Anaplastic pancreatic carcinoma growing within the main pancreatic duct complicated by a large pseudocyst

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A 71-year-old woman with epigastric pain and fever visited our hospital. She had elevated levels of serum amylase and C-reactive protein, and computed tomography revealed a large, 20 cm diameter, pancreatic cyst. A low-density nodule was also identified in the head of the pancreas with mild dilation of the distal main pancreatic duct (MPD). The patient was diagnosed with pancreatic ductal carcinoma complicated by a pancreatic pseudocyst (PPC). After drainage of the cyst, a pancreaticoduodenectomy was safely performed. Histological examination revealed anaplastic pancreatic carcinoma (APC) composed of spindle cells and osteoclast-like giant cells. The tumor occupied the lumen of the MPD and acute and chronic obstructive pancreatitis was evident. Although her postoperative course was uneventful, the tumor recurred as multiple liver metastases three months after surgery, and she died of disease progression four months after surgery. PPCs are often caused by alcohol use, biliary tract disease, or blunt trauma. However, PPCs caused by APC is rarely seen. Although extremely rare, pancreatic cancer or APC should be considered as a cause of PPCs. A spindle cell component to the tumor seems to be associated with a dismal prognosis, while growth within the pancreatic duct is reported to carry a better prognosis.