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Content available remote Surgical Treatment of Neuroendocrine Tumors of the Pancreas
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EN
Management of patients with neuroendocrine tumors (NETs) of the pancreas causes considerable controversy because rarity of this neoplasm.The aim of the study was to present our results of treatment of patients with NETs and to sum up our experience in surgical management.Material and methods. Thirty four patients with neuroendocrine tumors of the pancreas were treated in Department of General, Endocrine and Transplant Surgery of Medical University in Gdańsk (24 inulinomas and 10 nonfunctioning neuroendocrine tumors). Insulinoma was present in the head of the pancreas in 3 cases, in the body in 8 cases, and 10 patients had lesion situated within the tail.Results. Localization of the tumor in patients with organic hyperinsulinism was possible in 21 out of 24 operated patients (17 patients with use of preoperative imaging studies, 4 patients with Intraoperative ultrasonography). In 3 remaining patients the localization of the pathologic mass was impossible with use of pre- and intraoperative techniques.Conclusions. Treatment of choice of patients with neuroendocrine tumors of the pancreas is surgery. Management of patients with islet cells adenomatosis is still difficult clinical problem.
2
Content available remote Neuroendocrine Tumor in Choledochal Cyst - Case Report and Review of Literature
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EN
The report presents a rare case of carcinoid tumor in a 17 year female who presented with epigastric pain of one week duration. She was diagnosed to have type I choledochal cyst on abdominal ultrasound and MRI. She underwent total excision of choledochal cyst with roux-en-Y hepaticojejunostomy. His-topathological examination revealed a neuroendocrine tumor within choledochal cyst which was immunoreactive for Chromogranin A. Patient is well at 6 months of follow up. These tumors are characteristically slow-growing, therefore awareness of its presence preoperatively can facilitate optimal management by performing surgical resection with negative margins which offers the best chance of long-term survival.
EN
Introduction. Appendix, located within the Spiegel hernia is a rare condition. Few cases have been reported to date. Although it is generally asymptomatic, patients can apply with strangulation findings. Along with the physical examination findings, imaging methods play an important role in diagnosis and definitive diagnosis is made intraoperatively. Per-operative surgical method is determined according to the condition of the structures in the hernia sac. If an appendix is detected in the hernia sac, appendectomy is often preferred regardless of symptoms. Postoperative pathology is mostly benign but malign appendix pathologies should be kept in mind. Aim. Here, we aimed to present our case undergoing emergency surgery due to incarcerated hernia as it is the first case of appendix neuroendocrine tumor in the Spiegel hernia sac according to our literature review. Description of the case. A 77-year-old female patient who was admitted to the hospital with complaints of nausea and vomiting was evaluated as an emergency. In the clinical evaluation of the patient, we detected ileus due to hernia. We operated on the patient and found the appendix and cecum in the spiegel hernia. We did appendectomy and hernia repair. Histopathological examination of the appendix revealed a well-differentiated neuroendocrine tumor. Conclusion. Detection of the appendix in a Spiegel hernia is a rare condition. This is the first case of appendiceal malignancy in a Spiegelian hernia.
PL
Jedną z częstszych lokalizacji guzów neuroendokrynnych (Neuroendocrine Tumors, NET) przewodu pokarmowego jest jelito cienkie. W większości przypadków są to nowotwory wysoko zróżnicowane o powolnym tempie wzrastania i stanowią wyzwanie diagnostyczne dla gastroenterologów, radiologów i patomorfologów. Z klinicznego punktu widzenia NET jelita cienkiego mogą być nieczynne hormonalnie lub produkować substancje odpowiedzialne za powstawanie charakterystycznych objawów. Czułym, lecz niespecyficznym markerem tych zmian jest stężenie chromograniny A. Podstawę diagnostyki stanowią techniki obrazowe, pozwalające na lokalizację guza oraz endoskopowe, umożliwiające pobranie materiału do badania histopatologicznego i immunohistochemicznego. Chirurgiczne usunięcie zmiany jest leczeniem z wyboru, natomiast w farmakoterapii NET znajdują zastosowanie analogii somatostatyny, terapia radioizotopowa i chemioterapia. Przedstawiamy przypadek asymptomatycznego guza neuroendokrynnego zlokalizowanego w okolicy krętniczo-kątniczej u 59-letniego chorego.
EN
One of the more common locations of neuroendocrine tumors (Neuroendocrine Tumors, NET) of the gastrointestinal tract is the small intestine. In the majority of cases, these are slow to develop, highly differentiated tumors, which pose a diagnostic challenge to gastroenterologists, radiologists and pathologists. From the clinical viewpoint, NETs of the small intestine may be hormonally inactive or produce substances responsible for the occurrence of characteristic clinical symptoms. The serum concentration of chromogranin A is a sensitive, yet nonspecific, marker of such changes. The basic method of diagnosing is through the use of imaging techniques, which allow for the location of the tumor; and endoscopic techniques, which permit the extraction of a tissue sample for histopathology and immunohistochemistry ancillary tests. Surgical excision of a lesion is the treatment of choice. However, if pharmacotherapy is employed, the somatostatin analogs, radioisotope therapy and chemotherapy is used. We present a case study, of an asymptomatic neuroendocrine tumor of the ileocecal area, in a 59 year-old male patient.
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