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Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth

BACKGROUND: Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth is extremely rare. Diagnosis of pancreatic cancer on preoperative imaging is difficult when the pancreatic parenchyma is compressed by a pseudocyst and becomes unclear. Despite advances in imaging te...

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Autores principales: Ohkura, Yu, Sasaki, Kazunari, Matsuda, Masamichi, Hashimoto, Masaji, Fujii, Takeshi, Watanabe, Goro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430898/
https://www.ncbi.nlm.nih.gov/pubmed/25948237
http://dx.doi.org/10.1186/s12880-015-0055-2
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author Ohkura, Yu
Sasaki, Kazunari
Matsuda, Masamichi
Hashimoto, Masaji
Fujii, Takeshi
Watanabe, Goro
author_facet Ohkura, Yu
Sasaki, Kazunari
Matsuda, Masamichi
Hashimoto, Masaji
Fujii, Takeshi
Watanabe, Goro
author_sort Ohkura, Yu
collection PubMed
description BACKGROUND: Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth is extremely rare. Diagnosis of pancreatic cancer on preoperative imaging is difficult when the pancreatic parenchyma is compressed by a pseudocyst and becomes unclear. Despite advances in imaging techniques, accurate preoperative diagnosis of cystic lesions of the pancreas remains difficult. In this case, it was challenging to diagnose pancreatic cancer preoperatively as we could not accurately assess the pancreatic parenchyma, which had been compressed by a moderate-sized cystic lesion with extrapancreatic growth. CASE PRESENTATION: A 63-year-old woman underwent investigations for epigastric abdominal pain. She had no history of pancreatitis. Although we suspected pancreatic ductal carcinoma with a pancreatic cyst, there was no mass lesion or low-density area suggestive of pancreatic cancer. We did not immediately suspect pancreatic cancer, as development of a moderate-sized cyst with extrapancreatic growth is extremely rare and known tumor markers were not elevated. Therefore, we initially suspected that a massive benign cyst (mucinous cyst neoplasm, serous cyst neoplasm, or intraductal papillary mucinous neoplasm) resulted in stenosis of the main pancreatic duct. We were unable to reach a definitive diagnosis prior to the operation. We had planned a pancreaticoduodenectomy to reach a definitive diagnosis. However, we could not remove the tumor because of significant invasion of the surrounding tissue (portal vein, superior mesenteric vein, etc.). The fluid content of the cyst was serous, and aspiration cytology from the pancreatic cyst was Class III (no malignancy), but the surrounding white connective tissue samples were positive for pancreatic adenocarcinoma on pathological examination during surgery. We repeated imaging (CT, MRI, endoscopic ultrasound, etc.) postoperatively, but there were neither mass lesions nor a low-density area suggestive of pancreatic cancer. In retrospect, we think that the slight pancreatic duct dilation was the only finding suggestive of pancreatic cancer. CONCLUSIONS: It is difficult to diagnose pancreatic cancer with pseudocyst preoperatively. If a pancreatic cyst is found in patients who had normal tumor marker levels or no history of pancreatitis, we should always consider the possibility of pancreatic cancer. In such cases, slight pancreatic duct dilation may be a diagnostic clue.
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spelling pubmed-44308982015-05-15 Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth Ohkura, Yu Sasaki, Kazunari Matsuda, Masamichi Hashimoto, Masaji Fujii, Takeshi Watanabe, Goro BMC Med Imaging Case Report BACKGROUND: Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth is extremely rare. Diagnosis of pancreatic cancer on preoperative imaging is difficult when the pancreatic parenchyma is compressed by a pseudocyst and becomes unclear. Despite advances in imaging techniques, accurate preoperative diagnosis of cystic lesions of the pancreas remains difficult. In this case, it was challenging to diagnose pancreatic cancer preoperatively as we could not accurately assess the pancreatic parenchyma, which had been compressed by a moderate-sized cystic lesion with extrapancreatic growth. CASE PRESENTATION: A 63-year-old woman underwent investigations for epigastric abdominal pain. She had no history of pancreatitis. Although we suspected pancreatic ductal carcinoma with a pancreatic cyst, there was no mass lesion or low-density area suggestive of pancreatic cancer. We did not immediately suspect pancreatic cancer, as development of a moderate-sized cyst with extrapancreatic growth is extremely rare and known tumor markers were not elevated. Therefore, we initially suspected that a massive benign cyst (mucinous cyst neoplasm, serous cyst neoplasm, or intraductal papillary mucinous neoplasm) resulted in stenosis of the main pancreatic duct. We were unable to reach a definitive diagnosis prior to the operation. We had planned a pancreaticoduodenectomy to reach a definitive diagnosis. However, we could not remove the tumor because of significant invasion of the surrounding tissue (portal vein, superior mesenteric vein, etc.). The fluid content of the cyst was serous, and aspiration cytology from the pancreatic cyst was Class III (no malignancy), but the surrounding white connective tissue samples were positive for pancreatic adenocarcinoma on pathological examination during surgery. We repeated imaging (CT, MRI, endoscopic ultrasound, etc.) postoperatively, but there were neither mass lesions nor a low-density area suggestive of pancreatic cancer. In retrospect, we think that the slight pancreatic duct dilation was the only finding suggestive of pancreatic cancer. CONCLUSIONS: It is difficult to diagnose pancreatic cancer with pseudocyst preoperatively. If a pancreatic cyst is found in patients who had normal tumor marker levels or no history of pancreatitis, we should always consider the possibility of pancreatic cancer. In such cases, slight pancreatic duct dilation may be a diagnostic clue. BioMed Central 2015-05-07 /pmc/articles/PMC4430898/ /pubmed/25948237 http://dx.doi.org/10.1186/s12880-015-0055-2 Text en © Ohkura et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Ohkura, Yu
Sasaki, Kazunari
Matsuda, Masamichi
Hashimoto, Masaji
Fujii, Takeshi
Watanabe, Goro
Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth
title Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth
title_full Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth
title_fullStr Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth
title_full_unstemmed Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth
title_short Pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth
title_sort pancreatic cancer accompanied by a moderate-sized pseudocyst with extrapancreatic growth
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430898/
https://www.ncbi.nlm.nih.gov/pubmed/25948237
http://dx.doi.org/10.1186/s12880-015-0055-2
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