2. case female 75 yrs old U/D asthma , T2DM , HT
Hx 28/10/65 3 วัน PTA มาด ้วยปวดท ้องใต ้ชายโครงด ้านขวา ไข ้สูง
หนาวสั่น ตัวเหลือง
Dx : acute cholangitis ได ้ work up CT upper : CBD stone ,
2.7x5.9x3.4-cm mass at tail of pancreas , 1.8x0.8x1.8-cm lesion at
mid/lower pole Rt kidney and a 1.0x1.1x1.0-cm lesion at lower pole of
left kidney ได ้ทา ERCP : finding multiple CBD stone , GS s/p EST,
balloon extraction
4. CT 17/11/65
- Suspected a 1.0x1.0-cm enhancing lesion at distal CBD/ ampulla/head of pancreas
causing diffuse CBD dilatation and mild proximal IHDs dilatation, probably
periampullary cancer. Tissue or further investigation is advised.
- Diffuse thicken enticing wall of CBD, probably cholangitis or infiltrative lesion. -
Suspected air in bilateral IHDs.
- A 2.7x5.9x3.4-cm lobulated enhancing lesion at pancreatic tail. Further
investigation is advised.
- A 1.8x0.8x1.8-cm heterogeneous enhancing lesion at mid/lower pole of right
kidney and a 1.0x1.1x1.0-cm heterogeneous enhancing lesion at lower pole of left
kidney, probably metastasis; DDx RCC.
- Non-visualized uterus, probably post surgery.
- Several diverticula at hepatic flexure and sigmoid colon without CT evidence of
acute diverticulitis.
- Few subcentimeter nodes at periportal, portocaval and peripancreatic regions.
- Few centilobular nodule at lateral basal segment of LLL.
- Grade I spondylolitheiss of L5 over S1.
5.
6. mass at tail of pancreas
• นึกถึง pancreas NET
• Operation : lap distal pancreatectomy with splenectomy with
cholecystectomy 16/2/66
7. Pathology
• 1. GALLBLADDER (CHOLECYSTECTOMY):
- Chronic cholecystitis
- No neoplasm involvement
2. MASS, PANCREATIC BODY (DISTAL PANCREATECTOMY
AND SPLENECTOMY):
- Atypical epithelioid cell neoplasm, pancreas. SEE
COMMENT.
- Tumor size 6.1 cm in the greatest dimension
- All surgical margins are negative including pancreastic
resection and circumferential margin
- Tumor invade peripancreatic fat
- Spleen with no significant pathologic change and no
malignancy involement
- Omentum without malignancy involement
- All 6 lymph nodes without malignancy involvement
- Mitoses 5/2mm. Square.
IHC
ANTIBODY RESULT
AE1/AE3 Weakly positive, dot-like
ChromograninA Patchy positive
Synaptophysin Positive
Ki67 Positive, ~10%
Conclusion : Consistent with
Neuroendocrine tumor, grade 2.
8. Onco med
Clinicopathological diagnosis: pNET grade 2
Staging: stage II (T3N0M0)
PS: good with preserved organ function
Aim: curative intent
Treatment option:
-Surveillance : CT WA สค 66
