A 70-year-old man was admitted to the emergency room with clinical symptoms suggestive of acute pancreatitis.
As a background of interest the patient is a smoker of about 20 cigarettes a day, drinker of about 80 g of ethanol a day, suffers COPD in treatment with inhalants, septic ulcus osteoporosis without symptoms, gallstones.
In addition, she had previously developed pancreatitis episodes managed conservatively.
During admission, the patient presented symptoms of asthenia, anorexia, weight loss, diffuse abdominal pain, persistent jaundice and choluria.
Laboratory tests showed 18,850 leukocytes (71% neutrophils), GGT 512 U/ml, alkaline phosphatase 818 U/ml, platelets 763,000, total bilirubin 4 mg/dl (bilirrubin 49 U/dl).
CT scan showed acute pancreatitis Baltazar grade E, with a tenuous pancreatic tail causing obstructive jaundice and involvement of vascular structures with splenic infarcts.
With the diagnosis of acute necrotizing pancreatitis, it was decided to perform surgery.
After right subcostal laparotomy and exposure of the pancreatic cell appears a duodenal lesion located in the third portion that is removed; furthermore, cleaning of the pancreatic cell and cholecystectomy is performed.
After 14 days of postoperative stay, hospital discharge was decided due to the good evolution of the patient.
Anatomopathological analysis of the specimen showed that it was a high-grade biphasic synovial sarcoma of 9 cm, with typical immunohistochemical features and with the translocation t(X1q;18) gene re-expressed by the tumor.
