Search

Introduction: A tumoral mass at the clivus is uncommon and its differential diagnosis presents a challenge, since many different tumours may result in a similar radiological image. A chordoma is the most common of these tumours and represents 40% of all cases. Less common are meningiomas, astrocytoma, germinal cell tumours, lymphoma, metastases and rarely pituitary adenoma. We present a case of clivus tumour found to have hyperprolactinemia. Case Report: A 48 year old male patient who is a known case of cervical disc prolapse came with complaints of headache since 2 months, localised in the right temporo - occipital region without any visual disturbances or vomitings. General physical examination as well as neurological examination were unremarkable. MRI brain was done which showed a well defined hypointense mass lesion involving the clivus, superiorly invading the sella, elevating the pituitary with parasellar extension and encasement of the left carotid. On biochemical investigation serum prolactin was found to be 2613.77 ng/ml, free T4 -- 0.67, TSH -- 1.14, serum cortisol -- 150.1 nmol/L and serum testosterone -- 0.53 ng/ml. He was started on Tab. Cabergoline 0.5mg twice weekly along with thyroxine and steroid replacement. On follow up, his prolactin came down to 8.36 ng/ml. Conclusion: Care should be taken while evaluating clival tumours, as ectopic pituitary adenomas, through extremely rare, are a possibility. These cases require a complete endocrinological workup preoperatively as the majority may respond to medical treatment. [ABSTRACT FROM AUTHOR]

Introduction: Lipomatosis or fat replacement of the pancreas is the most frequent benign pathologic conditions of the adult pancreas. Most cases are asymptomatic and only some rare extreme degrees of lipomatosis lead to exocrine pancreatic insufficiency. We present a case of total pancreatic lipomatosis with steatorrhea. Case Report: A 50 year old female patient who is a known case of diabetes mellitus since 8 months on OHAs came with complaints of abdominal discomfort, decreased appetite, loose stools (3-4 episodes/ day) with steatorrhea since 1 year. History of weight loss of 3-4 kgs present since 2 months. There was no history of jaundice/pruritus / pale stools or any signs suggestive of pancreatitis/pancreatic cancer. Physical examination revealed pallor, grade 1 acanthosis and pitting oedema of bilateral lower limbs. Cardiovascular and respiratory system examination revealed no abnormality. Routine blood tests and renal function tests were normal. Liver function tests were also found to be normal. Ultrasound abdomen was done which revealed diffusely enlarged pancreas with hyperechoic echotexture. Computed tomography revealed near total fatty replacement of head, body and tail of the pancreas (attenuation value = -80 to -85 HU), and only a thin pancreatic parenchyma was seen. There was no calculus or dilatation of intrahepatic biliary radicals or common bile duct. Based on these findings, the diagnosis of diffuse pancreatic lipomatosis leading to steatorrhea was made. Conclusion: Despite the rarity of fatty replacement of the pancreas, clinicians must always exclude pancreatic lipomatosis in evaluation of cases of malabsorption. CT can reliably exclude the disease. [ABSTRACT FROM AUTHOR]