Successful transcatheter arterial embolization of an inferior pancreaticoduodenal artery aneurysm associated with celiac axis stenosis.

A case of inferior pancreaticoduodenal artery (IPDA) aneurysm associated with celiac axis stenosis was successfully treated using only transcatheter arterial embolization (TAE). A 57-year-old woman was urgently referred to our hospital with sudden abdominal pain; computed tomography revealed retroperitoneal hematoma due to bleeding from an aneurysm around the superior mesenteric artery (SMA). Selective angiography into the SMA showed an aneurysm derived from the IPDA posterior branch; the IPDA anterior branch was intact and contrast medium flowed into the common hepatic artery territory through the pancreatic arcade because of celiac axis stenosis. We subsequently performed TAE on the lesion. Arteriography after TAE showed that the aneurysm had disappeared and that the IPDA anterior branch was intact. She had no aneurysm recurrence for about two years after the treatment. We believe that TAE is effective even for a PDA aneurysm with celiac axis stenosis or occlusion. However, it is important to perform embolization precisely and over a long period.

Idiopathic unilateral adrenal hematoma: report of a case.

We report an unusual case of idiopathic unilateral adrenal hematoma, which was asymptomatic and unaccompanied by a hematologic disorder. The surgical specimen contained a large tumor comprised of subacute to chronic organized hematoma. The preoperative magnetic resonance imaging findings were compatible with characteristics reported previously, except for spotty strong enhancement in the peripheral part of the mass. It is important to differentiate this benign lesion from a neoplasm, although we were not able to identify it preoperatively and a precise diagnosis was only confirmed when the resected specimen was examined pathologically.

Huge endocrine tumor of the pancreas.

We report a case of a huge endocrine tumor of the pancreas. A 76-year-old woman was admitted for a left upper abdominal mass. She showed neither hormonal symptoms nor abnormal serum hormone levels. Ultrasound imaging showed that a heterogeneously solid and partly calcified tumor was located in the retroperitoneal space. Computed tomography showed a hypervascular tumor with central degeneration. Open laparotomy revealed that the tumor originated from the pancreas; it was removed in a mass including the spleen and the pancreatic body and tail. The resected specimen demonstrated that the 580-g tumor was multi-lobulated, encapsulated, and 14 x 14 x 7 cm in size. Microscopically, the tumor consisted of cuboidal cells with round nuclei; the cells formed palisade and trabecular structures. Immunohistologically, chromogranin A, neuronspecific enolase, and glucagon were positive only for the tumor cells. Final diagnosis was endocrine tumor of the pancreas immunohistochemically producing glucagon. No tumor recurrence has been found 3 years after the surgery. We conclude that huge tumors in the retroperitoneal space must be differentiated from nonfunctioning endocrine tumors of the pancreas because the clinical course is markedly different.