Minimally invasive ductal pancreatic carcinoma without low echoic area on endoscopic ultrasound examinations: a case report

Abstract

Herein, we reported two cases of minimally invasive ductal pancreatic carcinoma. The first patient was a 59-year-old woman and the second was 62-year-old woman. Both patients had localized main pancreatic duct (MPD) stenosis of the pancreatic head and dilatation of the upstream MPD, but no mass was detected using endoscopic ultrasound (EUS), enhanced computed tomography, magnetic resonance imaging, and Fluorodeoxyglucose-positron emission tomography examinations. We diagnosed pancreatic carcinoma in situ by endoscopic nasopancreatic drainage (ENPD) and serial pancreatic-juice aspiration cytological examinations (SPACEs). The patients underwent pancreaticoduodenectomy. Histological diagnosis were minimally invasive ductal pancreatic carcinoma in situ for both patients (tumor sizes 0.4×0.3cm and 0.3×0.2cm, respectively) with lymph node metastasis for the first case. When both localized MPD stenosis and dilatation are present, the possibility of an invasive ductal pancreatic carcinoma should be considered, even if a mass or low echoic areas are not detected using EUS. We argue the necessity of ENPD and SPACE in such cases.