A case of carcinoma in situ of the pancreas with a surrounding fibrotic region

Abstract

A 76-year-old woman who was followed after treatment of hepatocellular carcinoma was revealed of having dilatation of the main pancreatic duct of the body and tail of pancreas by computed tomography. Endoscopic ultrasonography (EUS) showed a low echoic region at the body of the pancreas and dilatation of the distal part of the main pancreatic duct. Endoscopic retrograde cholangio-pancreatography (ERCP) showed stenosis of the main pancreatic duct at the pancreatic body and dilatation of the upstream part of the main pancreatic duct. Cytological examination of the pancreatic juice revealed adenocarcinoma. Under the diagnosis of pancreatic body cancer, a distal pancreatectomy with splenectomy was performed. Pathological examination revealed carcinoma in situ in the main and branched pancreatic ducts. The distribution of carcinoma in situ did not completely correspond to the low echoic region demonstrated by EUS. Fibrotic change was detected in the pancreas parenchyma close to the carcinoma in situ and this region corresponded to the low echoic area disclosed by EUS. She is alive without any sign of recurrence two years and ten months after surgery.