1/55. pancreatic polypeptide hyperplasia causing watery diarrhea syndrome: a case report.Neuroendocrine tumours of the pancreas can secrete numerous peptides, leading to various recognizable clinical syndromes. The secretion of pancreatic polypeptide has been used as a marker for neuroendocrine tumours but is considered to be a biologically inert peptide. A 37-year-old woman had watery diarrhea syndrome from pancreatic polypeptide hyperplasia. Only 2 other reported cases in the literature have described pancreatic polypeptide hyperplasia; however, this is the first reported case in which the patient was successfully treated by surgical resection, with a 2-year follow-up. This report and review of the literature illustrate that pancreatic polypeptide hypersecretion may present as a clinical endocrinopathy.- - - - - - - - - - ranking = 1keywords = watery diarrhea syndrome, watery diarrhea, diarrhea syndrome, diarrhea (Clic here for more details about this article) |
2/55. Treatment of metastatic vipoma by liver transplantation.We report the first case of metastatic vipoma treated by orthotopic liver transplantation. A woman with explosive secretory diarrhea causing hypokalemic acidosis was diagnosed as having a vasoactive intestinal peptide secreting tumor with widespread hepatic metastases. The symptoms were initially controlled for 9 months with increasing doses of long-acting somatostatin analogue (Sandostatin, Sandoz Ltd, UK). Alpha interferon was not tolerated, causing an acute paranoid psychosis. Eventually orthotopic liver transplantation was performed with the removal of the primary tumor from the distal pancreas. Postoperatively, complications were associated with the distal pancreatectomy. The patient has no evidence of tumor recurrence on imaging or serum VIP level 12 months posttransplantation.- - - - - - - - - - ranking = 0.00016604996977961keywords = diarrhea (Clic here for more details about this article) |
3/55. Long-term survival after diagnosis of hepatic metastatic vipoma: report of two cases with disparate courses and review of therapeutic options.This report describes two patients with pancreatic cholera caused by vasoactive intestinal polypeptide (VIP)-producing tumors, which originated in the pancreas and showed metastases in both hepatic lobes at time of diagnosis. However, the two tumors displayed remarkably disparate clinical courses. Due to the protracted but progressive course over more than 10 years, a multifaceted therapeutic approach was performed to control symptoms and to improve quality of life. The long-acting somatostatin analog octreotide was the most effective treatment for relieving symptoms and correcting fluid and electrolytes disturbances. The effects of complementary treatments, including systemic chemotherapy and hyperselective chemoembolization, as well as concurrent application of octreotide and prednisolone or interferon with respect to clinical symptoms, VIP levels, and tumor growth are reviewed. Our experience, although small, emphasizes the need for an expert, well-planned, adaptive, and multidisciplinary approach in the care of these complex patients.- - - - - - - - - - ranking = 0.22241201416271keywords = pancreatic cholera, cholera (Clic here for more details about this article) |
4/55. Microscopic colitis syndrome: lymphocytic colitis and collagenous colitis.Microscopic colitis is a syndrome consisting of chronic watery diarrhea, a normal or near-normal gross appearance of the colonic lining, and a specific histological picture described as either lymphocytic colitis or collagenous colitis. Since its initial descriptions a quarter of a century ago, microscopic colitis has become a frequent diagnosis in patients with chronic diarrhea. Understanding of the cause and pathogenesis of microscopic colitis remain incomplete, but potentially important clues have been discovered that shed light on predisposing factors. In particular, specific HLA-DQ genotypes may be permissive for the development of microscopic colitis, and suggest a linkage to the pathogenesis of celiac sprue. Although the differential diagnosis of chronic watery diarrhea is broad, the diagnosis of microscopic colitis is straightforward, involving endoscopic inspection of the colonic mucosa and proper pathologic interpretation of biopsy specimens. As the limitations of drugs ordinarily used for other forms of inflammatory bowel disease are being recognized, new approaches, such as the use of bismuth subsalicylate, are being evaluated. The prognosis of patients with microscopic colitis syndrome remains good, and symptomatic improvement can be expected in most patients.- - - - - - - - - - ranking = 0.056516918626154keywords = watery diarrhea, diarrhea (Clic here for more details about this article) |
5/55. Overview of chronic diarrhea caused by functional neuroendocrine neoplasms.Eight different neoplastic disorders can cause chronic diarrhea attributable to humoral-mediated diarrhea. These include pancreatic endocrine tumor (PET) syndromes (gastrinomas, VIPomas, glucagonomas, somatostatinomas, PET's releasing calcitonin), carcinoid syndrome, medullary thyroid cancer, and systemic mastocytosis. Because these disorders are an uncommon cause of all chronic diarrheas (<1%), they are not often considered in the differential diagnosis, leading to a delay in diagnosis. This is problematic not only because all are treatable, but also because the neoplasm is frequently malignant. In this article, the characteristics and pathogenesis of the diarrhea, important clinical and diagnostic laboratory features, and treatment of each disorder are briefly reviewed, with an emphasis on recent insights.- - - - - - - - - - ranking = 0.0013283997582369keywords = diarrhea (Clic here for more details about this article) |
6/55. vipoma of pancreas in a child.An eleven-year-old girl had massive watery diarrhea. She was found to have pancreatic vipoma. It responded favorably to surgical resection of the tumor. There was no tumor recurrence at 18 months of follow-up.- - - - - - - - - - ranking = 0.028175434328187keywords = watery diarrhea, diarrhea (Clic here for more details about this article) |
7/55. Surgical treatment of pancreatic vasoactive intestinal polypeptide-secreting tumor: a case report.A 68-year-old woman presented with secretory watery diarrhea causing hypokalimia, hypoalbuminemia and dehydration for 5 years. Subsequent investigations including abdominal ultrasonography and computed tomography scanning revealed a mass measuring 7 x 6 cm in the pancreatic tail. The diagnosis of pancreatic VIPomas was suspected on the basis of clinical symptoms. The patient underwent distal pancreatectomy and splenectomy after resuscitation of electrolyte imbalance, dehydration and malnutrition. The pathological examination with histoimmunochemical stain confirmed the diagnosis. Postoperative course is uneventful and the patient does not have symptoms any longer during the follow-up period.- - - - - - - - - - ranking = 0.028175434328187keywords = watery diarrhea, diarrhea (Clic here for more details about this article) |
8/55. Dynamic gadolinium-enhanced MR imaging of pancreatic vipoma in a patient with Verner-Morrison syndrome.We describe a rare case of a pancreatic vipoma diagnosed in a patient presenting with watery diarrhea, hypokalemia, and achlorhydria, the so-called WDHA or Verner-Morrison syndrome. Emphasis is placed on the dynamic gadolinium-enhanced MR profile of the tumor, characteristics which have not been illustrated previously, to the best of our knowledge.- - - - - - - - - - ranking = 0.028175434328187keywords = watery diarrhea, diarrhea (Clic here for more details about this article) |
9/55. Vasoactive intestinal polypeptide-secreting tumor (vipoma) with liver metastases: dramatic and durable symptomatic benefit from hepatic artery embolization, a case report.neuroendocrine tumors often manifest an excess production of hormones that create severe metabolic abnormalities resulting in significant patient morbidity, independent of the tumor burden itself. VIPomas are rare neuroendocrine tumors arising from the pancreas and are associated with secretory diarrhea and electrolyte disturbances. We present a patient with vipoma and hepatic metastases who had greater than 10 loose stools a day for 4 yr since diagnosis, despite debulking surgery, multiple antidiarrheal medications, large doses of octreotide, and targeted radioisotope injections. The patient required several hospitalizations for treatment of dehydration and electrolyte disturbances, despite receiving daily intravenous fluids at home. hepatic artery embolization (HAE) immediately stopped the patient's diarrhea and provided a return to normal formed stools without any other symptom-support measures. One year after HAE, the patient remains asymptomatic and has returned to a productive life. HAE can be a very effective and durable treatment modality for patients with metastatic VIPomas (or other neuroendocrine tumors) and who are clinically symptomatic from the effects of hormone hypersecretion.- - - - - - - - - - ranking = 0.00049814990933882keywords = diarrhea (Clic here for more details about this article) |
10/55. Are pancreatic VIPomas paraneuron neoplasms? A clue to the neuroectodermal origin of these tumors.Three pancreatic vasoactive intestinal polypeptide (VIP)-producing tumors associated with the watery diarrhea-hypokalemia-achlorhydria syndrome were studied histologically, ultrastructurally, and immunocytochemically. All the tumors contained varying numbers of cells arranged in pseudoglandular structures. The cells showed a polar organization, with apical tuft of microvilli and basal VIP-containing, synaptic vesicle-like granules. Based on the morphology of the vipoma cells typical of recepto-secretory cells, together with the ability to synthesize and release a peptide that in normal conditions is expressed exclusively by neurons, and the absence of VIP-producing endocrine cells in normal pancreas and gastrointestinal mucosa, the hypothesis is drawn that the pancreatic VIPomas reported here are paraneuron neoplasms, which possibly originate from neuroectodermal ancestors.- - - - - - - - - - ranking = 0.028175434328187keywords = watery diarrhea, diarrhea (Clic here for more details about this article) |
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