Abstract
There have been few reported cases of remnant pancreatic ductal cancer developing after resection of invasive ductal cancer that implicated methachronous multicentric tumorigenesis.
A 67 years old man received a distal pancreatectomy due to pancreas body cancer. Twenty-five months after the surgery, he suffered from obstructive jaundice. Examinations revealed pancreas head cancer and no distant metastasis. Total pancreatectomy was performed and the metachronous invasive cancers of the remnant pancreatic head were surgically removed. Histological finding showed two regions of invasive cancer in the resected pancreas, one was at the caudal region and the other was at the groove region. There was no gross continuity with the lesions. This was a rare case because pancreatic cancer survivors are rare. This implicates two possibilities: 1, recurrence of the pancreas body cancer; 2, multicentric cancer. Additional analysis with molecular biological methods revealed a point mutation of K-ras codon 12 in the second cancer, in both the groove and the caudal portions whereas wild type K-ras was present in the first cancer. This supports a 'multicentric cancer', and 25 months between two surgeries was long enough to indicate the methachronous tumorigenesis.
