Abstract
A 72-year-old woman complaining of left hypochondrial pain was admitted to our hospital for medical examination and treatment. Abdominal enhanced computed tomography displayed a hypovascular mass 20 mm in diameter in the pancreatic head, dilation of the distal main pancreatic duct, and displacement of the portal vein owing to the mass. Abdominal magnetic resonance imaging displayed a mass in the pancreatic head and interruption of the main pancreatic duct. An increase in the cancer antigen 19-9 level to 254.3 U/mL was also found. The patient was diagnosed with pancreatic head carcinoma, and pylorus-preserving pancreatoduodenectomy with combined resection of the portal vein was performed. Pathological analysis demonstrated that the tumor mostly comprised poorly differentiated adenocarcinoma, and partly of pleomorphic and spindle cell-type anaplastic carcinoma, and morphologically closely resembled epithelioid angiosarcoma. Although the patient was treated with adjuvant chemotherapy S-1, multiple liver metastases and cancerous ascites appeared on postoperative day 75, and she died on post-operative day 88. We report this case because pathological analysis demonstrated a shift in cell composition from adenocarcinoma to anaplastic carcinoma, which we consider to be valuable for analysis of the underlying genetic mechanism of this disease.
