Primary pancreatic neoplasia or metastasis from colon carcinoma?

INTRODUCTION: The pancreas is an unusual but occasionally favored target for metastasis from other primary cancers. Metastases have been described for various non-hematologic neoplasms, such as renal-cell carcinoma, pulmonary small-cell carcinoma, melanoma and gastric carcinoma. CASE REPORT: We report the case of a 77-year old man with a mass in the pancreatic head five years after anterior resection for adenocarcinoma of the colon and three years after resection of a lung metastasis. The patient underwent pylorus-preserving pancreaticoduodenectomy (Longmire-Traverso) and lymph-node dissection of compartment II. DISCUSSION: It is rare to have solitary metastases to the pancreas which clinically may mimic a primary neoplasm of the pancreas. Clinical features, as well as MRI and PET findings in patients with pancreatic metastasis from colon carcinoma are similar to those of primary pancreatic ductal adenocarcinoma. The diagnosis of metastasis should be considered when patients have a pancreatic mass and a history of non-pancreatic malignant lesions. Radical resection may prolong survival in patients if the pancreas is the only locus for metastasis at the time of diagnosis.

Abdominal actinomycosis: a rare complication after laparoscopic gastric bypass.

A 33-year-old, morbidity obese woman underwent a laparoscopic Roux-en-Y gastric bypass in November 2004. She presented 18 months later with a history of recurrent pain in the upper region of the abdomen and severe vomiting. Radiologic and endoscopic evaluations revealed wall thickening in the transverse colon and a solid tumor near the liver. Therefore, a sonography-guided biopsy of the tumor was performed. Cytopathological examination revealed actinomycosis. Thus, therapy with penicillin was started, after which the parameters associated with the infection decreased. The symptoms persisted, however, and the decision was made to operate on the patient to resect the abdominal masses. Nearly 90% of the masses could be removed. Histological analysis showed a fibro-productive inflammation with an actinomycotic etiology. Antibiotic therapy with penicillin was continued for 6 months. Actinomycosis must be considered in the differential diagnosis of patients with abdominal mass, wall thickening of the intestine, and other such symptoms, including abdominal pain following bariatric surgery, even many years after the intervention.

Combined effect of tumor necrosis factor-alpha and ionizing radiation on the induction of apoptosis in 5637 bladder carcinoma cells.

BACKGROUND AND PURPOSE: Apoptosis can be induced by distinct but overlapping pathways. Ionizing radiation induces apoptosis by an "intrinsic", mitochondria-dependent pathway. Ligation of tumor necrosis factor-(TNF-)alpha, FAS (CD95) or TRAIL receptors are typical representatives of an extrinsic, death-receptor-mediated pathway. In this study the effect of irradiation, treatment with the cytokine TNF-alpha, or a combination of both on the induction of apoptosis and clonogenic survival of bladder carcinoma cells was investigated. MATERIAL AND METHODS: 5637 bladder carcinoma cells were treated with different concentrations of recombinant TNF-alpha (0-10 ng/ml), irradiated with single doses ranging from 0.5 to 10 Gy, or a combination of both modalities. Apoptotic cells were quantified by the TUNEL assay up to 96 h following treatment, clonogenic cell survival by a clonogenic assay. Synergistic effects of both modalities were evaluated using isobolographic analysis. RESULTS: Irradiation of 5637 carcinoma cells resulted in a discontinuous dose dependence of the apoptotic fraction with a pronounced increase in the range of 0-2 Gy and a slighter increase at 2-10 Gy. The percentage of apoptotic carcinoma cells also increased continuously after treatment with lower concentrations of TNF-alpha reaching a plateau at concentrations of 5.0-10.0 ng/ml. Isobolographic analysis revealed a supraadditive interrelationship between irradiation and TNF-alpha in the range between 0.005 and 0.5 ng/ml, and an additive effect for TNF-alpha concentrations>0.5 ng/ml. The additive effects were confirmed in clonogenic survival assays with reduced survival fractions following combined TNF-alpha administration and irradiation. CONCLUSION: The combination of two apoptosis-inducing modalities resulted in a synergistic effect on the induction of apoptosis in 5637 bladder carcinoma cells. Although a radiosensitizing effect still has to be proven in animal models, combined-modality treatment may increase the therapeutic effectiveness of irradiation in bladder cancer.