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

A 62-year-old man had complained of left abdominal pain and tenderness and a body weight loss. Abdominal ultrasonography and computed tomography revealed homogeneous tumor with clear margin, and an irregular shape (3.5 x 2.0 cm) in the body of the pancreas. Endoscopic retrograde cholangiopancreatography showed a shadow defect in the main pancreatic duct adjacent to the tumor, which suggested intraductal tumor spread. Distal pancreatectomy with splenectomy and left paraaortic lymph node dissection was performed. Microscopically, the tumor showed microtubular carcinoma, which was characterized by a cribriform pattern, medullary growth, and little interstitium. The tumor was encapsulated by a relatively thick fibrous capsule. The patient was discharged uneventfully, and he is alive 33 months after operation without a distinct sign of recurrence. In conclusion, cribriform carcinoma of the pancreas has specific characteristics, such as good prognosis, expansive growth with little invasion, intraductal growth and spread without mucin production and histological marked cribriform pattern. This type of carcinoma should be classified as a new disease entity of carcinoma of the pancreas.
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PMID:A case report of cribriform carcinoma of the pancreas with long time survival. 1126 83

Intraductal papillary-mucinous carcinoma of the pancreas has been reported with increasing frequency. We report a case with intraductal papillary-mucinous carcinoma of the pancreas and discuss surgical treatment and current imaging modalities. A case with intraductal papillary-mucinous carcinoma was analyzed by radiological findings and clinical course. A 47-year-old man developed abdominal pain and nausea. Computed tomography showed a diffusely dilated main pancreatic duct. Duodenoscopy showed a patulous orifice of the pancreas with massive mucus secretion, but the pancreatic juice was not positive for malignant cells. Endoscopic retrograde cholangiopancreatography revealed a markedly dilated pancreatic duct extending from the body to the tail of the pancreas. Distal pancreatectomy was performed with splenectomy and lymph nodes dissection. Histopathological diagnosis was intraductal papillary-mucinous carcinoma. Endoscopic retrograde cholangiopancreatography is useful for diagnosing intraductal papillary mucin-producing tumors. To avoid unnecessary total pancreatectomy and preserve pancreatic function, intraoperative frozen section examination is widely available for the surgical treatment of intraductal papillary mucin-producing tumors.
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PMID:A case of intraductal papillary-mucinous carcinoma of the pancreas with the onset of acute pancreatitis. 1206 2

We present a case of invasive carcinoma of the pancreas derived from intraductal papillary adenocarcinoma without mucin hypersecretion in a 65-year-old man with a 45-year history of alcohol abuse and a 2-year follow-up of chronic pancreatitis. Two years previously, in May 1998, he was admitted for investigation of abdominal pain. Computed tomography (CT) showed diffuse dilation of the main pancreatic duct with atrophy of the pancreatic parenchyma. Endoscopic retrograde pancreatography (ERP) showed a diffusely dilated main pancreatic duct with irregular side branches in the head of the pancreas. Chronic alcoholic pancreatitis was diagnosed on the basis of the pancreatography findings. The patient was readmitted for investigation of progressive weight loss in August 2000. Serum CA19-9 levels were markedly elevated (750 U/ml) and CT showed enlargement of the head and body of the pancreas. ERP showed irregularity of the main pancreatic duct in the head of the pancreas, and the distal main pancreatic duct (which was dilated on initial ERP examination) was interrupted in the body of the pancreas. Suspected pancreatic carcinoma was diagnosed, and pylorus-preserving pancreatoduodenectomy was performed. Frozen section examination of the cut end of the pancreas revealed ductal carcinoma, and total pancreatoduodenectomy with portal vein resection was performed. Histologically, the resected tumor was diagnosed as an invasive carcinoma derived from intraductal papillary adenocarcinoma without mucin hypersecretion. We recommend observing changes in the pancreatic duct on pancreatography to diagnose invasive carcinoma of the pancreas derived from intraductal papillary adenocarcinoma in a resectable state.
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PMID:Invasive carcinoma of the pancreas derived from intraductal papillary adenocarcinoma without mucin hypersecretion but with changes in the pancreatic duct on pancreatography. 1254 Oct 53

A 54 year old man presented with a six month history of abdominal pain. A computerised tomography scan showed a well defined intra-abdominal unilocular mass with a calcified wall just superior to the bladder. At laparotomy, pseudomyxoma peritonei was discovered, together with a midline abdominal mass adherent to the anterior abdominal wall originating from the fundus of the bladder. The specimen consisted of a cystic mass measuring 14 x 9.5 x 7 cm overall, which contained mucoid material. Histological examination revealed that the cyst was lined by mucinous epithelium, which in areas varied from having bland morphology to showing pronounced nuclear and architectural atypia. There was abundant extracellular mucin. The specimen was extensively sampled but there was no evidence of invasion. This tumour has many unusual features, namely: the absence of destructive invasion, association with pseudomyxoma peritonei, areas of dysplasia and cystadenoma, and stromal osseous metaplasia within the wall.
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PMID:Urachal adenocarcinoma in situ with pseudomyxoma peritonei: a case report. 1256 Mar 99

Mucinous cystadenomas usually occur in the appendix, ovaries and pancreas. This is the first report to describe mucinous cystadenoma of the ascending colon. A 32-year-old female presented with abdominal pain. Radiographic studies demonstrated a space-occupying lesion in the ascending colon associated with intussusception. Right colectomy revealed a cystic mass within the ascending colon that contained thick mucin and was lined by mucin-producing columnar epithelium. Clinical and pathologic features with a brief review of the literature are presented.
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PMID:Mucinous cystadenoma of the ascending colon: a novel presentation. 1468 26

Three cases of a distinctive intraductal tubular adenoma, pyloric type, of the main pancreatic duct are reported. The patients, two women and a man, whose ages ranged from 63 to 70 years, complained of abdominal pain attributed to chronic pancreatitis in two patients. The patient with the largest tumor also had symptoms of gastric outlet obstruction. The tumors, two of which arose in the head and one in the tail of the pancreas, led to occlusion and cystic dilatation of the main pancreatic duct. Two adenomas were sessile and one was attached to the wall of the pancreatic duct by a thin fibrous stalk. Microscopically, they were composed of lobules of closely packed tubular glands similar to pyloric glands. In one tumor, nearly all glands were lined by columnar mucin-secreting cells with abundant clear cytoplasm and basally oriented nuclei. In addition to pyloric glands, two adenomas contained glands lined by cells with little or no mucin as well as by pink oncocytic cells. Focal intestinal differentiation was identified in one tumor. Both intracellular and extracellular mucin was detected with the mucicarmine, periodic acid-Schiff, and alcian blue stains. All three adenomas were CK7 positive and CK20 negative. Focal carcinoembryonic antigen linear reactivity along the apical cytoplasm was seen in many cells, but few cells expressed cytoplasmic carcinoembryonic antigen. All three adenomas showed low proliferative activity as measured by the MIB-1 labeling index. The three adenomas were p53 negative and showed loss of DPC4 expression. No endocrine cells were identified in any of the tumors. All patients are alive and symptom free from 4 months to 5 years following surgical treatment.
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PMID:Intraductal tubular adenoma, pyloric type, of the pancreas: additional observations on a new type of pancreatic neoplasm. 1504 13

A 43-year-old male with a history of autosomal dominant polycystic kidney disease (ADPKD) was admitted to our center with severe abdominal pain and was diagnosed with acute pancreatitis. CT showed multiple cysts in the liver and both kidneys along with ADPKD and a cystic mass, 4 cm in diameter, in the pancreatic head. The main pancreatic duct was dilated to 1 cm in diameter. The patient was diagnosed with acute pancreatitis due to intraductal papillary mucinous tumor (IPMT), and pancreatoduodenectomy was performed. Histologic examination revealed a multiloculated cystic tumor filled with mucin in the head of the pancreas. Microscopically, the tumor was diagnosed as adenocarcinoma and was found to have invaded the main pancreatic duct. Although, in addition to our case, only seven cases with association between ADPKD and malignant neoplasms have been reported, five of these cases had neoplasms arising from the pancreas. Therefore, we suggest that some genetic interactions may exist between ADPKD and pancreatic carcinogenesis.
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PMID:Intraductal papillary mucinous tumor of the pancreas associated with autosomal dominant polycystic kidney disease. 1598 42

Intraductal papillary mucinous neoplasms of the pancreas (IPMNs) are increasingly recognized in clinical practice. They are a unique clinicopathologic entity that is characterized by mucin production, cystic dilation of the pancreatic ducts, and intraductal papillary growth. Histologically, they may demonstrate a spectrum of cellular atypia ranging from minimal mucinous hyperplasia to frank invasive carcinoma. Similar to invasive ductal adenocarcinoma of the pancreas, patients with IPMN generally present in the seventh or eighth decade of life with the head of the gland being the predominant disease site. The majority of patients are symptomatic at presentation with abdominal pain, weight loss, and diarrhea being the predominant symptoms. Traditionally, the diagnosis was made following an endoscopic retrograde cholangiopancreatography. However, a cross-sectional imaging study such as a computed tomography or magnetic resonance imaging is now the radiological imaging studies of choice. Current thinking suggests that at best IPMN represents a premalignant condition and, as such, surgical intervention should be recommended. The aim should be to resect all gross disease while attempting to achieve a negative surgical margin, which in the majority of cases can be achieved by a partial pancreatectomy. The disease seems to be somewhat indolent with resection of noninvasive disease being curative in the majority of patients with 5- and 10-year actuarial survival rates of 75% and 60% reported. However, up to 50% of cases will have invasive cancer, and for this cohort the prognosis is more guarded. The role of adjuvant therapies is unclear, and further studies are required in this area.
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PMID:Intraductal papillary mucinous tumors of the pancreas. 1600 42

A 50-year-old woman presented with intermittent diarrhea and upper abdominal pain. Laboratory data showed elevated serum amylase and elastase-I levels. Further image studies revealed a small, well-defined nodular lesion (8 mm in diameter) without mucin hypersecretion in the main pancreatic duct (MPD) of the pancreatic head and subsequent dilatation of the distal main pancreatic duct. A pylorus-preserving pancreatoduodenectomy with regional lymphadenectomy was performed. Microscopically, the tumor was an intraductal tubular carcinoma (ITC) in a tubular adenoma, suggesting direct histologic evidence of the adenoma-carcinoma sequence in intraductal tubular tumors, differing from previous reports of ITCs describing de novo-like development. The prognosis for ITC patients is sometimes dismal; therefore, early detection and appropriate surgical resection are mandatory to achieve long-term survival in ITC patients. MPD dilatation is a crucial sign and clue enabling the early detection of tiny pancreatic tumors.
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PMID:Intraductal tubular carcinoma in an adenoma of the main pancreatic duct of the pancreas head. 1693 9

CASE 1: A 64-year-old, otherwise healthy woman was referred to the surgery clinic for a presumed umbilical hernia. On physical examination, a cutaneous nodule was noted on the umbilical region and the patient was referred to the dermatology clinic. The patient was reexamined and an erythematous nodule was observed in the umbilicus measuring 2.5 cm in diameter. The patient denied pain, change in bowel habits, or weight loss. There were no other abdominal masses, no sign of ascites, and no regional lymphadenopathy. A skin biopsy from the nodule showed mucinous adenocarcinoma. Immunohistochemical staining was positive for carcinoembryonic antigen, and negative for cytokeratin (CK)7 and CK20. These results were consistent with a Sister Mary Joseph's nodule and led to the diagnosis of an occult colon carcinoma. The patient had no risk factors for colorectal carcinoma. The patient underwent surgery in another hospital, and died 3 months after the initial diagnosis of Sister Mary Joseph's nodule. CASE 2: A 73-year-old woman was referred to the dermatology clinic for evaluation of a painful, ulcerated, 3-cm lesion in the umbilicus (Figure 1). She was otherwise asymptomatic. A skin biopsy showed neoplastic glandular cells infiltrating among collagen bundles (Figure 2). Stainings for mucin and for CK7 were positive, while staining for CK20 was negative. An abdominopelvic CT scan demonstrated a 3.5-cm space-occupying lesion in the liver. Results of gastroscopy, colonoscopy, chest computed tomographic (CT) scan, and mammography were normal. Serum levels of the tumor-associated protein CA125 were elevated to 164 units, while those of CA 19-9 and carcinoembryonic antigen were within normal range. A gynecologic examination and a transvaginal ultrasound were normal. The patient had no personal or family history of any malignancy or any risk factors for developing a carcinoma. The patient was scheduled for a palliative resection of the umbilical nodule, combined with a laparoscopic inspection in search of the undetected primary tumor. She refused surgery and was lost to follow-up. She died 4 months after the initial diagnosis of umbilical metastasis. CASE 3: A 51-year-old man was aware of a silent mass in his umbilicus for 2 years without seeking medical advice. Following 2 weeks of increasing pain in this area, he was referred to the emergency room for a suspected incarcerated umbilical hernia. Surgery revealed a mass attached to the fascia and peritoneal fat. The mass was removed and diagnosed as a poorly differentiated adenocarcinoma, staining positively for carcinoembryonic antigen, and negatively for CK20, CK7, prostate-specific antigen, and prostatic acid phosphatase. Both gastroscopy and colonoscopy failed to detect the primary tumor. An abdominopelvic CT scan was normal, but a CT scan of the chest disclosed a nodule measuring 2.5 x 1.5 cm in the lower lobe of the right lung. On bronchoscopy, it was found to be an invasive adenocarcinoma, consistent with a primary tumor of the lung. The patient was a heavy smoker (45 pack-years). The patient received 4 cycles of combined chemotherapy with carboplatine and gemcitabine, with no improvement. A month later, the patient complained of abdominal pain. Following demonstration of intra-abdominal spread of disease by CT scan, a second line chemotherapy was instituted with paclitaxel. A month later the patient's condition deteriorated and he complained of cough, sweating, and pain along the right leg. A bone scan revealed bone metastases in the right femur and left tibia. Two weeks later he was admitted to the hospital with intestinal obstruction and underwent laparotomy. He had massive intra-abdominal spread of cancer and ascites. Only a palliative colostomy was performed. The patient died 3 weeks later, 9 months after the diagnosis of adenocarcinoma of the lung. The clinical data on the three patients are summarized in Table I.
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PMID:Sister Mary Joseph's nodule as a presenting sign of internal malignancy. 1695 43


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