Small cell lung cancer (SCLC) is notorious for its aggressive behavior and propensity for metastasis. Although metastasis to the pancreas from SCLC is relatively rare, it warrants attention due to its overlapping symptomatology with primary pancreatic malignancies and other abdominal pathologies (such as those involving the liver or gallbladder). Despite recent advances, the mechanisms driving SCLC metastasis to the pancreas remain elusive, providing challenges in diagnosis and treatment. This case report details the presentation of a 59-year-old woman with SCLC metastasis to the pancreas, initially masquerading as primary pancreatic carcinoma, as highlighted by her presenting symptoms of jaundice, weight loss, and abdominal pain. Diagnostic workup, including imaging studies and tissue sampling, confirmed the unexpected presence of metastatic SCLC in the pancreas. The patient was ultimately transferred to a tertiary care facility for further workup. This case serves as a reminder to maintain a broad differential diagnosis, particularly in the face of such an unusual presentation. It also highlights the need for further research to elucidate the molecular and cellular mechanisms driving SCLC metastasis to the pancreas, with the ultimate goal of improving diagnostic accuracy and therapeutic outcomes for patients with this aggressive disease.

Pancreatic masses are commonly encountered in clinical practice, with concern for the possibility of cancer. Tissue sampling or outright surgical resection may be offered in this setting. However, surgery has been unnecessarily performed in patients with pancreatic masses that proved to be benign. Less invasive options for pancreatic masses that may be benign like tuberculosis should thus be explored. Three adult Filipino patients less than 60 years old presented with symptomatic pancreatic masses suspected of cancer on abdominal imaging studies. Two were smokers without a history of prior tuberculosis. Without any tissue sampling, anti-tuberculosis treatment was eventually given to all three patients due to concomitant diagnoses of extrapancreatic tuberculosis. Endoscopic ultrasound documentation of post-treatment resolution of pancreatic masses was noted in all cases. In endemic regions, although clinical diagnosis of tuberculosis may be possible for pancreatic masses, empiric treatment should still be a last-line option in cases where tissue sampling cannot be done.

We describe a case of segmental arterial mediolysis (SAM) in a 2-year-old male who presented with symptoms of acute pancreatitis. SAM is a vascular entity of unknown etiology that involves medium-sized arteries in which the integrity of the vessel wall is compromised, resulting in increased susceptibility to ischemia, hemorrhage, and dissection. The clinical presentation is variable and can range from abdominal pain to more ominous findings of abdominal hemorrhage or organ infarction. This entity should be considered in the correct clinical setting and after other vasculopathies have been excluded. We aim to bring awareness to pediatric providers given this is a rare entity with variable presentation, which could be potentially life threatening.

Pancreatic cancer (PC) occurs when changes (mutations) in the pancreas cells lead them to multiply out of control. A mass of tissue can result. Sometimes, this mass is benign (not cancerous). In PC, however, the mass is malignant (cancerous). A 79-year-old male presents to the emergency department with complaints of yellow discoloration of the eyes and body as well as itching all over the body. On general examination, his vitals were normal. Laboratory investigations showed raised levels of bilirubin and hepatic enzymes. The CT abdomen study revealed abnormal enhancing soft tissue density in the pancreatic head region obstructing the pancreatic duct and common bile duct leading to its proximal gross with upstream dilatation. The lesion described lesion in the pancreatic head region is of a malignant neoplastic etiology and needed to be evaluated with endoscopic retrograde cholangiopancreatography (ERCP), biopsy, and histopathology correlation. Associated pancreatic parenchymal atrophy was also seen along with gross dilatation of the extrahepatic and intrahepatic biliary system. There were no associated enlarged draining lymph nodes and minimal free fluid was seen in the peritoneal cavity. Following the deployment of a stent in the common bile duct, the patient was discharged. The patient prognosis was good and the patient was scheduled for routine blood work after four weeks to assess bilirubin levels and hepatic enzymes.

We report a case of a 72-year-old man who was referred to our tertiary medical center for endoscopic ultrasound (EUS) evaluation for an incidental 2-cm mass in the tail of the pancreas seen on computed tomography (CT). On EUS, a 22 mm by 13 mm, well-defined hypoechoic mass was identified within the pancreatic tail, and a fine-needle biopsy was performed. Histopathology revealed benign pancreatic parenchyma and the presence of lymphocytes. A technetium-99m sulfur colloid scan was performed, which demonstrated uptake in the pancreatic tail lesion consistent with an intra-pancreatic splenule. This case demonstrates that a splenule or accessory splenic tissue should remain in the differential diagnosis of a pancreatic mass. An accurate diagnosis of pancreatic splenule can preclude surgical resection.

Haematological diseases with pancreatic masses as the first symptom are clinically rare but should not be ignored. This case report describes a 60-year-old female patient with acute leukaemia that had a pancreatic mass as her first symptom. The patient was admitted and elastography combined with endoscopic ultrasound (EUS) guided fine needle aspiration biopsy (EUS-FNA) was used for diagnosis, treatment planning and determination of prognosis. The site selected for the EUS-FNA puncture was the caudal section of the pancreatic body and the posterior wall of the gastric body was used as the puncture point. The elastography view of the head of the pancreas was blue/green with predominant blue colour. A 19 G puncture needle with a slow-draw core and two stitches of micro-negative pressure were used. Cytology detected heterotypic cells, pancreatic puncture histopathology, the presence of pancreatic alveolar structures and heterotypic tumour cells in the interstitium. Immunohistochemistry of the pancreatic puncture tissue showed B-cell lymphoblast-derived tumours and bone marrow puncture indicated acute lymphoblastic leukaemia. The patient was diagnosed with acute lymphoblastic leukaemia invading the pancreas and was treated with chemotherapy. After treatment, her condition was stable. Follow-up is ongoing and there have been no signs of tumour recurrence or metastasis.

Pancreatic schwannoma is a neuroendocrine cell tumor that arises in the pancreas. It is very rare, and, to date, only fewer than 70 similar cases have been reported in the literature. Here, we present another case of this type of tumor in a 68-year-old female. In addition to describing the pancreatic schwannoma, we discuss the major challenges associated with its diagnosis and management. As such, clinically and on imaging, pancreatic schwannomas are almost indistinguishable from other cancerous or benign pancreatic tumors. Therefore, only a biopsy can definitively diagnose pancreatic schwannomas by demonstrating spindle-shaped cells with immunohistochemistry positive for S-100. Because pancreatic schwannomas are very rare, it is important to increase awareness among clinicians about this condition and inform them regarding the challenges associated with its diagnosis and management.

UNASSIGNED: Pancreatic schwannoma (PS) is an extremely rare benign tumor. Here we describe the Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) results of PS in a 59 years old woman, as well as a review of the literature.
UNASSIGNED: A 59-year-old woman consulted for atypical epigastralgia without fatigue, weight loss or fever. CT scan and MRI showed a 35 mm inhomogeneous lesion with well-defined margins located in the pancreas head. The diagnosis of pancreatic tumor was made. The pathologic examination of the biopsied mass yielded a diagnosis of pancreatic schwannoma.
UNASSIGNED: On CT scans, almost all benign PS are well-defined cystic or low-density masses. MRI is helpful in characterizing their typical encapsulation.
UNASSIGNED: The detection of pancreatic schwannoma is extremely rare. Although multiple imaging modalities are currently available, it is challenging to make an accurate diagnosis before operation.

Solid pseudopapillary neoplasm of pancreas (SPN) is a rare entity. It is almost exclusively seen in females within the second and third decades of life with only small minority affecting children. Due to the paucity of the number of cases seen, the natural history of the disease is not fully understood. SPN tumors of the pancreas are usually found incidentally and usually have an excellent prognosis. We herein present a case of a 33-year-old lady diagnosed with SPN, who presented with abdominal fullness, two weeks post cesarean section.

BACKGROUND: Schwannomas are a benign tumor of peripheral nerve sheath origin. Although most commonly arising in the extremities, head, and neck there have been rare cases of schwannomas presenting within or adjacent to the pancreas reported in the literature.
METHODS: We present an asymptomatic and otherwise healthy 57-year-old male with an incidental peripancreatic mass measuring 3.5 × 3.7 cm found on abdominal computed tomography (CT). The patient underwent complete enucleation of the mass at our hospital. Pathological analysis of the excised specimen showed spindle shaped cells. Immunohistochemical staining was positive for S100 protein expression, confirming the definitive diagnosis of peripancreatic schwannoma. The patient\'s postoperative course was uneventful.
CONCLUSIONS: Schwannoma is a commonly benign, encapsulated, and slowly growing tumor arising from myelin producing cells of peripheral nerves. A schwannoma presenting within or adjacent to solid abdominal viscera, such as the pancreas, may be challenging to diagnose preoperatively as it may mimic other lesions. Radiological appearance of schwannoma may be nonspecific and definitive diagnosis is reliant upon pathological analysis. The use of endoscopic ultrasound (EUS) with fine needle aspiration (FNA) may assist the clinician in preoperative diagnosis, however these interventions are not widely available. Accurate preoperative diagnosis of a peripancreatic schwannoma is of high importance as it may preclude unnecessary pancreatectomy or radical resection.
CONCLUSIONS: Although rare, schwannoma should be part of the differential diagnosis of a cystic or solid appearing mass within or surrounding the pancreas. Total resection carries an excellent prognosis with little to no documented recurrence.