Abstract
The 48 year-old man was admitted under diagnosis of diabetes mellitus.The plain abdomen X-ray films showed calcifications in the pancreas, and pancreozyminsecretin test revealed a senere depression of pancreatic function. The concomitant cytologic examination revealed a few malignant cells in the duodenal juice.
A laparotomy was performed for suspicion of carcinoma of the pancreatic head. The main pancreatic duct was markedly dilatated, and many small calculi were palpable. By intraoperative cholangiography, a part of the main duct of the pancreatic head was narrowed, and needle aspiration cytology was performed around the lesion several times. Malignant cells were again found in a part of head, and therefore a pancreatoduodenectomy was performed.
A tiny papillary cancer, several mm in diameter, was found in the constricted portion of the main pancreatic duct.
The patient had been fairly well for successive four years, but diabetic disturbance could be not always regularly controled.
It was an unexpected event that he died of cancer apparently recurred, short by after Virchow's metastasis had developed at about four years after the operation mentioned above. The autopsy examination revealed a cancer, involved in almost of the pancreas remnant associated with wide spread metastasis all over the pancreatic body.
It seems probable that the cancer observed at autopsy is likely of different origin from the microcarcinoma of the pancreatic head detected by cytologic examinations and removed operatively. Otherwise, it can not be resonablly explained of this fact that the patient has been survived for more than four years after the operation under fairly well condition.
