High-grade pancreatic intraepithelial neoplasm with a mass and a high level of serum elastase 1: a case report

Abstract

The patient is a man in his 70s. Elevated serum Elastase1 and dilatation of the main pancreatic duct were detected on routine medical evaluation and he was referred for farther examination. A dynamic CT-scan and MRI showed an inhomogeneous 20mm mass in the pancreatic uncus with mild contrast enhancement. Pancreatic ductal adenocarcinoma was suspected. Pancreatic acinar cell neoplasm or neuroendocrine neoplasm were also considered and pylorus preserving pancreaticoduodenectomy was performed. The histopathological findings showed a papillary proliferation associated with nuclear atypia in the stenotic area of the main pancreatic duct. No cell invasion was seen beyond the pancreatic duct. The pathological diagnosis was a high-grade pancreatic intraepithelial neoplasm. The mass seen on the CT-scan was composed of marked fibrosis with invasion of fat tissue. The postoperative course was uneventful. Local fatty changes and atrophy of the pancreatic parenchyma were recently described as characteristic of early-stage pancreatic ductal adenocarcinoma, as seen in this patient. We report this patient with a literature review of the molecular mechanisms of fibrotic change.