title: 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.
authors.affiliation: Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamabuki
authors.affiliation: Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Ohara
authors.affiliation: Pathology, National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Kimura
authors.affiliation: Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Kunishige
authors.initials: K
authors.lastname: Okamura
authors.affiliation: Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Aki
authors.initials: A
authors.lastname: Kuroda
authors.affiliation: Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Ryo
authors.initials: R
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Kazuteru
authors.initials: K
authors.lastname: Komuro
authors.affiliation: Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan.
authors.forename: Nozomu
authors.initials: N
authors.lastname: Iwashiro
keywords: Arteriovenous malformation; Distal pancreatectomy; Pancreas