The utility of endoscopic ultrasonography (EUS) in the diagnosis of pancreatic deseases has already been established, and EUS is thought to be an essential technique. Because electronic scanning type EUS produces the same or better B-mode images, electronic scanning type EUS will replace mechanical scanning type EUS in the near future. Furthermore, electronic scanning EUS can make full use of many software programs, such as, color/power Doppler flow imaging, three dimensional image, real time tissue elastography. In this report, we will give an outline about the various kinds of diagnostic imaging that have become possible using the electronic scanning type EUS.

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A disorder of the coagulation-fibrinolysis system was investigated retrospectively in patients with severe acute pancreatitis (SAP). On admission, the rates of coagulation-fibrinolysis factors were aberrantly high, especially those of Thrombin-antithrombin III complex (TAT) and D-dimer were 100%. Prothrombin-international normalized ratio (PT-INR) and TAT had significantly positive correlation with the Japanese severity score, and the platelet count had a significantly negative correlation. TAT concentration on admission was higher in patients of Stages 3&4;. Compared with survivors, PT-INR was significantly higher, and TAT tended to be higher in non-survivors. In patients with PT-INR ≥ 1.15 or TAT ≥ 45ng/ml on admission, the mortality rate was significantly higher. These results suggest that TAT may be a useful marker for the assessment of severity and prognosis in SAP.

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Pancreatic exocrine secretion in conscious rats is mainly regulated by protease activities in the duodenum. A decrease in protease activities by oral administration of trypsin inhibitors (TI)s produces pancreatic hypertrophy via cholecystokinin (CCK) release. Since luminal CCK releasing factor (LCRF), was purified from rat intestine, we determined whether the levels of LCRF, CCK, and protein secretion were synchronized with each other. Changes in pancreatic secretion, plasma CCK levels, and LCRF contents produced by 2- and 4-h bile-pancreatic juice diversion (BPJD), were determined in rats with 7-day TI treatment and compared with controls. The levels of LCRF and CCK changed in parallel. Pancreatic protein secretion was higher in rats treated with TI than in controls throughout the experimental period. The plasma CCK and luminal LCRF content 4-h after BPJD was significantly lower in rats treated with TI than in controls. The hypertrophied pancreas may require a smaller dose of CCK to increase protein secretion.

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A 69-year-old male was admitted to our hospital for examination of pancreatic tumor. Laboratory tests were normal except for an elevated CA19-9 level. Several images demonstrated a mass lesion measuring approximately 5cm in diameter in the pancreatic body. We preoperatively diagnosed pancreatic lymphoepithelial cyst (LEC), because the patient was male with an elevated CA19-9 level and multilocular cysts that included keratinous debris. The patient underwent enucleation of the tumor. Pancreatic LEC is a comparatively rare disorder, and most tumors are surgically removed without preoperative diagnosis. Pancreatic LEC without symptoms is discovered during follow-up for other conditions. For the diagnosis of pancreatic cystic disease, it is important to consider not only the shape but also the gender and contents of the cyst.

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We analyzed the pathological features and sites of recurrence after pancreatectomy for invasive ductal carcinomas of the pancreas in 4 autopsied patients who died more than 5 years after their surgical resection. Pathological staging was Stage III in 2 patients and IVb in 2. The status of the residual tumor after surgery was R0 in 3 and R1 in one. The histological type was tubular adenocarcinoma in 3 cases and mucinous carcinoma in one. Autopsy findings demonstrated local recurrence and lung metastasis in all patients and liver metastasis in 3, peritoneal dissemination in 3, and other distant metastases in 3, suggesting the incidence of lung metastasis may increase in long-term survivors after pancreatectomy. These findings indicate that the risk of recurrence remains even though patients survive more than five years after surgery and that follow-up examination, including chest X-ray, because of the possibility of lung metastasis, should be continued.

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We report a case of pancreatic pleomorphic carcinoma. A 71-year-old man with obstructive jaundice and liver dysfunction was admitted to our hospital. Computed tomography showed a low density tumor measuring 30mm in diameter at the uncus of the pancreas. Magnetic resonance imaging revealed stenosis in the lower bile duct. Pylorus preserving pancreaticoduodenectomy, and partial resection of the liver were performed. The resected specimen was a soft tumor with partial necrosis; the cut-surface was yellowish white. The tumor showed expansive growth comprising various amounts of solid proliferated pleomorphic mononucleated or multinucleated malignant cells. The diagnosis was pleomorphic carcinoma of the pancreas. The postoperative course was good, but the patient died from liver failure one month after the operation.

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A 76-year-old man was admitted because of a large cystic lesion detected by ultrasonography. Contrast computed tomography demonstrated a low cystic lesion with a nodular enhanced mass in the body of the pancreas and an enhanced mass in the right lobe of the liver. Endoscopic retrograde pancreatography showed an obstruction of the main pancreatic duct in the body of the pancreas. MRI detected the cystic lesion as a hyperintense mass on T2-weighted imaging. Angiography demonstrated the tumor in the body of the pancreas and in the liver. Distal pancreatectomy and splenectomy were performed. Histological examination revealed invasive intraductal tubular carcinoma with a large bloody cystic lesion, and the sequence of intraductal tubular adenoma to carcinoma.

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