RESUMO
Two patients were referred to our hospital with cystic lesion (diameter 5 cm) of the pancreas and elevated serum CEA and CA19-9. We diagnosed them with malignant cystic neoplasms of the pancreas and performed distal pancreatectomy. Histologically, in both cases the cysts were lined with flat, transitional, squamoid cells without keratinization. Immunohistochemical staining confirmed two rare cases of squamoid cyst of the pancreatic ducts.
Assuntos
Cisto Pancreático/patologia , Ductos Pancreáticos/patologia , Idoso , Antígeno CA-19-9/sangue , Antígeno Carcinoembrionário/sangue , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Pancreatectomia , Cisto Pancreático/cirurgia , Ductos Pancreáticos/cirurgia , Neoplasias Pancreáticas/sangue , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios XRESUMO
We report a rare case of a patient with metastatic colorectal cancer who experienced hyperammonemic encephalopathy induced by 5 -fluorouracil(5-FU)and was continuously treated with capecitabine plus oxaliplatin(XELOX)therapy. A 60 years man with anorexia and weight loss was diagnosed with Stage IV rectal cancer, and chemotherapy with XELOX was initiated. When the second course of XELOX therapy was administered, the patient found it difficult to take oral capecitabine. Subsequently, modified FOLFOX6 was administered. Complications such as nausea and vomiting were observed on day 2, with confusion and cognitive disturbances on day 3 . Laboratory examination revealed hyperammonemia, and therefore, branched-chain amino acid solutions were administered as treatment. The patient's symptoms disappeared entirely on day 4. He is currently receiving XELOX therapy.
Assuntos
Aminoácidos de Cadeia Ramificada/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Encefalopatias Metabólicas/etiologia , Fluoruracila/efeitos adversos , Hiperamonemia/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Retais/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Encefalopatias Metabólicas/tratamento farmacológico , Capecitabina , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Fluoruracila/administração & dosagem , Fluoruracila/análogos & derivados , Fluoruracila/uso terapêutico , Humanos , Hiperamonemia/induzido quimicamente , Neoplasias Hepáticas/secundário , Masculino , Oxaloacetatos , Neoplasias Retais/patologiaRESUMO
We report here two cases of advanced colorectal cancer which received chemotherapy, in which partial splenic embolization (PSE) had been effective for controlling splenomegaly and thrombocytopenia. Case 1: A 50-year-old man presented with bloody urine and bloody stool. Computed tomography (CT) showed rectosigmoid cancer with urinary bladder invasion. He underwent colostomy and received chemotherapy. After 3 courses of FOLFOX and 6 courses of bevacizumab/FOLFOX, he suffered from thrombocytopenia with splenomegaly, which led to discontinuation of the therapy. PSE improved thrombocyte counts and enabled him to resume therapy. Case 2: A 72-year-old man presented with bloody stool. Endoscopy and CT showed an advanced rectosigmoid cancer with multiple liver metastases. He underwent low anterior resection and received chemotherapy with FOLFOX and FOLFIRI, together with bevacizumab. After 13 courses of chemotherapy, he also suffered from splenomegaly and thrombocytopenia. PSE produced an increase in thrombocyte count and allowed for a restart of chemotherapy. Oxaliplatin-based chemotherapy may possibly produce hepatic sinusoidal dilation and induce splenomegaly owing to portal hypertension. PSE seemed to be useful for treating thrombocytopenia with splenomagaly, and allowed continuation of the chemotherapy.
Assuntos
Antineoplásicos/efeitos adversos , Compostos Organoplatínicos/efeitos adversos , Neoplasias Retais/tratamento farmacológico , Neoplasias do Colo Sigmoide/tratamento farmacológico , Esplenomegalia/terapia , Trombocitopenia/terapia , Antineoplásicos/uso terapêutico , Embolização Terapêutica , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Compostos Organoplatínicos/uso terapêutico , Oxaliplatina , Neoplasias Retais/patologia , Neoplasias do Colo Sigmoide/patologia , Esplenomegalia/induzido quimicamente , Trombocitopenia/induzido quimicamente , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/secundárioRESUMO
We report a duodenal gastrinoma in a 50-year-old man who was admitted to our hospital with tarry stools. Esophagogastroduodenoscopy revealed multiple ulcers in the duodenal bulb and a submucosal tumor in the descending duodenum. His serum gastrin level was 1400pg/ml. We suspected Zollinger-Ellison syndrome and performed selective arterial calcium injection to locate the gastrinoma. Increase in the hepatic venous gastrin level was seen only in the gastroduodenal artery area. We diagnosed a gastrinoma located in the pancreaticoduodenal area. Genetic examination showed a single-base deletion in the MEN-1 gene. At operation, the tumor was found in the submucosal layer of the descending duodenum and was extirpated. He is alive without recurrence 3 years after surgery.
Assuntos
Gluconato de Cálcio , Neoplasias Duodenais/cirurgia , Gastrinoma/cirurgia , Neoplasia Endócrina Múltipla Tipo 1/complicações , Gluconato de Cálcio/administração & dosagem , Neoplasias Duodenais/complicações , Neoplasias Duodenais/diagnóstico por imagem , Gastrinoma/complicações , Gastrinoma/diagnóstico por imagem , Humanos , Injeções Intra-Arteriais , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
A 79-year-old man was admitted on the suspicion of acute pancreatitis. Computed tomography showed acute fluid collection but not typical acute pancreatitis; it formed pseudocysts gradually around the pancreas. Endoscopic retrograde pancreatography (ERP) revealed pancreatic disruption and leakage. Endoscopic nasopancreatic drainage (ENPD) and endoscopic pancreatic stenting (EPS) resulted in collapse of pseudocysts, improvement of symptoms and laboratory data, and a mass in the pancreatic body became distinct. The specimens obtained with endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) showed pancreatic cancer. In conclusion, ENPD and EPS are effective for pancreatic leakage with disruption of the pancreatic duct, and we should take into consideration the possibility of pancreatic cancer when we see patients with pancreatic disruption.
Assuntos
Drenagem/métodos , Ductos Pancreáticos/patologia , Neoplasias Pancreáticas/patologia , Stents , Idoso , Biópsia por Agulha Fina , Endoscopia , Humanos , MasculinoRESUMO
A 40's woman was seen at the emergency room because of severe back pain and vomiting. Abdominal CT scan revealed a tumor about 7cm in diameter located on the retroperitoneum. For 6 hours after admission, her body temperature was 39°C and respiratory failure occurred. After 30 hours, the patient died because of a complication in circulatory failure. From the abnormally high level of catecholamines in the blood and autopsy results, we determined that pheochromocytoma multisystem crisis had been caused by the retroperitoneal paraganglioma.
Assuntos
Catecolaminas/metabolismo , Paraganglioma/fisiopatologia , Neoplasias Retroperitoneais/fisiopatologia , Autopsia , Feminino , Humanos , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologiaRESUMO
We report a rare case of metastatic colorectal cancer who suffered from hyperammonemic encephalopathy induced by 5- FU and was continuously treated with FOLFOX therapy. A 50-year-old man with ileus was diagnosed with ascending colon cancer Stage IV, and a right hemicolectomy was performed. Postoperative chemotherapy with modified FOLFOX6 was performed. Complications of nausea and vomiting were seen on day 2 , with confusion and cognitive disturbances on day 3 . None of the other radiographic examinations provided an explanation for his symptoms. Laboratory examination revealed hyperammonemia, so branched-chain amino acid solutions and high-volume drip infusion were started for its treatment. His symptoms entirely disappeared on day 4. We changed to chemotherapy for FOLFOX4 using branched-chain amino acid solutions and drip infusion. The tumor marker level normalized following two courses, and CT following ten courses showed that the size of the lung metastasis and abdominal lymph node had reduced significantly. The patient is currently receiving FOLFOX4.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias do Colo/tratamento farmacológico , Fluoruracila/efeitos adversos , Hiperamonemia/induzido quimicamente , Neoplasias Pulmonares/tratamento farmacológico , Aminoácidos de Cadeia Ramificada/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Terapia Combinada , Fluoruracila/uso terapêutico , Humanos , Hiperamonemia/prevenção & controle , Leucovorina/efeitos adversos , Leucovorina/uso terapêutico , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Compostos Organoplatínicos/efeitos adversos , Compostos Organoplatínicos/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
A 65-year-old man was admitted to our hospital because of obstructive jaundice caused by a mass extending in the porta hepatis, neck of gall bladder and extrahepatic bile duct. The specimens obtained with ultrasound-guided needle biopsy showed malignant lymphoma (diffuse large B-cell lymphoma: DLBCL). CHOP with Rituximab therapy (R-CHOP therapy) was performed. The treatment resulted in remarkable reduction of the tumor size and improvement of the biliary stenosis. We should take into consideration malignant lymphoma when we see a patient with a tumor of the hepato-biliary system.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias dos Ductos Biliares/tratamento farmacológico , Neoplasias Hepáticas/tratamento farmacológico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Murinos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/patologia , Biópsia por Agulha , Ciclofosfamida/administração & dosagem , Ciclofosfamida/uso terapêutico , Doxorrubicina/administração & dosagem , Doxorrubicina/uso terapêutico , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Imageamento por Ressonância Magnética , Masculino , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Rituximab , Tomografia Computadorizada por Raios X , Vincristina/administração & dosagem , Vincristina/uso terapêuticoRESUMO
A 76-year-old woman with serous cystic tumor (SCT) was admitted to our hospital with abdominal pain and was given a diagnosis of severe acute pancreatitis. Infusion of intravenous protein inhibitor and continuous hemodiafiltration (CHDF) were started and she was placed on a respirator, but she died on the 6th day after diagnosis. On autopsy, each SCT cyst showed evidence of hemorrhage. We supposed that the growth of the SCT after hemorrhage compressed the main pancreatic duct and caused severe acute pancreatitis. SCT is benign, and there are no standard treatments. During follow-up of patients with SCT, we should consider the risk of severe acute pancreatitis.
Assuntos
Cistadenoma Seroso/complicações , Neoplasias Pancreáticas/complicações , Pancreatite/etiologia , Doença Aguda , Idoso , Feminino , Humanos , Recidiva Local de NeoplasiaRESUMO
Individuals with inflammatory bowel disease (IBD) are at increased risk of developing gastrointestinal cancer. Here, we have tested the possibility that chronic inflammation could trigger mutations. For this, we have used IL-10-deficient (IL-10-/-) mice, which spontaneously develop intestinal inflammation, in combination with a transgenic gpt gene and red/gam gene (gpt+IL-10-/-), which is a well-characterized mutation reporter locus. The total mutation frequency in the colon of gpt+IL-10-/- mice was about five times higher than that in normal gpt+IL-10+/+ mice. In the particular case of G:C to A:T transitions, the frequency of mutations in gpt+IL-10-/- mice was 4.1 times higher than that in control mice. Interestingly, the frequency of small deletions and insertions was also strikingly increased (approximately 10 times). The majority of the deletion or insertion mutations were observed in the monotonous base runs or adjacent repeats of short tandem sequences. In contrast, the frequency of large deletions, detected by loss of the Spi marker present in the red/gam transgene, was similar among the mouse strains. Finally, as a control, the mutation frequency in non-inflamed tissues, such as the liver, were similar between gpt+IL-10-/- mice and gpt+IL-10+/+ mice. Our data demonstrate that the chronic inflammatory environment in the colon promotes the generation of mutations.