DescriptionA 39-year-old woman with known systemic lupus erythematosus (SLE) nephropathy, antiphospholipid syndrome and chronic renal failure was evaluated for renal transplant. She was asymptomatic; nevertheless, the abdominal ultrasonogram showed splenic calcification (figure 1). The chest radiograph showed faint lesions suggestive of (L) hypochondrial calcification (figure 2). The tuberculin skin test result revealed induration of 3 mm. She had no history of treatment for tuberculosis or brucellosis. The angiotensin-converting enzyme was normal at 19 U/L (normal range 29-112 U/L). A CT scan of the abdomen and pelvis showed a bulky spleen that contained numerous small and differently sized smooth calcific foci probably related to granulomatous disease. No calcification was seen in the liver ( figure 3A, B). There were no definite or suspicious pulmonary nodules seen on a whole body fluorodeoxyglucose positron-emission tomography (PET) scan. Similarly, numerous tiny splenic calcifications with no abnormal metabolic activity were detected (figure 4). The haemoglobin level was 11.5 g/dL, white blood count was 7.1×10 9 /L, platelet count was 244×10 9 /L and erythrocyte sedimentation rate was 22 mm/hour. Results of the sickling test, HIV, brucella serology and hydatid and schistosoma serology tests were all negative. She was given a pneumococcal vaccine and is awaiting a deceased donor kidney transplant.Although splenomegaly is detected in 9%-18% of patients with SLE, splenic calcification has been rarely described in such patients.1 Splenic calcification may precede autosplenectomy and hyposplenism, emphasising the importance of
Background
Primary small cell carcinoma of the pancreas (SCCP) is a rare malignant neuroendocrine carcinoma (NEC). Typically, it presents with lymphovascular invasion as well as metastasis at the time of diagnosis which portends a dismal prognosis. Treatment is typically based on therapy used for other aggressive NECs such as small cell lung cancer. Although multimodal surgery, radiation and chemotherapy may improve prognosis, the outcome generally remains poor.
Case presentation
Here we present a primary SCCP managed with neoadjuvant multi-agent chemotherapy combined with radiotherapy and surgery
Conclusions
Multi-disciplinary therapy resulted in an ongoing 28 + month radiographic complete response and overall survival.
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