review of literature on clinical pancreatology - The Pancreapedia

elevated triglyceride level. Serum markers were noncontributory. It was <strong>review</strong>ed thedifferential diagnostic considerations leading to obstruction or retention <strong>of</strong> lymphatic fluids(malignancy, surgical, infective and traumatic), with an emphasis on the importance <strong>of</strong> onsitecytologic evaluation, correlation with clinical history and <strong>review</strong> <strong>of</strong> the etiologicconsiderations. The constellation <strong>of</strong> clinical, radiologic, cytologic and laboratory findingspresented in this case are diagnostic <strong>of</strong> diffuse retroperitoneal cystic abdominallynmphangiomatosis [635].Merkel cell carcinomaMerkel cell carcinoma is a relatively infrequent, rapidly progressive and <strong>of</strong>ten fatal cutaneousmalignancy exhibiting neuroendocrine differentiation. It has a penchant for local recurrenceand distant metastasis to various sites, including regional lymph nodes, distant skin, lung,liver, testis and other rare organs, such as the pancreas. There are only 4 cases <strong>of</strong> Merkelcell carcinoma metastatic to the pancreas reported in the English-language <strong>literature</strong>, andthey were all diagnosed by histology from pancreatic resection. A 79-year-old woman with alarge pancreatic tail mass underwent endoscopic ultrasound-guided fine needle aspirationShe had a history <strong>of</strong> Merkel cell carcinoma <strong>of</strong> the upper extremity with wide local excision 15months earlier. Metastatic Merkel cell carcinoma was diagnosed based on thecytomorphology, characteristic immunohistochemical staining pattern, clinical history andcomparison <strong>of</strong> the morphology with that <strong>of</strong> the primary tumor. The cytomorphology andimmunohistochemical pr<strong>of</strong>ile <strong>of</strong> this neoplasm mimicked a pancreatic endocrine tumor [636].Pancreatic tuberculosisTuberculosis <strong>of</strong> the pancreas is a rare entity, and anecdotal reports describing imagingfeatures <strong>of</strong> pancreatic tuberculosis have been described in medical <strong>literature</strong>. The imagingfeatures including computed tomography and ultrasonography in diagnosed cases <strong>of</strong>tubercular involvement <strong>of</strong> the pancreas are described, with an overview <strong>of</strong> clinical featuresand laboratory investigations. It was analyzed records <strong>of</strong> 384 patients <strong>of</strong> diagnosed cases <strong>of</strong>abdominal tuberculosis for involvement <strong>of</strong> pancreas and detected 32 patients (8 %) who hadpancreatic involvement. This included 22 men and 10 women with an age range <strong>of</strong> 19 to 64years (mean age <strong>of</strong> 43 years), who were detected to have pancreatic tuberculosis from 1999to 2004. The criteria for diagnosis <strong>of</strong> tuberculosis were based on ascitic fluid adenosinedeaminase level in 14 patients, fine-needle aspiration cytology <strong>of</strong> lymph nodes in 9 patients,and presence <strong>of</strong> pulmonary tuberculosis on chest radiograph, which was found in 9 patients.On follow-up, 6 months after antituberculous treatment, 25 patients showed response to anti-Koch's treatment, 3 patients had drug-resistant tuberculosis, 2 patients died, and 2 patientswere lost to follow-up. The male/female ratio was 2.2:1. The maximum number <strong>of</strong> patientswas in the fourth decade (30-39 years). The duration <strong>of</strong> symptoms was spanning between 2and 11 months, with a mean duration <strong>of</strong> 6 months. The most common symptom wasabdominal pain localized to the epigastrium. Sixteen patients were seropositive for HIV-1infection. Fourteen patients had history <strong>of</strong> tuberculosis <strong>of</strong> the lungs, whereas 18 patients hadpancreatic and peripancreatic involvement as the primary manifestation. Ultrasonographyshowed bulky inhomogenous pancreas in 5 patients; solitary or multiple hypoechoiccollections were observed in all 7 and 20 patients, respectively. CT findings demonstratedhypodense collections within the pancreas associated with peripancreatic lymphadenopathyin 29 patients. Three patients had a complex pancreatic mass lesion. It was concluded thatpancreatic tuberculosis can present with a variable spectrum <strong>of</strong> imaging findings.Tuberculosis <strong>of</strong> the pancreas should be considered as a diagnostic possibility in patients whopresent with a pancreatic space occupying lesion associated with peripancreaticlymphadenopathy [637].