[Endocrine tumors of the pancreas: experience in the ABC Medical Center]. / Tumores endocrinos del páncreas: experiencia en el Centro Médico ABC.

OBJECTIVES: To analyze presentation, diagnosis and treatment of islet cell tumors at the ABC Medical Center. MATERIALS AND METHODS: Medical records of the 7 patients with endocrine tumors diagnosed between 1995 and 2005 were reviewed and analyzed, with emphasis to clinical, biochemical and radiological characteristics, surgical treatment and outcome. RESULTS: There were 3 insulinomas, 1 gastrinoma, 1 VIPoma, and 2 non-functioning tumors. All insulinomas presented the Whipple's triad. The tumor was localized before surgery in 2 cases. In all patients intraoperative ultrasound confirmed the tumor and enucleation was performed in all three. The patient with gastrinoma was diagnosed by endoscopy in the presence of metastatic disease, therefore no surgical treatment was performed. The patient with VIPoma, presented the typical secretory diarrhea. A tumor in the pancreatic head was found and it was resected by pancreaticoduodenectomy. Histology revealed a malignant lesion. Both non functioning tumors were found by imaging studies, one benign tumor was treated by central pancreatectomy and the other was malignant and underwent distal en-block pancreatectomy. Immunohistochemistry was positive for VIP in the benign lesion. Two of the 3 malignant tumors have died and one is alive with recurrent disease. CONCLUSIONS: Distribution of islet cell tumors in our series followed the usual patterns. In all functioning lesions hormonal production was identified before surgery. Imaging studies localized the tumor in 7 of the 8 patients. Surgical resection cured all benign tumors.

[Solid-cystic pseudopapillary tumor of the pancreas: acute post-traumatic presentation. Case report and review of the literature]. / Tumor pseudopapilar sólido-quístico de páncreas. Presentación aguda postraumática. Reporte de un caso y revisión de la literatura.

OBJECTIVE: To report an infrequent case of pancreatic pseudopapillary solid-cyst tumor, known as Frantz tumor, discovered after blunt abdominal trauma, and to carry out a review of the literature. BACKGROUND: Frantz's tumor is a very uncommon low-grade malignant papillary-cystic neoplasm of the pancreas that is relatively frequent in young black women and was first described by Frantz in 1959. CASE REPORT: We present the case of a 15-years-old female patient who, 24 h after blunt abdominal trauma, came to the emergency room with intense abdominal and atypical pain and a palpable mass in the left upper quadrant. It was initially diagnosed as a post-traumatic pancreatic pseudocyst. The patient underwent distal pancreatectomy with spleen preservation; the histopathologic report was a pseudopapillary solid and cystic tumor of the pancreas without malignant cells. Clinical evolution has been satisfactory without recurrence of the tumor at 14 months of follow-up. CONCLUSIONS: Frantz's tumor has benign biologic behavior and treatment of choice consists of surgical resection. Outcome after surgical resection is excellent with 90% survival in the long term. Tumoral recurrence has been described in approximately 10% of patients.

Tumores sólidos seudopapilares del páncreas / Solid pseudopapillary tumors of the pancreas

El informe de tumores sólidos seudopapilares del páncreas, lesiones de potencial maligno incierto o francamente malignos, ha venido incrementándose a partir de su más amplio reconocimiento y caracterización como entidad anatomoclínica distintiva. Se les estima una frecuencia del 2 por ciento entre todas las neoplasias exocrinas del páncreas. Crecen lentamente sin correlación exacta entre aspecto histológico y comportamiento biológico. Presentamos los casos de dos pacientes femeninas de 24 y 15 años (casos 1 y 2), con excelente evolución luego del diagnóstico posquirúrgico, en el Centro Médico ABC de la Ciudad de México, de tumores sólidos seudopapilares del páncreas. Acudieron al hospital, por dolor abdominal, en el segundo caso precedido de trauma leve. El primer caso fue predominantemente quístico y el segundo predominantemente sólido, con 14 y 12 cm de diámetro respectivo. La histología, semejante en ambos, consistió en zonas sólidas y áreas de aspecto papilar con cambios mixoides. La inmunotinción destacó positividad para vimentina, expresión variable para marcadores neuroendocrinos, citoqueratina, receptores de progesterona y un hallazgo interesante: complejos ductuloinsulares en páncreas residual. Conclusiones: Ocurrencia en mujeres jóvenes; aspecto sólido-quístico; fácil exéresis; gran tamaño e histología sólida-papilar sugieren diagnóstico de tumor sólido seudopapilar pancreático, pudiendo evitar resecciones quirúrgicas excesivas.