RESUMEN
UNLABELLED: Pancreatic carcinoid tumours are extremely infrequent. Usually, the biological behaviour is indolent and diagnosis is late and often casual. We present the case of a patient initially diagnosed as having liver metastasis of unknown origin. PET identified a primary pancreatic site and the initial histologic diagnosis was adenocarcinoma. Following an uncertain response to chemo- and radio-therapy the repeat histologic assessment indicated a carcinoid tumour of the pancreas. After complete surgical resection and liver transplantation, patient remains free of disease. CONCLUSIONS: The co-existence of several diseases with similar morpho-structural features makes diagnosis complicated. PET is of uncertain use in the evaluation of carcinoid tumours, and is considered inferior to 111Indium-octreotide scan. The only curative treatment is surgical resection, with liver transplantation as a valid option in the treatment of these tumours.
Asunto(s)
Tumor Carcinoide/diagnóstico , Errores Diagnósticos , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Tumor Carcinoide/diagnóstico por imagen , Tumor Carcinoide/tratamiento farmacológico , Tumor Carcinoide/radioterapia , Tumor Carcinoide/secundario , Tumor Carcinoide/cirugía , Cisplatino/administración & dosificación , Terapia Combinada , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , Masculino , Pancreatectomía , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/cirugía , Tomografía de Emisión de Positrones , Inducción de Remisión , GemcitabinaRESUMEN
In 10%-15% of patients, myasthenia gravis is associated with thymoma. Because of its site, this tumour can have an un-noticed clinical history over a considerable time and be diagnosed when adjacent structures such as mediastinal vessels, heart or trachea become infiltrated. We present a patient with thymoma and infiltration of the superior vena cava, and which represents an incipient vena cava syndrome. The surgical treatment consisted of complete resection of the tumour including partial replacement of the vena cava with a pericardial patch. The surgery was complemented with radiotherapy.