Synchronous Pancreatic Ductal Adenocarcinoma in the Head and Tail, a Double Trouble: A Case Report and Literature Review.
Daniel ParamythiotisXanthippi MavropoulouEleni KarlaftiIoanna Abba DekaGeorgios PetrakisElisavet PsomaXanthippi MavropoulouFilippos KyriakidisSmaro NettaStylianos ApostolidisPublished in: Diagnostics (Basel, Switzerland) (2022)
Synchronous primary pancreatic ductal adenocarcinoma (PDAC) is very rare and can be formed either through multicentric carcinogenesis or intrapancreatic metastasis. We report the case of an 80-year-old man with a history of type 2 diabetes mellitus who presented with abdominal pain and weight loss. Laboratory tests showed elevated levels of blood glucose and CA 19-9, and Computed Tomography revealed two hypoenhancing lesions in the head and tail of the pancreas. Endoscopic ultrasound, which is the imaging method of choice for pancreatic cancer, was performed with a fine needle biopsy, and the cytological analysis diagnosed PDAC in both lesions. The patient underwent total pancreatectomy, and pathologic evaluation revealed synchronous primary PDAC with moderate to poor differentiation in the head and tail in the setting of IPMN (intraductal papillary mucinous neoplasia) and chronic pancreatitis. After his recovery from postoperative pulmonary embolism, the patient was discharged home with sufficient glycemic control. Multifocal PDAC occurs more often when precursor lesions, such as IPMN, pre-exist. The optimal treatment for multiple lesions spread all over the pancreas is total pancreatectomy. Diabetes mellitus is a serious complication of total pancreatectomy (new-onset or type 3c), but overall, long-term survival has been significantly improved.
Keyphrases
- glycemic control
- blood glucose
- pulmonary embolism
- weight loss
- ultrasound guided
- type diabetes
- computed tomography
- optic nerve
- abdominal pain
- fine needle aspiration
- magnetic resonance imaging
- bariatric surgery
- healthcare
- high resolution
- single cell
- roux en y gastric bypass
- patients undergoing
- inferior vena cava
- insulin resistance
- blood pressure
- positron emission tomography
- high grade
- body mass index
- adipose tissue
- photodynamic therapy
- image quality
- protein kinase
- obese patients