Solid Pseudopapillary Tumor of the Pancreas - Rare Neoplastic Disease in 20-Year-Old Woman.

INTRODUCTION: Benign cystic tumors represent only 2% of all pancreatic tumors (pancreatic cancer - PC). In contrast to malignant cystic tumors, these tumors occur typically in young women. A solid pseudopapillary tumor is a relatively rare affliction representing less than 4% of cystic PC. Although the tumor is considered benign, metastasis, especially to the spleen, has been reported in approximately 0.5-4% patients. Despite R0 resection, vascular and perineural invasion is monitored in 20% of cases. Invasion is the cause of tumor relapse in up to one third of affected patients. Characteristic features of the disease are latent clinical indicators such as signs of pain and malfunction of intestinal passage. The diagnostics is based on MR, sometimes in combination with positron emission tomography. Medical treatment is specifically surgical. CASE HISTORY: Authors present a case of a 20-year-old female patient who was examined due to pain in the epigastrium, further exasperated by a voluminous expansion of the abdominal cavity. An initial ultra-sonographic examination was conducted to examine for possible nodular focal nodular hyperplasia of the liver; however, an MRI scan revealed the likelihood of a malignant tumor in the subhepatic region. During laparotomy, a tumor protruding from the head of the pancreas was discovered and removed. Histological examination showed it was a solid pseudopapillary pancreatic tumor. After a month of good post-operative progress, the patient was re-operated because of the presence of pancreatic fistula. Complete healing of the fistula was achieved after total parenteral nutrition and administration of sandostatin. At her last examination, the patient was without any problems. CONCLUSION: Solid pseudopapillary pancreatic tumors are rare, mainly benign lesions. It is essential to consider them in the differential diagnostics of afflictions of the subhepatic region, especially in young women. The only generally accepted cure nowadays is surgical resection. It is necessary to monitor patients consistently considering the rather high frequency of relapse of disease despite R0 resections. In the case of surgical removal, the 5-year survival rate is near 97%. Key words: solid pseudopapillary tumor of pancreas - diagnostics - therapy The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 17. 4. 2018 Accepted: 13. 8. 2018.

New clinical scoring system for prognosis of early recurrence of colorectal liver metastases after surgical treatment.

BACKGROUND/AIMS: To determine the relationship between the mRNA expression of MMP-2, MMP-9, TIMP-1, TIMP-2 and CEA in tumour tissue and preoperative serum levels of these tumour markers in patients with colorectal liver metastases (CLM). Additionally, to establish a new scoring system based upon these results in combination with the volume of the metastatic process to identify patients with a high risk of early recurrence of CLM. METHODOLOGY: The correlation between the mRNA expression of CEA, TIMP-1, TIMP-2, MMP-2 and MMP-9 in tissue samples and preoperative serum levels of the named tumour markers was performed on 27 patients. The scoring system was proposed as a combination of all the independent parameters (mRNA expression of TIMP-1, MMP-9 and CEA in tumour tissue samples and preoperative serum levels of CEA and TIMP-1) in combination with the volume of the metastatic process. The evaluation was conducted in relation to the disease free interval (DFI). RESULTS: We observed a statistically significant relationship between the volume of liver metastases and DFI (p<0.0337). The scoring system divided the patients into groups with a tendency of early recurrence (p<0.0126). CONCLUSIONS: The high stages in our scoring systems augment the risk of recurrence. The proposed scoring system was shown to be an efficient instrument helpful in complex surgical and oncological access to patients after radical surgical treatment of CLM.

Portal and mesenteric vein thromboses in a patient with prothrombin G20210 mutation, elevated lipoprotein (a), and high factor VIII.

A 65-year-old man was examined for abdominal pain. Portal and mesenteric vein thromboses were described by ultrasound and computed tomography. No local cause was found. The patient had a positive history of venous thromboembolism. Thrombophilia workup revealed prothrombin G20210A mutation (heterozygous), C677T mutation of methylenetetrahydrofolate reductase gene (homozygous), elevated level of lipoprotein (a), and high level of coagulation factor VIII. Anticoagulation was started and planned for a long-term duration. The etiology of portal vein thrombosis is often multifactorial, with various combinations of systemic factors (inherited or acquired prothrombotic conditions) and local precipitating factors (inflammation, injury to the portal venous system, cancer of the abdominal organs, cirrhosis). The reported prevalence of hypercoagulable states in patients with portal vein thrombosis has been very heterogeneous so far. Some authors support a role of the prothrombin G20210A mutation. In the reported patient, this mutation was revealed in a combination with other hypercoagulable states.