Routine examinations with ultrasonography, endoscopic ultrasonography, MRCP, and blood tests were conducted to diagnose pancreatic cancer early in asymptomatic individuals since October 2017. Since health insurance did not cover these examinations, all participants underwent this evaluation at their own expense. By April 2020, 114 had been evaluated. If an abnormality was found, subsequent examinations such as contrast CT scan, medical treatment and observation were covered by health insurance. Reviewing the results, we found that 51% of healthy individuals had pancreatic abnormalities. Forty-two (37%) individuals with BD-IPMN and 11 (8%) with early chronic pancreatitis were identified. EUS and MRCP were generally superior for the detection of pancreatic lesions, but the detection rate using other modalities was higher depending on the individual. This study should be useful to establish a surveillance program for individuals at high risk of developing pancreatic cancer.

A 79-year-old woman was followed for branch type intraductal papillary mucinous neoplasms (IPMN) in the pancreatic head and tail for several years. She sought surgical treatment of pancreatic IPMN with preservation of postoperative glucose tolerance. Volumetry using MDCT was performed followed by spleen and middle segment preserving pancreatectomy (MSPP) leaving 26.2% (12.7cm³) of the pancreas and avoided postoperative diabetes. MSPP is a useful operative method to preserve pancreatic endocrine function. We report this patient with a discussion of the literature.

Chronic pancreatitis is a risk factor for pancreatic cancer, and surgical treatment of chronic pancreatitis prevents progression to pancreatic cancer. Therefore, few cases of pancreatic cancer are reported after surgical treatment of chronic pancreatitis. The patient is a 71-year-old woman status post longitudinal and lateral pancreatic jejunostomy for chronic pancreatitis at age 40 years. She was diagnosed with diabetes at age 55, and received regular follow-up as an outpatient since then. At age 71, computed tomography scan performed to investigate elevated carcinoembryonic antigen levels revealed a 20mm ischemic mass in the tail of the pancreas. The patient was diagnosed with cancer of the pancreatic tail, cT3N0M0, Stage IIA. After neoadjuvant chemotherapy, the pancreatic tail was resected, with pancreaticojejunal anastomosis performed from the body of the pancreas to the tail. As the anastomosis did not overlap the pancreatic incision line, the jejunal limb with pancreaticojejunal anastomosis was also dissected. The pathological diagnosis was pancreatic cancer with anastomotic infiltration. Even after radical treatment for chronic pancreatitis, long-term follow-up may be necessary because of the continued risk of developing pancreatic cancer.

An 80-year-old man was referred with a resectable 3.5×3cm carcinoma of the pancreatic tail with invasion of the gastric wall and splenic vessels. Staging laparoscopy revealed posterior gastric wall invasion, but no evidence of apparent metastases or disseminated disease. Neoadjuvant therapy with gemcitabine+nab-paclitaxel was given. Five days after administering the third course of chemotherapy, the patient developed hematemesis and hemorrhagic shock. Gastrointestinal hemorrhage due to rupture of the splenic artery pseudoaneurysm at the tumor invasion site in the posterior gastric wall was diagnosed based on abdominal dynamic CT scan. Vital signs stabilized with resuscitation. Transcatheter embolization of the splenic artery was performed and hemostasis achieved. CT scan before discharge revealed lung metastases, representing a contraindication for resection. Although the number of patients receiving preoperative chemotherapy is increasing, patients with adjacent organ involvement should be treated with caution.

A sixties man presented with a left neck mass and upper abdominal pain. The left parotid and submandibular glands were enlarged, and blood tests showed amylase 525IU/l, IgG 4,023mg/dl, and IgG4 3,120mg/dl. Abdominal ultrasonography, CT scan, and MRI revealed an enlarged pancreas, with a capsule-like rim, and multiple pancreatic cysts. Histopathological examination of tissue obtained by EUS-FNAB demonstrated mottled fibrosis, invasion of plasma cells, storiform fibrosis, and obliterative phlebitis. Based on these findings, the patient was diagnosed with type 1 autoimmune pancreatitis. Twelve weeks after starting administration of prednisolone, the pancreatic enlargement had resolved and the pancreatic cysts had almost disappeared. This is a rare case of multiple cysts associated with autoimmune pancreatitis that responded to steroid treatment.