A repeated pancreatectomy in the remnant pancreas 22 months after pylorus-preserving pancreatoduodenectomy for pancreatic adenocarcinoma.

Abstract

We report a case of a repeated curative pancreatic resection in the remnant distal pancreas 22 months after pylorus-preserving pancreatoduodenectomy (PpPD). The patient was a 52-year-old woman with a past history of PpPD for adenocarcinoma of the head of the pancreas 22 months prior to the present operation. The original tumor was histopathologically diagnosed as a papillary adenocarcinoma with clear surgical margin at the surgical cut end of the pancreas (R0, International Union Against Cancer [UICC] classification). Twenty months after the PpPD, a follow-up computed tomography (CT) scan showed multiple low-density lesions in the body and tail of the pancreas without any other distant metastasis. A second operation, curative resection of the remnant pancreas, with splenectomy and distal gastrectomy, was performed. The second tumor was a papillary adenocarcinoma, the same diagnosis as that of the first tumor, and it also showed similar histopathological findings, including immunohistochemical staining of Ki-67 and p53 protein, and the same pattern of K-ras point mutation. The patient is considered to have shown a rare, unique pancreatic cancer with metachronous carcinogenesis in the remnant pancreas.

• Authors: K Wada, T Takada, H Yasuda, H Amano, M Yoshida
• Journal: Journal of hepato-biliary-pancreatic surgery (J Hepatobiliary Pancreat Surg) Vol. 8 Issue 2 Pg. 174-8 ( 2001) ISSN: 0944-1166 [Print] Japan
• PMID: 11455476 (Publication Type: Case Reports, Journal Article)

Chemical References

• Ki-67 Antigen
• Tumor Suppressor Protein p53

Topics

• Adenocarcinoma, Papillary (diagnostic imaging, genetics, surgery)
• Cholangiopancreatography, Endoscopic Retrograde
• Female
• Genes, ras (genetics)
• Humans
• Immunohistochemistry
• Ki-67 Antigen (metabolism)
• Middle Aged
• Neoplasms, Second Primary (surgery)
• Pancreatectomy (methods)
• Pancreatic Neoplasms (diagnostic imaging, genetics, surgery)
• Point Mutation
• Reoperation
• Tumor Suppressor Protein p53 (metabolism)