Cystic islet cell tumors of the pancreas. A clinico-pathological report of two nonfunctioning cases and review of the literature.

Cystic islet cell tumors of the pancreas are extremely rare. The authors report their personal experience with two cases of nonfunctioning cystic endocrine neoplasms. The tumor was diagnosed preoperatively in one case by ultrasonography (US)-guided fine-needle aspiration cytology, while in the other it was identified only in the surgical specimen after a clinical-radiologic diagnosis of pancreatic mucinous cystic tumor. Immunohistochemical assay showed positivity for the generic neuroendocrine markers (neuron specific enolase, or NSE, synaptophysin, and chromogranin A) in both cases and also for glucagon in one case. The neoplasms were resected by distal pancreatectomy with splenectomy and intermediate pancreatectomy respectively. Both patients are alive and recurrence-free 6 mo and 2.5 yr, respectively, after surgery. The authors also review the existing literature, discussing the pathogenesis of such tumors and the imaging techniques and surgical strategies adopted in their management

Comparison between conventional radiography and Thoravision in the study of the normal chest

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Relationship between visceral fat, steroid hormones and insulin sensitivity in premenopausal obese women.

OBJECTIVES: The relationships between visceral fat distribution, steroid hormones and peripheral insulin sensitivity were studied. SETTING: All subjects were hospitalized in the Institute of Internal Medicine of the University of Verona, Italy. SUBJECTS: Nineteen fertile obese women were studied with ages ranging from 18 to 53 years and body mass indexes ranging from 27.3 to 48.4. INTERVENTION: Body fat distribution was evaluated by waist-to-hip circumference ratio and by computed tomography. The insulin tolerance test was used to evaluate peripheral insulin sensitivity. Glucose, insulin and C-peptide were measured in fasting conditions and during glucose load; total and free plasma testosterone and urinary cortisol excretion were also determined. RESULTS: Significant correlations emerged between visceral adipose tissue and fasting glucose, insulin, and C-peptide, but not between visceral adipose tissue and total testosterone, free testosterone or urinary cortisol excretion. A negative correlation emerged between visceral adipose tissue and insulin sensitivity (r = -0.70; P < 0.01). No significant correlations were found between insulin sensitivity and age, body weight, body mass index, total adipose tissue, subcutaneous adipose tissue or waist-to-hip ratio. Total testosterone correlated with body weight, subcutaneous adipose tissue and total adipose tissue. Free testosterone and urinary cortisol excretion correlated positively with body weight, and negatively with age. No correlation was found between insulin sensitivity and total testosterone, free testosterone or urinary cortisol excretion. The correlation between visceral adipose tissue and insulin sensitivity remained significant even after adjusting for both age and the body mass index. CONCLUSIONS: Our study shows that visceral fat is more closely associated with aberrations of insulin sensitivity than with obesity itself. Total testosterone, free testosterone and urinary cortisol excretion in our subjects do not seem to be associated with such aberration

Interrelationships between weight loss, body fat distribution and sex hormones in pre-menopausal and post-menopausal obese women.

OBJECTIVES: Relationships between regional body fat distribution and sex hormones as well as changes in sex hormones after weight loss were evaluated. SETTING: All subjects were hospitalized in the Institute of Internal Medicine of the University of Verona. SUBJECTS: Twenty-six premenopausal (age 33.7 +/- 10.2 years) and 15 postmenopausal (age 57.9 +/- 5.9 years) obese women. INTERVENTIONS: Body weight, body-mass index, waist and hip circumferences, visceral fat by computed tomography and sex hormones were evaluated before and after 4 weeks on a very low energy diet. RESULTS: Body-mass index was higher in pre-than in postmenopausal women, although the difference was not significant. Total and free testosterone were significantly higher in the pre- than in the postmenopausal group (P < 0.001). Significant negative correlations were found between age and total testosterone (r = -0.65; P < 0.001), free testosterone (r = -0.54; P < 0.001), androstenedione (r = -0.46; P < 0.01) and urinary cortisol excretion (r = -0.50; P < 0.01). A negative correlation was found between visceral fat and total testosterone (r = -0.41; P < 0.01). After adjusting for age, the negative correlation between total testosterone and visceral fat encountered both in the subject group as a whole and in premenopausal women was no longer significant, whilst a significant negative association between visceral fat and sex hormone binding globulin (SHBG) (r = -0.56; P < 0.001) was always found. When step-down regression analysis was used to evaluate the joint effect of age, menopausal status, and anthropometric and metabolic variables on sex hormones, age was the most powerful independent variable for predicting total testosterone, free testosterone and androstenedione levels, whilst menopausal status was the most powerful predictor of FSH and LH levels. Changes in hormones after VLED were analysed separately in pre- and postmenopausal women. None of the hormones changed significantly after VLED in the postmenopausal group, except for FSH values. LH, free testosterone and urinary cortisol excretion values decreased significantly after VLED in the premenopausal group. CONCLUSIONS: Our data show that age, to a greater extent than visceral fat, seems to be negatively associated with steroid sex hormones. Weight loss seems to be associated with changes in sex hormones only in premenopausal women

Spontaneous rupture of a pancreatic pseudocyst into the portal vein

Spontaneous rupture of a pancreatic pseudocyst into the portal vein is described. This has been previously reported in only five cases. Diagnosis was made by computed tomography (CT) and was confirmed by CT-guided transhepatic portography

Cystic dystrophy of the duodenal wall: radiologic findings

PURPOSE: To determine the radiologic characteristics of cystic dystrophy of the duodenal wall. MATERIALS AND METHODS: Ten patients with cystic dystrophy of the duodenal wall and chronic pancreatitis underwent ultrasonography (US) (n = 10), computed tomography (CT) (n = 10), endoscopic US (n = 5), and endoscopic retrograde cholangiopancreatography (ERCP) (n = 9). Cystic dystrophy of the duodenal wall was classified as either cystic or solid. The imaging findings were retrospectively analyzed and compared with findings at pancreatoduodenectomy (n = 10). RESULTS: The more frequent cystic type (n = 7) of cystic dystrophy of the duodenal wall was characterized by the presence of easily recognizable cystic lesions (diameter, more than 1 cm), located within the thickened wall of the second portion of the duodenum. The solid type (n = 3) of cystic dystrophy of the duodenal wall demonstrated fibrous thickening of the duodenal wall within which small cysts (diameter, less than 1 cm) were present. The intraduodenal cysts were usually elongated or bilobate with a thick wall. The thickening of the duodenal wall appeared as a solid layer between the duodenal lumen and the pancreas, hypoechoic at US, isoattenuating at unenhanced CT, and hypoattenuating in the early phase (after initiation of infusion of contrast material) and isoattenuating in the late phase (after completion of infusion) at contrast material-enhanced CT. Findings at retrospective analysis of CT and endoscopic US images were characteristic. CONCLUSION: Imaging modalities, notably CT and endoscopic US, helped establish the diagnosis of cystic dystrophy of the duodenal wall