26361431 Visualization

A 60 Age - year Age - old Age male Sex visited Activity our outpatient Nonbiological_location clinic Nonbiological_location with a mass Sign_symptom on his left Biological_structure hip Biological_structure .
He had diabetes Disease_disorder and alcoholic Disease_disorder hepatitis Disease_disorder .
On physical Diagnostic_procedure examination Diagnostic_procedure , a large Detailed_description mass Sign_symptom measuring 10 Distance cm Distance in diameter was observed on his hip Biological_structure and an approximate 5 Distance cm Distance left Biological_structure inguinal Biological_structure lymph Biological_structure node Biological_structure was palpable Sign_symptom (Figure ​1).
Serum Detailed_description tumor Diagnostic_procedure markers Diagnostic_procedure , including CEA Diagnostic_procedure and CA Diagnostic_procedure 19 Diagnostic_procedure - 9 Diagnostic_procedure , were within Qualitative_concept normal Qualitative_concept limits Qualitative_concept , whereas serum Detailed_description amylase Diagnostic_procedure ( 227 Lab_value IU/L Lab_value , normal range 43-116 IU/L), lipase Diagnostic_procedure ( 378 Lab_value IU/L Lab_value , normal range 7-60), fasting Diagnostic_procedure blood Diagnostic_procedure sugar Diagnostic_procedure ( 144 Lab_value mg/dL Lab_value , normal range, 70-100 mg/dL), and liver Diagnostic_procedure function Diagnostic_procedure test Diagnostic_procedure levels [including aspartate Diagnostic_procedure aminotransferase Diagnostic_procedure ( 178 Lab_value IU/L Lab_value , normal range, 7-38 IU/L), alanine Diagnostic_procedure aminotransferase Diagnostic_procedure ( 225 Lab_value IU/L Lab_value ; normal range, 4-43 IU/L), and serum Detailed_description alkaline Diagnostic_procedure phosphatase Diagnostic_procedure ( 370 Lab_value IU/L Lab_value , normal range, 103-335 IU/L)] were all above Qualitative_concept normal Qualitative_concept ranges Qualitative_concept .
An abdominal Biological_structure computerized Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) scan demonstrated not only a left Biological_structure hip Biological_structure mass Sign_symptom and an enlarged Sign_symptom left Biological_structure inguinal Biological_structure lymph Biological_structure node Biological_structure , but also a huge Qualitative_concept heterogeneous Detailed_description enhancing Detailed_description mass Sign_symptom on the body of the pancreas Biological_structure (Figure ​2).
On a PET Diagnostic_procedure scan Diagnostic_procedure , additional metastases Disease_disorder were not found.
We planned a staged Therapeutic_procedure surgery Therapeutic_procedure and performed a hip Biological_structure and inguinal Biological_structure mass Therapeutic_procedure excision Therapeutic_procedure on December Date 19, Date 2014 Date .
The histopathological Diagnostic_procedure report Diagnostic_procedure revealed a metastatic Detailed_description small Detailed_description cell Detailed_description neuroendocrine Disease_disorder carcinoma Disease_disorder with a maximal Distance diameter Distance of Distance 10.5 Distance cm Distance on the buttock Biological_structure mass Sign_symptom and a 7 Distance cm Distance growth Sign_symptom on an inguinal Biological_structure lymph Biological_structure node Biological_structure .
The mitotic Diagnostic_procedure index Diagnostic_procedure was over Lab_value 50 Lab_value mitoses Lab_value per Lab_value 50 Lab_value HPF Lab_value and the Ki-67 index Diagnostic_procedure measured at 50% Lab_value .
On January Date 21, Date 2015 Date , we performed a total Detailed_description pancreatectomy Therapeutic_procedure and a total Detailed_description gastrectomy Therapeutic_procedure , with the findings revealing a tumor Sign_symptom of the body of the pancreas Biological_structure about 9 Area cm Area × Area 6 Area cm Area in Area diameter Area involving the left Biological_structure gastric Biological_structure artery Biological_structure , splenic Biological_structure artery Biological_structure , and splenic Biological_structure vein Biological_structure .
The histopathological Diagnostic_procedure report Diagnostic_procedure was the same as that of a metastatic Detailed_description lesion Sign_symptom .
Additionally, the tumor Sign_symptom had spread to 8 Quantitative_concept of Quantitative_concept the Quantitative_concept 32 Quantitative_concept lymph Biological_structure nodes Biological_structure (Figure ​3).
On the 7th Date post Date - operative Date day Date , the patient developed a high Severity fever Sign_symptom and leukocytosis Sign_symptom .
We administered an abdominal Biological_structure CT Diagnostic_procedure scan, which revealed infected Detailed_description fluid Sign_symptom collection Sign_symptom in the lesser Biological_structure sac Biological_structure and a 4.7 Distance cm Distance - sized Distance recurring Detailed_description mass Sign_symptom which was detected at the operative bed of the left Biological_structure hip Biological_structure (Figure ​(Figure4).4).
After infection Disease_disorder of the abdominal Biological_structure cavity Biological_structure was treated by antibiotics Medication , we removed Therapeutic_procedure the left Biological_structure hip Biological_structure recurring Detailed_description mass Sign_symptom on February Date 3, Date 2015 Date .
The histopathology Diagnostic_procedure was the same as in the previous report; with a maximum Distance diameter Distance of Distance 7.5 Distance cm Distance .
The patient was discharged Clinical_event without other complications Disease_disorder on February Date 9, Date 2015 Date .
He is currently receiving chemotherapy Medication based on etoposide Medication and cisplatin Medication treatment.