A case of microglandular pancreatic carcinoma

Abstracts

f

Pancreatology 13 (201j) 52 598

(observed in 34 patients), reinterventions in 3 patients, because of bleeding, and 2 of those patients died. PF occurred was observed at 28 patients with PJ, and at 6 pateints with PG. Using multivariate analysis significant risk factors were small pancreatic duct, soft pancreatic parenPJ. Severe complications (graded with Dindo-Clavien) occurred more often with PJ, but not statistically significant. Overall mortalitet and reoperations were more often with PG,

chyma and

Conclusion: Combination

of soft pancreatic parenchyma, small of

pancreatic duct (under 3mm) and PJ can be considered as risk factors for PF after PD. We did not determine significantly higher incidence and clinical severity ofPF between PJ and PG.

Results: Two of patient's brothers died with pancreas cancer at 60 years of age. The first MRI. showed a multifocal branch duct IPMN (BDIPMN) of the pancreas with 3 major cystic lesions: a 23 mm in the head, a 15 mm in the body and a 20 mm in the tail ofthe pancreas. None ofthe lesions had radiological signs ofmalignancy, but due to the family history and symptoms (significant weight loss) the patient was considered for surgery. A total pancreatectomy was considered initially, but due to patient's age and the absence of radiological signs of malignancy, this was regarded as overtreatment, Therefore, enucleation of the three major cysts was performed with the double aim to confirm the diagnosis and potentially to treat the bigger lesions. The post-operative course was uneventful. The histology showed mild dysplasia IPMN in all the cysts. Conclusion: This case report shows that enucleation of BD-IPMN can be a useful diagnostic method and at the same time to treat patients with BD-IPMN who are at increased risk for pancreas cancer development.

PI-98 Abstract id: 86. Angiosarcoma of the pancreas mimicking severe acute pancreatitis Report of a case

-

Adrienn Csiszk61, Làszl6 Damjanovichl, Karoly Cdbor Szab61, Iswdn Làszlò2, Zsolt Kanyàril, Zsolt lknydrit, Zsolt Szentkeresztyl.

PI-100 Abstract id: 262. A case of microglandular pancreatic carcinoma

1 University of Debrecen Institute of Surgery, Hungary 2University of Debrecen Institute of Anaesthesiology and Intensive

Care, Hungary

Claudio Pasquali, Lucia Moletta, Anna Caterina Milanetto, Valbona Lico, Rita Alaggio, Cosimo Sperti, Sergio Pedrazzoli.

University of Padua, ltaly

Introduction: Angiosarcoma of the pancreas is a rare neoplasm.

Sar-

comas in the pancreas are often mimicking signs ofacute pancreatitis. Aims: Authors report a case of a primary angiosarcoma found in the pancreatic tail in a patient admitted for severe acute pancreatitis. Patients & methods: A 58-year-old man presented at the hospital with two weeks historty ofabdominal pain after excessive food intake and GI tract bleeding. Laboratory results were significant for CRP (87 mg/L), haemoglobin level was 10.6 g/dl. PCT was not elevated. Endoscopy failed to reveal the origin of bleeding. US and CT scan showed acute haemor-

rhogic, necrotizing pancreatitis involving the pancreatic tail, splenic hilum and small bowels. CT-guided drainage of intraabdominal and peripancreatic fluid was performed and parenteral feeding through a nasojejunal tube was strated. After 13 days, the amount of drained fluid persisted, the patient had fever, and a palpable mass in the left upper quadrant of the abdomen developed. Laparotomy was indicated. A large, haemorrhogic mass was found at the pancreatic tail, necrosectomy and drainage was performed. Results: Histology revealed angiosarcoma. On the third postoperative day the patient was reoperated because of abdominal compartment syndrome. Large amount of haemorrhogic ascites and paralytic ileus was found. Two days later the patient died of MOF, sepsis. Conclusion: Angiosarcoma of the pancreas is a rare entity and not well described. If the patient has fever without elevated PCT levels, the presence ofa malignant tumor in the pancreas should be considered.

Introduction: Microadenocarcinoma (MA) of the pancreas is rare. Cubilla and Fitzgerald in 1975 proposed this term for a subtype of pancreatic carcinoma, based on morphological features (small crowded microglandular structures forming a cribriform pattern and sometimes solid sheets).

Aims: To present a case of microglandular carcinoma of the pancreatic head observed in our Unit. Patients & methods: A 77-year-old man presented with dyspepsia and weight loss. Abdominal US showed a pancreatic head mass (5 x 5.5 cm), confirmed by CT scan and MRl. CA 19-9 was 46.3 kU/1. A 18FDG-PET showed an increased tracer uptake (SUV max 3.0). We performed a pancreaticoduodenectomy. Results: Histology: microglandular carcinoma of the pancreatic head (size 6.5 cm), with ductal and acinar differentiation. Immunohistochemistry: CAM 5.2 positive, neuroendocrine-related markers negative, t(i-67 70%.The patient died for disease progression 55 months after surgery and chemotherapy with Gemcitabine. Conclusion: The status of microadenocarcinoma as an independent tumor entity is still a matter of controversy. It is important to recognize this rare variant of pancreatic carcinoma in order to avoid misdiagnosis with other primary and metastatic neuroendocrine neoplasms. Immunohistochemical studies are useful in such cases for differential diagnosis.

PI-101 Abstract id: 279. PI-99 Abstract id: 272.

Enulcleation of three branch duct IPMN cysts in ily history of pancreatic cancer

a

patient with

a

fam-

Elena Rangelova, Ralf Segersvàrd, lohn Blomberg, Christoph Ansorge, Marco Del Chioro.

Postoperative pancreatic fistula after pancreaticoduodenectomy pancreaticogastrostomy - Initial experience

with

Nemanja Zaic, llija Pejovic, Nemanja Bidzic, Vladimir Djordjevic, Nikola Crubor, Djordje Knezevic, Zoron Raznatovic, Mirko lGrkez.

Clinic for digestive surgery Clinical center of Serbia, Serbia

I(arolinska Universi§ Hospital, Sweden

Introduction: IPMN might be a phenotypic expression of familial pancreatic cancer. However, no data are available in literature regarding

the natural history of IPMN in high-risk individuals and no treatment consensus exists.

Aims: Description of a clinical case. Patients & methods: A 75 year-old woman, treated 25 years earlier for rectal cancer, was recruited to a screening program for surveillance of patients at risk for pancreas cancer at l(arolinska University Hospital due to family history.

Introduction: Despite advances in pancreatic surgery, postoperative pancreatic fistula remains the most important postoperative complication after cephalic pancreaticoduodenectomy. Pancreaticogastrostomy (PG) is an alternative method to pancreaticojejunostomy(PJ) that has been reported to be safer in terms of preventing posloperative fistula formation Aims: We present our initial experiences with pancreaticogastrostomy after pancreaticoduodenectomy in terms of preventing postoperative pancreatic fistula. Patients & methods: A total of 20 patients underwent pancreaticoduodenectomy

for

carcinoma

of the

head

of the

pancreas,