Multifocal Pancreatic Ductal Adenocarcinomas Concomitant with Intraductal Papillary Mucinous Neoplasms of the Pancreas Detected by Intraoperative Pancreatic Juice Cytology. A Case Report
Context Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas have been detected with increasing frequency as a result of the progression of diagnostic modalities. Recently, invasive ductal carcinoma of the pancreas concomitant with IPMNs has been the focus of attention. Case report We report the case of a 57-year-old man with multifocal ductal carcinomas of the pancreas concomitant with IPMNs detected by intraoperative cytology. During a follow-up for branch duct IPMNs, a stenotic lesion of the main duct in the pancreatic body was found by ERCP, and brush cytology of the stenosis revealed an adenocarcinoma. A distal pancreatectomy was proposed; however, intraoperative pancreatic juice cytology from the pancreatic head also revealed adenocarcinoma, and a total pancreatectomy was finally carried out. Pathological examination of the resected specimen showed multifocal ductal carcinomas and IPMNs in the distal pancreas, and invasive ductal carcinoma in the pancreatic head which had not been detected by preoperative imaging studies. Conclusions Surgeons should be aware of the possibility of multifocal carcinomas in patients with concomitant IPMNs. Intraoperative pancreatic juice cytology should always be performed in order to confirm the absence of carcinoma in the pancreas to be left in place after planned resection.
Image: Schematic representation of the location of IPMNs and non-invasive and invasive ductal carcinomas.
Ohashi K, Murakami Y, Takekoshi T. Four cases of 'mucin-producing' cancer of the pancreas on specific findings of the papilla of Vater. Prog Dig Endosc 1982; 20:348-51.
Uehara H, Nakaizumi A, Ishikawa O, Iishi H, Tatsumi K, Takakura R, et al. Development of ductal carcinoma of the pancreas during follow-up of branch duct intraductal papillary mucinous neoplasm of the pancreas. Gut 2008; 57:1561-5. [PMID 18477671]
Ingkakul T, Sadakari Y, Ienaga J, Satoh N, Takahata S, Tanaka M. Predictors of the presence of concomitant invasive ductal carcinoma in intraductal papillary mucinous neoplasm of the pancreas. Ann Surg 2010; 251:70-5. [PMID 20009749]
Yamaguchi K, Yokohata K, Noshiro H, Chijiiwa K, Tanaka M. Mucinous cystic neoplasm of the pancreas or intraductal papillary-mucinous tumour of the pancreas. Eur J Surg 2000; 166:141-8. [PMID 10724492]
Yamaguchi K, Ohuchida J, Ohtsuka T, Nakano K, Tanaka M. Intraductal papillary-mucinous tumor of the pancreas concomitant with ductal carcinoma of the pancreas. Pancreatology 2002; 2:484-90. [PMID 12378117]
Eguchi H, Ishikawa O, Ohigashi H, Sasaki Y, Yamada T, Nakaizumi A, et al. Role of intraductal cytology combined with histology in detecting continuous and skip type intraductal cancer for intraductal papillary mucinous carcinoma of the pancreas. Cancer 2006; 107:2567-75. [PMID 17054109]
Ishikawa O, Imaoka S, Ohigashi H, Nakaizumi A, Uehara H, Wada A, et al. A new method of intraoperative cytodiagnosis for more precisely locating the occult carcinoma. Surgery 1992; 111:294-300. [PMID 1311875]
Yamaguchi K, Nakamura K, Yokohata K, Shimizu S, Chijiiwa K, Tanaka M. Pancreatic cyst as a sentinel of in situ carcinoma of the pancreas: Report of two cases. Int J Pancreatol 1997; 22:227-31. [PMID 9444555]
Rockey EW. Total pancreatectomy for carcinoma: case report. Ann Surg 1943; 118:603-11. [PMID 17858293]
Pierce RA, Spitler JA, Hawkins WG, Strasberg SM, Linehan DC, Halpin VJ, et al. Outcomes analysis of laparoscopic resection of pancreatic neoplasms. Surg Endosc 2007; 21:579-86. [PMID 17180287]
Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A. Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 2005; 19:1028-34. [PMID 16027987]
Sa Cunha A, Rault A, Beau C, Laurent C, Collet D, Masson B. A single-institution prospective study of laparoscopic pancreatic resection. Arch Surg 2008; 143:289-95. [PMID 18347277]
Casadei R, Marchegiani G, Laterza M, Ricci C, Marrano N, Margiotta A, Minni F. Total pancreatectomy: Doing it with mini-invasive approach. JOP. J Pancreas (Online) 2009; 10:328-31. [PMID 19454829]
Reddy S, Wolfgang CL, Cameron JL, Eckhauser F, Choti MA, Schulick RD, et al. Total pancreatectomy for pancreatic adenocarcinoma: evaluation of morbidity and long-term survival. Ann Surg 2009; 250:282-7. [PMID 19638918]
Copyright (c) 2010 Yasuhisa Mori, Takao Ohtsuka, Kosuke Tsutsumi, Takaharu Yasui, Yoshihiko Sadakari, Junji Ueda, Shunichi Takahata, Masafumi Nakamura, Masao Tanaka
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