Anti-pan Cytokeratin monoclonal antibody, clone CG3/CG5

Duodenal mucinous adenocarcinoma (DMA) is a malignancy with a rather low morbidity. However, its incidence in China has not been clearly determined. We herein report a case of a 70-year-old female patient who presented with ileus, obstructive jaundice and massive ascites simultaneously. Gastroendoscopy revealed copious amounts of colloidal mucin in the gastric cavity. The neoplasm was not visualized on computed tomography or magnetic resonance imaging, and an exploratory laparotomy was performed to investigate the abdomen. During the operation, the anterior wall of the gastric antrum was incised to explore the first and second portions of the duodenum, as well as the gastric lumen, and a neoplasm sized similar to 2.0 cm was identified at the antimesenteric border of the duodenal bulb after clearing the colloidal mucin content of the stomach and duodenum. Gastrojejunostomy rather than radical resection was performed due to the poor condition of the patient. The postoperative histopathological examination of the colloidal substance removed from the duodenal cavity revealed mucinous adenocarcinoma. On immunohistochemical analysis, the tissue stained positive for pan-cytokeratin, cytokeratin 19, CDX-2, carcinoembryonic antigen and Ki-67 (8%), and negative for excision repair-1. The general condition of the patient postoperatively was poor; thus, adjuvant chemotherapy was not administered and the patient finally succumbed to the disease 42 days after surgery.

A 54-year-old Caucasian male with history of hypertension, hyperlipidemia, insulin-dependent diabetes mellitus, and chronic skin rash of 4 years presented to the emergency department with worsening rash and weight loss. Physical examination revealed diffuse erythematous rash, skin ulceration, bullae with associated paresthesia in the lower extremities, trunk, bilateral upper extremities, and palms and soles. A computed tomography (CT) scan with contrast showed a large, heterogenously enhancing pancreatic mass measuring 9.4 ? 3.8 cm with surrounding low-attenuation soft tissue thickening. Blood tests showed hemoglobin A1C of 10.0%. Glucagon level was elevated to 2,178 (normal < 80 pg/dl). Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) from the pancreatic mass was suggestive of pancreatic endocrine tumor. The tumor cells were positive for synaptophysin, chromogranin, CD56, and pan-cytokeratin with focal positivity for glucagon, suggestive of glucagonoma. The patient underwent distal pancreatectomy along with splenectomy and cholecystectomy. The glucagon level normalized to 25 pg/dl within a week of tumor resection, and during his 6-week outpatient follow up, skin rash had completely resolved.