2022 Volume 37 Issue 4 Pages 175-186
A 58-year-old woman was found to have dilatation of the main pancreatic duct at screening ultrasonography performed for renal impairment. Evaluation showed stenosis of the main pancreatic duct in the head of the pancreas, a hypovascular region with ill-defined borders on contrast-enhanced computed tomography scan, and a slightly ill-defined hypoechoic region on endoscopic ultrasonography. Serial pancreatic juice aspiration cytologic examination (SPACE) and endoscopic ultrasound-fine needle aspiration showed no malignant findings. Pancreatic cancer could not be ruled out, and subtotal stomach-preserving pancreaticoduodenectomy was performed. Pathological examination revealed high-grade pancreatic intraepithelial neoplasia in the pancreatic duct branches in the head of the pancreas. Fibrosis surrounded the pancreatic duct branches where the lesions were located. Postoperatively, endoscopic ultrasound performed with an increase in serum tumor markers revealed a hypoechoic mass with a long diameter of 7mm in the residual pancreas. Atypical cells were detected by SPACE, and local recurrence in the residual pancreas was strongly suspected. Total pancreatectomy was performed 59 months after the initial resection. Pathological examination revealed an invasive ductal carcinoma with a long diameter of 8mm in the background of high-grade pancreatic intraepithelial neoplasia, which frequently occurs in the residual pancreas.
