Sandbox: DDx pancrease: Difference between revisions

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Haytham Allaham (talk | contribs)
nocaptcha, Administrators
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Haytham Allaham (talk | contribs)
nocaptcha, Administrators
5,080 edits
No edit summary
Line 1: Line 1:
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1200px"
|valign=top|
|valign=top|
|+
|+
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|'''Differential Diagnosis'''}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|'''Characteristics'''}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|'''Clinical Presentation'''}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|'''Insulinoma'''}}
! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|'''Lab values'''}}
! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|'''Vipoma'''}}
! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|'''Imaging'''}}
! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|'''Gastrinoma'''}}
! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|'''Histopathology'''}}
|-
 
! style="background: #8f8990; width: 150px;" | {{fontcolor|#FFF|'''Symptoms'''}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Diaphoresis'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Present
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Absent
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Absent
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Watery diarrhea'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Absent
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Present
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Absent
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Heartburn'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Absent
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Absent
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Present
|-
! style="background: #8f8990; width: 150px;" | {{fontcolor|#FFF|'''Lab values'''}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Hypoglycemia'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Present
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Absent
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Absent
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Hypokalemia'''
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Absent
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Present
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
Absent
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
'''Insulinoma'''
'''Hypergastrinemia'''
| style="padding: 5px 5px; background: #F5F5F5;"|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
* Weight loss
Absent
* Vague abdominal pain
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
* Loss of appetite
Absent
* Nausea and vomiting
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
* Jaundice
Present
* Anxiety
* '''Diaphoresis'''
* '''Tremor'''
* '''Palpitations'''
* '''Seizures'''
* '''Coma'''
| style="padding: 5px 5px; background: #F5F5F5;" |
* Decreased hemoglobin level
* Increased billirubin level (conjugated and total)
* Increase alkaline phosphatase
* Increased gamma-glutamyl transpeptidase
* Increased spartate aminotransferase
* Increased alanine aminotransferase
* Increased amylase and/or lipase
* '''Hypoglycemia'''
* '''Hyperinsulinemia'''
* '''Elevated C-peptide level'''
* '''Elevated Pro-insulin level'''
| style="padding: 5px 5px; background: #F5F5F5;"|
* CT scan: calcification and hyperattenuation of the mass
* MRI: Hypointense on T1-weighted image, hyperintense on T2-weighted MRI, and signal enhancement on T1 C+ image
* U/S: Homogeneously hypoechoic mass rounded in shape with distinct margins
| style="padding: 5px 5px; background: #F5F5F5;" |
* Solid or gyriform patterns, usually without glands
|-
|-
 
| style="padding: 5px 5px; background: #8f8990; font-weight: bold" align=center  |{{fontcolor|#FFF|
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
'''CT scan'''}}
'''VIPoma'''
| style="padding: 5px 5px; background: #F5F5F5;" align=left|
| style="padding: 5px 5px; background: #F5F5F5;" |
Calcification and hyperattenuation of the mass
::::<1.5 cm² residual tumor after resection
| style="padding: 5px 5px; background: #F5F5F5;" align=left|
| style="padding: 5px 5px; background: #F5F5F5;" |
Hypervascularity with diffuse multiple metastatic nodulation
::Subtotal resection '''or''' >1.5 cm² residual tumor after resection
| style="padding: 5px 5px; background: #F5F5F5;" align=left|
| style="padding: 5px 5px; background: #F5F5F5;" |
Small hypoattenuating nodule ± calcification
::::<1.5 cm² residual tumor after resection
| style="padding: 5px 5px; background: #F5F5F5;" |
::Subtotal resection '''or''' >1.5 cm² residual tumor after resection
 
|-
|-
 
| style="padding: 5px 5px; background: #8f8990; font-weight: bold" align=center |{{fontcolor|#FFF|
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
'''Histopathology'''}}
'''Tumor stage'''
| style="padding: 5px 5px; background: #F5F5F5;" align=left|
| style="padding: 5px 5px; background: #F5F5F5;" |
Solid or gyriform cellular patterns with amyloid deposition, absence of glands, and nesidioblastosis
:::M0 stage confirmed by [[MRI]] and [[CSF]] sampling
| style="padding: 5px 5px; background: #F5F5F5;" align=left|
| style="padding: 5px 5px; background: #F5F5F5;" |
Solid sheets with uniform cuboidal cells, centrally located nuclei, and granular cytoplasm
:::M1-M3 stage '''or''' presence of [[leptomeningeal]] seeding
| style="padding: 5px 5px; background: #F5F5F5;" align=left|
 
Lobular-trabecular pattern of gastrin positive tumor cells with infiltration of Brunner glands
| style="padding: 5px 5px; background: #F5F5F5;" |
:::M0 stage confirmed by [[MRI]] and [[CSF]] sampling
| style="padding: 5px 5px; background: #F5F5F5;" |
:::M1-M3 stage '''or''' presence of [[leptomeningeal]] seeding
|}
|}

Revision as of 01:21, 22 October 2015
Characteristics Insulinoma Vipoma Gastrinoma
Symptoms

Diaphoresis

Present

Absent

Absent

Watery diarrhea

Absent

Present

Absent

Heartburn

Absent

Absent

Present

Lab values

Hypoglycemia

Present

Absent

Absent

Hypokalemia

Absent

Present

Absent

Hypergastrinemia

Absent

Absent

Present

CT scan

Calcification and hyperattenuation of the mass

Hypervascularity with diffuse multiple metastatic nodulation

Small hypoattenuating nodule ± calcification

Histopathology

Solid or gyriform cellular patterns with amyloid deposition, absence of glands, and nesidioblastosis

Solid sheets with uniform cuboidal cells, centrally located nuclei, and granular cytoplasm

Lobular-trabecular pattern of gastrin positive tumor cells with infiltration of Brunner glands

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