in the pancreas tail, which measured 7.1 cm in the major axis. The patient underwent resection process. The cuts showed an ovoid reddish-brown tumor lesion predominantly solid, circumscribed, which measured 7.4 x 6.0 x 5.3 cm. Microscopic examination identified a tumor of monomorphic epithelioid cells of intermediate size, with cytoplasm exhibiting small hyaline globules arranged in solid and cystic areas. The process showed positive immunoreactivity for pancytokeratin, beta-catenin, synaptophysin, chromogranin A, CD56 and progesterone receptors, and negative immunoreactivity for E-cadherin, CDX-2 and TTF-1. The diagnosis of solid pseudopapillary tumor of the pancreas was then established. At a four-month follow-up, there was no clinical or radiological evidence of tumor recurrence(AU)

Different Strategies for Transpancreatic Septotomy and Needle Knife Infundibulotomy Due to the Presence of Unintended Pancreatic Cannulation in Difficult Biliary Cannulation

BACKGROUND/AIMS: Several precut techniques have been used to gain biliary access for difficult cases. The aim of this study was to evaluate the success and complication rates of two precut techniques, transpancreatic septotomy (TPS) and needle knife infundibulotomy (NKI), in difficult biliary cannulation due to the presence of unintended pancreatic cannulation. METHODS: Eighty-six patients who failed standard biliary cannulation were included. TPS was performed when we failed to achieve biliary access despite 5 minutes of attempted cannulation or when more than three attempted unintended pancreatic cannulations occurred. If deep cannulation was not achieved within 5 minutes for any duct, NKI was performed. If this failed, we crossed over to the other technique in the second attempt. RESULTS: The initial total success rate of biliary cannulation was 88.4% (86.6% for the TPS group and 94.7% for the NKI group, p=0.447). After crossover of the techniques, the final success rate was 95.3%. The complication rate was 20.9% in patients with TPS and 15.8% in patients with NKI (p=0.753). CONCLUSIONS: The use of different strategies based on the presence of unintended pancreatic cannulation may help increase the success rate for difficult biliary cannulation without increasing complication rates.

Cirugía preservadora del páncreas, ¿es la fístula pancreática un elemento menor a considerar? / Pancreatic preserving surgery: it is the pancreatic fistula a minor issue to consider?

Objetivo: La insuficiencia pancreática en especial la de carácter endocrino, reviste vital relevancia como complicación tardía de la cirugía pancreática esto debido a la morbilidad asociada y el difícil manejo de la diabetes pancreaticogénica, ante esta situación, se han ideado técnicas quirúrgicas que permitan preservar el mayor tejido pancreático intentando evitar esta temible complicación. Métodos: Se presenta una serie de casos (n=3) con tumores pancreáticos de potencial maligno bajo, a quienes se les practicó una cirugía preservadora del páncreas de los siguientes tipos: pancreatectomía central, pancreatectomía distal de margen mínimo y enucleación de tumor en la cabeza de páncreas, todas las lesiones fueron superiores a los 3 cm de diámetro. Resultados: Dos de los 3 pacientes presentaron fístulas pancreáticas: uno grado A y el otro grado B, con prolongación en su estancia hospitalaria, las cuales fueron manejadas medicamente hasta lograr su resolución. Los pacientes poseen un seguimiento promedio de 31,66 meses, siendo la de mayor seguimiento de 57 meses, actualmente todos se encuentra con eufunción endocrina y exocrina del páncreas, sin recurrencia de la enfermedad neoplásica. Conclusión: La cirugía preservadora ha demostrado ser segura desde el punto de vista oncológico; sin embargo, en lesiones que superen los 3 cm de diámetro hay que sopesar el riesgo dela fístula pancreática asociada(AU)

Objective: The pancreatic insufficiency related to pancreatic resection is one of the most dreaded complications, the difficult management of pancreaticogenic diabetes and the morbidity associated has pushed to create less aggressive surgery in order to preserve more pancreatic tissue. Methods: Case series presentation (n=3) with low malignant pancreatic tumors, were performed three types of surgeries: central resection, distal resection with minimum margin, and enucleation of tumor in the pancreatic head. All of tumors measured above 3 cm.Results:Two of 3 patients developed pancreatic fistulas, one type A and the other type B, the post-operative course was complicated by the fistula, extending the hospital stay, the pancreatic fistulas were management only medically until get resolution. The patients follow up was 31,66 month, with the longest of 57 months. All patients have normal pancreatic function and oncologic disease free. Conclusion: The pancreatic preserving surgery has demonstrated to be saving in terms of oncology, but tumor over 3 cm ithas to be taken in consideration the complication associated to pancreatic fistula(AU)

[Indications and prevalence of disorders in a referral clinic for endoscopic ultrasonography]

Endoscopic ultrasonography [EUS] has a pivotal role in staging and diagnosis of different gastrointestinal [GI] disorders. Although this equipment is not readily available and not all gastroenterologists are trained in this technique, the importance and efficacy of this imaging modality is obvious for all gastroenterologists. We report the indications and prevalence of lesions visualized by EUS, in a EUS center. We evaluated the demographic characteristics, indications, and recorded EUS diagnosis of patients during a 5 year [2007-2011] period. During the study period, 3198 patients [51.2% males] underwent EUS. Upper GI endosonography, within which, pancreatobiliary disorders followed by gastric cancer were the most common indications for patient referral. The rate of patient referral for EUS increased yearly. EUS is an accurate method for the diagnosis of different GI abnormalities. The most common cause for patient referrals are benign pancreatobiliary disorders

Pancreatitis traumática: revisión del tema y presentación de caso / Traumatic pancreatitis: review on the theme and presentation of a case

El traumatismo pancreático se está incrementando actualmente, y esto podría ser causado por accidentes de vehículo a alta velocidad o a una mejor detección de las lesiones pancreáticas. Se presentó un caso de trauma pancreático ingresado en el servicio del Hospital Provincial Clínico Quirúrgico Docente José R. López Tabrane, de Matanzas, teniendo en cuenta la importancia y severidad de algunas de sus formas, y que el diagnóstico, en ocasiones, de las formas más leves no se realiza. Se realizó una revisión de la bibliografía actualizada sobre esta patología para una mejor comprensión del caso...

Pancreatic trauma is increasing currently, and that may be caused by high speed car accidents or by a better detection of the pancreatic lesions. We present a case of pancreatic trauma admitted in the service of the Teaching Surgico-clinical Provincial Hospital Jose R. Lopez Tabranes, of Matanzas, taking into account the importance and severity of some of its forms, and that some of its most mild forms are not diagnosed sometimes. We made a review of the updated literature on this disease for a better comprehension of the case...

Tumor sólido pseudopapilar del páncreas: ¿una neoplasia de bajo potencial maligno? / Solid pseudopapillary tumor of the pancreas: a neoplasm of low malignant potential?

INTRODUCCIÓN: El tumor sólido pseudopapilar del páncreas es considerado una neoplasia de bajo potencial maligno, por lo que la radicalidad del abordaje quirúrgico es aún controversial. PACIENTES Y MÉTODOS: Se describe y analiza en forma retrospectiva los datos clínicos, radiológicos, de laboratorio, el reporte operatorio y el resultado patológico de 7 pacientes que fueron diagnosticados y operados por tumor sólido pseudopapilar del páncreas en el período 2003 al 2010, en nuestra institución. RESULTADOS: Seis pacientes fueron de sexo femenino y uno masculino. La mediana de edad fue 35 años (rango: 15-49). El síntoma más frecuente fue dolor abdominal (100%). Se presentó ictericia en un paciente (14.3%). La apariencia radiológica mixta sólido-quística fue la más frecuente. En 5 pacientes el tumor se localizó en la cabeza del páncreas(71.4%) y en 2 se ubicó en la cola (28.6%). La mediana del tamaño tumoral fue de 93 mm (rango: 20-150) Se realizó 4 procedimientos de Whipple (57.1%), 2 pancreatectomías distales con esplenectomía (28.6%), una por vía laparoscópica y una resección local. En 2 casos (28.6%) se encontró el borde de sección pancreático comprometido. Se presentó morbilidad en 4 pacientes. No hubo mortalidad postoperatoria, ni reoperaciones. Cuatro tumores mostraron comportamiento maligno (57.1%): infiltración de cápsula esplénica y metástasis hepática metacrónica (1), infiltración de arteria mesentérica superior (1), metástasis linfática (1) y metástasis hepática sincrónica, infiltración duodenal e invasión linfovascular (1). No se detectó mortalidad por la enfermedad durante el período de seguimiento que fue en promedio 26 meses (rango: 6-70 meses). CONCLUSIÓN: El tumor sólido pseudopapilar es una neoplasia con alto potencial maligno en nuestra experiencia, por lo que recomendamos una actitud quirúrgica agresiva, con resecciones radicales incluyendo linfadenectomía.

BACKGROUND: Solid pseudo papillary tumor of the pancreas is considered a neoplasm of low malignant potential. The radicality of surgical approach is controversial. PATIENTS AND METHODS: We describe and analyze retrospectively the clinical, radiological, laboratory, operative report and pathology results of seven patients who were diagnosed and operated by solid pseudo papillary tumor of the pancreas in the period 2003 to 2010, in our institution. RESULTS: Six patients were female and one male. The median age was 35 years (range: 15-49). The most common symptom was abdominal pain (100%). Jaundice in one patient (14.3%). The radiological appearance mixed solid-cystic was the most common. We performed four Whipple procedures (57.1%), 2 distal pancreatectomy with splenectomy (28.6%), one by laparoscopy and the other by local resection. Morbidity presented in four patients. There was no postoperative mortality or reoperation. Five tumors were located in the pancreatic head (71.4%) and two in the tail (28.6%). The median tumor size was 93 mm (range: 20-150). Two (28.6%) were R1 resections. Four tumors showed malignant behavior (57.1%): splenic capsule and infiltration of metachronous liver metastases (1), infiltration of superior mesenteric artery (1), lymphatic metastasis (1) and synchronous liver metastases, and lymphovascular invasion duodenal infiltration (1). There was no mortality from the disease during the average follow-up of 26 months (range 6-70 months). CONCLUSION: Solid pseudo papillary tumor is a neoplasm with high malignant potential in our experience. We recommend an aggressive surgical approach with radical resection including lymphadenectomy.

Xanthogranulomatous Pancreatitis Presents as a Solid Tumor Mass: A Case Report

Xanthogranulomatous inflammation (XGI) is a rare, idiopathic process in which lipid-laden histiocytes are deposited at various locations in the body. Although XGI has been reported to occur in various organs such as the gallbladder, kidney, bone, stomach, colon, appendix, lymph nodes, urachus, and urinary bladder and in soft tissues, xanthogranulomatous pancreatitis (XGP) is extremely rare. Herein, we report a case of XGP occurring in a 70-yr-old woman, who presented with abdominal pain for several months. On physical examination, mild epigastric tenderness was noted. Abdomen CT scan revealed a low attenuated mass in uncinate process of pancreas, suggesting malignant lesion. Whipple's operation was performed and the final pathologic diagnosis was XGP. The patient's post-operative course was uneventful, and no recurrence was found within 7 months of the operation. When a pancreatic mass does not show clinico-radiological features typical of common pancreatic neoplasms, XGP should be considered for a differential diagnosis.

Tumor pseudopapilar del páncreas: reporte de caso / Pancreatic pseudopapilar tumor: case report

El tumor pseudopapilar del páncreas es una entidad muy poco frecuente que afecta preferentemente a mujeres jóvenes. Se trata de un carcinoma quístico con bajo potencial maligno que se diagnostica generalmente de forma incidental pues no hay signos ni síntomas patognomónicos de dicha enfermedad. La resección quirúrgica es curativa en la mayoría de los casos y el pronóstico es excelente aun si hay metástasis al momento del diagnóstico. Se presenta el caso de una paciente de sexo femenino de 21 años de edad, sin antecedentes personales de importancia, quien consultó por dolor abdominal agudo. Se realizó tomografía computarizada, la cual reportó una masa de 75 x 80 x 76 mm en la cola del páncreas, por lo que se llevó a cirugía realizándose pancreatrectomía distal con resección completa del tumor y preservación esplénica. El estudio de anatomía patológica reportó tumor pseudopapilar del páncreas. La paciente tuvo una evolución satisfactoria y hasta el seguimiento a los 16 meses persiste asintomática y no ha presentado recurrencia.

Pseudo papillary tumor of the pancreas is a rare entity most commonly seen in young females. This neoplasm it is a cystic carcinoma of low malignant potential usually diagnosed incidentally because an abscense of typical signs or symptoms. Surgical resection it is usually curative with excellent prognosis even when metastasis are present at the time of diagnosis. We report the case of a 21-year-old female who presented with abdominal pain with no previous history of any abdominal discomfort or pain. Computed tomography showed a 75 x 80 x 76 mm solid mass located at the tail of the pancreas. A distal pancreatectomy with preservation of the Spleen was performed. Pathology reported: pseudo papillary tumor of the pancreas. Evolution was satisfactory with no complication and the follow up at 16 months showed no recurrence. Histological examination confirmed the diagnosis and the complete resection of this tumor has an excellent prognosis with rare recurrences.