Pancreatic Arteriovenous Malformation

Abstract

An unusual case of pancreatic arteriovenous malformation (P-AVM) combined with esophageal cancer is reported. A 59-year-old man was admitted with upper abdominal pain. Contrast-enhanced computed tomography showed numerous strongly enhanced abnormal vessels and a hypovascular lesion in the area of the pancreatic tail. Angiographic study of the celiac artery confirmed racemose vascular networks in the tail of the pancreas. Endoscopic retrograde pancreatography revealed narrowing and displacement of the main pancreatic duct in the tail of the pancreas. Screening esophagoscopy showed a 0-IIa+IIc type tumor in the lower thoracic esophagus. Histological examination of esophagoscopic biopsies showed squamous cell carcinoma. Based on these findings, P-AVM or pancreatic cancer and esophageal cancer were diagnosed. Video-assisted thoracoscopic esophagectomy and distal pancreatectomy were performed. Histological examination of the resected pancreas revealed abundant abnormal vessels with intravascular thrombi. In addition, rupture of a dilated pancreatic duct with pancreatic stones and both severe atrophy and fibrosis of the pancreatic parenchyma were observed. The final diagnoses were P-AVM consequent to severe chronic pancreatitis and esophageal carcinoma. The patient's postoperative course was relatively good.

Multimodality Imaging of Pancreatic Arteriovenous Malformation

“…1,3 In a survey by Meyer et al 9 of symptomatic arteriovenous malformations (AVMs) of the GI system, only 2 of 218 (0.9%) were pancreatic. PAVMs are most commonly located in the head of the pancreas, followed by the body or tail.…”

Surgical treatment for rectal cancer with abnormally expanded inferior mesenteric vein resulting from pancreatic arteriovenous malformations

“…Song et al state in their review that TAE is effective if there is a single apparent feeding artery [6]. If the P-AVMs are multiple, TAE is thought to be difficult [12]. …”

An Update of Treatment of Pancreatic Arteriovenous Malformations

“…The present research suggests that approximately 90% of patients have congenital pancreatic AVMs resulting from an aberrant formation of the arteriovenous plexus during embryonic development. Approximately 10% to 30% of cases are associated with Osler-Rendu-Weber syndrome, an autosomal dominant inherited disorder, which is also called hereditary hemorrhagic te- [46,50,52,53].…”