AAAAA
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51 year-old male presented with Diabetics. He weighs 140 lbs, presents with jaundice, 15 pounds wt loss and migratorythrombophlebitis. P. E. revealed palpable gallbladder on deep palpition.
What is the diagnosis ?
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More important, how do you make the diagnosis ?
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What is the treatment ?
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(Remember thin man in 50's developed Diabetics)
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| focussed
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Diagnosis: Pancreatic Cancer(head)
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| focussed
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Pancreatic cancer..probably glucagonoma
T/t :Surgery
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| jmn
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pancreatic cancer
Dx: Abd CT Scan
Tx: ERCP w Stent if Metastasis, can't do Sx
or Sx : Whipple?
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| achilles
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its glucagonoma.
Dx-CT scan
Rx-surgery is definitive. medical Mx-octreotide.
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| AAAAA
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Excellent !
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| karusmle
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is it glucagonoma or pancreatic cancer ,AAAA CAN U PLZ EXPLAIN IT
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| karusmle
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can migratory thrombophlebitis come in glucagonoma too???
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| AAAAA
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Smoking and health history can affect the risk of developing pancreatic cancer.
The following are possible risk factors for pancreatic cancer:
Smoking. Long-standing diabetes. Chronic pancreatitis. Certain hereditary conditions, such as hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical multiple mole melanoma syndrome (FAMMM).
Possible signs of pancreatic cancer include jaundice, pain, and weight loss.
These and other symptoms may be caused by pancreatic cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
Jaundice (yellowing of the skin and whites of the eyes). Pain in the upper or middle abdomen and back. Unexplained weight loss. Loss of appetite. Fatigue.
Pancreatic cancer is difficult to detect (find) and diagnose early.
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| AAAAA
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Smoking and health history can affect the risk of developing pancreatic cancer.
The following are possible risk factors for pancreatic cancer:
Smoking. Long-standing diabetes. Chronic pancreatitis. Certain hereditary conditions, such as hereditary pancreatitis, multiple endocrine neoplasia type 1 syndrome, hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome), von Hippel-Lindau syndrome, ataxia-telangiectasia, and the familial atypical multiple mole melanoma syndrome (FAMMM).
Possible signs of pancreatic cancer include jaundice, pain, and weight loss.
These and other symptoms may be caused by pancreatic cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
Jaundice (yellowing of the skin and whites of the eyes). Pain in the upper or middle abdomen and back. Unexplained weight loss. Loss of appetite. Fatigue.
Pancreatic cancer is difficult to detect (find) and diagnose early.
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| AAAAA
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Glucogonoma
Glucagonoma is a rare neuroendocrine tumor with nearly exclusive pancreatic localization. Malignant glucagonomas are islet cell pancreatic tumors that are discovered because of the glucagonoma syndrome, because of local mass effects, or incidentally. Glucagonomas originate from the alpha2 cells of the pancreas.
In 1942, Becker et al first described glucagonomas. Fewer than 250 cases of glucagonomas have been described in the literature. Unregulated production (overproduction) of peptide hormones and growth factors, which are not normally expressed in the tissue of origin, is characteristic of neuroendocrine tumors. Abnormal production of these bioactive peptides can lead to significant systemic toxic consequences and the promotion of further tumor growth. The origin of this pathology remained unknown until 1966 when McGavran assessed the radioimmunoassay (RIA) technique for glucagon.
In 75-80% of cases, the glucagonoma starts in malignant form, and in 50% of these cases, metastasis exists at diagnosis. This tumor is characterized by glucagon overproduction, diabetes mellitus, hypoaminoacidemia, weight loss, normochromic and normocytic anemia, and a necrolytic migrating erythema (NME), which is the most characteristic clinical sign of this pathology. NME presents as a phlogistic damage of tissues in areas exposed to friction and pressure. Another feature of the syndrome that is noteworthy is the high rate of thromboembolic complications and consequent pulmonary embolisms; this is dangerous for many patients who can succumb to it. Recognize unexplained thromboembolic disease as an alert to the possibility of glucagonoma.
Glucagonomas not associated with the syndrome are diagnosed in various ways. The tumor may appear as a malignant pancreatic tumor discovered because of local growth, with or without metastases, or the tumor may be associated with insulinoma or gastrinoma. Glucagonoma may also occur as a single microadenoma found incidentally at autopsy in elderly patients. Glucagonoma very rarely is a member of multiple endocrine neoplasia type 1 (MEN I) syndromes, and, in such cases, it appears as a single lesion and is biologically inactive. Similar to other islet cell tumors, the primary and metastatic lesions are slow growing.
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| AAAAA
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Dr. Archilles,
The most pronounced features between Pancreatic cancer and Glucagonoma is NME.
NME necrotic migratory erythema is not present in pancreatic cancer but very promintent in Glucagonoma.
(Just as Celiac Sprue, the definite dematologic feature is Dermatitis Herpetiform)
So the q did not mention the most pronounced feature of glucagonoma---NME----necrotic migratory erythema, you can exclude glucagonoma.
Most cases of glucagonoma will present with definite dermatological daignosis of NME, necrotic migratory erythema !
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| AAAAA
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NME is very common in glucagonoma and is the most pronounced dermatological feature in making the diagnosis of glucagonoma.
However, pancreatic cancer does not present with necrolytic migratory erythema.
Thank you for sharing with me !
Necrolytic migratory erythema. Characterized clinically by erythematous, vesiculobullous areas with underlying erosion (see photo below), necrolytic migratory erythema is commonly found in the perianal, perigenital, and facial regions. The earliest lesions are pustules that readily rupture and leave a thin necrolytic border. Associated findings include a beefy-red tongue and angular cheilitis. A biopsy specimen taken from the edge of the rash reveals the upper epidermal necrosis typical of this disorder.
Necrolytic migratory erythema is considered a diagnostic marker for the extremely rare glucagon-secreting (alpha-cell) type of pancreatic tumor called glucagonoma. Increased levels of serum glucagon are responsible for the cutaneous manifestations of this disease. The dermatitis is unresponsive to conventional therapy and may be associated with weight loss, intermittent diarrhea, and abdominal pain. The rash usually resolves quickly after the tumor is resected.usually indicates a poor prognosis, as the underlying neoplasm is often aggressive. The average survival period for patients with cancer-associated acanthosis nigricans is two years. The most common underlying cancer is adenocarcinoma of the gastrointestinal tract. When associated with gastrointestinal cancer, the skin lesions are typically more widespread and asymmetric and involve oral and mucosal surfaces.
Necrolytic migratory erythema. Characterized clinically by erythematous, vesiculobullous areas with underlying erosion (see photo below), necrolytic migratory erythema is commonly found in the perianal, perigenital, and facial regions. The earliest lesions are pustules that readily rupture and leave a thin necrolytic border. Associated findings include a beefy-red tongue and angular cheilitis. A biopsy specimen taken from the edge of the rash reveals the upper epidermal necrosis typical of this disorder.
Necrolytic migratory erythema is considered a diagnostic marker for the extremely rare glucagon-secreting (alpha-cell) type of pancreatic tumor called glucagonoma. Increased levels of serum glucagon are responsible for the cutaneous manifestations of this disease. The dermatitis is unresponsive to conventional therapy and may be associated with weight loss, intermittent diarrhea, and abdominal pausually indicates a poor prognosis, as the underlying neoplasm is often aggressive. The average survival period for patients with cancer-associated acanthosis nigricans is two years. The most common underlying cancer is adenocarcinoma of the gastrointestinal tract. When associated with gastrointestinal cancer, the skin lesions are typically more widespread and asymmetric and involve oral and mucosal surfaces.
Necrolytic migratory erythema. Characterized clinically by erythematous, vesiculobullous areas with underlying erosion (see photo below), necrolytic migratory erythema is commonly found in the perianal, perigenital, and facial regions. The earliest lesions are pustules that readily rupture and leave a thin necrolytic border. Associated findings include a beefy-red tongue and angular cheilitis. A biopsy specimen taken from the edge of the rash reveals the upper epidermal necrosis typical of this disorder.
Necrolytic migratory erythema is considered a diagnostic marker for the extremely rare glucagon-secreting (alpha-cell) type of pancreatic tumor called glucagonoma. Increased levels of serum glucagon are responsible for the cutaneous manifestations of this disease. The dermatitis is unresponsive to conventional therapy and may be associated with weight loss, intermittent diarrhea, and abdominal pain. The rash usually resolves quickly after the tumor is resected.in. The rash usually resolves quickly after the tumor is resected.
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| AAAAA
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NME
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06-01Fg3.jpg (28 KB, 5 downloads)
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