Small Pancreatic Head Carcinoma Limited to the Main Duct, Report of a Case Keizo Saeki 1 , Shintaro Tsukasa 1 , Masato Otsuji 1 , Shinichiro Aosaki 1 , Hiroshi Tojinbara 1 1The Second Department of Internal Medicine, Faculty of Medicine, Kagoshima University pp.851-856
Published Date 1988/8/25
DOI https://doi.org/10.11477/mf.1403108326
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 A 63-year-old female was seen because of transitory left hypochondralgia and elevated serum amylase level. Her serum CEA and CA19-9 levels were within normal limits. Ultrasound (Fig.1) and computed tomography (Fig.2) were negative except for slight dilatation of the main pancreatic duct. ERCP (Figs.3 a-c) showed an intraluminal filling defect in the main pancreatic duct, and histological examination of the biopsy specimen obtained from the pancreatic duct (Fig.3d) revealed carcinoma (Fig.4). Angiography was negative for the findings suggestive of malignancy (Fig.5).

 Macroscopic and histological examinations of the resected specimen revealed poorly differentiated adenocarcinoma limited to the main pancreatic duct. The tumor was unpedunculated, measuring 5 mm in diameter (Figs.7,8a and 8b). Mucosal lesions with atypia (Figs.8 c and d) were also seen in several portions of the ducts unaffected by the carcinoma, suggesting multicentric cancer development.

 ERCP was indispensable for detecting this small carcinoma, and endoscopic pancreatic ductal biopsy was essential in differential diagnosis.

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