ABSTRACT
INTRODUCTION: Pancreatic neuroendocrine tumors are rare. Treatment includes aggressive local management of the primary lesion and metastases, and systemic somatostatin. This is the first report of an isolated metachronous metastasis to the adrenal gland from a pancreatic neuroendocrine tumor that presented 90 months after the primary tumor. PRESENTATION OF CASE: The patient presented as a 53yo man with a left upper quadrant mass and synchronous metastases to the spleen and liver (pancreatic neuroendocrine tumor T4N0M1, Stage IV), which were resected (CD56-, synaptophysin+, chromogranin+, Ki-67<1%). Over the next 90 months, he underwent five procedures to treat hepatic recurrences (2 liver resections and 3 percutaneous radiofrequency ablations). Serum PIVKA levels were elevated prior to treatment of four of six lesions and returned to baseline after therapy. He presents now, asymptomatic, with a right adrenal mass found on routine imaging and no other lesions. Serum PIVKA was elevated to 44mg/dL. The adrenal gland was resected and shown to be a metastasis (CD56+, synaptophysin+, chromogranin+, Ki-67 15-20%). DISCUSSION: This patient's clinical course reflects aggressive local therapy of the primary lesion and multiple metastatic lesions to three organs (liver, spleen, adrenal) over nearly eight years. The utility of serum PIVKA levels in patients with pancreatic neuroendocrine tumors is not previously reported and needs further investigation. CONCLUSION: This patient has a pancreatic neuroendocrine tumor with metastases to the spleen, liver and adrenal gland and elevated PIVKA levels with recurrent disease. These unique clinical features add to the diversity of clinical presentation of these rare tumors.
ABSTRACT
This study elucidates the effect of zinc (Zn), which is an anticorrosive water additive, on the formation of silica scales from cooling water. In these experiments, the silica scales were analyzed by EPMA, and the results indicate that Zn is sorbed into the silica scales during formation. Measurements of the solubility of Zn(OH)(2) at various concentrations of silicic acid demonstrate that Zn is present as a silicato complex of Zn (SCZ) in cooling water. From adsorption experiments of the SCZ on silica and alumina, which are major components of the silica scales, it can be concluded that the SCZ accelerates the formation of silica scales from cooling water.
ABSTRACT
The mechanism of formation of silica scales from cooling water was studied by chemical analyses of the cooling water and silica scales, characterization of the aluminum in the silica scales by 27Al magic angle spinning NMR, the relationship between size distribution of particles in the cooling water and their Al/Si atomic ratios and zeta potentials, and the adsorption properties of the particles on the surface of silica gel powder as a mimic of silica scale. From our results, we determined that aluminum is concentrated from the cooling water into silica scales during their formation, 6-coordinate aluminum is preferentially adsorbed on the surface of the solid, and various particles with differing sizes, surface charges, and Al/Si atomic ratios are formed in the cooling water after addition of polyaluminum chloride. The formation mechanism for silica scales in the cooling water system is proposed based on the electrostatic interaction. The formation of aluminum hydroxide particles smaller than 0.2 microm with positive charges, consisting of 6-coordinate aluminum, and their subsequent adsorption on the surface of the solid are the most important factors contributing to the formation of silica scales.
