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A case report of intraductal papillary mucinous carcinoma of the pancreas including intraductal tubulo-papillary carcinoma
S102
Abstracts / Pancreatology 16 (2016) S1eS192
Vater. Cytology of the pancreatic juice was negative for malignancy. The tumor markers remained normal level. Preoperative diagnosis was a mixed type IPMN. Result: Although the definitive malignancy for the lesion was unproven, this case corresponded to the worrisome features in terms of the international consensus guideline for the management of IPMN and MCN of the pancreas. We proposed a surgical resection for the patient considering refractory pancreatitis. The patient underwent pancreatoduodenectomy. The operation time was 448 minutes and intraoperative blood loss was 559g. Histological diagnosis for the lesion showed a gastric type IPMN with intermediate grade dysplasia and the tumor proliferated both into main and branch pancreatic ducts. Resected margin of the pancreas was free of neoplasm. The patient is in good health without any sings of tumor recurrence 10 months after surgery. Conclusion: Long-term follow up must be advisable considering an occurrence of multicentric IPMN or nonconcurrent ductal adenocarcinoma in the remnant pancreas.
P-026. A case report of intraductal papillary mucinous carcinoma of the pancreas including intraductal tubulo-papillary carcinoma Yukio Asano, Shin Ishihara, Masahiro Ito, Akihiko Horiguchi Department of Pancreatic Surgery, Fujita-Health University, Japan A 78-years-old man presented to our hospital complaining of the body weight loss. Ultrasound and computer tomography showed a cystic mass measuring 50 mm in the uncus of the pancreas and there were the enhanced papillary lesion in the cyst. Endscopic retrograde cholangio pancreatography showed the dilated orifice of the duodenal papilla with mucin excretion. Gastroscopy showed a squamous cell carcinoma in the middle esophagus. We were diagnosed intraductal papillary mucinous carcinoma and esophagus carcinoma according to the above results. A treatment plan is operation for intraductal papillary mucinous carcinoma and Chemo-Radiotherapy for esophagus carcinoma. We performed sub stomach preserving pancreato-duodenectomy for intraductal papillary mucinous carcinoma. The pathological findings were tubular and papillary growth neoplasm composed of cuboidal and papillary cell. Its area were positive in MUC 1 and 6, and were negative MUC 5AC. We diagnosed intraductal tubulo-papillary carcinoma around intraductal papillary mucinous carcinoma in the uncus of the pancreas. Intraductal tubulo-papillary carcinoma is a new concept at the WHO classification in 2010, and rare case. We reported s case based on consideration from literatures.
P-027. Surgical treatment for serous cyst adenoma of the pancreas Yasuhiro Fujino 1, Hironori Yamashita 1, Hidetaka Tsumura 2, Ikuya Miki 2 1 Department of Gastroenterological Surgery, Hyogo Cancer Center, Japan 2 Department of Gastroenterology, Hyogo Cancer Center, Japan
Serous cyst adenoma of the pancreas (SCN) is a rare pancreatic neoplasm with a comparative good prognosis. We reviewed seven cases of SPN resected in our hospital between 2000 and 2015. The range of age was from 51 to 73 years old with the average of 61.9 years, and the gender ratio of male vs. female was 0.17. Six patients underwent operation because of malignant potential of the tumors, which were considered as IPMC, and one patient underwent operation because of jaundice. EUS usually showed microcystic pattern which was typical for SCN, although macrocystic or solid patterns could not make different diagnosis from IPMN or MCN. Four patients underwent distal pancreatectomy and three did pancreaticoduodenectomy. The mean size of tumors was 43.7 mm. Pathological examination showed no malignant findings.
Recent development of imagines could make accurate diagnosis for SCN. Although SCN is usually benign and can be closely observed, the patients with symptoms require operation.
P-028. A case of serous cystic neoplasm in pancreas, resembling mucinous cystic neoplasm Risa Hashimoto, Terumasa Hisano, Yoshikuni Nagashio, Rie Sugimoto, Masayuki Furukawa National Hospital Organization Kyushu Cancer Center, Japan A 24-year-old woman was admitted to the hospital for synovial sarcoma of her left femur in November 2015. A surgical resection of the tumor was performed. As a preoperative screening abdominal Computed Tomography (CT) revealed a 55-mm unilocular cystic lesion in pancreas body she was referred to our department for the detailed examination after the surgery. Magnetic resonance imaging (MRI) demonstrated that the center of the cyst showed high signal without solid component by T2 imaging. Furthermore communication of the cyst with pancreatic main duct was not observed and duct was not dilated. Endoscopic Ultrasonography (EUS) showed that a part of the wall was thickened and there was 10-mm cyst in cyst. These findings suggested the lesion should be mucinous cystic neoplasm rather than serous cystic neoplasm, or other. Distal pancreatectomy with splenectomy was performed in January 2016.The fluid in cyst was serous and pathological diagnosis identified serous cyst neoplasm. In this case preoperative diagnosis of serous cystic neoplasm with mucinous cystic neoplasm was so difficult, that differential diagnosis for pancreatic cystic lesion with various imaging might be limited to some extent.
P-029. Long-term survival of serous cystadenocarcinoma of the pancreas with synchronous liver metastases after surgical treatment Yuichiro Maruyama 1, Yoshiki Naito 2, Yoshinobu Okabe 3, Yohei Nakama 1, Daisuke Muroya 1, Shoichiro Arai 1, Goichi Nakayama 1, Masanori Akashi 1, Ryuichi Kawahara 1, Hiroto Ishikawa 1, Toru Hisaka 1, Masafumi Yasunaga 1, Shinji Uchida 1, Koji Okuda 1 1
Department of Surgery, Kurume University School of Medicine, Japan Department of Pathology, Kurume University School of Medicine, Japan 3 Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Japan 2
Introduction: Serous cystic neoplasm represent 1-2% of pancreatic neoplasms, and thought to be benign. Malignant serous cystic neoplasm of the pancreas is rare. There are few long-term prognostic reports of serous cystadenocarcinoma of the pancreas. Case report: A 56-year-old woman was initially admitted to our hospital in 1987 with a mass in the upper abdomen. A pancreatic tumor with the liver metastasis was diagnosed. We performed distal pancreatectomy and microwave coagulo-necrotic therapy (MCN) of the liver. Histological diagnosis was serous cystic adenocarcinoma with liver metastasis. Nine years later after initial surgery, four metastatic liver tumors were identified. We performed MCN for the liver tumors. For a while, there is no evidence of recurrence or metastases, however 19 years later, after initial surgery, multiple metastatic lesion in the liver and right chest wall metastasis were identified. The patient was followed-up without any treatment as patient's intent. Liver metastases showed slow growth, but right chest wall metastasis was increasing. She died for carcinomatous pleuris at 84 year old, 28 years later after initial surgery. Discussion: There are few reported case of malignant serous cystic neoplasm. We report here in case, long-term survival of serous cystadenocarcinoma of the pancreas with synchronous liver metastases after surgical treatment.
Abstracts / Pancreatology 16 (2016) S1eS192
Vater. Cytology of the pancreatic juice was negative for malignancy. The tumor markers remained normal level. Preoperative diagnosis was a mixed type IPMN. Result: Although the definitive malignancy for the lesion was unproven, this case corresponded to the worrisome features in terms of the international consensus guideline for the management of IPMN and MCN of the pancreas. We proposed a surgical resection for the patient considering refractory pancreatitis. The patient underwent pancreatoduodenectomy. The operation time was 448 minutes and intraoperative blood loss was 559g. Histological diagnosis for the lesion showed a gastric type IPMN with intermediate grade dysplasia and the tumor proliferated both into main and branch pancreatic ducts. Resected margin of the pancreas was free of neoplasm. The patient is in good health without any sings of tumor recurrence 10 months after surgery. Conclusion: Long-term follow up must be advisable considering an occurrence of multicentric IPMN or nonconcurrent ductal adenocarcinoma in the remnant pancreas.
P-026. A case report of intraductal papillary mucinous carcinoma of the pancreas including intraductal tubulo-papillary carcinoma Yukio Asano, Shin Ishihara, Masahiro Ito, Akihiko Horiguchi Department of Pancreatic Surgery, Fujita-Health University, Japan A 78-years-old man presented to our hospital complaining of the body weight loss. Ultrasound and computer tomography showed a cystic mass measuring 50 mm in the uncus of the pancreas and there were the enhanced papillary lesion in the cyst. Endscopic retrograde cholangio pancreatography showed the dilated orifice of the duodenal papilla with mucin excretion. Gastroscopy showed a squamous cell carcinoma in the middle esophagus. We were diagnosed intraductal papillary mucinous carcinoma and esophagus carcinoma according to the above results. A treatment plan is operation for intraductal papillary mucinous carcinoma and Chemo-Radiotherapy for esophagus carcinoma. We performed sub stomach preserving pancreato-duodenectomy for intraductal papillary mucinous carcinoma. The pathological findings were tubular and papillary growth neoplasm composed of cuboidal and papillary cell. Its area were positive in MUC 1 and 6, and were negative MUC 5AC. We diagnosed intraductal tubulo-papillary carcinoma around intraductal papillary mucinous carcinoma in the uncus of the pancreas. Intraductal tubulo-papillary carcinoma is a new concept at the WHO classification in 2010, and rare case. We reported s case based on consideration from literatures.
P-027. Surgical treatment for serous cyst adenoma of the pancreas Yasuhiro Fujino 1, Hironori Yamashita 1, Hidetaka Tsumura 2, Ikuya Miki 2 1 Department of Gastroenterological Surgery, Hyogo Cancer Center, Japan 2 Department of Gastroenterology, Hyogo Cancer Center, Japan
Serous cyst adenoma of the pancreas (SCN) is a rare pancreatic neoplasm with a comparative good prognosis. We reviewed seven cases of SPN resected in our hospital between 2000 and 2015. The range of age was from 51 to 73 years old with the average of 61.9 years, and the gender ratio of male vs. female was 0.17. Six patients underwent operation because of malignant potential of the tumors, which were considered as IPMC, and one patient underwent operation because of jaundice. EUS usually showed microcystic pattern which was typical for SCN, although macrocystic or solid patterns could not make different diagnosis from IPMN or MCN. Four patients underwent distal pancreatectomy and three did pancreaticoduodenectomy. The mean size of tumors was 43.7 mm. Pathological examination showed no malignant findings.
Recent development of imagines could make accurate diagnosis for SCN. Although SCN is usually benign and can be closely observed, the patients with symptoms require operation.
P-028. A case of serous cystic neoplasm in pancreas, resembling mucinous cystic neoplasm Risa Hashimoto, Terumasa Hisano, Yoshikuni Nagashio, Rie Sugimoto, Masayuki Furukawa National Hospital Organization Kyushu Cancer Center, Japan A 24-year-old woman was admitted to the hospital for synovial sarcoma of her left femur in November 2015. A surgical resection of the tumor was performed. As a preoperative screening abdominal Computed Tomography (CT) revealed a 55-mm unilocular cystic lesion in pancreas body she was referred to our department for the detailed examination after the surgery. Magnetic resonance imaging (MRI) demonstrated that the center of the cyst showed high signal without solid component by T2 imaging. Furthermore communication of the cyst with pancreatic main duct was not observed and duct was not dilated. Endoscopic Ultrasonography (EUS) showed that a part of the wall was thickened and there was 10-mm cyst in cyst. These findings suggested the lesion should be mucinous cystic neoplasm rather than serous cystic neoplasm, or other. Distal pancreatectomy with splenectomy was performed in January 2016.The fluid in cyst was serous and pathological diagnosis identified serous cyst neoplasm. In this case preoperative diagnosis of serous cystic neoplasm with mucinous cystic neoplasm was so difficult, that differential diagnosis for pancreatic cystic lesion with various imaging might be limited to some extent.
P-029. Long-term survival of serous cystadenocarcinoma of the pancreas with synchronous liver metastases after surgical treatment Yuichiro Maruyama 1, Yoshiki Naito 2, Yoshinobu Okabe 3, Yohei Nakama 1, Daisuke Muroya 1, Shoichiro Arai 1, Goichi Nakayama 1, Masanori Akashi 1, Ryuichi Kawahara 1, Hiroto Ishikawa 1, Toru Hisaka 1, Masafumi Yasunaga 1, Shinji Uchida 1, Koji Okuda 1 1
Department of Surgery, Kurume University School of Medicine, Japan Department of Pathology, Kurume University School of Medicine, Japan 3 Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Japan 2
Introduction: Serous cystic neoplasm represent 1-2% of pancreatic neoplasms, and thought to be benign. Malignant serous cystic neoplasm of the pancreas is rare. There are few long-term prognostic reports of serous cystadenocarcinoma of the pancreas. Case report: A 56-year-old woman was initially admitted to our hospital in 1987 with a mass in the upper abdomen. A pancreatic tumor with the liver metastasis was diagnosed. We performed distal pancreatectomy and microwave coagulo-necrotic therapy (MCN) of the liver. Histological diagnosis was serous cystic adenocarcinoma with liver metastasis. Nine years later after initial surgery, four metastatic liver tumors were identified. We performed MCN for the liver tumors. For a while, there is no evidence of recurrence or metastases, however 19 years later, after initial surgery, multiple metastatic lesion in the liver and right chest wall metastasis were identified. The patient was followed-up without any treatment as patient's intent. Liver metastases showed slow growth, but right chest wall metastasis was increasing. She died for carcinomatous pleuris at 84 year old, 28 years later after initial surgery. Discussion: There are few reported case of malignant serous cystic neoplasm. We report here in case, long-term survival of serous cystadenocarcinoma of the pancreas with synchronous liver metastases after surgical treatment.