EUS-FNAで診断に至った退形成性膵管癌の1例

抄録

A 68-year-old man presented at our hospital with abnormal results of blood tests performed by a local physician. Computed tomography revealed a tumor in the tail of the pancreas with multiple liver tumors, splenic invasion, and gastric-wall invasion, and the patient was admitted. Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) was subsequently performed, and anaplastic carcinoma of the pancreas was diagnosed. The patient was started on combination chemotherapy with gemcitabine and S-1. On day 4 of treatment, he developed fever and altered consciousness, and the chemotherapy was discontinued. On day 45, the patient vomited blood, presumably because of direct invasion of the stomach by the pancreatic ductal carcinoma. Subsequently, multiple organ failure developed, and the patient died on day 56.
Anaplastic carcinoma is an extremely rare type of pancreatic cancer that is characterized by extremely rapid progression and poor outcomes as compared to the usual pancreatic ductal carcinomas. Most anaplastic carcinomas are diagnosed at surgery or autopsy. We describe our experience of a rapidly progressive case of anaplastic carcinoma of the pancreas with gastric invasion that was diagnosed by EUS-FNA.