Nonsurgical management is usually recommended for serous cystic neoplasm of pancreas which is an uncommon benign tumor. However, resection is carried out for patients with symptoms or massive tumors. The aim of this study was to determine the operative indication for serous cystic neoplasm based on the clinicopathological characteristics of our 12 resected patients. The mean age was 63 years, and 9 patients were female. Three patients were symptomatic. The tumor was located at head of the pancreas in 5 patients, body in 3 patients, and tail in 4 patients. Mean tumor diameter was 6.9cm, and tumor growth was found in 6 patients. Stenosis or dilatation of main pancreatic duct was observed in 6 patients. Of the 6 patients, the minimum tumor diameter was 4.0cm. Patients were pathologically diagnosed as microcystic type in 10 patients and macrocystic type in 2 patients. There was one patient diagnosed with serous cystadenocarcinoma with liver metastasis and invasion of the transvers colon. Based on these results, surgical resection for serous cystic neoplasm is recommended for patients with tumors larger than 4cm, because these patients have symptoms, and stenosis or dilatation of the main pancreatic duct.

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A 64-year old man was admitted for mild acute pancreatitis. His recovery was unremarkable until abdominal pain recurred when oral feeding was initiated. Computed tomography (CT) revealed massive ascites with a high concentration of amylase. Endoscopic retrograde pancreatography (ERP) revealed pancreatic disruption and leakage. Endoscopic pancreatic stenting (EPS) led to improvement in symptoms and laboratory data. We report a rare case of pancreatic ascites presenting as an acute complication in mild acute pancreatitis.

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We report two cases of mucinous (non-cystic) carcinoma of the pancreas. The first case was 73-year-old woman. Computed tomography showed a 45mm tumor in the pancreas head, and we performed pylorus-preserving pancreaticoduodenectomy. The pathological diagnosis was mucinous (non-cystic) carcinoma of the pancreas (T2N0M0 fStage II). The second case was 53-year-old man. Computed tomography showed a 47mm tumor in the pancreas tail, and we performed distal pancreatectomy. The tumor was diagnosed as mucinous (non-cystic) carcinoma of the pancreas (T2N0M0 fStage II). In the vast majority of cases, mucinous (non-cystic) carcinoma develops from pre-existing intraductal papillary mucinous neoplasms (IPMN). However, an IPMN component was not observed in the specimens from both cases. The pathological diagnosis was mucinous (non-cystic) carcinoma, a histological variant of invasive ductal carcinoma. Besides, the differential diagnosis of mucinous (non-cystic) carcinoma was difficult, since the endoscopic ultrasound-guided fine needle aspiration should not be indicated due to its cystic appearance. On the other hand, endoscopic ultrasonography showed characteristic images in both cases. Endoscopic ultrasonography may be useful in the differential diagnostics in patients with mucinous (non-cystic) carcinoma.

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We report the case of a 65-year-old man who was admitted to our hospital with high fever and anorexia. On admission, the peripheral leukocyte count and serum granulocyte colony-stimulating factor (G-CSF) were elevated to 27,900/mm³ and 165pg/ml, respectively. Abdominal computed tomography demonstrated a pancreatic tail tumor and para-aortic lymph node swelling. We performed an open para-aortic lymph node biopsy, and intraoperative pathological diagnosis revealed no lymph node metastasis. Therefore, we performed distal pancreatectomy, splenectomy, and partial gastrectomy. After the surgery, the leukocyte count and serum G-CSF decreased, but multiple liver metastases and an intra-abdominal recurrence were detected. We administered chemotherapy with TS-1 followed by gemcitabine, but the patient died on post-operative day 116. The autopsy showed anaplastic carcinoma of the pancreas and multiple metastases to the liver, lung, vertebrae, diaphragm, abdominal lymph nodes, and peritoneum. Carcinoma of the pancreas associated with G-CSF production is very rare. Here we present this case along with a review of the literature.

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We report a case of pancreatic tail carcinoma, which was not evident in the preoperative imaging of the pancreas, with massive invasion to the spleen. A-67-year-old woman complaining of left hypochondriac pain was found to have a splenic tumor in the imaging studies and was referred to our hospital. Preoperative imaging, including abdominal CT and MRI, revealed no abnormal findings except for a massive splenic tumor. According to the increase of the tumor marker and strong accumulation of F-18-fluorodeoxyglucose to the splenic tumor on PET imaging, we suspected a malignant tumor. We resected the tumor for the purpose of diagnosis and treatment. A distal pancreatectomy and splenectomy was performed due to the severe adhesion of the splenic tumor and pancreatic tail. In the resected specimen, histopathological findings revealed the presence of well differentiated invasive ductal pancreatic carcinoma with massive invasion to the spleen. The possibility of a pancreatic cancer should be considered as a differential diagnosis of a splenic tumor, even if there is no abnormal finding in contrast enhanced CT and MRI.

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A 71-year-old woman with borderline resectable cancer of the head of the pancreas with involvement of the portal vein and splenic artery was referred to our hospital. Gastrointestinal endoscopy and contrast-enhanced CT scan demonstrated a large tumor in the head of the pancreas involving the duodenum, portal venous system, and splenic artery. ERCP showed an abrupt interruption of the main pancreatic duct in the head of the pancreas and subsequent pancreatic juice cytology demonstrated adenocarcinoma. The patient underwent pancreaticoduodenectomy with splenic artery reconstruction to avoid performing a total pancreatectomy, which resulted in the R0 resection. Histologically, the tumor was a well-differentiated invasive ductal adenocarcinoma of the pancreas with invasion to the portal vein, as well as the duodenum. The patient received adjuvant chemoradiotherapy and has been cancer-free for 91 months after surgery with favorable nutrition and quality of life. Our case suggests that a curative pancreatectomy with preservation of the pancreatic functional reserve, as much as possible, may allow the patient to receive an adequate postoperative adjuvant therapy and lead to a favorable outcome in patients with borderline resectable pancreatic head cancer.

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Three out of 14 patients with pancreatic carcinoma in situ had a high degree of fatty changes of the pancreatic parenchyma adjacent to the lesion, which were recognized on CT. All the lesions were present in the pancreatic body. In one patient, the cancerous lesion spread widely along the pancreatic duct and CT showed that in the other two patients, the lesions were mainly restricted to the branches with a slight advancement into the main pancreatic duct. CT showed widely distributed fatty change of the pancreatic body along the pancreatic duct with a widely spread cancerous lesion in one patient. The other two patients had local fatty changes of the pancreatic body on CT. Interaction of pancreatic carcinoma in situ and fatty change of pancreatic parenchyma remains unclear, however, we speculate that the Peroxisome Proliferator-Activated Receptor γ (PPARγ) plays a key role. Our three cases suggest that a high degree of fatty change of the pancreatic body could indicate pancreatic carcinoma in situ.

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