Ighi hospital, via massarenti, 9, bologna 40138, italy   hisa t, ohkubo h, shiozawa s, ishigame h, takamatsu m, furutake m, nobukawa b, suda k. cialis dosage Growth process of small pancreatic carcinoma: a case report with imaging observation for 22 months. World j gastroenterol 2008; 14(12): 1958-1960  available from: url: doi:   introduction invasive ductal carcinoma (idc) of the pancreas has the worst prognosis of all digestive carcinomas. cialis best price Its histogenesis and natural progression are unknown, and small idcs are still difficult to detect. what is cialis This is an extremely rare case of a small idc in which the growth process was observed on imaging studies for 22 mo. viagra effects women wiki   case report a 77-year-old man, who was being followed-up for chronic hepatitis c infection, was referred to our department for evaluation of a pancreatic mass on screening transabdominal ultrasonography (us). cheap online cialis Us showed a low-echoic mass, 7 mm in diameter, in the pancreatic body, without distal dilatation of the main pancreatic duct (mpd) ( figure 1a ). cialis original Endoscopic ultrasonography (eus) demonstrated an extremely low-echoic mass with posterior echo enhancement, which appeared to be a cyst ( figure 2a ). cheap viagra jelly uk     contrast-enhanced computed tomography (ct) scan and magnetic resonance cholangiopancreatography (mrcp) revealed a grape-like cyst in the pancreatic body. viagra 10 mg coupon Endoscopic retrograde pancreatography (erp) indicated mucus in the mpd and a dilated branch pancreatic duct in the pancreatic body without mural nodules ( figure 3a ). cheap viagra jelly uk We misinterpreted the low-echoic mass in us/eus images as a benign intraductal mucinous-papillary neoplasm (ipmn) of the branch duct type, and observed the lesion by us/eus every 6 mo (figures 1b and 2b). viagra viagra same Twenty-two months after the initial diagnosis, us/eus showed the low-echoic mass had increased in diameter to 13 mm (figures 1c and 2c). cheap cialis Then, for the first time, we detected a grape-like cyst distal to the lesion on us/eus (figure 1d), and recognized the low-echoic mass being followed was not identical to the initially diagnosed ipmn. A contrast-enhanced ct scan revealed a hypovascular area proximal to the grape-like cyst. On mrcp, the cyst did not show any change, but mpd in the pancreatic body became unclear. Erp demonstrated slight compression of the mpd proximal to a dilated branch duct (figure 3b), and brush cytology did not detect any malignant cells. Distal pancreatectomy was performed under a diagnosis of idc concomitant with ipmn. The cut surface of the resected specimen showed a white, irregular-shaped mass with a clear margin in the pancreatic body, and a dilated branch pancreatic duct distal to the mass. Microscopic examination showed that th. viagra over the counter sydney Saltar intro