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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinical features and changes of the pancreatic duct system in nine patients with mucin-producing tumor of the pancreas were serially studied to clarify the natural history and evolution of pancreatograms. The observation periods ranged from 6 to 50 months (mean, 30 months), and all patients were examined by endoscopic retrograde pancreatography two or more times. Four of the nine cases exhibited obvious progression of pancreatic duct dilation in association with increased amounts of mucin in the dilated duct, whereas five did not show apparent progression of ductal changes. Changes in the pancreatograms of mucin-producing tumor occurred when mucin secretion by the tumor became prominent, and such cases frequently presented with abdominal pain and pancreatitis. In contrast, most of the branch duct type remained unchanged; all three cases of main duct type showed progression of pancreatograms. There was no apparent relationship between degree and progression of ductal changes and the tumor malignancy.
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PMID:Mucin-producing tumor of the pancreas: natural history and serial pancreatogram changes. 838 81

We present the autopsy case of an 82-year-old Japanese woman with a mucin-producing adenoma accompanied by pancreas divisum and a hepatic hilar carcinoma. She had suffered from a cholangiocellular carcinoma at the hepatic hilus for 2 months, which was treated with radiation and chemotherapy. She did not complain of any abdominal pain. Obstructive jaundice deteriorated despite percutaneous transhepatic bile duct drainage, and she died of hepatic insufficiency. At autopsy, a hepatic tumor was confirmed to have caused severe obstructive jaundice. Histological examinations showed moderately to poorly differentiated cholangiocellular adenocarcinoma with squamous metaplasia, probably due to radiation. A yellowish mucinous tumor was found in the head of the pancreas near the minor papilla. It consisted of multiple rice-sized cystic lesions with thin septa. Although it had no capsule, its margin was clear. Neither a wide opening of the major or minor papilla nor mucous drainage was observed. Gross examinations revealed unfused pancreatic ducts. The slightly dilatated dorsal duct and a branch of the mildly dilatated ventral duct showed tumor involvement. Histological examinations showed mild atypia of the epithelia, and this pancreatic tumor was diagnosed as branch duct-type mucin-producing adenoma with postradiation dysplasia. The combination of a mucin-producing tumor and pancreas divisum is rare, and this is only the third reported case.
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PMID:Mucin-producing adenoma associated with pancreas divisum and hepatic hilar carcinoma: an autopsy case. 872 42

Mucus-secreting pancreatic lesions, most commonly described by the Japanese, are often malignant (as in cystic or mucin-producing adenocarcinomas), but can be benign (hyperplastic or adenomatous cytology). We report a case of total pancreatic ductal enlargement without a localized lesion in which abdominal pain was relieved by endoscopic sphincterotomy and partial septotomy in which cytology remains benign. In the absence of pancreatic cyst, mass, or localized ductal abnormality, total pancreatectomy is the only treatment that can completely remove the risk of malignant degeneration of apparently benign, mucus-secreting pancreatic ductal enlargement. Disability after total pancreatectomy is severe, but the risk of metastasis from mucinous ductal ectasia is low without pancreatic cyst or mass. Therefore, regular observation of mucus-secreting ductal enlargement with computerized tomography and pancreatography are appropriate, especially in older patients. Endoscopic sphincterotomy may relieve symptoms and allow access for ampullary biopsy and brushings.
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PMID:Spectrum of mucus-secreting pancreatic neoplasia. 899 58

We report a case of a mucin-producing tumor of the pancreas, a rare neoplasm of which only a few cases have been described in Europe. The finding of progressive hyperamylasemia without abdominal pain suggests the presence of this type of tumor. At endoscopic retrograde cholangio-pancreatography (ERCP), mucinous excretion and ductal dilation were found. Its prognosis is better than adenocarcinoma.
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PMID:[Mucin-hypersecretory pancreatic tumors: a pathology with defined characteristics]. 944 46

A 38-year-old female with systemic lupus erythematosus presented with abdominal pain, diarrhea and iron-deficient anemia. Computed tomogram showed a 2 x 4 cm inhomogeneous lesion of the right adnexa. An unusual mass was identified extending from the appendiceal orifice at colonoscopy, and an 8 cm tubular appendix, apparently prolapsed into the cecum, was identified at celiotomy. An appendectomy with cecectomy was performed. On cut section, mucin was extruded from the lumen of the appendix. A mucinous neoplasm of the appendix with mucinous dissection to the serosal surface was reported at the time of frozen section. No gross ovarian pathology or peritoneal implants were noted. Cystadenoma with associated mucocele formation was verified by permanent histology. Mucocele of the vermiform appendix is a rare condition associated with neoplastic transformation in approximately 75% of all cases. Benign mucinous cystadenoma of the appendix should be differentiated from cystadenocarcinoma by frozen section at the time of celiotomy to ensure appropriate treatment. While systemic lupus erythematosus can lead to cutaneous mucinosis, an association with mucinous cystadenoma of the appendix has not been previously reported. Surveillance for metachronous colonic neoplasms is warranted in patients diagnosed with a mucinous neoplasm of the appendix.
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PMID:Mucinous cystadenoma of the appendix in a patient with systemic lupus erythematosus. 992 68

Most of the successful serological markers used in pancreatic cancer diagnosis detect circulating mucins which are back-secreted into the blood circulation. These markers have sensitivities (70-95%) and specificities (70-95%) which compare well with those achieved by imaging tests yet they have been subjected to very critical review and are still not widely used. There seem to be two main reasons for this: firstly, they are biochemical tests and clinicians tend to expect and demand 100% accuracy for such tests: secondly, the failure of serological tests to prove adequate for screening seems to have deterred clinicians from using them in more appropriate situations. It should have been realised that screening of asymptomatic cases was never going to be achievable until methods could be found for defining a high risk population. With a prevalence of about 10 per 100,000, say 20 per 100,000 adults, a test with 99% specificity (far in excess of that achievable by any current imaging or biochemical tests) would produce 1,000 false positive results for every 20 true positives, a hopelessly unacceptable ratio. In symptomatic patients the odds are very different. The prevalence of pancreatic cancer may be as high as about 15% in patients over 40 years old who have unexplained upper abdominal pain or weight loss and in whom upper G-I endoscopy is negative. In these patients serological tests (with a false positive rate of about 15%) will fare at least as well as imaging tests. Combination of the two modalities i.e. an imaging test such as ultrasound or CT scanning together with a biochemical test such as CA19.9, DuPan2 or CAM17.1 seems both logical and highly practical and has been shown to enhance diagnostic accuracy. The best established pancreatic tumour marker assays all detect mucins. Pancreatic cancers have a particular propensity to secrete mucin into the blood either because of mechanical blockage of the pancreatic duct, loss of polarity of pancreatic cells or early blood vessel invasion. Other mucin secreting cancers e.g. colon and ovary can also cause increased concentrations of the same serological markers albeit less frequently but this is not usually a major cause of confusion since the clinical features are usually distinguishable. Serological markers correlate with tumour staging but are nevertheless still effective in resectable cancer. They may also have a useful role in monitoring after surgical resection or chemotherapy. A serological mucin assay such as CA19.9, CAM17.1, DuPan2 or SPan-1 should be used in conjunction with a scanning test in the diagnosis of patients over 40 with endoscopy-negative abdominal pain, in the investigation of patients with a known pancreatic mass or cyst, and for monitoring following resection or chemotherapy for pancreatic cancer.
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PMID:Usefulness of novel tumour markers. 1043 1

Intrahepatic cholangiocarcinomas that secrete macroscopically excessive mucin into the biliary system are rare, and few of the previously reported cases have achieved a curative resection. We defined these tumors as "mucin-producing intrahepatic cholangiocarcinomas" and clarify the optimal preoperative and surgical management for them. Eleven patients with mucin-producing intrahepatic cholangiocarcinomas underwent surgical resection in our department. The clinical, radiologic, surgical, and pathologic findings were studied. The clinical presentation of the 11 patients included repeated abdominal pain, jaundice, and fever. Conventional cholangiographies, such as percutaneous transhepatic cholangiography or endoscopic retrograde cholangiography, could not offer precise information about tumor location and extension because of abundant mucin in the biliary system. Using percutaneous transhepatic biliary drainage (PTBD) and percutaneous transhepatic cholangioscopy (PTCS), we were able to drain the mucin and determine precisely the cancer extension into intrahepatic segmental bile ducts. Based on these findings, various types of liver resection with or without extrahepatic bile duct resection were planned, and 10 patients obtained curative resection. The cumulative 5-year survival rate after curative resection was 78%. In patients with mucin-producing intrahepatic cholangiocarcinoma, PTBD and PTCS are important for evaluating the cancer extension. Rational surgery based on accurate preoperative diagnosis improved the prognosis of patients with this disease.
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PMID:Treatment strategy for mucin-producing intrahepatic cholangiocarcinoma: value of percutaneous transhepatic biliary drainage and cholangioscopy. 1051 44

The ciliated hepatic foregut cyst is an unusual solitary cystic lesion of the liver. In a series of 7 cases of hepatic ciliated cysts, we performed a histological, histochemical, and immunohistochemical study to better define the histogenesis of this rare entity. The patients were 4 women and 3 men, aged 39 to 75 years. Four patients presented with abdominal pain. In 3 cases the cyst was discovered incidentally on ultrasonography. The cysts measured from 1 to 4 cm in diameter. Microscopically, the lining of the columnar epithelium was composed of ciliated cells and mucin secreting goblet cells. The wall was composed of bands of smooth-muscle fibers surrounded by an outer fibrous capsule. The goblet cells stained with PAS, alcian blue, and high-iron diamine. The immunohistochemical study showed that endocrine cells were present within the cyst epithelium, positive for chromogranin, synaptophysin, bombesin, and calcitonin, and negative for serotonin, somatostatin, glucagon, insulin, gastrin, and pancreatic polypeptide. In all the cases, immunoreactivity of some cells for CC10 strongly suggested the presence of Clara cells. Our study shows that the epithelium lining ciliated hepatic foregut cysts has histological, histochemical, and immunohistochemical features similar to those observed in the bronchiolar epithelium. This lesion is a developmental ventral foregut abnormality that could arise from a bronchiolar bud of the tracheobronchial diverticulum.
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PMID:The ciliated hepatic foregut cyst, an unusual bronchiolar foregut malformation: a histological, histochemical, and immunohistochemical study of 7 cases. 1068 41

Despite being relatively common in the rectum, foamy histiocytes have received scant attention as to the antecedent lesion that causes them to form or their histologic characterization on the types of muco-substances they accumulate. One-hundred consecutive tissue sections of the rectum from an equal number of patients were reviewed for the presence of foamy histiocytes, evaluated for their associated histologic features, and examined histochemically for five types of mucin. Immunohistochemical and electron microscopic studies were performed. Forty (40%) of the rectal biopsy tissues contained foamy histiocytes. Patients presented with diarrhea, hematochezia, intestinal habit change, constipation, hemorrhoids, and abdominal pain. Endoscopically, 19 patients were thought to have rectal nodules or polyps. Histologically, 25 of the patients had regenerative changes in the adjacent mucosa and 14 had hyperplastic changes. In 36 patients (90%), the foamy histiocytes were located superficially in the lamina propria. Associated changes indicated that they are found in areas that are subject to an injury that is in a healing phase. These changes included mild fibrosis and chronic inflammation of lamina propria with mild architectural distortion. Thirty-five (88%) cases showed staining for D-PAS, Alcian blue stain pH 2.5, and the cocktail Alcian blue stain/PAS. Mucicarmine was positive in 25 (63%) cases. The Alcian blue stain pH 1.0 was positive in 19 (59%) of 32 cases. Ultrastructural studies showed electron-dense globules. Two cases were histologically identical to the other 38 but they did not stain for any mucin. Ultrastructural features disclosed clear vacuoles and thus represent a xanthelasma of the rectum. The foamy cells in all cases were confirmed to be histiocytes by immunohistochemistry and electron microscopy. Although muciphages and xanthelasma of the rectum may mimic polyps endoscopically, they are not related to any specific symptom or clinical finding, despite the fact that they probably represent remnants of a previous injury. Muciphages contain neutral, weakly acidic or strongly acidic mucin. The main type of acidic mucin is sialomucin with a smaller component of sulfated mucin.
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PMID:Histochemical and immunohistochemical characterization of foamy histiocytes (muciphages and xanthelasma) of the rectum. 1089 24

To review a population-controlled single institution experience with intraductal papillary mucinous tumors (IPMTs) of the pancreas treated in the United States and generate an incidence of this recently described disease process.First decribed in 1982, mucin-secreting pancreatic cancer constituted a newly recognized category of pancreatic exocrine tumors distinct from mucinous cystic neoplasms. Since that time, several small series of IPMTs of the pancreas have been reported. Most studies come from Asia and Europe, with limited data from American institutions and no description of the incidence.The authors retrospectively reviewed all patients who underwent pancreatic resections at Madigan Army Medical Center from October 1992 through November 1999. Cases suggestive of IPMTs underwent re-examination by a staff pathologist. Clinical presentation, imaging studies, treatment, histopathology, and outcomes were reviewed for those with IPMTs. The data base of all patients eligible for care was evaluated to obtain a population denominator and determine an incidence for this neoplasm.Over 7 years, 78 patients underwent pancreatic resections. Forty-two had pancreatic neoplasms and, of those, 8 (19%) had IPMTs. The mean age was 67 years, with equal numbers of males and females. All patients were symptomatic (abdominal pain, 75%; jaundice, 25%; weight loss, 25%). Abnormal computed tomography scans were noted in 7/8 (88%) cases. Mucin was visualized during endoscopic retrograde cholangiopancreatography in 5/7 (71%) patients. Preoperative diagnosis of IPMT was made in 5 (62%) cases. The locations of the tumors were head (63%), tail (12%), head and body (12%), and body and tail (12%). All lesions were resectable, and procedures included 5 pancreatoduodenectomies, 2 distal pancreatectomies, and 1 total pancreatectomy. Main duct tumors were noted in 63%, whereas the remainder had both main and branch duct lesions. Tumor invasion was discovered in 2 (25%) cases. Mean follow-up was 29 months. Those without invasion were all alive (follow-up, 6 to 86 months). One patient with tumor invasion died 4 months after surgery and the other was living 20 months later. The incidence of IPMTs was 1 case/281,000 patients/year.The incidence of IPMTs of the pancreas may be higher than previously recognized. Aggressive resection is warranted based on the favorable prognosis of patients without tumor invasion.
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PMID:The incidence of intraductal papillary mucinous tumors of the pancreas(1). 1112 Mar 7


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