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OBJECTIVE: Thrombosis represents one of the most feared complications of the COronaVIrus Disease-2019 (COVID-19). Although pulmonary embolism and deep venous thrombosis are the most described complications, some investigations reported thrombotic localization also in the splanchnic venous district. METHODS: We describe the case of a patient with SARS-CoV-2 infection presenting with abdominal pain and diagnosed with portal vein thrombosis. In addition, we shortly review available literature supporting the possible role of COVID-19 as leading cause of splanchnic venous thrombosis. RESULTS: After in-depth diagnostic workup, we excluded the commonest causes of portal thrombosis and concluded that SARS-CoV-2 infection represented the main explanation of this finding. CONCLUSIONS: Our study warns the clinicians to maintain a high index of suspicion for thrombosis in patients diagnosed with SARS-CoV-2 infection manifesting gastrointestinal symptoms. An appropriate diagnostic work-up could allow to obtain an early diagnosis and consequently improve the clinical outcome of patients.

Fever of unknown origin (FUO) is extremely difficult to diagnose. It is defined as an illness lasting more than 3 weeks with a temperature exceeding 38 °C on several occasions and with an uncertain diagnosis after 1 week of intensive investigations in the hospital. The major causes of FUO are infection, neoplasm, and collagen vascular disease, but the percentages of each of these categories are subject to change due to improvements in diagnostic capability. The diagnostic workup of FUO is complex and, to date, there is no consensus published in the literature regarding guidelines as to the correct approach. A number of diagnostic tests and numerous non-invasive and invasive procedures, which however sometimes fail to explain the fever, are often necessary. In about 20% of cases of FUO the diagnosis is never established. In this article the case of a young man with fever of unknown origin is presented, the cause of which remains undiagnosed, in order to illustrate the difficulties of the diagnostic process. A “watch and wait” approach seems to be acceptable in a clinically stable patient for whom no diagnosis can be made after extensive investigation, and the prognosis is likely to be good.

OBJECTIVES: Contrast-enhanced ultrasound (CEUS) has been developed to better characterize the microvasculature of solid masses in several organs, including the pancreas. In this study, we assessed CEUS accuracy in differentiating exocrine from endocrine pancreatic tumors. METHODS: A total of 127 patients with single, undetermined pancreatic masses were prospectively examined with transabdominal ultrasound and CEUS, before surgical resection or percutaneous biopsy. RESULTS: Exocrine and endocrine pancreatic tumors showed different intralesional vascularization patterns: 98.9% (90/91) of exocrine tumors were hypoenhancing, whereas 95.8 % (23/24) of endocrine tumors had a hypervascular supply. A hypoenhancing pattern, indicative of ductal adenocarcinoma, had a significant (P < 0.001) diagnostic accuracy of 91.3% with a sensitivity of 96.8%, a specificity of 85.3%, a positive predictive value and a negative predictive value of 94.7% and 90.6%, respectively. The hyperenhancing pattern, indicative of endocrine tumors, had a significant (P = 0.031) diagnostic accuracy of 73.8% with a sensitivity of 83.3%, a specificity of 60.0%, a positive predictive value and negative predictive value of 83.3% and 60.0%, respectively. CONCLUSIONS: Contrast-enhanced ultrasound has a valuable diagnostic accuracy in differentiating exocrine from endocrine pancreatic tumors, which is a fundamental step to address appropriate histological evaluation, therapeutic approach, and follow-up.

Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant endocrine disorder and is characterised by the concurrent appearance of adenomas of the parathyroid glands, neuroendocrine-enteropancreatic tumours, and pituitary adenomas, as well as other types of less frequent tumours, such as adrenal cortical tumours, carcinoid tumours, lipomas, etc. Two different forms, familial and sporadic, have been described. The gene responsible, MEN1, consists of 10 exons encoding a 610-amino acid protein known as menin. The MEN1 syndrome is caused by inactivating mutations in MEN1 tumour suppressor gene. The combination of clinical and genetic investigation helps in the diagnosis. Genetic testing has been advocated to identify MEN1 carriers of the MEN1 families for the purpose of earlier detection of tumours. We present a patient with traditionally described manifestations of MEN1 (a parathyroid hyperplasia associated with a pancreatic neuroendocrine tumour and a gastrinoma), but with a negative genetic test for the MEN1 mutation.

Pancreatic neuroendocrine tumors (pNETs) account for 1–2% of all pancreatic tumors. Approximately two-thirds of patients have an advanced disease with metastases at diagnosis. Surgery is still the gold-standard treatment in most cases, while few medical options exist for inoperable tumors. A new potential therapeutic approach for advanced pNETs results from targeting intracellular molecular pathways. Rapalogs – rapamycin analogs including everolimus – target the mTOR signaling cascade, inhibit cell proliferation and evoke apoptosis. Recent Phase II and III clinical trials demonstrated that everolimus is effective in advanced pNETs as it increases progression-free survival of treated patients. Everolimus appears to be promising for advanced pNETs and is usually tolerated with mainly mild adverse events. Future studies will establish whether everolimus, alone or in combination with other compounds (e.g., new somatostatin analogs, cytotoxic agents and anti-angiogenetic drugs), will also prove to be a valid o...

BACKGROUND Patients with ileal endocrine tumors have a good survival rate. AIM To assess the quality of life of patients with endocrine tumors of the ileum. PATIENTS Forty-four consecutive patients (30 males, 14 females, mean age 61.1 years, range 26-79) with proven endocrine tumor of the ileum were studied. METHODS Italian version of the SF-12 Health Survey (SF-12) questionnaire able to explore the physical and mental aspects of daily life were used. Forty-four sex-matched and age-matched Italian normative participants were also considered for SF-12 evaluation. RESULTS The overall analysis of the SF-12 questionnaire in the 44 patients showed values of physical component summary (PCS) and mental component summary (MCS) scores representative of a relatively good quality of life and not significantly different from those of the normative population (PCS: 46.5+/-10.3 vs. 47.0+/-4.7, P = 0.792; MCS: 45.9+/-10.8 vs. 49.1+/-2.0, P = 0.057). PCS was significantly impaired in nonsmokers (P = 0.028), in those who underwent less invasive surgery (P = 0.007), in those who had pain at onset of the disease (P = 0.002), and in those who received multimodality treatment (P = 0.013). To evaluate the factors independently related to PCS, a multivariate analysis was performed and we found that specific surgery (P = 0.046) and presence of pain at onset of the disease (P = 0.001) were the only two factors that showed an independent relationship with PCS. CONCLUSION The patients with endocrine tumor of the ileum seem to perceive their quality of life as relatively good.