Total Remnant Pancreatectomy Performed in a Patient with Recurrence at the Site of Gastropancreatic Anastomosis of Cancer of the Papilla of Vater after Pancreatoduodenectomy

Abstract

A 75-year-old man underwent pancreatoduodenectomy for cancer of the papilla of Vater. The tumor was histologically diagnosed as well differentiated tubular adenocarcinoma without lymph node metastasis (T3aN0M0, Stage IIA). Serous CEA started increasing 12 months after the resection and abdominal CT performed 4 years and 7 months later revealed a 4-cm tumor at the site of gastropancreatic anastomosis. Upper gastrointestinal endoscopy showed a tumor at the site of anastomosis, and the biopsy revealed moderately differentiated tubular adenocarcinoma. We diagnosed recurrence of cancer of the papilla of Vater at the remnant pancreas. A total remnant pancreatectomy, along with partial gastrectomy, was performed 5 years and 6 months after the pancreato­duodenectomy. A white solid tumor with an indefinite margin localized at the site of anastomosis was recognized. The tumor was histologically and immunostained in a similar manner as the previous tumor of the papilla of Vater, which had showed involvement of pancreatic ducts. In particular, the similarity in the mucin core protein expression and the abnormal expression p53 protein led to the conclusion that the two tumors were of the same origin.