-Case Reports-

Pancreatic Ductal Adenocarcinoma in Remnant Pancreas after Pancreaticoduodenectomy for Acinar Cell Carcinoma: A Case Report

Seitaro Nishimura¹, Masashi Utsumi¹, Hideki Aoki¹, Yuta Une¹, Hajime Kashima¹, Yuji Kimura¹, Fumitaka Taniguchi¹, Takashi Arata¹, Koh Katsuda¹, Kohji Tanakaya¹ and Yumiko Sato²

¹Departments of Surgery, National Hospital Organization, Iwakuni Clinical Center, Japan
²Departments of Pathology, National Hospital Organization, Iwakuni Clinical Center, Japan

We report a case of a pancreatic ductal adenocarcinoma (PDAC) in the remnant pancreas of a 78-year-old man after pancreaticoduodenectomy for acinar cell carcinoma, a relatively rare pancreatic neoplasm. After diagnosis of pancreatic carcinoma, subtotal stomach-preserving pancreaticoduodenectomy was performed. The pathological diagnosis was acinar cell carcinoma of the pancreas (disease stage IA, pT1, pN0, M0), without regional lymph node invasion. Cancer antigen 19-9 levels gradually increased during the 22 months after surgery, and computed tomography showed two solid tumors, 1.1 and 2.1 cm in diameter, at the site of the remnant pancreas. Endoscopic ultrasound fine-needle aspiration revealed pancreatic ductal adenocarcinoma. The tumor cells were not immunoreactive for trypsin. Both tumors were diagnosed as PDAC of the remnant pancreas. The patient declined curative resection, and chemoradiotherapy was started as alternative treatment. The patient died 28 months after surgery. Because this is an extremely rare case, additional cases and studies are needed in order to clarify its pathogenesis.

J Nippon Med Sch 2019; 86: 279-283

Keywords
acinar cell carcinoma, pancreatic ductal adenocarcinoma, pancreaticoduodenectomy, pancreatic cancer

Correspondence to
Masashi Utsumi, MD, PhD, Department of Surgery, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni, Yamaguchi 740-8510, Japan
masashi11232001@yahoo.co.jp

Received, August 10, 2018
Accepted, March 12, 2019