Abstract
Pancreatic ductal carcinoma of the usual type often invades the portal vein, but rarely causes portal vein tumor thrombus. We here present a case of pancreatic invasive ductal adenocarcinoma with portal vein tumor thrombus.
A 72-year-old man presented with fever and vomiting was found having an impacted pancreatic stone in the main pancreatic duct and dilatation of the caudal pancreatic duct on CT. Endoscopic retrograde cholangiopancreatography (ERCP) revealed stricture of the main pancreatic duct and the lower bile duct. Contrast-enhanced CT scan and endoscopic ultrasonography (EUS), however, showed no tumor shadow at the pancreas head. Histopathology also revealed no malignant findings. We decided to follow the clinical course of the patient with a diagnosis of stricture due to chronic cholangitis. Two months later the patient developed obstructive cholangitis and close exploration using CT and EUS showed a tumor shadow in the portal vein. Although no pathological definite diagnosis could be achieved, we confirmed and abnormal uptake of FDG to the pancreatic head on FDG-PET CT as well as decreased diffusion on MRI. Pancreaticoduodenectomy and associated resection of the portal vein were performed. The histopathological diagnosis was well differentiated adenocarcinoma widely extending in the pancreas parenchyma. Invasion into the wall of portal vein was noted and the tumor in the portal vein was clarified to be tumor thrombus.
