Intrapancreatic accessory spleen: An eluding diagnosis

Intrapancreatic accessory spleen (IPAS) is a benign anomaly of splenic embryology and a rare cause of pancreatic pseudotumour. Here, we report a case of a 70-year-old Malay lady whose IPAS was discovered incidentally during her surveillance computed tomography for her underlying left lower lung fibrosis. Radiologically, the lesion mimicked a neuroendocrine pancreatic tumour and was only diagnosed pathologically as IPAS after surgery. In conclusion, recognising IPAS as a differential for enhancing pancreatic mass allows us to exhaust all non-invasive diagnostic means to diagnose this benign lesion. It will allow the patient to avoid unnecessary surgery and its accompanying complications.

Derivation and characterization of Chinese human embryonic stem cell line with high potential to differentiate into pancreatic and hepatic cells / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Human embryonic stem cells have prospective uses in regenerative medicine and drug screening. Every human embryonic stem cell line has its own genetic background, which determines its specific ability for differentiation as well as susceptibility to drugs. It is necessary to compile many human embryonic stem cell lines with various backgrounds for future clinical use, especially in China due to its large population. This study contributes to isolating new Chinese human embryonic stem cell lines with clarified directly differentiation ability.</p><p><b>METHODS</b>Donated embryos that exceeded clinical use in our in vitro fertilization-embryo transfer (IVF-ET) center were collected to establish human embryonic stem cells lines with informed consent. The classic growth factors of basic fibroblast growth factor (bFGF) and recombinant human leukaemia inhibitory factor (hLIF) for culturing embryonic stem cells were used to capture the stem cells from the plated embryos. Mechanical and enzymetic methods were used to propagate the newly established human embryonic stem cells line. The new cell line was checked for pluripotent characteristics with detecting the expression of stemness genes and observing spontaneous differentiation both in vitro and in vivo. Finally similar step-wise protocols from definitive endoderm to target specific cells were used to check the cell line's ability to directly differentiate into pancreatic and hepatic cells.</p><p><b>RESULTS</b>We generated a new Chinese human embryonic stem cells line, CH1. This cell line showed the same characteristics as other reported Chinese human embryonic stem cells lines: normal morphology, karyotype and pluripotency in vitro and in vivo. The CH1 cells could be directly differentiated towards pancreatic and hepatic cells with equal efficiency compared to the H1 cell line.</p><p><b>CONCLUSIONS</b>This newly established Chinese cell line, CH1, which is pluripotent and has high potential to differentiate into pancreatic and hepatic cells, will provide a useful tool for embryo development research, along with clinical treatments for diabetes and some hepatic diseases.</p>

Small cell carcinoma of pancrease

Small cell cancer commonly occurs in the lungs, but it is rarely found in other organs. Small cell cancer that occurs in the pancreas is rare and its progress very rapid, and most patoents' tumor has already spread by metastasis when it is discovered. Although this cancer has a poor prognosis, we report here on treating case with combined curative resection and chemotherapy and showed a good prognosis.

Laparoscopic Enucleation of a Pancreatic Mucinous Cystadenoma

We report a case of a 52-year-old man in whom a cystic pancreatic tumor was successfully removed by laparoscopic enucleation. The patient had a followup CAT-scan for a resolving right upper lobe pneumonia which demonstrated a unilocular hypodense 3.9x2.2 cm sized cyst in the uncinate process of the pancreas. He had a laparoscopic biliopancreatic diversion with duodenal switch in July 2002, and also had laparoscopic cholecystectomy for cholelithiasis in December 2003. Laparoscopic intraoperative ultrasonography revealed a solitary cystic tumor in the inferior portion of pancreatic head. Laparoscopic enucleation of the tumor was performed using Ultracision(R) between the cyst outer wall and the normal pancreatic parenchyma. The operative time was 160 minutes, the estimated blood loss was 20 ml, and there were no perioperative complications. The patient's postoperative course was uneventful, and he was discharged on the first postoperative day. The histopathologic diagnosis showed a mucinous cystadenoma. We reported a new technique for safe management of small cystic tumors located on surface of the pancreas.

Pancreatic Tuberculosis with Microcystic Adenoma

Tuberculosis of the pancreas is a rare disorder. The clinical presentation of pancreatic tuberculosis include nonspecific symptoms such as fever, fatigue and weight loss. The radiological features mimic pancreatic malignancy or pancreatitis. So, the diagnosis of pancreatic tuberculosis is very difficult. A 62-year-old man was referred for pancreatic mass. Findings on preoperative imaging modalities were consistent with pancreatic carcinoma, and fine needle aspiration test indicated microcystic adenoma or carcinoma. Pylorus-preserving pancreaticoduodenectomy was done. Final diagnosis was pancreatic tuberculosis combined with microcystic adenoma. We conclude in that patients who have a mass in the pancreas, pancreatic tuberculosis should be considered, particularly in the developing country and immunosuppressed individuals.

A Case of Dermatomyositis Associated with Thyroid Cancer / 대한류마티스학회지

Dermatomyositis is an autoimmune connective tissue disorder characterized by symmetrical proximal muscle weakness due to chronic inflammation and degeneration of skeletal muscle. Cancer occurs in patients with dermatomyositis with a frequency estimated between 15~20%. The common sites of malignancy are stomach, breast, ovary, lung and etc. The cases that have been reported so far are dermatomyositis associated with lymphoproliferative disorder and cancer of colon, liver, pancrease, pharynx, uterine cervix, testis, kidney. But dermatomyositis associated with thyroid cancer has not been reported in Korea. We, the authors, experienced a case of dermatomyositis associated with the thyroid cancer and as such we are reporting the case with literature reviews.

Hemosuccus Pancreaticus (Hemoductal Pancreatitis, Gastrointestinal Hemorrhage Due to Rupture of a Splenic Artery Aneurysm into the Pancreatic Duct)

Hemorrhage through the pancreatic duct into the duodenum is rare presentation of upper gastrointestinal bleeding. This condition is most commonly associated with inflammatory disorders of the pancrease with the bleeding originating from an area of hemorrhagic pancreatitis, abscess, or pseudocyst. A pseudoaneurysm of the splenic artery be can form as a result of erosion and autodigestion by the inflammatory process of this major blood vessel. More frequently, splenic artery aneurysms rupture into the greater or lesser peritoneal sacs, stomach, retroperitoneum, colon, or splenic vein. We experienced a patient with a prolonged history of upper gastrointestinal bleeding in which the diagnosis of hemosuccus pancreaticus secondary to a ruptured splenic artery aneurysm was diagnosed preoperatively. We report our experience with a review of the related literature.

Clinical efficacy of various tumor markers in medical screening / 대한내과학회지

BACKGROUND: Many tumor markers have been investigated for early diagnosis of the malignancy, yet they were turned out to be inappropriate for the purpose. This study was carried out to investigate the efficacy of tumor markers. METHODS: Employing radioimmunoassay, CEA, AFP, CA19-9, PSA, CA125 were done in 31,389 patients(20,878 males, 10,511 females) who visited our medical screening center from Jan. 1 1997 to Dec. 31 1997. RESULTS: Total mean value of CEA is 1.90+/-1.37 ng/mL(male: 2.17+/-1.37, female: 1.37+/-0.86). Male showed significantly higher level of CEA. Only 2 subjects had values over 25 ng/mL, and one was diagnosed to have stomach cancer but the other did not. Total mean value of AFP is 2.46+/-6.47 ng/mL (male: 2.32+/-3.55 ng/mL, female: 2.73+/-10.06 ng/mL). Female showed significantly higher level of measured AFP. One had AFP value over 400 ng/mL and was diagnosed of hepatoma. Total mean value of CA19-9 is 11.48+/-7.61 ng/mL,(male: 10.9+/-26.78 ng/mL, female: 12.61+/-8.97 ng/mL). Female showed significantly higher CA19-9. 65 subjects (male: 31, female: 34) showed measured CA19-9 level over 37 ng/mL. 5 subjects had values over 100 ng/mL and 1 subject was diagnosed of pancrease cancer. Total mean value of PSA is 0.79+/-1.88 ng/mL. 90 subjects showed measured PSA level over 4 ng/mL and mean value in this group was 10.92 ng/mL. 54 subjects were older than age 50. 4 out of 90 subjects were diagnosed of prostate cancer. Total mean value of CA125 is 13.08+/-10.93 ng/mL. 160 subjects showed measured CA125 level over 35 ng/mL. 19 subjects had value over 100 ng/mL and none of the malignancy was detected. CONCLUSION: Tumor markers are inappropriate measures for screening of malignancy.

In vivo Assessment for the Antioxidant Activity of the Calcium Channel Blocker Nicardipine in 3% Sodium-Taurocholate-induced Acute Pancreatitis

BACKGROUND: Although several pathophysiological sequences, such as protease activation, free radical generation, and inflammatory mediator release, have been described in acute pancreatitis, the precise mechanism by which acute pancreatitis is initiated is unkown. Cellular calcium, a key function and also a crucial pathological intracellular messenger in cell injury, appears to be involved in the initiation and development of acute pancreatitis. The aim of this study is to evaluate the role of cellular calcium and therapeutic effect of administering the Ca++ channel blocker nicadipine as an antioxidant. METHOD:Nicardipine, known to be a calcium channel blocker and a most potent antioxidant, was wed as a pretreatment 1 hour before induction of pancreatitis by intraductal infusion of 3% sodium taurocholate or as a post-treatment 1 hour after induction of aucte pancreatitis by retrograde infusion of sodium taurocholate. The net weight of the pancrease, the amounts of s-amylse, GSH and MDA in the pancreatic tissue, and the histologic damage were examined 12 hours after the induction of pancreatitis. RESULTS: Nicardipine administration ameliorated pancreatic edema and reduced the amount of s-amylase compare to untreated necrotizing pancreatitis group. Also, pre- or post-treatment with nicardipine had beneficial protective effect with respect to free radical-induced injury; in particular, pre-treatment with nicardipine was much better. With respect to the histologic findings, pancreatic necrosis, hemorrhage, and neutrophil infiltration were prominent in the necrotizing group, however, in the group treated with nicardipine, the necrosis and hemorrhage were ameliorated remarkably. CONCLUSION:The free oxygen radicals and the intracellular calcium influx were major elements in the pathogenesis of acute pancreatitis, and nicardipine ameliorated pancreatic necrosis and hemorrage and exerted an antioxidant effect. The administration of nicardipine should be considered in the early stage of pancreatitis or in case of risk of pancreatitis.

Pancreatic Mucinous Ductal Ectasia A clinical study of four patients

Four cases of mucinous ductal ectasia of the pancreas are presented, along with a review of the literature. Mucinous ductal ectasia is a clinicopathologic entity characterized by dilation and filling of the main pancreatic duct or its side branches with thick, viscid mucus, leading to recurrent acute pancreatitis or symptoms that mimic chronic pancreatitis. Three of the patients were male (M:F=3:1) and the patients were 54~74 years old. The symptoms of two patients were abdominal pain and they had a frequent admission history due to pancreatitis. One patient had jaundice, and one patient presented no symptoms. In all of the patients, the tumor was located in the read of the pancrease and the size of tumor was about 3 cm. A total pancreatectomy was performed, and three pancreatico-duodenectomy were performed. The pathologic report revealed that two cases were malignant and two cases were borderline malignant. The tumor marker did not correlate with the presence of malignancy. Because mucinous ductal ectasia is recognized as a premalignant disease, the treatment of choice is pancreatic resection.

Distrubution of gamma-Glutamyltransferase in Blood-Brain Barrier Pericytes Using Monoclonal Anti gamma-Glutamyltransferase Antibodies

gamma-Glutamyltransferase(GGT: E.C. 2.3.2.2.) is a glycoprotein enzyme which is involved in glutathione metabolism and amino acid transport through the plasma membrane. It is distributed widely in several organs including liver, kidney, pancrease and brain. GGTs derived from the brain of Wister rats and BALB/c mice were biochemically purified to a specific activity of 4246.2, 862.1 units per mg of protein, a purification folds 93.7, 43.8 and the final yield 65.8, 44.0% respectively. Electrophoretic pattern of purified GGTs from rats and mice brain shows very similar protein fraction each other. We have produced six monoclonal antibodies(GGT-Mab 1-6) against 2-acetamidogluorene treated rat liver GGT. Using these GGT-Mab 1-6 we performed immunohistochemistry(IHC) to study the distribution of GGT isozymes in normal tissues of rat brain and in neoplastic tissues of human brain. The results indicated that human brain GGT was localized in pericytes of blood-brain barrier, especially in the blood-rich portion of the brain(e.g. cerebellum of rat, meningioma and craniopharyngioma of human). Therefore these Maps may be used to evaluate the distribution of GGT isozymes in different tissues.

Nine Case of Congenital Variants of the Pancreatic Duct Diagnosed by ERCP / 대한소화기내시경학회지

Although variation is the rule with pancreatic duct morphology, certain variants occur as a result of altered embroological development. These ductal configurations, most striking deviations from the normal configuration, may be classfied according to alterations of embryological development. These congenital variants of pancreatic duct may be important for several reasons. First, the pseudomass effect of ductal anomalies can be mistaken for carcinoma by the inexperienced radiologists. Second, whether or not the anomaly is important, it is present in many patients with recurrent pacreatitis. Original descriptions were based on small sampling of postmortem studies and surgical specimen, but more recently the advent of endoscopic retrograde cholangiopancreatography(ERCP) has confirmed of the work of early anastomists and increased awareness of these variants. To evalute of frequency, characteristics of associated disease and clinical significance of pancreatic anomalies, we have reviewed of 5330 case of ERCP filmes which were undertaken between July, 1973 and August, 1993. Having reviewed of ERCP filmes, we found out 9 case of pancreatic duct variants. Among them, 7 cases were classified as ductal duplication anomalies, 4 cases of number variation, most, bifuricaiton and 3 cases of form variation, which were composed of loop, spiral and terminal N. Three cases of fusion anomalies were also noted, which were 2 cases of panceratic divisum and 1 case of incomplete pancreatic divisum. The associated diseases were 6 cases of bile duct and galbladder stones and 3 cases of pancreatic cancer. We could not find out the case of congenital anomalies as cause of obstructive pain and pseudomass effect.

A case of solid and papilary tumor of pancreas

We report a cases of solid and papillary neoplasm of the pancreas, which is a rare pancreatic tumor. we described clinical characteristics, sonographic, computed tomographic and pathologic finding. The tumors had a smooth, enhanced capsule and variable architecture. The tumor was distributed tail of pancreas without local invasion. the origin of the tumor is probably from a multipotential stem cell of the pancreas. Neoplasm usually behave like a very low grade malignancy, so that complete removal is the treatment of choice for the tumor arising anywhere in the pancrease. This unusual tumor should be considered in the differential diagnosis of a young female with pancreatic mass.

Atypical manifestation of solid and papillary epithelial neoplasm of the pancrease: case report

We report a rescently experienced case with atypical radiologic manifestation of solid and papillary epithelial neoplasm of the pancreas in a 37 years old female patient. The tumor had heavy calcification on its capsule wall and septa. Instead of the usual encapsulated lesion with partly solid and partly cystic-hemorrhagic components, the lesion consisted of numerous fine cavitations containing air without fluid component except focal abscess fluid.

Staging of gastric carcinoma by computed tomography

Gastric cancer is the most prevalent gastrointestinal tract malignancy in Korea. By the time the patient hassymptoms, these tumors are usually advanced in stage. In high risk populations,screening such as double contrastUGI or gastric endoscopy is needed and patient with vague symptoms should be studied. However, these screeningshave high diagnostic accuracy rate, only CT scan can identify accurately abnormal stomach wall thickening andintraabdominal tumor extension. And CT is important for palnning of treatment, assessing surgical resectability,postoperative evaluation and prognostic implications. Author reviewed CT scan of 67 cases of confirmed gastriccancer by double contrast UGI or endoscopic biopsy, for 29 months from March 1983 to August 1985 at Department ofRadiology, Pusan National University Hospital. The results were as follows: 1. The most frequent site ofinvolvement of gastric cancer was gastric antrum in 49.9%(33/67). 2. By CT staging, stage 3 was 40.2%(27/67) andstage 4 was 38.8%(26/67). 3. In CT scan analysis, the structures involved by diect invasion were regional lymphnodes, pancrease, and gastrocolic ligament in order of frequency. The structures involved by distant metastaseswere liver, systemic lymph nodes, and mesentery in order of requency. 4. The diagnostic accuracy of CT staging was73.9%(17/23) by correlation of surgical and pathological findings. 5. In determination of stage by CT, the rate ofin accuracy of stage 2 was highest as 33%(2/6), and that of stage 3 was 29.2%(3/11). 6. Of all misdiagnoses,83.3%(5/6) was owing to failure to differentiate lymph node invasion from reactive hyperplasia of lymph node.

Diagnostic significance of computed tomography in gastric cancer

Gastric cancer is the most common gastrointestinal malignancy in Korea. Identification and evaluation ofgastric mass lesions and regional-distant metastases by abdominal CT scan are important for the treatment planningand prognostic implications of gastric cancer patients. Author reviewed CT scan are important for the treatemntplaning and prognostic implications of gastric cancer patients. Author reviewed CT scan of 61 cases of pathologyproven gastric cancer, retrospectively, for recent 20 months from July 1983 to Feb. 1985 at department ofradiology, Korea University, Hae Wha Hospital. The results were as follows: 1. There were 50 cases of advanced adenocarcinoma, 8 cases of early gastric cancer, 2 cases of leiomyosarcoma, and 1 case of lymphoma in total 61cases. 2. The sex ratio of male to female was 2:1. Age distribution was from 24 to 75 year old and peak incidencewas in 6th decade. 3. The most frequent site of involvement with gastric cancer was gastric antrum in 51%. 4. 48of the 50 patients with advanced gastric adenocarcinoma(96%) had a wall thickness greater than 1 cm, and all of 8cases of early gastric cancer had a wall thickness less than 1 cm. Regional lymph node tumor infiltration wasfound in 100% of gastric wall thickness greater than 2.0cm, in 64% of cases of 1.5 to 2.0cm, in 50% of cases of1.9 to 1.5cm, and 12.5% of cases of less than 1.0cm. 5. In a comparison of enlargement of reginal lymph node by CTscan to tumor infiltration of regional lymph node by histology, senitivity was 52%, specificity was 87%, and reliability was 66%. 6. The structures involved by distant metastases of these cases were the retroperitoneallymph node in 15, liver in 8, and pancrease in 3. 7. The diagnostic accuracy of CT staging was considered about68% by correlation of the surgical and histological findings. 8. The CT scan is one of the accurate and simpletool for evaluation of size, shape, extent, as well as distant metastases in the cases of gastric malignancies.

Radiological aspect of pancreatic pseudocysts

Pancreatic pseudocyst occurs as a complication of pancreatitis or trauma, which results in the escape of pancreatic enzymes from the parenchyma or ductal system of pancreas. At that time, serum amylase may have returned to normal level, and the patient may be subjectively asymptomatic. In this phase, the radiologic findings are relatively greater significance than laboratory data. In the conventional radiologic study, pancreatic pseudocyst have been frequently confused with other retroperitoneal mass, but recently with clinical application of ultrasound and CT scan, more accurate diagnosis can be obtained. The brief results are as follows; 1. Male to female ratio was 3:2 in 15 patients. Incidence was most common in young adult age. Most frequent symptom was epigastic pain, and which was noted in 11 cases of patients. 7 cases of patients had past history of abdominal trauma and past history of pancreatitis was only in 1 case. Most common laboratory finding was leukocytosis in 8cases of patients and elevated serum amylase was also noted in 7 cases. 2. In each 5 cases of patients, plain chest roentgenologic evidence of left side pleural effusion and hemidiaphragm elevation were observed. 3. On flat abdomen film, soft mass shadow was visualized in 8 cases of patients. On UGI series, evidence of retrogastric space widening was observed in 11 cases of patients. 4. The location of pseudocyst is mainly in body and tail of pancrease in 11 cases of patients. 5. More accruable diagnosis can be obtained through application of ultrasound and CT scan.