Head Mass Research Articles

A Case of Complete Remission from Pancreatic Cancer Following Palliative Chemotherapy

The prognosis for pancreatic cancer is still poor with a 5-year survival rate around 10%. We report a case of complete remission after palliative chemotherapy for pancreatic cancer in a 61-year-old-female. She presented with indigestion and weight loss. A computed tomography scan revealed a 1.8 cm mass in the pancreatic head. Carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA) levels were elevated. The patient underwent endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) and the pathologic examination showed adenocarcinoma. Positron emission tomography (PET) and magnetic resonance imaging (MRI) of the pancreas showed a metastatic nodule in the S6 segment of the liver and a metastatic portocaval lymph node. The final diagnosis was stage IV pancreatic cancer. The patient received 24 cycles of palliative FOLFIRINOX regimen. Response evaluation demonstrated disappearance of all the lesions. She underwent pyloruspreserving pancreatoduodenectomy (PPPD). The pathologic examination of the surgical specimen showed complete remission of the pancreatic cancer. The patient is currently undergoing adjuvant chemotherapy.

The role of various laboratory parameters associated with obstructive cholestatic jaundice in pancreatic tumor: A case report and literature review

Introduction: Obstructive jaundice can be caused by pancreatic cancer, where most tumors block bilirubin excretion, and excess bilirubin accumulation causes jaundice. Jaundice occurs in more than 65% of pancreatic cancer patients. Jaundice is caused by the location of the tumor, usually located in the head of the pancreas, suppressing the bile ducts and creating a blockage characterized by an increase in bilirubin, especially direct bilirubin. Aspartate transaminase (AST) and alanine transaminase (ALT) may also be elevated in pancreatic cancer patients but to a lesser extent. Case Presentation: A 63-year-old male patient presented with ocular symptoms and generalized jaundice that had lasted for 2 months. Patients also complain of a bloated stomach and feel thin due to continued weight loss. The patient's stool was the color of putty and brown, like viscous urine. A physical examination revealed conjunctival jaundice in both eyes and hepatomegaly. Abdominal ultrasonography (USG) results suggest a pancreatic head mass with a dilated pancreatic duct and edema of the gallbladder with dilated extrahepatic bile duct (EHBD). Laboratory tests showed that the patient had elevated liver function, total bilirubin 11.90 mg/dl, direct bilirubin 8.29 mg/dl, SGOT 33 U/l, SGPT 54 U/l, and three positive urinary bilirubin values. It became clear that. The patient was diagnosed by observing cholestatic jaundice and the differential diagnosis of suspected pancreatic cancer of the head and cholangiocarcinoma. Conclusion: Examining laboratory parameters such as total bilirubin, especially direct bilirubin, liver enzymes SGOT, and SGPT may help localize obstructions, such as those caused by pancreatic tumors causing post hepatic obstructive jaundice.

THU521 A Case Of Multifocal Pancreatic Neuroendocrine Tumor With Multiple Twists

Abstract Disclosure: A. Syeda: None. V. Kantorovich: None. Background: Multifocal pancreatic neuroendocrine tumors (PNETs) are rare and are usually associated with genetic syndromes like Multiple Endocrine Neoplasia 1 (MEN1). Sporadic multifocal PNETs have been infrequently reported. Case: A 68-year-old Caucasian female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes mellitus, morbid obesity, multiple renal cysts, and Barrett’s esophagus presented to endocrinology for evaluation of PNET. An MRI performed for evaluation of renal cysts demonstrated pancreatic lesions suspicious for neoplasm. An endoscopic ultrasound (EUS) guided fine needle aspiration biopsy (FNAB) of the largest lesion was consistent with low grade PNET positive for chromogranin A (CgA) and synaptophysin. Biochemical workup was remarkable for elevated CgA of 4800 ng/mL (n: <311 ng/mL) and elevated gastrin level of 700 pg/mL (n: <100 pg/mL); however, the patient was on proton pump inhibitors. A Ga-68 DOTATATE scan revealed 4 DOTATATE avid masses in the pancreatic head, neck, body and tail, the largest measuring 2.3 cm in the pancreatic head. No metastatic lesions were identified. Family history is significant for hyperparathyroidism in one sister and endometrial cancer in another sister. Genetic testing was negative for 86 genetic mutations including MEN1, VHL, TSC1 and TSC2. The patient underwent a successful total pancreatectomy, splenectomy and duodenectomy with a hepaticojejunostomy and gastrojejunostomy. Surgical pathology revealed 5 multifocal tumors, measuring 0.4-2.2 cm in diameter, with clear margins, without any lymphovascular invasion and 19 lymph nodes negative for malignancy. Mitotic rate was <2 mitoses per mm2 and Ki-67 index was < 3 %. Next Generation Sequencing of the surgical specimen was positive for ATM gene deletion. Interestingly, immunohistochemistry stained strongly for insulin, glucagon and INSM1 suggestive of nesidioblastosis although the patient did not have preoperative hypoglycemia that would raise a clinical suspicion. Discussion: This case highlights several unique features in a multifocal PNET. A recent study suggested that multifocality is not associated with worse prognosis or increased risk of recurrence. Another distinctive finding in our patient is the ATM gene mutation. Heterozygous pathogenic variants in ATM gene are known to be associated with hereditary pancreatic cancer but there has been no reported association with PNETs. ATM gene down regulation is linked with metastatic NETs and was proposed as a potential predictive marker for metastasis and as a novel target in metastatic gastroenteropancreatic NETs. Concurrent occurrence of nesidioblastosis and PNET has been rarely reported in the literature, however, it was a clinically silent phenomenon in our case. Presentation: Thursday, June 15, 2023

SAT171 An Unusual Presentation Of Insulinoma With Postprandial Hypoglycemia

Abstract Disclosure: J.G. Melendez-Rivera: None. F.H. Morgan: None. A. Aneja: None. Background: Insulinomas are rare neuroendocrine tumors of the pancreas with an incidence of four cases per million individuals per year. The most common presentation of insulinoma is fasting hypoglycemia with associated neuroglycopenic symptoms. Postprandial hypoglycemia has been previously reported, usually in combination with fasting hypoglycemia. Exclusive postprandial hypoglycemia is estimated to occur in 6% of insulinomas. Clinical Case: A 61-year-old woman presented with episodes of postprandial blurry vision, diaphoresis, nausea, and dizziness occurring for the last 18 months that have become more frequent. The patient reported blood glucose measurements in the 35 - 40 mg/dL range at the time of symptoms. Fasting blood glucose levels remained consistently in the 70 - 90 mg/dL range. These symptoms were originally sporadic but progressively became more common to the point that they were occurring daily after meals, and she gained 20 pounds due to increased food intake. BMI was 36.28. Her physical exam was unremarkable. Fasting labs revealed a glucose of 82mg/dl and C-peptide of 2.8ng/ml with normal cortisol. After a short trial of a reactive hypoglycemia diet, the patient had no improvement in symptoms, and was admitted for a 72-hour fast. She developed hypoglycemia with a glucose of 42mg/dl within four hours of starting her inpatient fast. At the time of hypoglycemia, insulin and C-peptide were inappropriately normal (insulin 15.9 mIU/mL and C-peptide 2.57 ng/mL) with an elevated proinsulin (42.3 pmol/L). An MRI abdomen with and without IV contrast showed a 16 mm hypervascular mass in the head of the pancreas. She subsequently underwent endoscopic ultrasonography with fine needle aspiration showing findings consistent with a well-differentiated pancreatic neuroendocrine tumor. Ga-68 DOTATATE PET CT revealed increased DOTATATE avidity in the pancreatic head mass compatible with neuroendocrine tumor but no evidence of metastatic disease. She underwent surgical resection of the tumor with resolution of symptoms. Conclusion: The absence of fasting hypoglycemia does not rule out pancreatic neuroendocrine tumors. While rare, exclusive postprandial hypoglycemia can be seen in these types of tumors, especially proinsulin-secreting tumors. This case illustrates the importance of considering insulinoma during the evaluation of postprandial hypoglycemia in the absence of fasting hypoglycemia and persistent hypoglycemia despite dietary modifications. Presentation: Saturday, June 17, 2023

FRI668 Insulinoma As A Cause Of New Onset Hypoglycemic Episodes

Abstract Disclosure: S. Zahra: None. M.A. Abbas: None. R. Subramani: None. F. Manas: None. S. Yavuz: None. 37 years old female with a past medical history of hypothyroidism presented with complaints of shakiness, lightheadedness, and palpitations, relieved by eating. The physical examination was unremarkable. Fasting blood work showed low glucose of 41 mg/dl (70-99 mg/dl), normal insulin levels of 8.4 UIU/ ml (normal:1.9-23 UIU/ml), elevated proinsulin 21.1 pmol/ L (normal:<8.0 pmol/L), normal C Peptide 2.5 ng/ ml (normal:1.1-4.4 ng/ml), and negative for insulin antibody. Serum ACTH and cortisol levels were normal. Blood testing for hypoglycemia-inducing medications was negative. CT and MRI abdomen pelvis contrast was normal. She was prescribed to wear Dexcom to monitor her blood glucose round the clock. She continued to have low blood glucose, sometimes without symptoms and was rescued by the alarm. She underwent endoscopic ultrasound and was found to have a 10mm x 9mm ill-defined rounded pancreatic head mass with diffuse echogenicity of the pancreas. Biopsy of the mass revealed clusters of epithelial cells with neuroendocrine differentiation, compatible with insulinoma. She underwent surgical resection of the mass. She was also referred to genetic testing due to the association of pancreatic tumors with MEN syndrome. The diagnosis of Insulinomas is clinical as well as biochemical with presenting symptoms of Whipple’s Triad along with the presence of the following lab findings: hypoglycemia with plasma glucose of less than 50mg /dl, insulin greater than 5 UIU/L, C-Peptide greater than 0.2 nmol/L (0.6 ng/mL), Insulin/C-Peptide ratio of greater than 1.0, Proinsulin greater than 20pmol/L, and the absence of sulfonylurea metabolites in plasma or urine. Insulinoma is the most common pancreatic neuroendocrine and functional endocrine tumor of the beta cells of the pancreas with a prevalence of 1-4 people per million with equal gender distribution. They are mainly seen in the fifth decade of life but can occur at any age. They can occur sporadically or can be associated with MEN 1. Insulinomas are mostly benign, about 5-10% can be malignant. When to do medical vs surgical management? For benign insulinomas, surgical resection is preferred. For locally invasive and malignant tumors, aggressive surgical resection is performed, unless surgery is contraindicated for any other reason or patient refuses it. Medical treatment is reserved for the patients with diffuse Beta cell disease, multiple insulinoma and unresected malignant insulinoma. In the presence of unresectable metastatic disease; radiofrequency ablation, selective embolization, intraarterial chemotherapy, alone or in combination has been shown to be effective in controlling hypoglycemic episodes and improving quality of life. Octreotide, via inhibiting insulin secretion, normalizes the blood glucose levels. For better detection of hypoglycemia and adequate response to medical therapy, continuous glucose monitoring is helpful. Presentation: Friday, June 16, 2023

THU094 Multiple Endocrine Neoplasia Type 1 Tumor Recurrence After Loss To Follow Up

Abstract Disclosure: S.J. Sternlieb: None. K.G. Romo: None. R.S. Boothe: None. D. Englert: None. N. Manuel: None. Q.Z. Iqbal: None. Multiple Endocrine Neoplasia Type 1 Tumor Recurrence After Loss to Follow-up Sternlieb, S. J., Romo, K.G., Boothe, R., Manuel, N., Iqbal, Q.Z., Grissett, B., Englert, D. Background: MEN1 is a rare, autosomal dominant tumor disorder due to mutations in the MEN1 tumor suppressor gene. It is characterized by parathyroid, enteropancreatic and pituitary tumors. We present a young woman with MEN1 with prolactinoma, primary hyperparathyroidism and multiple pancreatic neuroendocrine tumors. Clinical Case: A 30-year-old woman with MEN1 presented with complaints of abdominal pain and GI bleeding (GIB). She was diagnosed with a prolactinoma at age 14 after presenting for primary amenorrhea and galactorrhea. She didn’t tolerate medical therapy with bromocriptine or cabergoline and required transphenoidal resection. At age 19, she presented with hypoglycemia and was found to have multiple pancreatic neuroendocrine tumors (NET) as well as a left (L) adrenal gland tumor. She underwent distal pancreatectomy and L adrenalectomy. Ten tumors in the pancreas stained variably for insulin, glucagon, gastrin and VIP. Multiple cortical adenomas were found in the adrenal gland. Post-operatively she developed a spinal cord hematoma related to placement of an epidural catheter for pain control, which led to permanent paraplegia. At age 21, she was diagnosed with primary hyperparathyroidism. She underwent left parathyroidectomy, then was lost to follow-up for 9 years. EGD showed multiple superficial duodenal ulcers. MRI brain identified a right (R) cavernous sinus mass inseparable from the R pituitary. CT abdomen showed a pancreatic head mass. Given the concern for neuroendocrine etiology, she underwent an EUS showing a pancreatic mass and a liver mass. Pancreatic mass pathology confirmed low-grade NET with Ki67 proliferation rate <1%, positive synaptophysin and chromogranin staining. After multidisciplinary discussion, the consensus was to continue PPI and sucralfate for GI ulcers, start lanreotide, and obtain somatostatin receptor scintigraphy. Surgery was not recommended unless significant GIB occurred on maximal therapy. She was referred to follow-up with GI, endocrinology, and NSGY. Since discharge, she has presented several times to other hospitals for abdominal pain, but has not adhered to follow-up. Conclusions: This case of recurrent neuroendocrine and pituitary tumors despite prior resections demonstrates the consequences of prolonged loss to follow-up with MEN1. Without routine surveillance, recurrence is likely. This patient lives in a rural area with lack of access to nearby subspecialty care, which is a barrier. More resources are needed to support patients with social barriers and progressive endocrinopathies. Key words: MEN1, prolactinoma, gastrinoma, NET, health care barriers Presentation: Thursday, June 15, 2023

Aggressive Adult Pancreatoblastoma with Early Recurrence: A Case Report

Background: Pancreatoblastoma (PB) is a rare malignant epithelial tumor of the pancreas, mainly occurring in pediatric population. Pancreatoblastoma of the adult is extremely rare and usually shows a more aggressive biological behavior and a worse prognosis. Case Presentation: The patient was a 54-year-old man admitted for abdominal pain and weight loss. A computed tomography (CT) scan showed a 12 cm heterogeneous hypoattenuating mass in the pancreatic head. An endoscopic ultrasound-guided biopsy suggested the diagnosis of pancreatoblastoma (PB). The patient underwent a pancreaticoduodenectomy (PD) combined with limited liver resections for intraoperative finding of multiple liver metastasis. Pathological findings confirmed the diagnosis of PB metastatic to the liver. The tumor recurred in the liver 5 months after surgery and the patient succumbed due to tumor dissemination 8 months after initial diagnosis. Conclusion: Adult pancreatoblastoma is a rare pancreatic neoplasm with malignant behavior. The aim of this manuscript is to report our experience with pancreatoblastoma in the adult and to contribute improving knowledge about the clinical behavior of this rare and aggressive malignancy.

S2066 Chameleonic Chloroma: A Case of Myeloid Sarcoma Presenting as a Pancreatic Head Mass

S2066 Chameleonic Chloroma: A Case of Myeloid Sarcoma Presenting as a Pancreatic Head Mass

An Unusual Case of Dual Pancreatic Tumors

ABSTRACT We report a simultaneous occurrence of pancreatic adenocarcinoma and pancreatic neuroendocrine tumor. A 64-year-old woman presented with abdominal pain and weight loss. Abdominal computed tomography revealed a pancreatic head mass with a mesenteric artery encasement. Endoscopic ultrasound revealed a second mass in the tail of the pancreas. Pathology reported adenocarcinoma of the head of the pancreas and a neuroendocrine tumor in the tail of the pancreas. The neuroendocrine tumor was nonfunctional, with no symptoms or signs present on assessment. The patient had advanced unresectable carcinoma, so she was treated with chemotherapy.

The influence of steel reinforcements on static rigidity of epoxy granite spindle head for dynamic performance enhancement of machining center: Experiments and finite element simulation

Machine tool structures are subjected to continuous distortions and unwanted vibrations during machining. The structures should have excellent static and dynamic properties to minimize the adverse effects due to vibration. Cast iron is generally used as a structural material for machine tools owing to its higher structural rigidity and moderate damping properties. The lack of desired dynamic properties results in poor surface finish of the machined components. Epoxy granite is a resin mineral-based composite found to provide superior damping ability but it has lesser material stiffness. Steel reinforcements are more appropriate to enhance the static rigidity of epoxy granite structures. The cast iron spindle head of the vertical machining center is considered for the present study. Static structural analysis has been performed by finite element analysis and the results are considered as a benchmark for the design of epoxy granite spindle head. Multiple design configurations of steel reinforcements are evolved through topology optimization to achieve improved stiffness with a higher damping ratio. A model which exhibited higher stiffness with minimum steel has been proposed for fabrication. A 1:2 scaled model of the proposed configuration has been fabricated using epoxy granite. Experimental modal analysis and numerical static analyses have been carried out and the results are compared to those of cast iron spindle head. A significant reduction in mass and deformation of the epoxy granite spindle head by 22% and 57%, respectively, was observed compared to that of cast iron spindle head.

Çocukluk Çağı Benign Baş Boyun Kitlelerinde Tanı ve Tedavi Yaklaşımı

Objective: Head and neck masses are frequently encountered in childhood. Radiological characterization of these lesions plays a crucial role in determining the appropriate treatment approach. At this stage, considering radiation exposure, radiological treatment and, if necessary, surgery should be directed. This study, it was aimed to discuss the diagnostic approach in childhood benign head and neck masses.
 Methods: A retrospective analysis was conducted on 64 pediatric patients who presented with head and neck masses and underwent radiological imaging between 2018 and 2022. Demographic data, radiological diagnostic methods, lesion localization, characterization, treatment approaches, and pathological findings of patients with congenital and acquired masses were obtained from the hospital system.
 Results: The distribution of age and gender among the 64 patients was similar across groups. Head and neck masses were predominantly located in the anterolateral cervical triangle. Thyroglossal duct cysts were the most common cystic masses, displaying mixed sonographic characteristics. Venolymphatic malformations (VLM) were the second most frequently observed masses, predominantly exhibiting cystic features. Hemangiomas were the most common solid masses encountered. In addition, while the cystic lesions were most frequently congenital, the solid ones were acquired.
 Regarding treatment planning, 32 patients (50%) underwent surgical intervention. Among the patients, 15.6% of the patients underwent sclerotherapy at least once. Medical treatment involved non-selective beta-blocker administration in 10 (15.6%) patients.
 Conclusion: The etiology of childhood head and neck masses encompasses a wide spectrum. Therefore, accurate diagnosis plays a crucial role in guiding clinicians toward appropriate medical and/or surgical treatment options.

Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature

BackgroundObstructive jaundice has various causes, and one of the rarest is pancreaticoduodenal artery aneurysm (PDAA), which is often associated with celiac axis stenosis caused by median arcuate ligament syndrome (MALS).Case presentationThe patient was a 77-year-old Azeri woman who presented with progressive jaundice, vague abdominal pain, and abdominal distension from 6 months ago. The intra- and extrahepatic bile ducts were dilated, the liver's margin was slightly irregular, and the echogenicity of the liver was mildly heterogeneous in the initial ultrasound exam. A huge cystic mass with peripheral calcification and compressive effect on the common bile duct (CBD) was also seen near the pancreatic head, which was connected to the superior mesenteric artery (SMA) and had internal turbulent blood flow on color Doppler ultrasound. According to the computed tomography angiography (CTA) findings, the huge mass of the pancreatic head was diagnosed as a true aneurysm of the pancreaticoduodenal artery caused by MALS. Two similar smaller aneurysms were also present at the huge aneurysm's superior margin. Due to impending rupture signs in the huge aneurysm, the severe compression effect of this aneurysm on CBD, and the patient's family will surgery was chosen for the patient to resect the aneurysms, but unfortunately, the patient died on the first day after the operation due to hemorrhagic shock.ConclusionIn unexpected obstructive jaundice due to a mass with vascular origin in the head of the pancreas, PDAA should be considered, and celiac trunk should be evaluated because the main reason for PDAA is celiac trunk stenosis or occlusion by atherosclerosis or MALS. The treatment method chosen (including transarterial embolization, open surgery, or combined method) depends on the patient's clinical status and radiological findings, but transarterial embolization would be safer and should be used as a first-line method.

A rare case of sarcomatoid carcinoma of the pancreas

Sarcomatoid carcinoma of the pancreas is a rare malignancy characterised by a predominant sarcomatoid component associated with a well-differentiated adenocarcinomatous component. We report the case of an 84-year-old patient with a history of cardiac arrhythmia who was admitted to hospital with jaundice of one month's duration. Ultrasound and abdominal computed tomography revealed a solid and locally advanced pancreatic head mass. The patient underwent endoscopic ultrasound with biopsy of the mass and placement of a biliary stent. Pathological examination of the biopsy revealed a sarcomatoid carcinoma of the pancreas. In view of the patient's bedridden condition and comorbidities, it was decided at a multidisciplinary consultation meeting to withhold treatment. The patient died 1 month later.

Accelerated loss of lean body mass in head and neck cancer patients during cisplatin-based chemoradiation

Background This study investigated changes in body weight, lean body mass (LBM), fat mass (FM), muscle strength and functional performance during radiation treatment in head and neck cancer (HNSCC) patients. Secondly, it investigated the impact of cisplatin-based chemoradiation (CCRT) on LBM loss compared with radiation alone. Methods 48 patients (all tumor sites) received either 6 weeks of radiation alone (n = 16) with 66–68 Gy in 33–34 Fx, 5-6 Fx/week or CCRT, adding weekly cisplatin or carboplatin (n = 32). LBM and FM was evaluated using Dual-energy X-ray Absorptiometry bi-weekly from pre- to two weeks post-treatment. Maximal muscle strength (knee extension, leg - and chest press) and functional performance (stair climb, chair rise, and arm curl) were assessed pre- and post-treatment. Results Body weight and LBM had declined significantly already week 2 into treatment and declined significantly further through week 4 and 6 before leveling off after week 6. Bi-weekly, from treatment start to week 2, 2–4, and 4–6, LBM declined 1.2 ± 0.4 kg (p = .002; 95% CI: 0.4;2.0), 2.0 ± 0.4 kg (p < .0001; 1.2;2.8) and 1.4 ± 0.4 kg (p = .001; 0.6;2.2). With a two-week delay, FM declined significantly from week 2–8. All measures of muscle strength declined significantly from pre- to post-treatment. Functional performance was unchanged. LBM loss from pre- to post-treatment was significantly associated with impaired muscle strength (R 2 = 0.3–0.5). CCRT patients lost 3.1 ± 0.8 kg of LBM (p = .0001; 1.5;4.7) more from pre- to post-treatment compared with patients receiving radiation alone. Analyses adjusting for nimorazole, tumor stage, baseline BMI, mean radiation dose to constrictor muscles and oral cavity confirmed this. Conclusion Accelerated and substantial LBM loss was already initiated within the first two weeks of treatment - before the onset of radiation-induced mucositis. LBM loss was associated with muscle strength impairment. Patients receiving CCRT experienced significantly larger LBM loss than patients receiving radiation alone. Registered on clinincaltrials.gov (Identifier: NCT05890859).

Endoscopic Ultrasonography-Guided Biliary Drainage: Experience of a Moroccan Center

Background: Endoscopic ultrasound-guided biliary drainage (EUS-BD) is a relatively new therapeutic modality in the arsenal of endoscopists for attaining satisfactory biliary drainage when traditional ERC fails. The aim of our study is to describe the first Moroccan experience with EUS-BD in patients with malignant biliary obstruction after a failed or inaccessible ERCP. Methods: This is a retrospective study conducted at Ibn Sina Hospital, from Mars 2018 to July 2022, which include 27 patients with an inoperable or metastatic malignant biliary obstruction who underwent endoscopic ultrasonography-guided biliary drainage (EUS-BD) in case of endoscopic retrograde cholangiopancreatography (ERCP) failure. Results: From a total of 288 patients with malignant biliary obstruction,27 underwent EUS-BD (9,3%), 15 EUS-guided hepaticogastrostomy (55,5%) and 12 EUS-guided choledocoduodenostomy (44,4%) were performed. The mean age was 62.5 years (age range: 23-74 years), a male predominance of 59% was noted, cholestatic jaundice was present in 100% of patients and associated with pruritus in 92.59% of cases. The mean level of Total Bilirubin was 190 mg/l. The causes of biliary obstruction were: an inoperable pancreatic head mass in 13 patients(48,1%), a cholangiocarcinoma in 7 patients (25.9%), an ampullary mass in 4 patients(14,8%), a gallbladder cancer with hepatic and duodenal invasion in one patient (3,7%), a gastric antropyloric adenocarcinoma with pancreatic head invasion in one patient (3,7%) and Duodenal adenocarcinoma in one patient (3,7%).The leading causes of failed ERCP were secondary to tumor infiltration of the duodenal wall and critical duodenal stenosis in 11 cases (40,7%), in 9 cases due to a difficult cannulation (33.3%) and in 7 cases due to a failure to pass the stricture by ERCP (25.9%). In EUS-HG The technical and the clinical success rates were 86.6% (13/15) and 84.6% (11/13), respectively, the complication rate was 13.3% (2/15) including one case of stent migration complicated with bile leak and one case of cholangitis. In EUS-CD The technical and the clinical success rates were 91.6% (11/12) and 81.8% (9/11)), respectively, the complication rate was 16.6% (2/12) including two cases of cholangitis. The technical and the clinical success rates in all EUS-BD were 85.1% (24/27) and 83.3% (20/24), respectively. The complication rate was 14.8% (4/27). Conclusion: EUS-BD appears to be an effective and safe therapeutic option for biliary decompression in cases where ERCP fails.

Applications of indocyanine green (ICG) fluorescence technology in open surgery: preliminary experience in pediatric surgery.

Indocyanine green fluorescence technology (ICG) in pediatric minimally invasive surgery has undergone an important improvement in the last 5 years. However, its use in open surgery is still limited. In this paper, we aim to report our preliminary experience with Rubina® lens ICG fluorescence technology in combination with the IMAGE1 S™ system from KARL STORZ in open excision of masses in children. The records of 18 patients undergoing open surgery for head, neck and thorax masses between September and November 2022 were retrospectively reviewed. Rubina® lens ICG fluorescence technology system was used in all the cases. In 10 cases we adopted the holding arm system and in 8 cases the hand-held technique. Data about patients' demographics, surgery and outcomes were collected and analyzed through the following criteria: mass localization, intraoperative time (min), ICG administration (ml), intraoperative complications, postoperative complications. A total of 18 patients were operated: 4 thyroglossal duct cysts, 3 supraorbital cysts, 2 neck masses, 2 pre-auricular and 2 scalp cysts, 2 gynecomastias, 2 lymphangiomas, 1 nose mass. In all the cases, intralesional injection of 0.5-1 ml of ICG solution was performed peri-operatively. Mean operative time was 58.4 min (35-134 min). Postoperative complications included seroma formation in 2 cases. Surgical pathology reports confirmed complete mass excision in all the cases. Based on our preliminary experience, ICG fluorescence guided surgery using Rubina® lens system was very helpful also in open surgery procedures. Rubina® lens system permits to have a very low complication rate, a time-saving surgery, a real time reliability of anatomic structures and an excellent clinical safety. In our experience, holding arm system seems more comfortable than hand-held system. However, further cases need to be performed to evaluate the exact role and to identify new indications of this technique in open pediatric surgical procedures.

Unusual Initial Presentation of Hepatocellular Carcinoma as a Clavicular Head Mass

Unusual Initial Presentation of Hepatocellular Carcinoma as a Clavicular Head Mass

Endoscope-Assisted Hairline Approach for Head and Neck Masses: A Review.

Conventional surgery through a transcervical incision is indicated for the treatment of certain tumors in the head and neck. However, this method can cause multiple problems, including scarring and cosmetic concerns. The endoscope-assisted hairline approach, which serves as an alternative to conventional surgical procedures, is gaining popularity due to its excellent cosmetic and functional outcomes. However, given the anatomical complexity involved, the endoscope-assisted hairline technique is not frequently employed in head and neck surgery. The evolution of the hairline surgical approach has been influenced by changes in disease conditions and recent advances in surgical tools. This review article discusses the use of endoscope-assisted hairline approaches in the resection of head and neck masses, focusing on the surgical procedure and postoperative clinical outcomes.

Case of Treatment of Solid Pseudopapillary Pancreatic Tumor

Introduction. A solid pseudopapillary pancreatic tumor accounts for less than 3 % of all pancreatic tumors. It is more common in young women aged 20 to 30. The prognosis for this pathology is favorable. Complete removal of the tumor leads to full recovery in more than 85 % of patients. Materials and methods. The paper presents a clinical case which demonstrates the surgical outcome of a patient with a malignant pancreatic tumor. Patient M., female, born in 1998, underwent inpatient treatment at the I.K. Akhunbaev Clinic of National Hospital, Kyrgyzstan, from January 12, 2015 to January 26, 2015 with a clinical diagnosis — pancreatic head mass, which was found intraoperatively. Due to this, the decision was made to expand the scope of the surgery. Histopathological examination revealed a solid pseudopapillary tumor. Results and discussion. This tumor is extremely rare and is usually detected accidentally during preventive examinations, or when the tumor becomes large. Against the background of treatment, the dynamics of observation for 7 years revealed no signs of progression and relapse of this pathology. Conclusion. Solid pseudopapillary tumor is a rare, highly differentiated malignancy, which develops most oft en in young women. It is characterized by a relatively favorable clinical course, which is demonstrated by this case report.

Geometric and Inertial Properties of the Pig Head and Brain in an Anatomical Coordinate System.

Porcine models in injury biomechanics research often involve measuring head or brain kinematics. Translation of data from porcine models to other biomechanical models requires geometric and inertial properties of the pig head and brain, and a translationally relevant anatomical coordinate system (ACS). In this study, the head and brain mass, center of mass (CoM), and mass moments of inertia (MoI) were characterized, and an ACS was proposed for the pre-adolescent domestic pig. Density-calibrated computed tomography scans were obtained for the heads of eleven Large White × Landrace pigs (18-48kg) and were segmented. An ACS with a porcine-equivalent Frankfort plane was defined using externally palpable landmarks (right/left frontal process of the zygomatic bone and zygomatic process of the frontal bone). The head and brain constituted 7.80 ± 0.79% and 0.33 ± 0.08% of the body mass, respectively. The head and brain CoMs were primarily ventral and caudal to the ACS origin, respectively. The mean head and brain principal MoI (in the ACS with origin at respective CoM) ranged from 61.7 to 109.7kgcm2, and 0.2 to 0.6kgcm2, respectively. These data may aid the comparison of head and brain kinematics/kinetics data and the translation between porcine and human injury models.