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Imaging features in six cases of groove pancreatic carcinoma
Abstracts / Pancreatology 16 (2016) S1eS192
A 64-year-old woman was admitted to our hospital because her pancreatic duct dilation was pointed out at the medical examination in October 2011. CT and MRI showed an IPMN of main pancreatic duct type in the head of pancreas. PET-CT showed an accumulation of SUV4.0 in the tumor. Under the diagnosis of an invasive carcinoma derived from IPMN, SSPPD was performed. In the pathological findings, a large amount of tumor cells grew papillary in the head of pancreas. Most of tumor cells located in the dilated main pancreatic duct, a part of them extended to a stromal tissue around the duct, and a muscle layer of duodenum. In addition, a main pancreatic duct invasion was found. We diagnosed an invasive carcinoma derived from IPMN, pT3N0M0 Stage2A (UICC). Adjuvant was performed with Gemcitabin. A recurrence was not detected after surgery, a long-term survival was achieved for 4-years and 3-months.
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enhancement at equilibrium phase of contrast-enhanced MDCT and four cases showed peripheral enhancement and arterial encasement, whereas the tumor included cystic lesions in four cases. In esophagogastroduodenoscopy, all cases had abnormal findings at the duodenum, such as tumor exposure, stenosis, reddening or edema of mucosa. One case did not only show any specific image finding but also could not make histological diagnosis. Conclusion: Most of groove pancreatic carcinoma shows the specific image findings, and they may be helpful for diagnosis.
P-069. A rare case of mixed acinar-ductal carcinoma of pancreatic head Katsuhiko Ito P-067. A case of invasive ductal carcinoma of pancreas with specific tumor growth Yutaka Nakano, Minoru Kitago, Osamu Itano, Masahiro Shinoda, Hiroshi Yagi, Yuta Abe, Taizo Hibi, Kenta Inomata, Yusuke Katsuki, Yuko Kitagawa Department of surgery, Keio University, Japan A 70-year-old man was referred to our hospital because of dilatation of the main pancreatic duct (MPD). Abdominal ultrasound showed dilatation of the MPD and a low echoic mass at the pancreas head. Other imaging examinations and cytology did not reveal malignancy. To rule out autoimmune pancreatitis, we performed a steroid test by administering 20 mg prednisolone. Follow-up computed tomography/magnetic resonance cholangiopancreatography revealed worsening of the dilatations of the MPD and common bile duct. We could not distinguish pancreatic cancer from tumor-forming pancreatitis. The patient was admitted to our hospital because of acute cholangitis and underwent surgery. Although intraoperative biopsy showed malignancy, pancreaticoduodenectomy was performed. Macroscopic findings did not reveal an obvious tumor. Microscopic findings indicated ductal carcinoma, which tends to be invasive between lobular and lobular along with lymph and blood vessels retaining their lobular form. The tumor morphology was similar to that of the pancreas in chronic pancreatitis and we could not detect the mass formation. We report a case of invasive ductal carcinoma of the pancreas with specific tumor growth, which was difficult to diagnose.
Department of Surgery, Narita Red Cross Hospital, Japan Background: Acinar-ductal carcinoma is a rare pancreatic neoplasm accounting for less than 1% of all primary pancreatic neoplasm. Moreover, mixed acinar-ductal carcinoma is very rare. I present a case of mixed acinarductal carcinoma of pancreatic head with its image and histologic findings. Patient: A 63-year old man was found a pancreatic tumor by abdominal CT during the follow up of HBV-LC and HCC. Dynamic CT showed an about 3cm sized marginally enhanced round mass in pancreatic head. CT finding of pancreatic tumor was not typical of pancreatic ductal adenocarcinoma. According to the endoscopic ultrasound-fine needle aspiration (EUS-FNA), poorly differentiated adenocarcinoma was found. FDG-PET showed the accumulation at the head of pancreas only. Result: As preoperative diagnosis of pancreatic adenocarcinoma was made, the operation was performed. At the laparotomy finding, there was no metastasis of liver and peritoneum. So, I performed pancreaticoduodenectomy with portal vein resection. Macroscopically, 3cm sized white hard mass with clear marginal was found at the pancreatic head. The tumor was grown with expansive pattern. Microscopically, the tumor was very cellular. Acinar and trabecular patterns of growth were identified. Immunohistochemistry for trypsin and bcl-10 were partially positive. We diagnosed mixed acinar-ductal carcinoma. Conclusion: Mixed acinar-ductal carcinoma of pancreatic head is a rare neoplasm. Herein, I report a case of mixed acinar-ductal carcinoma of pancreas.
P-070. P-068. Imaging features in six cases of groove pancreatic carcinoma Takeharu Nakamura, Kiyonori Kusumoto, Yoshitaka Nakai Department of Gastroenterology, Kyoto Katsura Hospital, Japan
A case of adenosquamous carcinoma presenting with mostly squamous cell carcinoma and little amount of adenocarcinoma component Ryuta Muraki 1, Hideyuki Kanemoto 1, Michiro Takahashi 1, Yusuke Kyoden 1, Noriyuki Oba 1, Takafumi Kurokami 2, Makoto Suzuki 3, Masakazu Takagi 1 1
Background: Although it is quite important to distinguish groove pancreatic carcinoma from groove pancreatitis, the differential diagnosis is difficult because these diseases frequently show similar image findings and clinical symptoms. Previous articles have reported that peripheral enhancement at portal venous phase and arterial encasement were specific image findings of groove pancreatic carcinoma, while cystic lesion and calcification were characteristic findings of groove pancreatitis. Purpose: To clarify the specific imaging findings of groove pancreatic carcinoma. Materials and methods: Between January 2014 and December 2015, we had six cases of groove pancreatic carcinoma. We retrospectively reviewed MDCT, MRI and endoscopic images (esophagogastroduodenoscopy and EUS) of these cases. Results: There were one case of stage III and five cases of stage IVb. Three cases were diagnosed by EUS-FNA, and each one case was by endoscopic biopsy and by laparoscopic biopsy. All cases showed delayed
Department of Surgery, Shizuoka General Hospital, Japan Department of Gastroenterology, Shizuoka General Hospital, Japan 3 Department of Pathology, Shizuoka General Hospital, Japan 2
A 66-year-old woman visited was admitted for a history of left quadrant pain and unintentional weight loss of 10kg during the past 6 months. Serum levels of tumor markers were elevated (CEA 40.0 mg/ml, CA19-9 240 mg/ml, SCC 48.7 mg/ml). Contrast-enhanced computed tomography of the abdomen showed a 13-cm poorly enhancing mass in the left hypochondrium, causing invasion to stomach and spleen. Upper gastrointestinal endoscopic examination revealed tumor infiltration from the submucosa in the greater curvature of the stomach, and the biopsy specimen showed malignant cells. Based on clinical examination, tumor markers, imaging, and biopsy, a diagnosis of pancreatic adenosquamous carcinoma (PASC) with gastric invasion was made. After 2 courses of neoadjuvant chemotherapy with gemcitabine and nab-paclitaxel, we performed distal pancreatectomy with total gasterectomy, splenectomy and transverse
A 64-year-old woman was admitted to our hospital because her pancreatic duct dilation was pointed out at the medical examination in October 2011. CT and MRI showed an IPMN of main pancreatic duct type in the head of pancreas. PET-CT showed an accumulation of SUV4.0 in the tumor. Under the diagnosis of an invasive carcinoma derived from IPMN, SSPPD was performed. In the pathological findings, a large amount of tumor cells grew papillary in the head of pancreas. Most of tumor cells located in the dilated main pancreatic duct, a part of them extended to a stromal tissue around the duct, and a muscle layer of duodenum. In addition, a main pancreatic duct invasion was found. We diagnosed an invasive carcinoma derived from IPMN, pT3N0M0 Stage2A (UICC). Adjuvant was performed with Gemcitabin. A recurrence was not detected after surgery, a long-term survival was achieved for 4-years and 3-months.
S113
enhancement at equilibrium phase of contrast-enhanced MDCT and four cases showed peripheral enhancement and arterial encasement, whereas the tumor included cystic lesions in four cases. In esophagogastroduodenoscopy, all cases had abnormal findings at the duodenum, such as tumor exposure, stenosis, reddening or edema of mucosa. One case did not only show any specific image finding but also could not make histological diagnosis. Conclusion: Most of groove pancreatic carcinoma shows the specific image findings, and they may be helpful for diagnosis.
P-069. A rare case of mixed acinar-ductal carcinoma of pancreatic head Katsuhiko Ito P-067. A case of invasive ductal carcinoma of pancreas with specific tumor growth Yutaka Nakano, Minoru Kitago, Osamu Itano, Masahiro Shinoda, Hiroshi Yagi, Yuta Abe, Taizo Hibi, Kenta Inomata, Yusuke Katsuki, Yuko Kitagawa Department of surgery, Keio University, Japan A 70-year-old man was referred to our hospital because of dilatation of the main pancreatic duct (MPD). Abdominal ultrasound showed dilatation of the MPD and a low echoic mass at the pancreas head. Other imaging examinations and cytology did not reveal malignancy. To rule out autoimmune pancreatitis, we performed a steroid test by administering 20 mg prednisolone. Follow-up computed tomography/magnetic resonance cholangiopancreatography revealed worsening of the dilatations of the MPD and common bile duct. We could not distinguish pancreatic cancer from tumor-forming pancreatitis. The patient was admitted to our hospital because of acute cholangitis and underwent surgery. Although intraoperative biopsy showed malignancy, pancreaticoduodenectomy was performed. Macroscopic findings did not reveal an obvious tumor. Microscopic findings indicated ductal carcinoma, which tends to be invasive between lobular and lobular along with lymph and blood vessels retaining their lobular form. The tumor morphology was similar to that of the pancreas in chronic pancreatitis and we could not detect the mass formation. We report a case of invasive ductal carcinoma of the pancreas with specific tumor growth, which was difficult to diagnose.
Department of Surgery, Narita Red Cross Hospital, Japan Background: Acinar-ductal carcinoma is a rare pancreatic neoplasm accounting for less than 1% of all primary pancreatic neoplasm. Moreover, mixed acinar-ductal carcinoma is very rare. I present a case of mixed acinarductal carcinoma of pancreatic head with its image and histologic findings. Patient: A 63-year old man was found a pancreatic tumor by abdominal CT during the follow up of HBV-LC and HCC. Dynamic CT showed an about 3cm sized marginally enhanced round mass in pancreatic head. CT finding of pancreatic tumor was not typical of pancreatic ductal adenocarcinoma. According to the endoscopic ultrasound-fine needle aspiration (EUS-FNA), poorly differentiated adenocarcinoma was found. FDG-PET showed the accumulation at the head of pancreas only. Result: As preoperative diagnosis of pancreatic adenocarcinoma was made, the operation was performed. At the laparotomy finding, there was no metastasis of liver and peritoneum. So, I performed pancreaticoduodenectomy with portal vein resection. Macroscopically, 3cm sized white hard mass with clear marginal was found at the pancreatic head. The tumor was grown with expansive pattern. Microscopically, the tumor was very cellular. Acinar and trabecular patterns of growth were identified. Immunohistochemistry for trypsin and bcl-10 were partially positive. We diagnosed mixed acinar-ductal carcinoma. Conclusion: Mixed acinar-ductal carcinoma of pancreatic head is a rare neoplasm. Herein, I report a case of mixed acinar-ductal carcinoma of pancreas.
P-070. P-068. Imaging features in six cases of groove pancreatic carcinoma Takeharu Nakamura, Kiyonori Kusumoto, Yoshitaka Nakai Department of Gastroenterology, Kyoto Katsura Hospital, Japan
A case of adenosquamous carcinoma presenting with mostly squamous cell carcinoma and little amount of adenocarcinoma component Ryuta Muraki 1, Hideyuki Kanemoto 1, Michiro Takahashi 1, Yusuke Kyoden 1, Noriyuki Oba 1, Takafumi Kurokami 2, Makoto Suzuki 3, Masakazu Takagi 1 1
Background: Although it is quite important to distinguish groove pancreatic carcinoma from groove pancreatitis, the differential diagnosis is difficult because these diseases frequently show similar image findings and clinical symptoms. Previous articles have reported that peripheral enhancement at portal venous phase and arterial encasement were specific image findings of groove pancreatic carcinoma, while cystic lesion and calcification were characteristic findings of groove pancreatitis. Purpose: To clarify the specific imaging findings of groove pancreatic carcinoma. Materials and methods: Between January 2014 and December 2015, we had six cases of groove pancreatic carcinoma. We retrospectively reviewed MDCT, MRI and endoscopic images (esophagogastroduodenoscopy and EUS) of these cases. Results: There were one case of stage III and five cases of stage IVb. Three cases were diagnosed by EUS-FNA, and each one case was by endoscopic biopsy and by laparoscopic biopsy. All cases showed delayed
Department of Surgery, Shizuoka General Hospital, Japan Department of Gastroenterology, Shizuoka General Hospital, Japan 3 Department of Pathology, Shizuoka General Hospital, Japan 2
A 66-year-old woman visited was admitted for a history of left quadrant pain and unintentional weight loss of 10kg during the past 6 months. Serum levels of tumor markers were elevated (CEA 40.0 mg/ml, CA19-9 240 mg/ml, SCC 48.7 mg/ml). Contrast-enhanced computed tomography of the abdomen showed a 13-cm poorly enhancing mass in the left hypochondrium, causing invasion to stomach and spleen. Upper gastrointestinal endoscopic examination revealed tumor infiltration from the submucosa in the greater curvature of the stomach, and the biopsy specimen showed malignant cells. Based on clinical examination, tumor markers, imaging, and biopsy, a diagnosis of pancreatic adenosquamous carcinoma (PASC) with gastric invasion was made. After 2 courses of neoadjuvant chemotherapy with gemcitabine and nab-paclitaxel, we performed distal pancreatectomy with total gasterectomy, splenectomy and transverse