Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal solid malignancies with increasing incidence. The poor prognosis is due to the aggressive nature of the tumor, late detection, and the resistance to chemotherapy and radiotherapy. A radical surgery procedure is the only treatment that has been shown to improve the 5-year survival rate to 20-25%. However, the majority of patients (80-85%) are diagnosed with locally advanced or metastatic disease and just 15-20% patients are diagnosed in an early stage allowing them to undergo the potentially curative surgical resection. The early detection of PDAC without the use of invasive methods is challenging and discovery of a cost-effective biomarker with high specificity and sensitivity could significantly improve the treatment and survival in these patients. In this review, we summarize current and newly examined biomarkers in early PDAC detection.

Exocrine pancreatic insufficiency (EPI), an important cause of maldigestion and malnutrition, results from primary pancreatic disease or is secondary to impaired exocrine pancreatic function. Although chronic pancreatitis is the most common cause of EPI, several additional causes exist. These include pancreatic tumors, pancreatic resection procedures, and cystic fibrosis. Other diseases and conditions, such as diabetes mellitus, celiac disease, inflammatory bowel disease, and advanced patient age, have also been shown to be associated with EPI, but the exact etiology of EPI has not been clearly elucidated in these cases. The causes of EPI can be divided into loss of pancreatic parenchyma, inhibition or inactivation of pancreatic secretion, and postcibal pancreatic asynchrony. Pancreatic enzyme replacement therapy (PERT) is indicated for the conditions described above presenting with clinically clear steatorrhea, weight loss, or symptoms related to maldigestion and malabsorption. This review summarizes the current literature concerning those etiologies of EPI less common than chronic pancreatitis, the pathophysiology of the mechanisms of EPI associated with each diagnosis, and treatment recommendations.

The differential diagnosis of solid pancreatic masses is notably problematic, given the broad spectrum of possible malignant and benign etiologies. Metastases of other malignancies constitute less than 5% of pancreatic lesions, with metastases of melanoma being among the least common. Melanoma is generally diagnosed via careful examination of the body surface. Exceptions to this include ocular and mucosal forms, cases with spontaneous regression of the primary site, and cases missed because of insufficient physical examination. We present a case of a symptomatic solid pancreatic mass, diagnosed by endosonography with fine needle aspiration biopsy, as a rare metastasis of malignant melanoma. The primary skin tumor was thereafter detected after careful physical examination. Timely skin examinations could lead to earlier diagnosis without the need for expensive and invasive procedures such as endosonography with fine needle aspiration biopsy. This case report stresses the general importance of careful skin self-examinations and skin examinations by physicians, beginning with general practitioners. This case also highlights the potential importance of performing a skin examination (an inexpensive and simple tool) when investigating pancreatic masses, as metastatic melanoma should always be considered a possibility during differential diagnosis.

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We present a case of a fish bone impacted in the papilla of Vater resulting in dyspepsia and mild elevation in liver function tests, that was subsequently treated endoscopically. Fish bones are one of the most commonly encountered of swallowed foreign bodies. However involvement of the biliary tract, such as the one described by us, represents an extremely rare complication of fish bone ingestion. The diagnosis of a foreign body in the biliary tract can be difficult and early endoscopic or surgical extraction may be required to avoid complications such as biliary stone formation, obstructive jaundice, cholangitis or cholecystitis and/or biliary sepsis. Prompt endoscopic treatment can avoid severe biliary complications or surgical therapy.