A Case of Minute Pancreas Cancer, c-Ki-ras Gene Codon 12 Point Mutation Analysis of Pancreatic Juice Suggested its Existence

Abstract

A 46-year-old male complaining with upper abdominal pain was referred to our hospital, and admitted to gastroenterology department for further investigation and treatment in May 1997. Tumor markers were negative. EUS revealed 1.1cm in diameter tumor which showed round in shape and hypoechoic echogenity. ERP demonstrated stenosis of distal main pancreatic duct. And c-Ki-ras gene codon 12 point mutation was distinctively positive for DNA extracted from pancreatic juice collected during ERP examination by enriched PCR RFLP.
These data were highly suspicious of pancreas cancer existence, so pylorus-preserving pancreatoduodenectomy was done in June 1997. Subsequent pathological examination showed 1.0×0.8cm fibrosis in size at pancreas head and intraductal papillary adenocarcinoma growth limited to inside of MPD at proximal side of fibrosis. Microdissection method for surgical specimen confirmed this c-Ki-ras gene codon 12 point mutation was certainly originated from cancer tissue.