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Lymphangiomas of the pancreas are very rare benign tumors of lymphatic origin, accounting for less than 1% of these neoplasms. We report a case of a 55-year-old woman who presented with a palpable mass in the left abdomen. Abdominal sonography and computed tomography showed a lobulated, hypodense mass extending from the left diaphragmto the pelvis, measuring 10×25 cm. A preoperative diagnosis of mucinous cystadenoma of the pancreas was suggested and the patient underwent laparotomy. Distal pancreatectomy with splenectomy was performed, encompassing a segment of descending colon because of close relationship to the mass. The cystic mass was histologically diagnosed as lymphangioma of the pancreas. The patient is well and free of disease 12 months after surgery. Pancreatic lymphangioma should be kept in mind when a huge, multiloculated mass is encountered in the abdomen, especially in adult women. Although lymphangioma is considered a benign tumor, involvement of adjacent organs sometimes occurs and extended resection is required to obtain a radical treatment. [ABSTRACT FROM AUTHOR]

The most common cause of hyperinsulinaemic hypoglycaemia in adult is insulinoma. Although nesidioblastosis is a rare but well-recognized disorder of persistent hypoglycaemia in infants, it is extremely rare in adults.We present a case of a 59-year-old woman with small neuroendocrine tumour of the tail of the pancreas, diagnosed by CT scans and MRI, and hypoglycaemic syndrome. Laparoscopic distal pancreatectomy was performed, and pathologic examination showed a well-differentiated, non-functioning endocrine tumour of the pancreas and diffuse nesidioblastosis in the remnant gland. In the early postoperative period, recurrent hypoglycaemia occurred in spite of oral diazoxide therapy. Plasma proinsulin levels were extremely high. 18F-DOPA positron emission tomography showed a pathologic uptake of tracer in the head and the uncinate process of the pancreas. Subtotal pancreatectomy was suggested but the patient refused operation: she is taking diazoxide 100 mg three times daily. Coexistence of nesidioblastosis with a neuroendocrine tumour makes preoperative diagnosis and management of severe hypoglycaemia more difficult. Nesidioblastosis should be considered in differential diagnosis of hypoglycaemic syndrome, but histological examination is necessary for a definitive tissue diagnosis.

Context: Acinar cell carcinoma is a rare pancreatic malignant tumor, which can be associated with a particular manifestation: pancreatic panniculitis. It presents with erythematous subcutaneous nodules located mainly on the legs. The skin lesions can precede, be concurrent with or follow the pancreatic illness. The pathogenesis is not fully understood, but it is believed to be associated with high levels of serum lipase produced by the neoplasm, causing fat necrosis in tissues. The treatment of pancreatic panniculitis is directed at the underlying pancreatic disease, which may result in regression of the skin lesions. We report a case of pancreatic acinar cell carcinoma associated with subcutaneous panniculitis together with a review of the English literature., Case Report: A 79-year-old woman, with a 13-month history of acute pancreatitis, asthenia, weight loss, and the CT finding of a mass in the pancreatic head, presented complaining of multiple, migrant and painful subcutaneous nodules on her lower extremities. High serum lipase levels were also present. She underwent a pancreaticoduodenectomy, with subsequent regression of the skin lesions and normalization of her serum lipase levels. Histology revealed an acinar cell carcinoma of the pancreas. Liver metastases occurred six months after surgery, and the patient underwent chemotherapy with gemcitabine. She is still alive 14 months after the initial surgery., Conclusions: Although rare, the association between acinar cell carcinoma and pancreatic panniculitis has been described in the literature. In a patient with subcutaneous nodules, the presence of acinar cell carcinoma should be considered in order to prevent long delays in the diagnosis and treatment of this pancreatic malignancy.

Background: The aim of the present study was to evaluate maspin expression in bladder urothelial papillary neoplasms and test the results for correlation with clinicopathological parameters., Patients and Methods: A total of 111 urothelial neoplasms from 66 patients were evaluated: pathological examination of primary tumours disclosed 48 pTa and 18pT1. Fourteen additional biopsies, negative for neoplasm, were collected as control biopsies. For each of the 111 neoplastic samples and for the 14 control cases maspin and MIB1 immunoreactivity was evaluated. The immunohistochemical reactions of the 66 primary neoplasms were used for statistical analysis when the disease-free interval, presence and number of relapses, and progression of the disease were tested, whereas all of the 111 tumors were used when the association between the maspin pattern and histological grade and/or pT were evaluated. Thirty-three patients with primary pTa papillary neoplasms (68.7%) and 11 out of eighteen with pT1 (61%), had subsequent relapses of disease. For maspin immunoreactivity the presence/absence of nuclear staining and the pattern of staining were considered. Four patterns of reactivity were recognized and were used for statistical analyses., Results: A statistical association was found between the maspin pattern and pT, histological grade and nuclear staining., Conclusion: In papillary urothelial neoplasms, maspin has a pattern of distribution that is associated with the histological grade and pathological stage, and this probably reflects its different activities in the neoplastic process.

Background: Tumour angiogenesis is the result of an inbalance between anti- and pro-angiogenic factors. CD105 (endoglin) is a component of the receptor complex of transforming growth factor (TGF-beta1). Vascular endothelial growth factor receptor 2 (VEGFR2 or Flk-1/KDR) belongs to the high-affinity VEGF receptors. The aim of the study was to investigate the expression, cellular localization and role of CD105 and VEGFR2 in laryngeal carcinoma., Patients and Methods: Sections of 62 laryngeal carcinomas were stained with CD105 and VEGFR2/Flk-1/KDR antibodies., Results: A significant association between CD105 expression and locoregional recurrence was found (p = 0.009). Interestingly, in N0 patients CD105 expression was significantly associated with locoregional recurrence of the carcinoma (p = 0.03). The log-rank test showed a significant difference in the disease-free interval in patients stratified according to CD105 expression (p = 0.02). Statistical analysis showed no significant associations between vessel endothelial cell or laryngeal carcinoma cell VEGFR2 expressions and recurrence of disease or disease-free intervals., Conclusion: CD105 expression but not VEGFR2 expression correlated with carcinoma recurrence after treatment and shorter disease free interval. The CD105 expression may be useful to detect cervical node-negative patients with a higher risk of early laryngeal carcinoma recurrence.

Aim: Maspin is a unique serine proteinase inhibitor which has tumor suppressor activity. The aim of the present study was to investigate the role of maspin in ampullary adenocarcinomas, its correlation with apoptosis and its value as a prognostic marker., Patients and Methods: Twenty-three cases of ampulla of Vater adenocarcinoma were collected from archival material. For each sample, maspin, M30, p53 and Mib1 immunohistochemical reactivity were evaluated and results compared with clinicopathological parameters., Results: A statistical relation was found between nuclear maspin and M30 (Spearman's Q = 0.46, p = 0.02), and p53 (Kruskal-Wallis = 0.03); a trend was found between nuclear maspin and pT (Kruskal-Wallis = 0.09), and pM (Mann-Whitney = 0.08) and pN status (Fisher's mid-point test: p = 0.070)., Conclusion: The present study evaluated the role of maspin in ampullary adenocarcinomas and for the first time demonstrated its association with apoptosis, tumor growth and metastasis.

Background: MASPIN, a tumour suppressing serpin, is a potent inhibitor of angiogenesis. CD105 is a proliferation-associated protein acting in endothelial cells of angiogenic tissues. For the first time the relation between nuclear MASPIN expression and CD105-assessed micro-vessel density (MVD) in laryngeal carcinoma was investigated., Patients and Methods: The sub-cellular distribution of MASPIN and nuclear MASPIN expression were immunohistochemically determined in 35 cases of laryngeal carcinoma. The percentage of the fields occupied by CDl05-assessed micro-vessels was also calculated., Results: MVD was significantly lower in laryngeal carcinomas with MASPIN nuclear staining than in carcinomas with cytoplasmic staining (p=0.02). The mean nuclear MASPIN expression was higher in patients without carcinoma recurrence than in those with recurrence (p=0.06). The mean MVD was significantly higher in patients with recurrence of carcinoma (p=0.024)., Conclusion: The crucial role of MASPIN nuclear localization in reducing the MVD has been demonstrated. Nuclear MASPIN re-expression should be investigated as a potential therapeutic option in the treatment of laryngeal carcinoma.