Spontaneous rupture of the splenic metastasis in acinar cell carcinoma

Rupture of small cystic pancreatic neuroendocrine tumor with many microtumors

Pancreatic neuroendocrine tumors (pNETs) are particularly rare. The various forms of PNETs, such as cystic degeneration, make differentiation from other similar pancreatic lesions difficult. We can detect small lesions by endoscopic ultrasound (EUS) and obtain preoperative pathological diagnosis by EUS-guided fine needle aspiration (FNA). We describe, here, an interesting case of pNET in a 42-year-old woman with no family history. Computed tomography and magnetic resonance imaging revealed an 18 mm × 17 mm cystic lesion with a nodule in the pancreatic tail. Two microtumors about 7 mm in diameter in the pancreatic body detected only by EUS, cystic rim and nodules all showed similar enhancement on contrast-harmonic EUS. Preoperative EUS-FNA of the microtumor was performed, diagnosing multiple pNETs. Macroscopic examination of the resected pancreatic body and tail showed that the cystic lesion had morphologically changed to a 13-mm main nodule, and 11 new microtumors (diameter 1-3 mm). Microscopically, all microtumors represented pNETs. From the findings of a broken peripheral rim on the main lesion with fibrosis, rupture of the cystic pNET was suspected. Postoperatively, pituitary adenoma and parathyroid adenoma were detected. The final diagnosis was multiple grade 1 pNETs with multiple endocrine neoplasia type 1. To the best of our knowledge, no case of spontaneous rupture of a cystic pNET has previously been reported in the English literature. Therefore, this case of very rare pNET with various morphological changes is reported.

Splenic rupture due to metastatic disease: a rare complication

We report a case of splenic rupture in an 83-year-old woman presenting with symptoms concerning for upper gastrointestinal malignancy. CT imaging revealed marked gastric thickening and a 33×33 mm splenic metastasis, with subsequent gastroscopy demonstrating a large lesion at the gastro-oesophageal junction. While awaiting further investigation, the patient developed acute onset left upper quadrant pain, peritonism and hypovolaemic shock. Urgent CT imaging demonstrated a ruptured spleen with extensive haemoperitoneum, necessitating emergency splenectomy.

Tonsillar carcinoma metastatic to the spleen presenting as trauma: a case report

BACKGROUND

Cancers of the head and neck rarely metastasize to the spleen. To the best of our knowledge, there is no reported case of a tonsillar carcinoma metastasizing to the spleen.

METHOD AND RESULTS

This patient had a splenic capsular rupture likely related to his metastases that presented as a traumatic splenic injury. The patient had received neoadjuvant chemotherapy followed by concurrent chemoradiotherapy. Two months after completion of radiotherapy, he fell out of bed. The next day he had acute abdominal pain and hypotension. CT findings were consistent with splenic rupture, and he underwent splenectomy. Pathologic assessment of the specimen showed metastatic SCC.

CONCLUSION

New splemic lesions in patients with head and neck cancer should be investigated.

Spontaneous rupture of a pancreatic acinar cell carcinoma presenting as an acute abdomen

INTRODUCTION

Pancreatic acinar cell carcinoma is a rare malignant pancreatic neoplasm. To the best of our knowledge, there has been no report on spontaneous rupture of acinar cell carcinoma.

PRESENTATION OF CASE

A 39-year-old Azari male presented with a history of sudden onset, acute epigastric pain of 12-h duration. Eight hours later the patient's general condition rapidly deteriorated, blood pressure was decreased to 90/70mm/Hg and heart rate was increased to 120beat/min. Emergent abdominal computed tomography scan showed a well-defined hypo-dense, necrotic mass, measured 12cm×12cm that was originating from the uncinate process of pancreas with marked free peritoneal fluid and extensive haziness of retroperitoneal and mesenteric fat compatible with marked bleeding. Emergent abdominal operation was performed and histopathology revealed acinar cell carcinoma of the pancreas.

DISCUSSION

Pancreatic acinar cell carcinoma (ACC) usually presents with abdominal pain, nausea and vomiting. To best of our knowledge, no report has been made of spontaneous rupture of ACC.

CONCLUSION

Pancreatic carcinoma may present as acute abdomen due to rupture of underlying neoplasm.