Hiroyasu Imayama

Insulinoma occurring in association with fatty replacement of unknown etiology in the pancreas: report of a case.

A 66-year-old woman with a 10-year-history of diabetes mellitus was admitted to our hospital for investigation of several recent attacks of hypoglycemia. Her fasting blood glucose level was very low, at 30–40 mg/dl, and abdominal ultrasonography and computed tomography revealed a tumor in the pancreatic tail with fatty changes. Endoscopic retrograde cholangiopancreatography revealed absence of the main pancreatic duct from the body to tail of the pancreas. Abdominal angiography showed a hypervascular tumor stain in the pancreas, and percutaneous transhepatic portal vein sampling demonstrated a step-up of immunoreactive insulin levels in the splenic vein. Based on these clinical findings, we made a preoperative diagnosis of an insulinoma accompanied by fatty changes in the pancreatic body and tail. During laparotomy for the insulinoma, fat tissue was identified in the anatomic location of the pancreatic body and tail, and resected. Pathological examination of the resected specimen revealed a number of Langerhans islets in the adipose tissue, and an islet cell tumor with fatty replacement of the pancreatic tissue around the tumor. The insulinoma was found not to have caused obstruction of the main pancreatic duct. We present herein a rare case of an insulinoma that developed in the pancreas, and was associated with fatty replacement of unknown etiology.

Gastric enterochromaffin-like-cell tumor with liver and splenic metastases

Abstract: We report a patient with gastric enterochromaffin-like-cell tumor with liver and splenic metastases. He was 68 years old and presented with major complaints of epigastric pain and weight loss. Under the diagnosis of gastric carcinoma with liver metastasis, total gastrectomy with splenectomy and lateral seg-mentectomy of the liver was performed. Intraoperative findings resulted in a diagnosis of adenocarcinoma T3N2P0H1, in stage IVa. Histological examination of the resected specimens showed a well differentiated neuroendocrine carcinoma (enterochromaffin-like-cell tumor) with liver and splenic metastasis which demonstrated high-grade lymphatic and vascular invasion. There was no lymph node metastasis. The tumor cells in the stomach, liver and spleen were immunoreactive for chromogranin A and Grimelius—positive. We review the literature, as well as presenting this case report.

Surgical Results of Pancreatoduodenectomy for Disease in the Pancreatic Head Region

Between January 1965 and September 1995, 330 patients underwent pancreatoduodenectomy in our institution. In 249 cases, we performed the Child method of reconstruction after pancreatoduodenectomy. Of these patients, 299 underwent pancreatoduodenectomy because of malignant disease and 19 died in the hospital after the operation; the mortality rate was 5.8%. We must be aware of certain complications after pancreatoduodenectomy, especially anastomotic leakage of the pancreatiocojejunostomy. It 16 cases of pancreatic fistula, 7 patients died of this complication. Five-year survival rates of patients with carcinoma of the pancreas, bile duct, and papilla of Vater were 17.3%, 19.7%, and 56.2%, respectively. In cases of carcinoma of the papilla of Vater with no lymph node involvement, the 5-year survival rate was 64.9%; for cases with lymph node involvement, it was 40.0%. Many more strategies must be developed to obtain a better outcome in cases of carcinoma of the pancreas and bile duct. The most important need is to prevent metastasis of carcinoma to the liver in these patients.