D.*, * Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil, † Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil. “
“Pancreatic tumors are an unusual cause of acute or relapsing pancreatitis. For example, in acute pancreatitis, tumors are identified as the underlying abnormality in only 1% of patients. However, this frequency may increase to 5% if modes of presentation are analyzed in patients with known pancreatic neoplasms. The presentation with acute or relapsing pancreatitis has been PI3K inhibitor well-described with carcinoma of the pancreas but other benign and malignant neoplasms can present in this way including cancer of the ampulla of Vater

and various solid and cystic neoplasms. When carcinoma of the pancreas presents with pancreatitis, inflammation is usually mild (90%) and relapses are common. The presentation with acute pancreatitis ALK inhibitor does not appear to influence prognosis. The cause of pancreatitis is presumably related to

duct obstruction but this risk is higher with acute obstruction (such as that caused by gallstones) than with the gradual onset of obstruction associated with neoplasms. The latter is often associated with pancreatic atrophy. In the patient illustrated below, relapsing pancreatitis was the mode of presentation of a solid pseudopapillary neoplasm of the pancreas. This may only be the second report of this association. The patient was investigated because of several episodes of abdominal pain over the preceding 3 months. With one episode of pain, her serum amylase and lipase increased to 874 and 1520 U/l, respectively. On examination, the only abnormality was mild tenderness in the epigastrium. A computed tomography scan showed a thick-walled cystic lesion, 5 cm in diameter, in the head of the pancreas with apparent internal debris (Figure 1). A subsequent endoscopic ultrasound study confirmed these findings and, in addition, showed hyperechoic internal solid projections. There was also dilatation of the main pancreatic duct and minor inflammatory changes in the body and tail of the pancreas. MCE A fine needle aspirate demonstrated

tufts of uniform, polygonal, epithelioid cells clinging to a myxoid stroma with a central capillary network (Figure 2). Immunostaining was strongly positive for β-catenin and negative for synaptophysin and chromogranin. The diagnosis of a solid pseudopapillary tumor of the pancreas was made and the patient was treated by pancreaticoduodenectomy. Her post-operative course has been uncomplicated and she has not had further episodes of abdominal pain. Contributed by “
“Using a case-control analysis, Chaiteerakij et al.[1] revealed that diabetes mellitus (DM) was associated with a 3.6-fold risk of developing intrahepatic cholangiocarcinoma (ICC) and that metformin use for DM reduced the risk of ICC by 60%. Furthermore, hyperlipidemia was found to be a protective factor against ICC. These findings are impressive, but may not be translated into the general population.

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