scholarly journals Pancreatic ductal adenocarcinoma in a patient with pancreas divisum and gastrointestinal duplication cyst: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Naoto Takahashi ◽  
Hiroyuki Nitta ◽  
Akira Umemura ◽  
Hirokatsu Katagiri ◽  
Shoji Kanno ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Pancreas Divisum ◽  
Duplication Cyst ◽  
Ductal Adenocarcinoma ◽  
Ct Examination ◽  
History Of

Abstract Background The complication of duplication of alimentary tracts and pancreas divisum (PD) is a rare malformation and the development of pancreatic ductal adenocarcinoma (PDAC) in this malformation is also extremely rare. There have been some reports of complication of malignancy in a gastric duplication cyst (GDC) and PD. However, there have been no reports of complication of PDAC in cases with GDC and PD. Case presentation A 54-year-old woman was followed up at the previous hospital due to a history of ovarian endometrial adenocarcinoma. She also had a surgical history of partial excision for a GDC and pancreatic tail of PD in her childhood. A gynecological follow-up computed tomography (CT) examination revealed the pancreatic body tumor and the bifurcated main pancreatic duct dilatation. Furthermore, magnetic resonance cholangiopancreatography also revealed that the ventral main pancreatic duct communicated with the GDC. The initial levels of tumor markers were high, but we could not achieve preoperative histopathological diagnosis. The preoperative diagnosis was PDAC occurring in a case with PD and GDC. She received two courses of neoadjuvant chemotherapy with gemcitabine and nab-paclitaxel. A CT examination after neoadjuvant chemotherapy revealed the shrinkage of the tumor, and then we performed distal pancreatectomy with splenectomy and GDC resection. A histopathological examination revealed invasive PDAC and lymph node metastases; pathological staging was T1N1M0, stage III. Furthermore, PD and GDC were also histopathologically detected. The postoperative course was uneventful, and she was discharged on the postoperative day 25. She received S-1 monotherapy for 6 months, and no recurrence has been detected at 1 year after radical resection. Conclusions We herein presented an extremely rare combined case of PD, GDC and PDAC. We successfully treated it by neoadjuvant chemotherapy and distal pancreatectomy with GDC resection, and postoperative chemotherapy.

Pancreatic Cyst: Pseudocyst or Neoplasm? Pitfalls in Endoscopic Retrograde Cholangiopancreatography Diagnosis

2010 ◽  
Vol 76 (7) ◽  
pp. 725-730
Author(s):  
Clayton Tyler Ellis ◽  
John R. Barbour ◽  
Thomas M. Shary ◽  
David B. Adams
Keyword(s):  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Main Pancreatic Duct ◽  
Pancreatic Cyst ◽  
Mucinous Cystadenoma ◽  
Cystic Lesions ◽  
Endoscopic Retrograde ◽  
Pancreatic Tail ◽  
History Of

Pancreatic pseudocysts represent the majority of cystic lesions, and can usually be differentiated from cystic neoplasms, which have malignant potential. Endoscopic retrograde cholangiopancreatography (ERCP) can help in solving diagnostic dilemmas. When ERCP demonstrates cyst communication with the pancreatic duct, the diagnosis of pseudocyst is usually secure. There are exceptions, however, as reported in these two case reports. A retrospective chart review was conducted of two patients undergoing distal pancreatectomy in 2008 to 2009 for cystic lesions communicating with the main pancreatic duct on ERCP. Both patients were women (ages 37 and 42) with a history of chronic abdominal pain and pancreatitis. Radiologic imaging showed cystic lesions in the pancreatic tail. ERCP demonstrated main pancreatic duct communication. When endoscopic management failed, surgical therapy was undertaken. Both patients underwent distal pancreatectomy with splenectomy. Pathologic findings were mucinous cystadenoma. The conventional wisdom that a pancreatic cyst communicating with the main pancreatic duct is a benign pseudocyst is not always wise. As seen in this series, mucinous cystadenomas can erode into the main pancreatic duct. Women in the fourth and fifth decade with symptomatic cysts in the pancreatic tail with a history of pancreatitis should undergo distal pancreatectomy, regardless of ductal communication on ERCP.

Main pancreatic duct spread in resected invasive ductal adenocarcinoma: A clinicopathological study with propensity score-matched patients

Pancreatology ◽  
2016 ◽  
Vol 16 (4) ◽  
pp. S87
Author(s):  
Yasutoshi Kimura ◽  
Masayuki Ishii ◽  
Shintaro Sugita ◽  
Masafumi Imamura ◽  
Tatsuya Ito ◽  
...  
Keyword(s):  
Propensity Score ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Ductal Adenocarcinoma ◽  
Clinicopathological Study ◽  
Invasive Ductal Adenocarcinoma

scholarly journals Is neoadjuvant chemotherapy always justified in clinical T1 pancreatic ductal adenocarcinoma?

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S233
Author(s):  
H.S. Kim ◽  
K. Nakagawa ◽  
T. Akahori ◽  
K. Nakamura ◽  
T. Takagi ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Ductal Adenocarcinoma

scholarly journals Diagnostic Pitfalls and Therapeutic Strategies in the Treatment of Pancreatic Duct Haemorrhage

HPB Surgery ◽  
1997 ◽  
Vol 10 (5) ◽  
pp. 293-297 ◽  
Author(s):  
P. J. Gallagher ◽  
G. Mclauchlin ◽  
P. C. Bornman ◽  
J. E. J. Krige ◽  
J. Thomson ◽  
...  
Keyword(s):  
Alcohol Abuse ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Splenic Artery ◽  
Epigastric Pain ◽  
Gastroduodenal Artery ◽  
Diagnostic Dilemma ◽  
Artery Ligation ◽  
Men 2 ◽  
History Of

Haemorrhage via the pancreatic duct, a rare cause of upper gastrointestinal bleeding (GIB), often poses a diagnostic dilemma. We analysed our experience with 10 patients (8 men, 2 women; mean age 44 years, range 34 – 62) treated during a 12 year period. All had a history of alcohol abuse and presented with major upper GIB requiring a median of 8 units (range 2 – 40) blood, transfusion. Nine had upper abdominal pain at the time of admission and nine had a history of pancreatitis. Upper gastroduodenal endoscopy (median 4; range 1 – 9), was diagnostic in only one. Side-viewing endoscopy showed bleeding from the pancreatic duct in 7 of 8 patients. Visceral aneurysms were demonstrated in 7 of 9 patients in whom coeliac angiography was carried out: (splenic artery 4, gastroduodenal artery 2, and pancreaticoduodenal artery 1). Two of 4 selective embolisations were successful. Six patients underwent distal pancreatectomy, 1 had gastroduodenal artery ligation and 1 died of coagulopathy following a total pancreatectomy. Pancreatic duct haemorrhage should be considered in patients with unexplained recurrent upper GIB, alcohol abuse and epigastric pain, particularly in those with established chronic pancreatitis. Selective angiography is essential for diagnosis and management. For bleeding sites in the head of the pancreas, embolisation should be attempted to avoid major resection. Distal pancreatectomy is preferred for splenic artery lesions.

scholarly journals Anatomical Patterns of the Pancreatic Ductal System – A Cadaveric and Magnetic Resonance Cholangiopancreatography Study

2019 ◽  
Vol 36 (04) ◽  
pp. 279-285
Author(s):  
Mythraeyee Prasad ◽  
Sipra Rout ◽  
Tharani Putta ◽  
Reuben Thomas Kurien ◽  
Sudipta Dhar Chowdhury ◽  
...  
Keyword(s):  
Chronic Pancreatitis ◽  
Magnetic Resonance ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Pancreas Divisum ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Radiological Study ◽  
Ductal System ◽  
Type Iii ◽  
Ansa Pancreatica

Abstract Introduction Morphological variants of the pancreatobiliary system can predispose to chronic pancreatitis. The goal of the present study is to assess the prevalence of pancreatic duct patterns in the Indian population, both by cadaveric dissection and by magnetic resonance cholangiopancreatography (MRCP). Materials and Methods A total of 15 adult pancreas specimens of unknown age and gender, and 5 fetal pancreas specimens of different gestational ages with the intact second part of duodenum, were dissected by the piecemeal method. For clinical relevance, MRCP images of 103 clinically-diagnosed chronic pancreatitis patients irrespective of their etiology were obtained retrospectively from the existing database and studied. The anatomical patterns were classified as five different types based on the course of the main pancreatic duct and the accessory pancreatic duct and their openings into the duodenal wall, including variants like pancreas divisum and ansa pancreatica. Results In the cadaveric study, the main pancreatic duct was single with a straight course in 46.67% of the adult specimens, and in the MRCP study, the main pancreatic duct showed a descending course in 77.66% of the cases. The most common pattern was type III in both the cadaveric (80%) and radiological (55.33%) studies, and the accessory duct was absent on the MRCP in all type-III cases, while it ended blindly in the cadaveric specimens. Ansa pancreatica (type V) was observed in 1 adult specimen (6.7%), but not in the radiological study. Pancreas divisum (type IV) was observed in the 8 cases (7.76%) cases in the radiological study. Conclusion Knowledge of the anatomical variants of the pancreatic ductal system may be helpful for the radiologists during diagnostic and therapeutic interventional procedures.

scholarly journals Pancreatic neuroendocrine tumor featuring growth into the main pancreatic duct and tumor thrombus within the splenic vein: a case report

2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Takashi Miyata ◽  
Hiroyuki Takamura ◽  
Ryosuke Kin ◽  
Hisashi Nishiki ◽  
Akifumi Hashimoto ◽  
...  
Keyword(s):  
Neuroendocrine Tumor ◽  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Splenic Vein ◽  
Pancreatic Neuroendocrine Tumor ◽  
Ductal Adenocarcinoma ◽  
Pathological Examination ◽  
Left Edge ◽  
Pancreatic Stump ◽  
Pancreatic Body

Abstract A 48-year-old woman was admitted to our hospital because of upper abdominal pain. Computer tomography showed an enhancing mass in the pancreatic body, dilation of the main pancreatic duct (MPD) and a filling defect within the splenic vein. On the basis of the preoperative diagnosis of pancreatic body cancer, distal pancreatectomy was scheduled. The pancreas was divided along the left edge of the gastroduodenal artery; however, frozen pathological examination of the pancreatic stump was tumor positive, and therefore a total pancreatectomy was performed. The lesion was a white expansive nodular mass that had spread into the MPD and protruded into the splenic vein. A pathological diagnosis of non-functioning neuroendocrine tumor (NET) was made. In general, imaging findings of disruption of the MPD and tumor vein thrombus are characteristics of pancreatic ductal adenocarcinoma, but are uncommon in NET. However, NET should be included in the differential diagnosis for such patients.

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