Clear Cell Carcinoma of the Pancreas Infiltrating Duodenum: A Case Report of a Multiface Aspect of an Intriguing Entity

Background: Although Clear-cell carcinoma has been found in various organs as a variant of ductal carcinoma of the pancreas, it still hasn’t been well recognized. According to the WHO classification, primary Clear-cell carcinoma of the pancreas is rare, and it is classified as a “miscellaneous” carcinoma. To date it has been poorly characterized and only few cases have been reported in the literature [1]. Case presentation: We report here an unusual case of Clear-cell carcinoma in a 59-year-old man involving the head of the pancreas and the second part of the duodenum initially misconceived as pyloric gland adenoma, a rare duodenal entity. Nevertheless, duodenal sub stenosis was suspected of malignancy, so further investigations were made. Subsequent abdominal computed tomography (CT) detected not only a duodenal vegetation but also an alteration of the duodenal-pancreatic interface with thickening of the duodenal wall and a common bile duct dilatation. The malignant clinical aspect and behavior of the lesion, associated to the impossibility of further investigations due to the duodenal sub stenosis, led to an exploratory laparotomy.The laparotomy revealed a retracting area straddling the duodenum and the pancreatic head. A duodenum pancreatectomy of the head of the pancreas with extended lymphadenectomy was performed and the histological evaluation showed a ductal Clear-cell adenocarcinoma of the pancreas infiltrating the duodenum. The postoperative course was characterized by a pancreatic fistula grade B. At 6 months from the surgery, the patient hasn’t had recurrence.Conclusion: Because it is a rare tumor with very few cases reported previously, the incidence and prognosis are not well known for this neoplasm. The report of our case would aid in the identification of this rare neoplasm. Further studies and more case reports are needed to clarify the diagnosis and prognostic significance of the clear cell differentiation of these tumors.

Metachronous multiple primary cancer of the pancreatic head and liver: a case of hepatocellular carcinoma 10 years after pancreatoduodenal resection

The Aim. Study of a clinical case of metachronous primary multiple cancer of the head of the pancreas and liver.Materials and methods. The work was carried out with modern domestic and foreign literature sources devoted to the problem of primary multiple malignant neoplasms. A retrospective analysis of the patient’s clinical and anamnestic data was performed, the necessary medical documentation was studied.Results. In 2011, a pancreatoduodenal resection was performed on a patient for ductal adenocarcinoma of the head of the pancreas. In 2021, an MRI scan revealed a formation in S5-S6 with dimensions up to 34x35x29 mm. According to the histological examination of the biopsy material, hepatocellular carcinoma was confirmed. Resection of the 5th segment of the liver was performed in the conditions of the NMIC Oncology in Rostov-on-Don.Conclusion. The presented case of primary multiple cancer of the head of the pancreas and hepatocellular carcinoma of the liver is of direct interest both from the point of view of oncological surgery and chemotherapy.

USING NEURAL NETWORK MODELING TO PREDICT THE COURSE OF ACUTE PANCREATITIS

The database of studies of 82 patients with acute pancreatitis are presented. Using neural network analysis, the most indicative parameters for predicting acute pancreatitis were revealed: indexes of Kalf-Kalif intoxication modified by Kostyuchenko and Khomich, Reis, Garkavi, the ratio of leukocytes to ESR, leukocyte index, general intoxication index; sonographic parameters – the size of the head of the pancreas, the diameter of the splenic vein, the presence of free fluid in the abdominal cavity; biochemical parameters – blood amylase concentration, urine diastase. When conducting clustering in a multidimensional feature space, a Kohonen neural network was created. All analyzed objects were effectively divided into 3 clusters. The most severe and prognostically unfavorable is cluster 1, which included data from 30 patients, with the maximum mortality rate and maximum hospital stay.

“Stomach mass” as the first manifestation of IgG4-related disease: a case report

Background IgG4-related disease mainly manifests as organomegaly and is accompanied by tissue fibrosis (Mimori, Mod Rheumatol 29(2):213, 2019) which is frequently confused with tumour (Dawei et al., J Gastroenterol Hepatol 29(12):1375–8, 2020). There are few reports with of IgG4-related disease with the first clinical manifestation involving the stomach. Case presentation We present the case of 46-year-old male patient with a “stomach tumour” as the first manifestation of IgG4-related disease. Gastroscopy showed a mass in the stomach, however, the pathology result was chronic inflammation with IgG4 positivity. CT scans of abdomen showed that the stomach wall was thick, the head of the pancreas was swollen, and retroperitoneal fibrosis was severe.The serum IgG4 level was 75 g/L (normal range 0.03–2.01 g/L).After treatment with methylprednisolone for one month, the symptoms were greatly relieved. Conclusions To reduce the suffering of patients and relieve their financial burden, we should consider the possibility of IgG4-related disease when the initial manifestation is a stomach mass.

Isolated metastasis of uterine leiomyosarcoma to the pancreas: clinical observation

The article presents a clinical case of successful surgical treatment of a patient with isolated metastasis of uterine leiomyosarcoma to the head of the pancreas 3 years after the removal of the primary tumor. A pancreatectomy with immunohistochemical examination was performed. The patient was examined 6 months after the operation. There are no signs of a relapse of the disease.

Pancreatic Carcinosarcoma with a Rare Presentation

Introduction/Objective Carcino-sarcoma of the pancreas is a rare tumor and very limited clinical and pathologic data have been reported in the literature. As per World Health Organization (WHO) classification of tumors of the digestive system, the carcinosarcoma of the pancreas is classified together with sarcomatoid carcinoma and anaplastic giant cell carcinomas in undifferentiated carcinoma of pancreas. Carcinosarcoma is a rare entity with very poor prognosis. Methods/Case Report Here we report a rare case of pancreatic carcinosarcoma in a 68 year old male patient who underwent a pancreatoduodenectomy for unilocular cystic mass in the head of the pancreas. The mass grossly replaces the whole head of the pancreas. Histologically, the lesion showed a high-grade spindle cell component and adjacent moderately differentiated adenocarcinoma. On immunohistochemical examination, the carcinomatous component was positive for epithelial markers, and the sarcomatous component was positive for DOG1 and had a focal cytoplasmic staining for S-100. The diagnosis of pancreatic carcinosarcoma was rendered. Treatment options are same as of pancreatic carcinoma. Surgical resection is the best option available for patients. Systemic chemotherapy is indicated for patients with distant metastasis or patients with other contraindications. Despite surgery and adjuvant chemotherapy, recurrence rates are high, and prognosis is poor. However, there are no relevant standard chemotherapies available. Based on the limited number of reported cases, the prognosis of carcinosarcoma of the pancreas appears to be poor. But some cases with long term survival have been reported. There are very few primary pancreatic neoplasms with carcinomatous and sarcomatous components reported in the current literature. Results (if a Case Study enter NA) NA Conclusion This case highlights the importance of familiarity with histopathology of this rare entity, and to order proper immunohistochemical and molecular work-up when there is a suspicious abnormal spindle cell component.