Hemolymphangioma: A rare differential diagnosis of cystic-solid or cystic tumors of the pancreas

We report a case of pancreatic hemolymphangioma. Hemolymphangioma is a malformation of both lymphatic vessels and blood vessels. The incidence of this disease in the pancreas is extremely rare. To the best of our knowledge, only seven cases have been reported worldwide (PubMed). A 39-year-old woman with a oneday history of abdominal pain was admitted to our hospital. There was no obvious precipitating factor. The preoperative examination, including ultrasonography and computed tomography, showed a cystic-solid tumor in the pancreas, and it was considered to be a mucinous cystadenoma or cystadenocarcinoma. Pancreaticbody-tail resection combined with splenectomy was performed. After the operation, the tumor was pathologically demonstrated to be a pancreatic hemolymphangioma. Although pancreatic hemolymphangioma is rare, we believe that it should be considered in the differential diagnosis of cystic-solid tumors of the pancreas, particularly when there is no sufficient evidence for diagnosing cystadenoma, cystadenocarcinoma or some other relatively common disease of the pancreas.

Contrast-enhanced multiple-phase imaging features in hepatic epithelioid hemangioendothelioma

AIM： To investigate and review the contrast-enhanced multiple-phase computed tomography （CEMP CT） and magnetic resonance imaging （MRI） findings in patients with pathologically confirmed hepatic epithelioid hemangioendothelioma （HEHE）. METHODS： Findings from imaging examinations in 8 patients （5 women and 3 men） with pathologically confirmed HEHE were retrospectively reviewed （CT images obtained from 7 patients and MR images obtained from 6 patients）. The age of presentation varied from 27 years to 60 years （average age 39.8 years）. RESULTS： There were two types of HEHE： multifocal type （n = 7） and diffuse type （n = 1）. Tn the multifocal-type cases, there were 74 lesions on CT and 28 lesions on MRI with 7 lesions found with diffusion weighted imaging; 18 （24.3%） of 74 lesions on plain CT and 26 （92.9%） of 28 lesions on pre-contrast MRI showed the target sign. On CEMP CT, 28 （37.8%） of 74 lesions appeared with the target sign and a progressive-enhancement rim and 9 （12.2%） of 74 lesions displayed progressive enhancement, maintaining a state of persistent enhancement. On CEMP MRI, 27 （96.4%） of 28 lesions appeared with the target sign with a progressive-enhancement rim and 28 （100%） of 28 lesions displayed progressive-enhancement, maintaining a state of persistent enhancement. In the diffuse-type cases, an enlarged liver was observed with a large nodule appearing with persistent enhancement on CEMP CT and MRI. CONCLUSION： The most important imaging features of HEHE are the target sign and/or progressive en- hancement with persistent enhancement on CEMP CT and MRI. MRI is advantageous over CT in displaying these imaging features.

Estrogen receptor expression in adrenocortical carcinoma

Objective: Adrenocortical carcinoma (ACC) is a rare but highly malignant tumor, and its diagnosis is mostly delayed and prognosis is poor. We report estrogen receptor (ER) expression in this tumor and our clinical experiences with 17 ACC cases. Methods: The data of the 17 patients (9 females and 8 males, age range from 16 to 69 years, mean age of 42.6 years) with ACC were reviewed, and symptoms, diagnostic procedures, treatment, and results of follow-up were evaluated. Immunohistochemistry was used to detect ER expression in tumor samples from the 17 patients. Results: At the time of diagnosis, 4 tumors were classified as Stage I, 4 as Stage II, 3 as Stage III, and 6 as Stage IV. Eight patients demonstrated positive nuclear immunostaining of ER. The prognosis of patients with ER positive was significantly better (P<0.05) than that of patients with ER negative, with 1- and 5-year survival rates at 86% and 60% for ER-positive patients, and 38% and 0% for ER-negative patients, respectively. Conclusion: ER-positivity may be one of the factors associated with a worse prognosis of ACC.

Case Report:Gastric duplication cyst lined by pseudostratified columnar ciliated epithelium: a case report and literature review

Gastric duplication cyst (GDC) lined by pseudostratified columnar ciliated epithelium (PCCE) is an uncommon lesion stemming from a foregut developmental malformation.Its clinical and radiological presentation is usually nonspecific.In this study,we reported a 76-year-old man who presented with an incidentally found perigastric mass.An exploratory laparotomy revealed a non-communicating cyst below the gastroesophageal junction,measuring 4 cm×4 cm in size.Microscopically,the gastric cyst was lined merely by PCCE.Although rare,GDC lined by PCCE should be included in the differential diagnosis of gastric wall masses.Surgical intervention is warranted in patients who have clinical symptoms,or who are aged more than 50 years.

Case Report:Pancreatic somatostatinoma with obscure inhibitory syndrome and mixed pathological pattern

Somatostatinoma is a very rare neuroendocrine tumor that originates from D cells and accounts for less than 1% of all gastrointestinal endocrine tumors. The duodenum is the most frequent site for this tumor, followed by the pancreas. We here describe a 46-year-old Chinese woman who developed pancreatic somatostatinoma presenting with the characteristic "inhibitory" syndrome, but the symptoms were obscure and seemingly uncorrelated. This case is also unique for its large tumor size and mixed pathological pattern. Distal pancreatectomy was performed, and the patient has remained well since operation. As the syndromes of somatostatinoma may be obscure and atypical, clinicians should review all clinical findings to obtain an accurate diagnosis. Aggressive surgery is preferred to improve the survival.