MULTIPLE MYELOMA AND PANCREATIC MASS: ARE WE RELATED?

Filipe Taveira, Daniel Brito, Paula César, Carlos Faria, Graça Fernandes, Ana Teresa Cadime

A 49-year-old male with the diagnosis of an IgG kappa Multiple Myeloma (MM) with two years evolution with clinical stability and no extramedullary involvement is referred to our department after a follow-up CT-scan showing two pancreatic lesions suspicious for malignancy. EUS with FNA was performed. Both pancreatic lesions were confirmed: in the dependence of the pancreatic tail a hypoechogenic nodular lesion, heterogeneous of ill-defined contours, with 27mm, richly vascularized (A); and in the head of the pancreas/uncinate process, another hypoechogenic nodular lesion, poorly defined, vascularized, with 25mm (B). FNA performed in the cephalopancreatic lesion (C). The cytological analysis shows cells in different stages of differentiation, nuclear pleomorphism and immunoexpression to CD138, compatible with MM (D). Therefore, the diagnosis of pancreatic involvement of MM was made. This represents an exceptionally rare presentation of MM, usually presenting with secondary lesions in other organs rather than the pancreas.

WHEN A SIMPLE TOOL MAGICALLY DETECTS A RARE LESION

Diana Ramos, Eduardo Pereira, Ana Caldeira, Marisa Linhares, Flávio Pereira, António Banhudo

Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal

A 35-year-old presented with abdominal pain, weight loss and anemia(6.1g/dL). After a normal esophagogastroscopy, an abdominal ultrasound revealed an irregular parietal thickening of the jejunum, with imprecise external limits, aspects that suggested a neoplastic nature (Fig1-2). This thickening was better defined after administration of oral contrast (water). Several adenopathies have also been observed(Fig3). After a CT (Fig4) has demonstrated a probable neoplasic lesion of the small bowel, the patient underwent a segmental resection and the anatomopathological evaluation revealed a schwannoma of the small bowel. In this case, a simple abdominal US with oral contrast easily detected an important change and contributed to an early patient orientation. Schwannomas are tumors that rarely develop in the gastrointestinal tract. Usually diagnostic resection and immunostaining is needed for accurate diagnosis. Although small bowel schwannomas are rare, it is important to consider them as a differential diagnosis of neoplasms of the small intestine.

PANCREATIC MASS UNDER INVESTIGATION: A RARE AND SURPRISING DIAGNOSIS

Diana Ramos, Ana Caldeira, Eduardo Pereira, Marisa Linhares, Flávio Pereira, António Banhudo

Gastrenterology departement, ULS Castelo Branco

A 56-years old female was referred for endoscopic ultrasound(EUS) to study a pancreatic mass which was accidentally found on an abdominal ultrasound (Fig1). An EUS was performed and documented a heterogeneous mass with 40x30mm and ill-defined limits(Fig2). The elastographic study reflected soft elasticity pattern (Fig3). EUS-FNA was performed. The smear was negative for screening for neoplastic cells and revealed mature adipocytes, which fit in the context of angiomyolipoma(AML). Subsequent CT also suggested the same diagnosis (Fig4). AML usually occurs in the kidney and liver but can involve, rarely, other locations. Pancreatic AML is extremely rare and it should be included in the differential diagnosis of a pancreatic mass. The majority of AMLs are benign and asymptomatic, but examples of malignant behaviour or complications (bleeding/rupture) have been described. Owing to very few pancreatic AML reports, no ideal management has been established. Reporting of such cases is essential to delineate its natural history.