Invasive Thyroglossal Duct Cyst Papillary Carcinoma: A Case Report and Review of the Literature.

BACKGROUND Thyroglossal duct cyst is a common congenital anomaly of the thyroid gland, usually found centrally. The presence of malignancy occurring in a thyroglossal duct cyst is a rare condition, accounting only for 1% of all cases of thyroglossal duct cyst. This report is of a rare case of papillary carcinoma arising in a thyroglossal duct cyst and includes a review of the literature. CASE REPORT A 27-year-old female patient was referred to our department with a painless cystic mass in the neck. After initial physical examination and endocrinology investigations, a fine needle aspiration (FNA) of the cyst was performed. Cytology showed a papillary neoplasm. The patient underwent total thyroidectomy and surgical excision of the thyroglossal duct cyst (the Sistrunk's procedure). Histopathology of the surgical excision specimen showed a thyroglossal duct cyst with a maximum diameter of 7.5 cm containing a primary invasive papillary carcinoma, measuring 1.5 cm in diameter that infiltrated into the cyst wall. The remaining thyroid gland was normal. CONCLUSIONS Thyroglossal duct carcinoma, most commonly papillary carcinoma, is a rare condition that should be considered in patients presenting with cystic midline neck masses. Surgery and complete excision is the main treatment and the optimal patient management includes multidisciplinary consultation in order to improve survival. The diagnosis of malignancy is made postoperatively, as in the present case.

Direct inguinal hernia containing bladder carcinoma: A case report and review of the literature.

INTRODUCTION: Inguinal hernia containing bladder carcinoma is a very rare occurrence. PRESENTATION OF CASE: We report a case of a male patient who presented with a left groin hernia containing an irregular mass. The hernia was repaired without the use of mesh and a partial cystectomy was done. DISCUSSION: Only 1-3% of all inguinal hernias involve the bladder, with very few reports containing a carcinoma. CONCLUSION: Treatment consists of removing the tumor and repairing the hernia.

Late solitary pancreatic metastasis from renal cell carcinoma: a case report.

We report a case of a 70-year-old man with renal cell carcinoma and metastasis to the pancreas. Symptomatic patients usually present with obstructive jaundice, abdominal pain, or GI bleeding. The diagnosis usually occurs in asymptomatic patients during followup for renal cell carcinoma. It usually befalls slowly from 2 to 18 years after the onset of the primary tumor of the kidney. A 70-year-old man presented in our department with weight loss, anorexia, and elevated blood glucose, having a large tumor on the head of the pancreas treated successfully by pancreatoduodenectomy. Three years after his treatment, the patient is doing well and without recurrence of the tumor. In conclusion, metastasis of renal cell carcinoma to the pancreas is a rare neoplasm accounting for 0.25-3% of all pancreatic tumors.

Limy bile syndrome: review of seven cases.

BACKGROUND: Milk of calcium bile or limy bile is a rare disorder in which the gall bladder is filled with a thick, paste-like, radiopaque material. METHODS: Seven patients with limy bile syndrome were treated in our department from 1980 to 2003. There were five women and two men, and their age ranged from 30 to 64 years. A retrospective analysis of clinical symptoms, diagnostic work-up, treatment approach and operative findings was performed. RESULTS: All patients presented with intermittent right upper abdominal quadrant pain. Three of the seven patients (42.85%) presented with complications like acute cholecystitis (two of seven patients) and obstructive jaundice (one of seven patients). Diagnosis was based on clinical findings, plain abdominal X-rays, ultrasonography and computed tomography scanning. Surgery was the treatment of choice and cholecystectomy alone or in combination with common bile duct exploration and drainage (if needed) was performed. CONCLUSION: The clinical aspect of the disease is similar to that of biliary lithiasis and the diagnosis is easily made by the characteristic spontaneous opacification of the gall bladder on plain abdominal X-rays. Complications such as acute cholecystitis, pancreatitis or obstructive jaundice can also be present. Although some cases of conservative pharmaceutical treatment as well as cases of spontaneous disappearance of limy bile have been reported, surgical treatment remains the treatment of choice.

Mixed exocrine-endocrine tumor of the pancreas.

CONTEXT: Neoplasms of the pancreas usually show ductal, acinar or endocrine differentiation. Tumors with mixed exocrine and endocrine components are unusual. We herein describe a case of a mixed ductal-endocrine tumor. CASE REPORT: A 65-year-old woman was referred to our department with a diagnosis of carcinoma of the tail of the pancreas. The patient had a short history of upper abdominal pain, nausea and melena. Upper gastrointestinal endoscopy revealed gastric fundus varices and CT scan demonstrated an inhomogeneous tumor located in the tail of the pancreas infiltrating the spleen and the splenic vein. The patient underwent distal pancreatectomy and splenectomy, and had an uneventful recovery. Pathological examination revealed a mixed ductal-endocrine tumor. The endocrine component was immunoreactive for glucagon, gastrin and somatostatin, and non-reactive for insulin. CONCLUSIONS: Because of the rarity and unpredictable biologic behavior of these tumors, the need for adjuvant therapy has not yet been well-defined. The patient has had a follow-up CT scan every six months, and one and a half years later remains disease free.

Somatostatin-producing pancreatic endocrine carcinoma presented as relapsing cholangitis -- a case report.

Somatostatin-producing endocrine tumors are rare neoplasms usually arising in the pancreas and duodenum and they account for less than 1% of all gastrointestinal endocrine tumors. Besides somatostatinoma syndrome, which is characterized by diabetes mellitus, steatorrhea and cholelithiasis, patients with somatostatin-producing endocrine tumors commonly complain of nonspecific symptoms such as vague abdominal pain, weight loss or changes in bowel habits. Tumor behavior cannot be predicted by histological features alone, and malignancy is determined by the presence of metastases. We report here a case of malignant pancreatic endocrine tumor producing somatostatin presented as relapsing cholangitis who was treated with Whipple pancreatoduodenectomy.

Effect of early octreotide administration on the development of esophageal varices in cirrhotic rats.

This study was conducted to investigate the effect of chronic octreotide administration on the development of esophageal varices in rats being at the early stages of carbon tetrachloride-induced cirrhosis. For the development of liver cirrhosis and esophageal varices 96 rats underwent ligation of left adrenal vein followed by phenobarbital and carbon tetrachloride administration. After 2 weeks of carbon tetrachloride administration, rats were randomly separated into three groups. Chronic octreotide administration started in group A, normal saline in group B, while 32 rats consisted control group. Haemodynamic studies and morphometric analysis of the lower esophagus were performed 2 weeks after complete induction of cirrhosis. Total submucosal vessel area, mean cross-sectional area of submucosal vessels, percentage of submucosa occupied by vessels, the area of the most dilated submucosal vessel as well as the number of submucosal vessels were studied. Octreotide administration induced a significant ( [Formula: see text] ) decrease of portal vein pressure. Morphometric analysis revealed a significant reduction ( [Formula: see text] ) in octreotide-treated rats of both "total submucosal vessel area" and area of "the most dilated submucosal vessel". Chronic octreotide administration partially prevented rats from the development of esophageal varices. Octreotide-treated rats were found to have a less pronounced dilatation of submucosal veins compared to placebo-treated group rats. We believe that this effect was mainly due to the decrease of portal vein pressure induced by chronic octreotide administration.