ДВА СЛУЧАЈА ПОЛИПЕПТИДНОГ ТУМОРА ГЛАВЕ ПАНКРЕАСА ОД КОЈИХ ЈЕ ЈЕДАН С ЦЕНТРАЛНОМ ШУПЉИНОМ КОЈА ЈЕ ФИСТУЛИЗИРАЛА У ДУОДЕНУМ

Abstract

PP omas are rare, usually malignant tumours of the PP cells of the Langerhan’s islets which secrete pancreatic polipeptide. The autors present two women operated for PP-omas of the pancreas. The first was 55 year-old woman in whom we did a cephalic duodenopancreatectomy (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 Chromogramin 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. Folowing 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.