A distal pancreatectomy for osteoclast-like giant cell tumor of the pancreas was performed on a 66-year-old male 9 years ago (1999). He has since been followed-up monitoring imaging and tumor markers. In February 2008, his serum CA19-9 level was elevated, which suggested the recurrence of pancreatic cancer. PET/CT, as well as FDG accumulation, disclosed a mass lesion at the head of the pancreas. Based on these findings, he was diagnosed with pancreatic cancer [T4 (TS2, CH (-), DU (-), S (+), RP (+), PV (+), A (-), PL (-), OO (-)) N2M0, Stage IVb]. A pancreatoduodenectomy was begun, however, it was aborted because of macroscopic invasion into nerve plexuses around the celiac artery. Chemotherapy using gemcitabine was then started on this patient.
This is quite a rare case in which pancreatic cancer (tubular adenocarcinoma) developed 9 years after the resection of another pancreatic cancer (giant cell carcinoma of osteoclast) type.

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A 49-year-old male presented at the emergency clinic by ambulance with sudden abdominal and back pain. Strong tenderness in the entire right abdomen and a tumor mass in the right upper abdomen were felt, while an abdominal CT showed the presence of a wide range of hematomas in the retroperitoneum and a 3D-CT showed a pancreaticoduodenal arterial aneurysm. When conducting an abdominal angiographic examination for the purpose of intensive examination and treatment for the aneurysm, superior mesenteric arteriography showed an aneurysm measuring 8mm in diameter in the arcade between the anterior inferior pancreaticoduodenal artery and the anterior superior pancreaticoduodenal artery. Therefore, TAE with central/peripheral bilateral obstruction and a central focus on the aneurysm was performed. CT after TAE showed the elimination of the aneurysm, and subsequently, there has been no reoccurrence of bleeding and he is currently being managed by ambulatory follow-up. Pancreaticoduodenal arterial aneurysms are rare and reported to account for about 2% of all aneurysms in the abdominal viscera. Recently, with the advances in IVR, there have been more treatment reports of TAE being less invasive than regular surgical treatment. This time, we experienced 1 case in which TAE for a pancreaticoduodenal arterial aneurysm rupture was able to arrest the hemorrhage and save the patient's life. This report suggests that for aneurysms, such as the one observed in this case, it is necessary to consider the hemodynamics and vessel diameter in the obstruction of peripheral vessels, and to also select a larger coil. We have also added a discussion regarding these points to our findings.

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Acinar cell carcinomas (ACCs) of the pancreas are rare pancreatic neoplasms. At the time of detection, ACCs measuring less than 2cm are very uncommon.
When a 61-year-old female first visited a neighboring clinic, a low-echoic/low-attenuated mass in the body of the pancreas, 15mm in diameter, was detected by ultrasound (US)/enhanced CT. A return visit two years later showed that the mass increased to 3cm at which point the patient refused to undergo surgery. Three a half years after her first visit, she was seen in our institution and was informed that the mass had grown to 7cm. At this point she finally underwent surgery. We considered the tumor to be rather malignant, because she died with multiple liver metastases 5 months after the operation. The final histologic diagnosis, determined immunohistochemically, was mixed acinar-endocrine carcinoma of the pancreas.
Although a low-echoic/low-attenuated mass less than 2cm present, identified by US or CT and mimicking a cystic lesion, in the pancreas is commonly followed up, we highly recommend advancing to dynamic CT, MRI, EUS, and/or PET because of the possibility of the early stage of a solid neoplasm like ACC.

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A 49-year-old woman visited our hospital because upon screening, PET imaging showed increased fluorodeoxyglucose uptake in the pancreas tail. CT scan and MR imaging revealed a 1cm solid tumor mass in the pancreas tail. No cysts or calcifications were identified. Serum levels of tumor markers and endocrine hormones were within normal levels. We performed distal pancreatectomy because of suspicious pancreatic cancer. On histological examination, we identified small and uniform tumor cells with eosinophilic cytoplasm having a solid growth pattern. Immunohistochemical staining showed that tumor cells were positive for α1-antitrypsin, CD10, NSE and CD56, and negative for synaptophysin and Chromogranin A. We diagnosed this case as a solid pseudopapillary neoplasm (SPN). A small SPN having no calcification or cyst is difficult to distinguish from pancreatic cancer. Since small SPN can have a high uptake of FDG, PET imaging is not useful for the differential diagnosis from pancreatic cancer.

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