Abstract
A 59-year-old woman was admitted for acute pancreatitis. Abdominal computed tomography and magnetic resonance imaging revealed a swollen pancreatic parenchyma with dilatation of the main pancreatic duct (MPD) of the pancreas tail, which was separated from the normal pancreas body side by a locally atrophic part of the pancreas. Magnetic resonance cholangiopancreatography showed MPD stricture in the pancreas tail with dilatation of the upstream MPD. Endoscopic ultrasonography revealed that the MPD stricture of the pancreas tail was surrounded by a blurred and hypoechoic area. Endoscopic retrograde cholangiopancreatography was performed for serial pancreatic-juice aspiration cytologic examination (SPACE). The result indicated adenocarcinoma. Distal pancreatectomy was performed, and the histopathological examination showed high-grade PanIN (carcinoma in situ of the pancreatic duct) of the pancreas tail with atrophy and fibrosis of the pancreatic parenchyma, and local fat replacement adjacent to the lesion. The final histopathological diagnosis was carcinoma in situ of the pancreatic duct of the pancreas tail. Acute pancreatitis and local fatty change of the pancreatic parenchyma with MPD stricture are important clinical manifestations of pancreatic carcinoma in situ (PCIS) and performing SPACE in cases of MPD stricture without a recognizable mass is preferable for a diagnosis of PCIS.
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Egawa S, Toma H, Ohigashi H, et al. A digest of pancreatic cancer registry report 2007. J Jpn Pancreas Soc. 2008;23:105–23.
Yoon SH, Lee JM, Cho JY, et al. Small (20 mm) pancreatic adenocarcinomas: analysis of enhancement patterns and secondary signs with multiphasic multidetector CT. Radiology. 2011;259:442–52.
Yasuda I, Iwashita T, Doi S, et al. Role of EUS in the early detection of small pancreatic cancer. Dig Endosc. 2011;23:22–5.
Helmstaedter L, Riemann JF. Pancreatic cancer−EUS and early diagnosis. Langenbecks Arch Surg. 2008;393:923–7.
Maehira H, Sugiura T, Kanemoto H, et al. A case of carcinoma in situ of the pancreas with a surrounding fibrotic region. J Jpn Pancreas Soc. 2014;6:919–25.
Mizutani Y, Otuka H, Morishima H, et al. A case of carcinoma in situ of the pancreas. J Jpn Pancreas Soc. 2013;6:785–91.
Iiboshi T, Hanada K, Fukuda T, et al. Value of cytodiagnosis using endoscopic nasopancreatic drainage for early diagnosis of pancreatic cancer: establishing a new method for the early detection of pancreatic carcinoma in situ. Pancreas. 2012;41:523–9.
Ryu S, Motidome N, Fujino M, et al. Early detection of pancreatic cancer or malignant intraductal papillary mucinous neoplasms of the pancreas in the acute pancreatitis patients. J Biliary Tract Pancreas. 2014;35:1207–11.
Uematsu T, Kubota H, Suzuki H, et al. Carcinoma in situ of the pancreas presenting with acute pancreatitis−report of a case. J Jpn Surg Assoc. 2002;7:1799–803.
Kimura U, Kikuyama M, Kodama Y. Acute pancreatitis as a possible indicator of pancreatic cancer: the importance of mass detection. Intern Med. 2015;54:2109–14.
Ito T, Usui M, Iizawa Y, et al. A case of carcinoma in situ of pancreas detected by acute pancreatitis and atrophy of pancreas body. Ther Res Hepato-Biliary-Pancreat Dis. 2016;14:56–62.
Yuge R, Hanada K, Iiboshi T, et al. A case of ductal carcinoma in situ of the pancreas initially suggested by the slightly dilatation of the main pancreatic duct. Hepato-Biliary-Pancreat Imaging. 2012;14:72–7.
Imaizumi T, Hatori T, Nakasako T, et al. A resected case of carcinoma in situ of the pancreatic body diagnosed preoperatively as invasive ductal adenocarcinoma. J Biliary Tract Pancreas. 1996;17:1083–7.
Detlefsen S, Sipos B, Feyerabend B, et al. Pancreatic fibrosis associated with age and ductal papillary hyperplasia. Virchows Arch. 2005;447:800–5.
Kiukuyama M, Hanada K, Ueki T. Pancreatic carcinoma in situ presenting prominent fatty change of the pancreatic body on CT: experiences from 3 cases. J Jpn Pancreas Soc. 2015;30:626–32 (in Japanese).
Rosen ED, Hsu CH, Wang X, et al. C/EBPalpha induces adipogenesis through PPARgamma: a unified pathway. Genes Dev. 2002;16:22–6.
Kubota N, Terauchi Y, Miki H, et al. PPARγ mediates high-fat diet-induced adipocyte hypertrophy and insulin resistance. Mol Cell. 1999;4:597–609.
Kruse ML, Hopf-Jensen S, Timke C, et al. Differentiation potential of pancreatic fibroblastoid cells/stellate cells: effects of peroxisome proliferator-activated receptor gamma ligands. Int J Cell Biol. 2011;2011:816791.
Rebours V, Gaujoux S, d’Assignies G, et al. Obesity and fatty pancreatic infiltration are risk factors for pancreatic precancerous lesions (PanlN). Clin Cancer Res. 2015;21:3522–8.
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Tatsunori Satoh, Masataka Kikuyama, Shinya Kawaguchi, Hideyuki Kanemoto, Hiroyuki Muro and Keiji Hanada declare that they have no conflict of interest.
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All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
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Informed consent was obtained from all patients for being included in the study.
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Satoh, T., Kikuyama, M., Kawaguchi, S. et al. Acute pancreatitis-onset carcinoma in situ of the pancreas with focal fat replacement diagnosed using serial pancreatic-juice aspiration cytologic examination (SPACE) . Clin J Gastroenterol 10, 541–545 (2017). https://doi.org/10.1007/s12328-017-0776-6
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DOI: https://doi.org/10.1007/s12328-017-0776-6