膵管内乳頭粘液性腫瘍に併存し異時性多中心性に発生した膵癌の根治切除例 [in Japanese] Metachronous multicentric pancreatic cancer with multiple intraductal papillary mucinous neoplasms (IPMN) [in Japanese]
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We report a rare surgical case of metachronous multicentric pancreatic cancer with multiple intraductal papillary mucinous neoplasms (IPMN). A 58-year-old woman with diabetes mellitus and a family history of pancreatic cancer (her father suffered from pancreatic cancer), was admitted to our hospital because of backache in November 2008. Distal pancreatectomy was performed for pancreatic cancer of the body concomitant with multiple IPMNs of uncinate process and distal pancreas in April 2009. Histopathological investigation revealed well-differentiated tubular adenocarcinoma concomitant with branch duct type IPMN. The final diagnosis based on general rules of JPS was T3N0M0, Stage III (R0). Although the margin of the surgical specimen was negative for carcinoma, a surgical specimen near the pancreatic stump showed PanIN1A-1B. Thirty-seven months after resection, the serum CA 19-9 value was elevated. Imaging examinations revealed a mass in the remnant pancreas. Forty-six months after the initial surgery, total pancreatectomy with portal vein resection was performed. Although the tumor was pathologically diagnosed as well-differentiated tubular adenocarcinoma, multicentric carcinogenesis was suggested because of histological differentiation from the initial tumor. The main tumor had no continuity with a branch duct type IPMN of the uncinate process. Therefore, the patient was diagnosed as metachronous multicentric pancreatic cancer concomitant with multiple IPMNs.
Suizo 31(1), 93-100, 2016
Japan Pancreas Society