[A case of peritoneal dissemination from mucinous carcinoma of the duodenum, which was associated with tumor thrombosis in the accessory pancreatic duct and successfully treated by chemotherapy].

A 72-year-old woman was admitted with an abdominal tumor, which had been detected by computed tomography scanning. Endoscopic examination of the upper gastrointestinal tract revealed a type 3 tumor in the descending limb of the duodenum. A diagnosis of adenocarcinoma was made on the basis of the histological analysis of the biopsy sample. Pancreatoduodenectomy was performed, and peritoneal dissemination was confirmed at surgery. The pathological findings indicated primary duodenal cancer (mucinous carcinoma) associated with tumor thrombosis in the accessory pancreatic duct. Postoperative chemotherapy was performed. Carcinomatous peritonitis was controlled and the patient showed long-term survival.

Role of osteopontin in calcification in autoimmune pancreatitis.

OBJECTIVES: The aim of the present study was to determine the potential for pancreatic calcification in autoimmune pancreatitis by investigating osteopontin and CD44 expression. METHODS: Human pancreatic tissues in normal pancreas, chronic pancreatitis, and autoimmune pancreatitis were obtained from the surgical specimens of 42 patients. Pancreatic tissues from male Wistar Bonn/Kobori rats were also used as an animal autoimmune pancreatitis model. RESULTS: The incidences of osteopontin expression in centroacinar cells in chronic pancreatitis with calcification and in autoimmune pancreatitis were significantly greater than that in normal pancreas (P < 0.05). Some cases of chronic pancreatitis and autoimmune pancreatitis expressed CD44 in centroacinar cells and ductal cells. In male Wistar Bonn/Kobori rats, the inflammatory area and percentage of osteopontin-CD44-positive cells increased with advancing age (P < 0.01 or 0.05). CONCLUSIONS: These results suggest that autoimmune pancreatitis has the potential for pancreatic calcification over a long-term clinical course.

[Case of duodenal stenosis due to hematoma after rupture of the inferior pancreaticoduodenal artery aneurysm treated by coil embolization].

A 59-year-old woman was admitted because of vomiting, CT examinations it was determined that the cause of vomiting was duodenal stenosis due to hematoma after rupture of the inferior pancreaticoduodenal artery aneurysm. In addition, it was believed that the aneurysm had been caused by obstruction of the celiac artery. The aneurysm of the inferior pancreaticoduodenal artery was detected by angiography, and embolization was performed using coils. The embolization was successful. Since then the duodenal stenosis improved and the vomiting symptoms disappeared. We reviewed 28 cases of duodenal stenosis due to rupture of the pancreaticoduodenal artery aneurysm in the Japanese literature.

Liver atrophy and portal stenosis in two cases of sclerosing cholangitis associated with autoimmune pancreatitis.

Sclerosing cholangitis with autoimmune pancreatitis (SC with AIP) takes a better clinical course than primary sclerosing cholangitis due to the effectiveness of steroid therapy. However, the morphological and functional changes in SC with AIP during long-term observation have not yet been reported. We encountered two cases of SC with AIP that resulted in liver atrophy and portal obstruction during long-term observation. One case was followed up without steroid therapy. The other case was treated with endoscopic biliary drainage initially. These cases may provide further information regarding steroid therapy for SC with AIP.

Usefulness of transpapillary bile duct brushing cytology and forceps biopsy for improved diagnosis in patients with biliary strictures.

BACKGROUND AND AIM: Transpapillary bile duct brushing cytology and/or forceps biopsy was performed in the presence of an indwelling guidewire in patients with biliary stricture, and the treatment time, overall diagnosis rate, diagnosis rate of each disease, complications, and influences on subsequent biliary drainage were investigated. METHODS: After endoscopic retrograde cholangiography, brushing cytology was performed, followed by forceps biopsy. In patients with obstructive jaundice, endoscopic biliary drainage (EBD) was subsequently performed. To investigate the influences of bile duct brushing cytology and forceps biopsy on EBD, patients who underwent subsequent EBD by plastic stent were compared with patients who underwent EBD alone. RESULTS: The samples for cytology were collected successfully in all cases, and the sensitivity for malignancy/benignity, specificity, and accuracy were 71.6%, 100%, and 75.0%, respectively. The biopsy sampling was successful in 51 patients, and samples applicable to the evaluation were collected in all 51 patients. The sensitivity for malignancy/benignity, specificity, and accuracy were 65.2%, 100%, and 68.6%, respectively. Combination of the two procedures increased the sensitivity and accuracy to 73.5% and 76.6%, respectively. The time required for cytology and biopsy was 11.7 min, which is relatively short. Cytology and biopsy did not affect drainage. Regarding accidents, bile duct perforation occurred during biopsy in one patient (1.9%), but was rapidly improved by endoscopic biliary drainage. CONCLUSIONS: Transpapillary brushing cytology and forceps biopsy could be performed in a short time. The diagnosis rate was high, and the incidence of complication was low, having no influence on subsequent biliary drainage.