[11] In the 2011 survey, 101,875 adults from 39,509 households were interviewed. The overall age-adjusted prevalence of severe headache or migraine in the www.selleckchem.com/products/ly2157299.html last 3 months among adults 18 or older was 16.6% (10.8% for males and 22.3% for females). Prevalence within specific age strata were as follows: 19.4% in those aged 18-24, 19.0% in those aged 25-44, 19.4% in those aged 45-54, 14.0% in those aged 55-64,

9.5% in those aged 65-74, and 6.1% in those 75 and older. Substantial sex- and age-related variability in headache prevalence was evident, however, as shown in Figure 1 —. The highest prevalence of 26.1% occurred among females aged 18-44. The lowest prevalence of 4.6% occurred among males 75 or older. Headache/migraine prevalence was inversely related to income and educational attainment (Figs. 2 — and 3 —). Income-related disparities were less pronounced among Hispanics/Latinos compared with whites or African Americans. The most current summary NAMCS results are from the 2009 survey.[12] Based on the “Reason for Visit Classification” used in this Palbociclib cost survey, “pain in the

head” was among the top 20 reasons (as provided by patients) for outpatient office visits. Overall head pain was listed as the reason for an office visit in 1.2% (±0.1 standard error [SE]) of visits. For females, headache was responsible for 1.5% of visits (SE 0.2) and for males 0.7% (SE 0.1). This translates, based

on 2000 census estimates, into 12,100,000 office visits for headache (SE 1,680,000). NAMCS also provides detailed information on prescriptions issued at outpatient visits. Analgesics were the most commonly learn more mentioned drugs, accounting for 11.4% of all drugs mentioned. An estimated 6,227,452 prescriptions were written for antimigraine drugs in 2009. As shown in Figures 4 — and 5 —, triptans account for over 80% of prescriptions issued for specific antimigraine drugs, nearly half of which were for sumatriptan. The most recent summary NHAMCS data are for 2009.[12] Overall, headache or pain in the head was the fifth leading cause of visits to the ED, as reported by patients (Fig. 6 —). When examined by age and sex, however, head pain was the third leading patient-reported reason for ED visits for women 15-64, accounting for 2.6% of ED visits; in men in that age group, it was the fifth leading reason (1.1%). 2009 NHAMCS data on final, physician diagnoses for ED visits also showed that in females ages 15-64 who attended the ED, “headache” was the seventh most common diagnosed condition (1.3%) and “migraine” specifically the 16th most common (1.0%). Comparatively, among males, “headache” ranked as the 19th most common condition diagnosed in emergency settings (0.5%), while migraine was not among the top 20 conditions. NHAMCS also provides data on imaging and other testing performed during ED visits.

However, the potential benefits of erythropoietin must be weighed against its potential side effects, the fact that its use in HCV therapy is

not approved by the FDA, and its considerable cost. If a PI treatment–limiting adverse event occurs, PegIFN and RBV can be continued provided Cobimetinib concentration that an on-treatment response had occurred. There are no data to help guide substitution of one for the other HCV PI. If a patient has a serious adverse reaction related to PegIFN and/or RBV, the PegIFN and/or RBV dose should be reduced or discontinued. If either PegIFN and/or RBV are discontinued, the HCV PI should be stopped. Additional information on management of other adverse events can be found in the package insert. Because patients with CHC frequently receive medications in addition to those used to treat HCV infection, and because the PIs can inhibit hepatic drug-metabolizing enzymes such as cytochrome P450 2C (CYP2C), CYP3A4, or CYP1A, both BOC and TVR were studied for potential interactions with a number of drugs likely to be coadministered. These included statins, immune suppressants, drugs used to treat HIV coinfection, opportunistic infections, mood disorders, R788 datasheet and drug addiction support medications. Both BOC and TVR, were noted to cause interactions with several of the drugs examined, either increasing

or decreasing pharmacokinetic parameters. It is particularly important, therefore, that the medical provider review this information as listed in the package insert for each of the drugs before starting treatment for CHC. This information check details can be obtained at the FDA Web site: www.accessdata.fda. gov/scripts/cder/drugsatfda/index.cfm. Other helpful sites are: http//:222.drug-interactions.com and www. hep-druginteractions.org Emergence of antiviral-resistant variants during PI-based therapy has been observed during all trials and is associated with virological failure and relapse (Tables 2 and 3). Mutations that confer either high or low level resistance to BOC and TVR cluster around the catalytic site of the NS3/4A serine protease. Similar

variants were detected in both BOC and TVR-treated subjects, suggesting that some degree of cross-resistance exists between the two PIs. In both phase 3 studies, sequence analysis of the NS3/4A region was performed in all subjects at baseline and for all subjects who failed to achieve an SVR. Antiviral resistant variants were detected in a small proportion of patients at baseline, 7% in the BOC studies and 5% in the TVR trials, but did not appear to impact response to either PI.25, 26 Therefore, there is currently no clinical indication for baseline resistance testing. Among treatment-naïve patients receiving a BOC regimen, antiviral resistant variants developing during treatment were observed overall in 16% of patients (Table 2).

In Taiwan, HIV-infected patients are provided free access to HIV care that includes monitoring of CD4 count and plasma HIV RNA load, and combination antiretroviral therapy (cART) that was introduced

in Taiwan in 1997. CART was defined as the use of at least three agents from at least two classes of antiretroviral agents according to the local treatment guidelines for adults with HIV infection. The study was approved by the Research Ethics Committee of the hospital and subjects gave written informed consent (NCT registration no. 01102296). HIV-infected subjects were Rapamycin mouse sequentially enrolled to receive two doses and three doses of HAV vaccine (1440 ELISA units) (HAVRIX 1440; GlaxoSmithKline, Biologicals, Rixensart, BGJ398 chemical structure Belgium). Enrollment of HIV-infected subjects to receive three doses of HAV vaccine began after completion of enrollment of HIV-infected subjects to receive two doses of vaccine. In the two-dose vaccination schedule in HIV-infected and HIV-uninfected subjects, HAV vaccine was administered at week 0 and week 24, while in the three-dose schedule, HAV vaccine was administered at week 0, week 4, and week 24. The subjects were contacted by cell phone to inquire reactions following vaccination.

Anti-HAV antibody was determined at week 24 (before the last dose was administered) and week 48. The primary endpoint was seroconversion at week 48. The secondary endpoints were seroconversion at week 24 and the geometric mean concentration (GMC) of anti-HAV antibody at weeks 48 and 72. Patients who had no serum available for determination of anti-HAV antibody at week 24 were considered as nonresponders. At week 48, those patients who had no serum samples available, but had achieved seroconversion at week 24, were considered as responders; those without seroconversion at week 48, or having no serologic data available before the last dose of vaccination at week 24 were considered as nonresponders (intention-to-treat [ITT] analysis using last-observation-carried-forward

principle). Sensitivity analyses were performed in patients who had available results of anti-HAV antibody at different time points (per-protocol [PP] analysis). Because the baseline characteristics were statistically significantly different in age and immunologic and virologic characteristics selleckchem between the two-dose HIV-infected and three-dose HIV-infected group (Table 1), pairs from the two groups were selected that were matched for CD4 count (±20 cells/μL) and age (±2 years) to better assess the serologic responses to HAV vaccination between the two groups receiving different doses of HAV vaccine. Serum samples were collected before vaccination (week 0) and at weeks 24, 48, and 72. The determinations of anti-HAV antibody of serum samples were performed at the central laboratory of the hospital via chemiluminescence immunoassay according to the manufacturer’s protocol (ARCHITECT HAVAb-IgG, Abbott Diagnostics, Wiesbaden, Germany).

In Taiwan, HIV-infected patients are provided free access to HIV care that includes monitoring of CD4 count and plasma HIV RNA load, and combination antiretroviral therapy (cART) that was introduced

in Taiwan in 1997. CART was defined as the use of at least three agents from at least two classes of antiretroviral agents according to the local treatment guidelines for adults with HIV infection. The study was approved by the Research Ethics Committee of the hospital and subjects gave written informed consent (NCT registration no. 01102296). HIV-infected subjects were selleck kinase inhibitor sequentially enrolled to receive two doses and three doses of HAV vaccine (1440 ELISA units) (HAVRIX 1440; GlaxoSmithKline, Biologicals, Rixensart, Crizotinib research buy Belgium). Enrollment of HIV-infected subjects to receive three doses of HAV vaccine began after completion of enrollment of HIV-infected subjects to receive two doses of vaccine. In the two-dose vaccination schedule in HIV-infected and HIV-uninfected subjects, HAV vaccine was administered at week 0 and week 24, while in the three-dose schedule, HAV vaccine was administered at week 0, week 4, and week 24. The subjects were contacted by cell phone to inquire reactions following vaccination.

Anti-HAV antibody was determined at week 24 (before the last dose was administered) and week 48. The primary endpoint was seroconversion at week 48. The secondary endpoints were seroconversion at week 24 and the geometric mean concentration (GMC) of anti-HAV antibody at weeks 48 and 72. Patients who had no serum available for determination of anti-HAV antibody at week 24 were considered as nonresponders. At week 48, those patients who had no serum samples available, but had achieved seroconversion at week 24, were considered as responders; those without seroconversion at week 48, or having no serologic data available before the last dose of vaccination at week 24 were considered as nonresponders (intention-to-treat [ITT] analysis using last-observation-carried-forward

principle). Sensitivity analyses were performed in patients who had available results of anti-HAV antibody at different time points (per-protocol [PP] analysis). Because the baseline characteristics were statistically significantly different in age and immunologic and virologic characteristics find more between the two-dose HIV-infected and three-dose HIV-infected group (Table 1), pairs from the two groups were selected that were matched for CD4 count (±20 cells/μL) and age (±2 years) to better assess the serologic responses to HAV vaccination between the two groups receiving different doses of HAV vaccine. Serum samples were collected before vaccination (week 0) and at weeks 24, 48, and 72. The determinations of anti-HAV antibody of serum samples were performed at the central laboratory of the hospital via chemiluminescence immunoassay according to the manufacturer’s protocol (ARCHITECT HAVAb-IgG, Abbott Diagnostics, Wiesbaden, Germany).

Addition of hTERT increased the anchorage independent growth of PHH. Transformed PHH harbored a dedifferentiated phenotype with decreased expression of hepatocytic markers, increased expression of some stemness markers and cancer stem cell self-renewal markers. Interestingly, transformed PHH showed an increased expression of Wnt/beta-catenin target genes in association with strong overexpression of upstream activators well known as AT9283 datasheet implied in hepatocarcinogenesis such as Wnt3 ligand and Frizzled-7 receptor. Regarding the p53 family, TAp73 and DNp73 were strongly upregulated. We described for the first time a unique model

of in vitro transformation of human liver cells. We showed that both differentiated hepatocytes and bipotent progenitors are permissive to transformation. This process was accompanied by alteration of differentiation capabilities, and appearance of stemness markers in transformed PHH. Interestingly, some pathway deregulations previously described in human HCC tissues were also observed in our models : Wnt/beta-catenin and TP73. This could be an interesting tool for a better understanding of hepatocarcinogenesis and drug discovery. Disclosures: David Durantel – Grant/Research Support: Hoffmann-La Roche [Background] Liver cirrhosis is one of the most important risk factors for the development of liver cancer.

Various lineages of stromal cells including stellate cells, Sotrastaurin in vitro activated myofibroblasts, and vascular endothelial cells as well as lymphocytes are known to emerge see more in the cirrhotic liver. However, it is unclear how microenvironment alteration induced by these cells affects the process of liver cancer development. In this study, we evaluated the role of stromal cells on stemness of the tumor, which is closely associated with the

aggressiveness of liver cancer. [Methods]Primary hepatocellular carcinoma (HCC) cells obtained from surgically resected specimens as well as Huh7 cells were co-cultured with various stromal cells in vitro using cell culture inserts. Gene and protein expression was evaluated by qRT-PCR and Western blotting. Fluorescence-activated cell sorting (FACS) was used to evaluate the frequency of cancer stem cells expressing EpCAM/CD1 33. Cancer stem cell characteristics were evaluated by spheroid formation, invasion, and tumorigenicity in immune deficient mice. Time-lapse image analysis was performed to monitor cell motility affected by stromal cells. [Results] Co-culture of HCC cells with fibroblasts resulted in the enhanced cell motility, spheroid formation, and invasion capacities of HCC cells, whereas those co-cultured with vascular endothelial cells or stellate cells did not show such phenotypes. FACS analyses demonstrated the enrichment of EpCAM/CD1 33-positive cells when co-cultured with fibroblasts.

Addition of hTERT increased the anchorage independent growth of PHH. Transformed PHH harbored a dedifferentiated phenotype with decreased expression of hepatocytic markers, increased expression of some stemness markers and cancer stem cell self-renewal markers. Interestingly, transformed PHH showed an increased expression of Wnt/beta-catenin target genes in association with strong overexpression of upstream activators well known as see more implied in hepatocarcinogenesis such as Wnt3 ligand and Frizzled-7 receptor. Regarding the p53 family, TAp73 and DNp73 were strongly upregulated. We described for the first time a unique model

of in vitro transformation of human liver cells. We showed that both differentiated hepatocytes and bipotent progenitors are permissive to transformation. This process was accompanied by alteration of differentiation capabilities, and appearance of stemness markers in transformed PHH. Interestingly, some pathway deregulations previously described in human HCC tissues were also observed in our models : Wnt/beta-catenin and TP73. This could be an interesting tool for a better understanding of hepatocarcinogenesis and drug discovery. Disclosures: David Durantel – Grant/Research Support: Hoffmann-La Roche [Background] Liver cirrhosis is one of the most important risk factors for the development of liver cancer.

Various lineages of stromal cells including stellate cells, GSI-IX price activated myofibroblasts, and vascular endothelial cells as well as lymphocytes are known to emerge learn more in the cirrhotic liver. However, it is unclear how microenvironment alteration induced by these cells affects the process of liver cancer development. In this study, we evaluated the role of stromal cells on stemness of the tumor, which is closely associated with the

aggressiveness of liver cancer. [Methods]Primary hepatocellular carcinoma (HCC) cells obtained from surgically resected specimens as well as Huh7 cells were co-cultured with various stromal cells in vitro using cell culture inserts. Gene and protein expression was evaluated by qRT-PCR and Western blotting. Fluorescence-activated cell sorting (FACS) was used to evaluate the frequency of cancer stem cells expressing EpCAM/CD1 33. Cancer stem cell characteristics were evaluated by spheroid formation, invasion, and tumorigenicity in immune deficient mice. Time-lapse image analysis was performed to monitor cell motility affected by stromal cells. [Results] Co-culture of HCC cells with fibroblasts resulted in the enhanced cell motility, spheroid formation, and invasion capacities of HCC cells, whereas those co-cultured with vascular endothelial cells or stellate cells did not show such phenotypes. FACS analyses demonstrated the enrichment of EpCAM/CD1 33-positive cells when co-cultured with fibroblasts.

However, there are limited data on the standardized diagnosis of gastric mucosa atrophy and gastric intestinal metaplasia. The aim of this study was to characterize atrophic and metaplastic gastric mucosa under conventional endoscopy, NBI and pCLE modes, and set up pCLE diagnostic JQ1 mouse criteria for these lesions. Methods: 89 Patients with gastric mucosal lesion diagnosed by gastrointestinal endoscopy were enrolled in the study. Suspicious lesions were evaluated under normal WLI, NBI and pCLE mode respectively. Descriptive characteristic of gastric mucosal atrophy and metaplasia under each mode were described. Diagnostic accuracy of each endoscopy mode was evaluated by measuring the concordance

with histology. Results: A total of 89 patients with 286 lesions were enrolled in the study. The diagnostic accuracy of WLI and NBI in atrophic gastritis and metaplasia were different compared to histology (each P < 0.005). Maraviroc The diagnostic concordance of atropic and metaplasia between pCLE and pathology

was good. The quantitive standard of atrophic gastritis were described as vessel diameter >11.5 um, distance between glands >26 um, and sum of glands in 5 fields <10. The optimal cutoff values of different grades of intestinal metaplasia were 13 goblet cells between mild and moderate grade, and 23 between moderate and sever grade. Conclusion: pCLE showed high potential for the diagnosis of atrophic gastritis and metaplasia based on quantitive standard, and had the ability to substitute with histology for the diagnosis of diffuse lesion in stomach. Key Word(s): 1. CLE; 2. Atrophic Gastritis; 3. Intestinalisation; 4. Narrow-Band Imaging; Presenting Author: HYE-WON YUN Additional Authors: KI-NAM SHIM, SUN-KYUNG

NA, JAE-IN RYU, MIN-JIN LEE, EUN-MI SONG, SEONG-EUN KIM, HYE-KYOUNG JUNG, SUNG-AE JUNG, SUN YOUNG YI Corresponding Author: KI-NAM SHIM Affiliations: Ewha Womans University, Mokdong Hospital; Objective: Suppression of GI peristalsis during GI endoscopy commonly requires intravenous click here or intramuscular injection of antispasmodic agents such as hyoscin butylbromide, atropine, glucagon, cimetropium bromide, etc.; however, these agents sometimes cause unexpected adverse reactions. Phloroglucin, administered orally, was expected to reduce pain and discomfort better than intravenous or intramuscular injection of antispasmodic agents. This study examined the effectiveness of oral phloroglucin for suppressing peristalsis, patient’s compliance, and complications and compared it with administration of intravenous or intramuscular cimetropium bromide. Methods: This was a randomized, investigator-blind, prospective comparative study. The 134 patients were randomized into 2 groups according to the medication administered prior to upper endoscopy: oral phloroglucin (group A, n = 68), and cimetropium bromide (group B, n = 66).

However, there are limited data on the standardized diagnosis of gastric mucosa atrophy and gastric intestinal metaplasia. The aim of this study was to characterize atrophic and metaplastic gastric mucosa under conventional endoscopy, NBI and pCLE modes, and set up pCLE diagnostic BGB324 research buy criteria for these lesions. Methods: 89 Patients with gastric mucosal lesion diagnosed by gastrointestinal endoscopy were enrolled in the study. Suspicious lesions were evaluated under normal WLI, NBI and pCLE mode respectively. Descriptive characteristic of gastric mucosal atrophy and metaplasia under each mode were described. Diagnostic accuracy of each endoscopy mode was evaluated by measuring the concordance

with histology. Results: A total of 89 patients with 286 lesions were enrolled in the study. The diagnostic accuracy of WLI and NBI in atrophic gastritis and metaplasia were different compared to histology (each P < 0.005). Erlotinib molecular weight The diagnostic concordance of atropic and metaplasia between pCLE and pathology

was good. The quantitive standard of atrophic gastritis were described as vessel diameter >11.5 um, distance between glands >26 um, and sum of glands in 5 fields <10. The optimal cutoff values of different grades of intestinal metaplasia were 13 goblet cells between mild and moderate grade, and 23 between moderate and sever grade. Conclusion: pCLE showed high potential for the diagnosis of atrophic gastritis and metaplasia based on quantitive standard, and had the ability to substitute with histology for the diagnosis of diffuse lesion in stomach. Key Word(s): 1. CLE; 2. Atrophic Gastritis; 3. Intestinalisation; 4. Narrow-Band Imaging; Presenting Author: HYE-WON YUN Additional Authors: KI-NAM SHIM, SUN-KYUNG

NA, JAE-IN RYU, MIN-JIN LEE, EUN-MI SONG, SEONG-EUN KIM, HYE-KYOUNG JUNG, SUNG-AE JUNG, SUN YOUNG YI Corresponding Author: KI-NAM SHIM Affiliations: Ewha Womans University, Mokdong Hospital; Objective: Suppression of GI peristalsis during GI endoscopy commonly requires intravenous click here or intramuscular injection of antispasmodic agents such as hyoscin butylbromide, atropine, glucagon, cimetropium bromide, etc.; however, these agents sometimes cause unexpected adverse reactions. Phloroglucin, administered orally, was expected to reduce pain and discomfort better than intravenous or intramuscular injection of antispasmodic agents. This study examined the effectiveness of oral phloroglucin for suppressing peristalsis, patient’s compliance, and complications and compared it with administration of intravenous or intramuscular cimetropium bromide. Methods: This was a randomized, investigator-blind, prospective comparative study. The 134 patients were randomized into 2 groups according to the medication administered prior to upper endoscopy: oral phloroglucin (group A, n = 68), and cimetropium bromide (group B, n = 66).

45 healthy volunteers were chosen as a control. The ability of melatonin, APACHE II and BISAP scoring systems to predict SAP was evaluated using Receiver operating characteristic (ROC) curve. The optimal cutoff concentration for SAP from the ROC curve was used to classify the patients into high concentration group (34 cases) and low concentration group (21 cases), the differences of high score rate of APACHE II and BISAP scoring systems between the two groups were compared respectively. Results: The MAP patients had

KU-60019 research buy a higher melatonin Levels than that of SAP and control, 38.34 versus 26.77 ng/L (P = 0.021), 38.34 versus 30.73 ng/L (P = 0.003), respectively. No significant difference in melatonin concentrations existed between SAP group and the control group (P > 0.05). The accuracy for SAP by melatonin, APACHE II score and BISAP score were 0.758,0.872,0.906 according to the ROC curve. A melatonin concentration≤28.74 ng/L was associated with an increased risk of developing SAP. Incidence of high score (≥3) of BISAP was significantly higher in patients with low

melatonin concentration (≤28.74 ng/L) compared to those with high concentration (>28.74 ng/L), 42.9% versus 14.7% (P = 0.02). For the APACHE II score, the incidence of high score (≥10) between the two groups had no significant difference (P > 0.05). Conclusion: Melatonin concentration variations find more is closely related to the severity of AP and BISAP score. We judge the severity Selleck U0126 of disease by measuring the levels of serum melatonin. Key Word(s): 1. Pancreatitis; 2. Melatonin; 3. Cutoff; 4. Predict; Presenting Author: LI ZHANG Additional Authors: XIANG ZHU, YONGHUI HUANG Corresponding Author: LI ZHANG, XIANG ZHU, YONGHUI HUANG Affiliations: Peking University Third Hospital Objective: Pancreatic neuroendocrine tumor (PNET) is a rare malignant tumor of the pancreas. Methods: We present a case of AFP-producing PNET, and the AFP-producing site was determined by immunohistochemical approach in the resected specimen. Results: The

patient was admitted to our hospital with elevated serum AFP with values of up to 321.4 ng/ml (normal 0–20 ng/ml). The pancreas was enlarged and contained a mass measuring 5.2 × 4.8 × 4.1 cm which showed probable encasement of the splenic vein by contrast-enhanced abdominal computed tomography. The patient underwent resection of the pancreatic tail and body. Interoperatively, no metastatic nodule on the liver surface, or lymph node metastasis was found. Light microscopy predominantly showed circumscribed cellular islands of tumor composed of large and small solid nests of polygonal cells. The tumor cells had moderate amounts of cytoplasm and round to oval nuclei with mild to moderate atypia.

45 healthy volunteers were chosen as a control. The ability of melatonin, APACHE II and BISAP scoring systems to predict SAP was evaluated using Receiver operating characteristic (ROC) curve. The optimal cutoff concentration for SAP from the ROC curve was used to classify the patients into high concentration group (34 cases) and low concentration group (21 cases), the differences of high score rate of APACHE II and BISAP scoring systems between the two groups were compared respectively. Results: The MAP patients had

Erlotinib in vivo a higher melatonin Levels than that of SAP and control, 38.34 versus 26.77 ng/L (P = 0.021), 38.34 versus 30.73 ng/L (P = 0.003), respectively. No significant difference in melatonin concentrations existed between SAP group and the control group (P > 0.05). The accuracy for SAP by melatonin, APACHE II score and BISAP score were 0.758,0.872,0.906 according to the ROC curve. A melatonin concentration≤28.74 ng/L was associated with an increased risk of developing SAP. Incidence of high score (≥3) of BISAP was significantly higher in patients with low

melatonin concentration (≤28.74 ng/L) compared to those with high concentration (>28.74 ng/L), 42.9% versus 14.7% (P = 0.02). For the APACHE II score, the incidence of high score (≥10) between the two groups had no significant difference (P > 0.05). Conclusion: Melatonin concentration variations selleck compound is closely related to the severity of AP and BISAP score. We judge the severity GSK2126458 of disease by measuring the levels of serum melatonin. Key Word(s): 1. Pancreatitis; 2. Melatonin; 3. Cutoff; 4. Predict; Presenting Author: LI ZHANG Additional Authors: XIANG ZHU, YONGHUI HUANG Corresponding Author: LI ZHANG, XIANG ZHU, YONGHUI HUANG Affiliations: Peking University Third Hospital Objective: Pancreatic neuroendocrine tumor (PNET) is a rare malignant tumor of the pancreas. Methods: We present a case of AFP-producing PNET, and the AFP-producing site was determined by immunohistochemical approach in the resected specimen. Results: The

patient was admitted to our hospital with elevated serum AFP with values of up to 321.4 ng/ml (normal 0–20 ng/ml). The pancreas was enlarged and contained a mass measuring 5.2 × 4.8 × 4.1 cm which showed probable encasement of the splenic vein by contrast-enhanced abdominal computed tomography. The patient underwent resection of the pancreatic tail and body. Interoperatively, no metastatic nodule on the liver surface, or lymph node metastasis was found. Light microscopy predominantly showed circumscribed cellular islands of tumor composed of large and small solid nests of polygonal cells. The tumor cells had moderate amounts of cytoplasm and round to oval nuclei with mild to moderate atypia.