Granular cell tumor of the pancreas:A case report and review of literature

Granular cell tumors,also called Abrikossof's tumors,were originally described by Abrikossof A in 1926.The f irst case of a pancreatic granular cell tumor was described in 1975 and only 6 cases have been reported.We describe a case of granular cell tumor in the pancreas showing pancreatic duct obstruction.Because imaging studies showed f indings compatible with those of pancreatic carcinoma,the patient underwent distal pancreatectomy.Histological examination showed that the tumor consisted of a nested growth of large tumor cells with ample granular cytoplasm and small round nuclei.The tumor cells expressed S-100 protein and were stained with neuron-specific enolase and periodic acid-Schiff,but were negative for desmin,vimentin,and cytokeratin.The resected tumor was diagnosed as a granular cell tumor.To our knowledge,this is the seventh case of Granular cell tumor of the pancreas to be reported.

Pancreatic duct drainage using EUS-guided rendezvous technique for stenotic pancreaticojejunostomy

The patient was a 30-year-old female who had undergone excision of the extrahepatic bile duct and Rouxen-Y hepaticojejunostomy for congenital biliary dilatation at the age of 7.Thereafter,she suffered from recurrent acute pancreatitis due to pancreaticobiliary maljunction and received subtotal stomach-preserving pancreaticoduodenectomy.She developed a pancreatic fistula and an intra-abdominal abscess after the operation.These complications were improved by percutaneous abscess drainage and antibiotic therapy.How ever,upper abdominal discomfort and the elevation of serum pancreatic enzymes persisted due to stenosis from the pancreaticojejunostomy.Because we could not accomplish dilation of the stenosis by endoscopic retrograde cholangiopancreatography,we tried an endoscopic ultrasonography(EUS) guided rendezvous technique for pancreatic duct drainage.After transgastric puncture of the pancreatic duct using an EUS-fine needle aspiration needle,the guidewire was inserted into the pancreatic duct and finally reached to the jejunum through the stenotic anastomosis.We changed the echoendoscope to an oblique-viewing endoscope,then grasped the guidewire and withdrew it through the scope.The stenosis of the pancreaticojejunostomy was dilated up to 4 mm,and a pancreatic stent was put in place.Though the pancreatic stent was removed after three months,the patient remained symptomfree.Pancreatic duct drainage using an EUS-guided rendezvous technique was useful for the treatment of a stenotic pancreaticojejunostomy after pancreaticoduodenectomy.

MSX2 overexpression inhibits gemcitabine-induced caspase-3 activity in pancreatic cancer cells

AIM: To evaluate the effect of MSX2 on gemcitabineinduced caspase-3 activation in pancreatic cancer cell line Panc-1.METHODS: Using V5-tagged MSX2 expression vector,stable transfectant of MSX2 was generated from Panc-1cells (Px14 cells). Cell viability under gemcitabine administration was determined by MTT assay relative to control cell line (empty-vector transfected Panc-1 cells;P-3EV cells). Hoechst staining was used for the detection of apoptotic cell. Activation of caspase-3 was assessed using Western blotting analysis and direct measurement of caspase-3 specific activities.RESULTS: MSX2 overexpression in Panc-1 cells resulted in decreased gemcitabine-induced caspase-3 activation and increased cell viability under gemcitabine treatment in Px14 cells.CONCLUSION: MSX2 exerts repressive effects on gemcitabine-induced apoptotic pathway. This novel apoptosis-regulating function of MSX2 may provide a new therapeutic target for pancreatic cancer.

IgG4-unrelated type 1 autoimmune pancreatitis

A 50-year-old male was referred to our hospital for the evaluation of hyperproteinemia.Fluorodeoxyglucose positron emission tomography revealed high fluorodeoxyglucose uptake in the pancreas,bilateral lacrimal glands,submandibular glands,parotid glands,bilateral pulmonary hilar lymph nodes,and kidneys.Laboratory data showed an elevation of hepatobiliary enzymes,renal dysfunction,and remarkably high immunoglobulin(Ig) G levels,without elevated serum IgG4.Abdominal computed tomography revealed swelling of the pancreatic head and bilateral kidneys.Endoscopic retrograde cholangiopancreatography showed an irregular narrowing of the main pancreatic duct in the pancreatic head and stricture of the lower common bile duct.Histological examination by endoscopic ultrasonography-guided fine-needle aspiration revealed findings of lymphoplasmacytic sclerosing pancreatitis without IgG4-positive plasma cells.Abnormal laboratory values and the swelling of several organs were improved by the treatment with steroids.The patient was diagnosed as having type 1 autoimmune pancreatitis(AIP) based on the International Consensus Diagnostic Criteria.Therefore,we encountered a case of compatible type 1 AIP without elevated levels of serum IgG4 or IgG4-positive plasma cells.This case suggests that AIP phenotypes are not always associated with IgG4.