Adenoma in Ectopic Pancreas: A Case Report

Introduction: The presence of pancreatic tissue that lacks anatomical or vascular communication with the pancreatic organ has a frequency in autopsy studies that ranges between 0.5% and 13.7%. It is most commonly found in the stomach, specifically in the antrum. Treatment is not clearly established. Surgical resection is recommended in symptomatic patients whose only cause of symptoms is ectopic pancreatic tissue or cancerous formations. Objective: Report a case of ectopic pancreatic adenoma given its low incidence. Case Report: This study reports the case of a 45-year-old male with a history of clinical diagnosis of gastroesophageal reflux disease and a Nissen fundoplication. He presented poor evolution 6 months after the surgery. An endoscopy which revealed postpyloric “polyp” at the level of the duodenal bulb and an inconclusive histopathological study of the same were performed. Reassessment with CT showed a tumor in the first portion of the duodenum measured at 2.2cm, without adenopathies, and a normal-appearing pancreas. It has been made a subtotal gastrectomy and Roux “Y” reconstruction, without complications, with good postoperative evolution, discharged at home on the sixth day. With hematoxylin and eosin technique, the histopathology report reported bile duct adenoma originating in ectopic pancreatic tissue, positive immunohistochemistry for cytokeratin 7 (IHC-7), predominantly expressed by ductal epithelial cells of the pancreatobiliary tract. The patient after surgery had a good clinical evolution and disappearance of symptoms. Conclusion: The clinical cases of rare pathologies are presented to increase the world bibliography and to be able to compare the diagnosis and treatment. In this case, a heterotopic pancreatic adenoma was presented, which is a diagnostic challenge.

Hypoglycemic Syndrome in a Patient with Proinsulin-Only Secreting Pancreatic Adenoma (Proinsulinoma)

We describe an unusual case of hypoglycemic syndrome in a 69-year old woman with a proinsulin-only secreting pancreatic endocrine adenoma. The clinical history was highly suggestive of an organic hypoglycemia, with normal or relatively low insulin concentrations and elevated proinsulin levels. Magnetic resonance and computed tomography of the abdomen showed a 1 cm pancreatic nodule and multiple accessory spleens. The diagnosis was confirmed by selective angiography, showing location and vascularization of the nodule, despite no response to intra-arterial calcium. After resection, the hypoglycemic syndrome resolved. The surgical specimen was comprised of a neuroendocrine adenomatous tissue with high proinsulin immunoreactivity. Study of this unusual case of proinsulinoma underlines (i) the need to assay proinsulin in patients with hypoglycemia and normal immunoreactive insulin, (ii) the differential diagnosis in the presence of accessory spleens, (iii) the unresponsiveness to intra-arterial calcium stimulation, and (iv) the extensive evaluation needed to reach a final diagnosis.

Exocrine Pancreatic Neoplasia in the Cat: A Case Series

Eight cases of feline pancreatic adenocarcinoma and two cases of pancreatic adenoma were reviewed. The adenomas were incidental findings. Most cats with adenocarcinomas had anorexia (75%) and vomiting (63%), while 38% had abdominal pain, a palpable abdominal mass, and/or jaundice. Diagnostic abnormalities included leukocytosis, hyperglycemia, increased alanine aminotransferase activity, poor serosal detail on abdominal radiography, and an abdominal mass effect on ultrasonography. The majority of cats with carcinomas had metastases (mostly to liver, lung, and small intestine), and all were euthanized or died within 7 days of diagnosis. Clinically, feline pancreatic carcinoma may be difficult to distinguish from feline pancreatitis.