ఆర్కైవ్స్ ఆఫ్ సర్జికల్ ఆంకాలజీ

A 53-year-old woman received a total colonoscopy for a FOBT (Faecal Occult Blood Test) positive and detected a sessile type poly in the sigmoid colon. Colonoscopy exhibited a “somewhat of a white tone” and measured 6 mm sessile type poly, with no irregular pit pattern, and suspected an adenoma. Also, endoscopic mucosal resection was done. The pathological diagnosis was a well differentiated adenocarcinoma and the depth of invasion was 1,200 micron. Submucosal invasive adenocarcinoma with 6 mm, non-depressive sessile type case is very rare. Therefore, one should recommended an endoscopic mucosal resection, not observation, when the endoscopic findings was recognized a “white tone” sessile type polyp.

A 55 year old female presented large left upper quadrant mass and episodes of recurrent hypoglycemia. Preoperative laboratory testing revealed normal insulin, IGF-I and IGF-II levels. Big-IGF-II levels were unable to be measured because the laboratory test was unavailable. A CT scan of her abdomen and pelvis revealed a large 19 × 15 × 12 cm left upper quadrant mass appearing to involve the pancreas, spleen, and left kidney. The mass was surgically extirpated and was consistent with a hemangiopericytoma. Subsequently, her hypoglycemic attacks along with abdominal symptoms resolved. We hypothesize that this patient’s hypoglycemic attacks were a consequence of tumor secretion of a pro-hormone form of IGF-II called ‘Big IGF-II’.