Two pp-omas of the head of the pancreas one of which with central necrosis fistulated into the duodenum

Abstract

PP omas are rare, usually malignant tumors of the PP cells of the Langerhan¢s islets which secrete pancreatic polipeptide. The authors present two women operated for PP-omas of the pancreas. The first was 55 year-old woman in whom we did a cephalic duodenopan-createctomy (Whipple's procedure) for the tumor of the head of the pancreas with central cavity containing gas due to comunication with the duodenum. Imunohistochemistry showed a PP oma with strong generalised immunoreactivity with antibodies against Chromogra-min A, neuron specific enolasa and PP with more the 95% of tumor cells and coexpression of somatostatine in 35% and VIP in less then 5% of tumor cells. Following uneventful recovery the patient stayed symptom free so far and put 20 kilograms in weight. The second patient was 19 year-old girl with a multinodal tumor of almost the entire pancreas in whom a local excision of the nodal mass of the head of the pancreas had been carried out in the other hospital, three years ago and relaparotomy and tumor biopsy a month before admission to our institution. In her we did a total duodenopancreatectomy and standard limphadenectomy for a multinodal mass ocupying almost the entire pancreas. Immunohistochemistry showed a strong generalised immunoreactivity with antibodies agains Chromographin A, Neuron speciphic enolasa and PP for more then 95% of tumor's cells. Glucagon was expressed in few focuses (in less then 1% of cells), somatostatin was expressed very rarely in single cells while the rest of tumor markers did not show a visible immunologic reactions in the majority of tumor's cells. Three years after surgery she died due to multiple liver secondaries.

Keywords

• PP-oma
• duodenum
• fistula
• duodenopancreatectomy