Lege Artis Medicinae

[Pancreatic carcinoma mimicking primary retroperitoneal fibrosis]

RÉDEI Csaba, ESZES Noémi, HAJNAL Péter, MÁTÉ Miklós, SIMON Károly, TÓTH Julianna, POZSÁR József, TOPA Lajos

OCTOBER 20, 2010

Lege Artis Medicinae - 2010;20(10)

[INTRODUCTION - One of the defining feature of pancreatic ductal adenocarcinoma (PDA) is the presence of extensive desmoplasia. The volume of stroma production can be disproportionate relative to mass of the tumor. Primary retroperitoneal fibrosis (PRF) is characterized by progressive accumulation and spread of connective tissue in the retroperitoneal space often leading to entrapment of ureters and/or the distal part of the duodenum. The large amount of stroma can mimic the radiologic features of PRF. We present a case when the diagnosis of pancreatic ductal adenocarcinoma was delayed because of the tumor showed retroperitoneal spread and imaging studies were distinctive for PRF. CASE REPORT - The past medical history of the 77 year old patient was significant for chronic renal failure of postrenal origin diagnosed one year before. The abdominal CT-scan performed six month ago was unremarkable except for focal stricture and upstream dilation of both ureters. After a relatively uneventful course during the past six months, the patient presented with abdominal distension and vomiting of five days period. Abdominal CT-scan revealed an extensive infiltration of the retroperitoneal space by a tissue with radiologic features characteristic for PRF. The fibrotic tissue involved the prerenal fascia, both ureters, and the third part of the duodenum. Duodenoscopy disclosed complete duodenal obstruction caused by an external compression at the level of ligament of Treitz. At surgery, a hard, fibrous tissue extending form the hepatic hilum down to the pelvis have been seen. The infiltrating tissue also entrapped the distal duodenum leading to its obstruction. Histologic evaluation of specimens taken at surgery showed features of fibroplastic PDA. CONCLUSION - PDA may present as an extensive retroperitoneal fibrosing process without detectable intrapancreatic tumor on radiologic studies. Obsructive signs of any retroperitoneal organ (ie. ureters, duodenum) should raise the possibility of retroperitoneally expanding PDA.]

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[INTRODUCTION - The molecular and cellular interactions between the immune system and bone tissue have been established. Sex hormone deficiency at the time of menopause has multifunctional role by influencing growth, differentiation and metabolism of the skeletal and the immune system. We have used non-parametric and multidimensional expression pattern analyses to determine significantly changed mRNA profile of immune system-associated genes in postmenopausal (POST) and premenopausal (PRE) non-osteoporotic bone. MATERIALS AND METHODS - Ten bone tissue samples from POST patients and six bone tissue samples from PRE women were examined in our study. The transcription differences of selected 50 genes were analyzed in Taqman probe-based quantitative real-time RT-PCR system. RESULTS - Mann-Whitney test indicated significantly down-regulated transcription activity of 3 genes (CD14, HLA-A, ITGAM/CD11b) and upregulated gene expression of 6 genes (C3, CD86, IL-10, IL-6, TGFB3, TNFSF11/RANKL) in POST bone. According to the canonical variates analysis results, the groups of postmenopausal and premenopausal women are separable by genes coding for cytokines, co-stimulators and cell surface receptors affected in antigen presentation and T cell stimulation which have high discriminatory power. CONCLUSIONS - Based on a complex gene expression patterns in human bone cells, we could distinguish POST and PRE states from an immunological aspect. Our data might provide further insight into the changes of the intersystem crosstalk between immune and skeletal system, as well as local immune response in the altered microenvironment of POST bone.]

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