Abstract
BackgroundClinical evidence of intraductal dissemination through the pancreatic duct has been rare. We herein describe a case of ampullary carcinoma that disseminated in the remnant pancreas through the pancreatic duct.Case presentationA 68-year-old woman underwent SSPPD for ampullary carcinoma. The tumor was diagnosed as adenocarcinoma without lymph node metastasis (T2N0M0, stage IB). Computed tomography (CT) performed 3 years later revealed a 14-mm tumor near the site of the pancreaticojejunal anastomosis. Endoscopic ultrasound-guided fine needle aspiration showed adenocarcinoma that was morphologically similar to the specimen from the first surgery. We diagnosed recurrence of ampullary carcinoma in the remnant pancreas. A total remnant pancreatectomy was performed. We found a white solid tumor at the 20-mm distal side of pancreaticojejunal anastomosis. The tumor was morphologically similar and immunostaining showed a pattern identical to that of the original tumor, suggesting that the two tumors were of the same origin.ConclusionThe recurrent lesion was most likely the result of tumor cells leaving the tumor and implanting in the remnant pancreatic duct epithelium. Intraductal dissemination of adenocarcinoma is thought to be a cause of remnant recurrence after SSPPD in cases of obstruction of the pancreatic duct or an iatrogenic procedure.
Highlights
Clinical evidence of intraductal dissemination through the pancreatic duct has been rare
We describe a case of ampullary carcinoma that disseminated and implanted in the remaining pancreas through the pancreatic duct after subtotal stomach preserving pancreatoduodenectomy (SSPPD)
Laboratory findings were notable for carcinoembryonic antigen (CEA) level within normal limits; carbohydrate antigen 19-9 (CA19-9) level was slightly high (65.9 U/mL), and liver enzyme levels were elevated: aspartate aminotransferase, 155 IU/L; alanine aminotransferase, 98 IU/L; γ-glutamyl transpeptidase, 1620 IU/ L; alkaline phosphatase, 1980 IU/L; and total-bilirubin, 5.3 mg/dL
Summary
The recurrent lesion was most likely the result of tumor cells leaving the tumor and implanting in the remnant pancreatic duct epithelium.
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