AN UNUSUAL CASE OF PANCREATIC TUMOR; OSTEOCLASTIC LIKE GIANT CELL TUMOR. Pankreas?n nadir rastlanan tüm?rü; Osteoklastik tip dev hücreli kanser.

摘要

The osteoclast-like giant cell tumor of the pancreas, described by Rosai, is a rare pancreatic tumor. Since then, only 40 cases have been reported in the literature. A 51-year-old Turkish woman was admitted because of nocturnal fever, trembling and jaundice. Blood tests on admission showed a liver cytolitic syndrome. The patient had laparotomy which confirmed the presence of a big epigastric mass adherent to the distal portion of stomach and spleen, and the portal vein thrombosis. Total pancreaticoduodenectomy was performed while the obturated portion of the portal vein was resected and replaced by polytetrafluoroethylene vascular graft. The postoperative period was uneventful. Unfortunately, three months after surgery, liver and lung metastases were noted. The patient passed away about four months after the cancer diagnosis. This case is being reported mainly to report an unusual tumor and secondary to discuss about the agressivity observed despite a radical excision of the tumor. ?ZET ?lk kez Rosai taraf?ndan tan?mlanan pankreas?n osteoklastik tip dev hücreli tüm?rlerine nadir rastlanmaktad?r. Literatürde ?imdiye kadar 40 vaka bildirilmi?tir. Olgumuz 51 ya??nda kad?n hastad?r. Ate? yüksekli?i, sar?l?k nedeniyle ba?vurdu. Yap?lan kan biyokimya tetkikleri sonucunda hastada t?kanma ikteri oldu?u saptanarak hastaneye yat?r?ld?. Perkutan safra drenaj? ve intraven?z antibiyotik tedavisi uyguland?. Ate? yüksekli?inin devam etmesi üzerine operasyona karar verildi. Operasyonda tüm üst kar?n? dolduran, mide ve dala?? kendine do?ru ?eken, portal vende tromboza neden olan yakla??k 20 cm boyutunda kitle saptand?. Olguya splenektomi ile birlikte total pankreatikoduodenektomi uyguland?. Ayr?ca tromboze olmu? portal ven segmenti ??kart?larak portal ven devaml?l??? politetrafloroetilen damar grefti ile sa?land?. Operasyon sonras? izleminde hastada maj?r cerrahi sorunla kar??la??lmadan taburcu edildi. Takiplerinin 3. ay?nda yayg?n karaci?er ve akci?er metastazlar? saptand?. Operasyon sonras? 4. ay?nda metastazlara ba?l? tüm?r yükü nedeniyle geli?en komplikasyonlar sonucu hasta kaybedildi. Bu makalede pankreas?n nadir rastlanan kanser türü olan osteoklastik tip dev hücreli kanserli bir olgudaki agresif cerrahi tedaviyi ve sa?kal?m süresini sunmay? ama?lad?k.