A case of ductal carcinoma of the pancreas with sarcomatoid component which might be derived from ectopic pancreas

Abstract

A 68-year-old man who had been followed for diabetes mellitus at another hospital developed poor appetite and weight loss from around July 2005. Upper gastrointestinal endoscopy performed at the hospital on August 6, 2005 revealed an elevated lesion about 5cm in diameter slightly proximal to the papilla of Vater at the descending portion of duodenum. Biopsy specimen disclosed only necrotic tissue without malignant findings. The patient was referred and admitted to our hospital for close exploration and treatment on September 5, 2005. Although no definite diagnosis was made before surgery, pylorus-preserving pancreato-duodenectomy was performed with a diagnosis of primary duodenal cancer on September 16. Histopathologically the tumor was present in the proper muscular layer of the duodenum, and was composed of adenocarcinoma (about 50%), squamous cell carcinoma and adenosquamous cell carcinoma (about 15%), and sarcomatoid tumor (about 35%). Furthermore ectopic pancreas coexisted with ductal adenocarcinoma in the proper muscuhlar layer, suggesting that the tumor had been derived from the pancreatic duct.
In this paper we report this case of ductal carcinoma of the pancreas associated with sarcomatoid component in the duodenum which might be derived from the ectopic pancreas. The patient's postoperative course has been uneventful. Some bibliographical comments are also presented.