Pancreatic ductal adenocarcinoma arising from the pancreatic parenchyma compressed by a huge pancreatic lipoma: a case report
Abstract Background Pancreatic lipomas (PLs) arising from the adipose tissue in the pancreatic parenchyma are rare among pancreatic tumors. Coexisting pancreatic ductal adenocarcinoma (PDAC) and PLs have not been previously reported. Herein, we report a case of PDAC arising from the pancreatic paren...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2023-08-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-023-01720-w |
| _version_ | 1797752594569887744 |
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| author | Seiji Nakahara Shunsuke Doi Satoshi Nishiwada Satoshi Yasuda Minako Nagai Kota Nakamura Yasuko Matsuo Taichi Terai Yuichiro Kohara Takeshi Sakata Yuji Nitta Kohei Morita Masayuki Sho |
| author_facet | Seiji Nakahara Shunsuke Doi Satoshi Nishiwada Satoshi Yasuda Minako Nagai Kota Nakamura Yasuko Matsuo Taichi Terai Yuichiro Kohara Takeshi Sakata Yuji Nitta Kohei Morita Masayuki Sho |
| author_sort | Seiji Nakahara |
| collection | DOAJ |
| description | Abstract Background Pancreatic lipomas (PLs) arising from the adipose tissue in the pancreatic parenchyma are rare among pancreatic tumors. Coexisting pancreatic ductal adenocarcinoma (PDAC) and PLs have not been previously reported. Herein, we report a case of PDAC arising from the pancreatic parenchyma with chronic pancreatitis compressed by a large PL. Case presentation The patient was a 69-year-old male. He had been diagnosed with a PL using computed tomography (CT) 12 years previously. The tumor had been slowly growing and was followed up carefully because of the possibility of well-differentiated liposarcoma. During follow-up, laboratory data revealed liver damage and slightly elevated levels of inflammatory markers. Contrast-enhanced CT revealed the previously diagnosed 12 cm pancreatic head tumor and an irregular isodensity mass at the upper margin of the tumor that invaded and obstructed the distal common bile duct. Magnetic resonance cholangiopancreatography demonstrated no specific findings in the main pancreatic duct. Based on these imaging findings, the patient underwent endoscopic retrograde biliary drainage and bile duct brushing cytology, which revealed indeterminate findings. The differential diagnosis of the tumor at that time was as follows: (1) pancreatic liposarcoma (focal change from well-differentiated to dedifferentiated, not lipoma), (2) distal cholangiocarcinoma, and (3) pancreatic cancer. After the cholangitis improved, a pancreatoduodenectomy was performed. Histologically, hematoxylin–eosin staining revealed moderately differentiated PDAC compressed by proliferating adipose tissue. The adipose lesion showed homogeneous adipose tissue with no evidence of sarcoma, which led to a diagnosis of lipoma. Additionally, extensive fibrosis of the pancreatic parenchyma and atrophy of the acinar cells around the lipoma was suggestive of chronic pancreatitis. The pathological diagnosis was PDAC (pT2N0M0 pStage Ib) with chronic pancreatitis and PL. The postoperative course was uneventful, and the patient was discharged on the 15th day after surgery. The patient received adjuvant chemotherapy and has remained recurrence-free for more than 6 months. Conclusions PL may be associated with the development of PDAC in the surrounding inflammatory microenvironment of chronic pancreatitis. In cases of growing lipomas, careful radiologic surveillance may be needed not only for the possibility of liposarcoma but also for the coincidental occurrence of PDAC. |
| first_indexed | 2024-03-12T17:06:41Z |
| format | Article |
| id | doaj.art-02da674e63164fd790e78047d0ba908a |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-03-12T17:06:41Z |
| publishDate | 2023-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-02da674e63164fd790e78047d0ba908a2023-08-06T11:23:21ZengSpringerOpenSurgical Case Reports2198-77932023-08-01911610.1186/s40792-023-01720-wPancreatic ductal adenocarcinoma arising from the pancreatic parenchyma compressed by a huge pancreatic lipoma: a case reportSeiji Nakahara0Shunsuke Doi1Satoshi Nishiwada2Satoshi Yasuda3Minako Nagai4Kota Nakamura5Yasuko Matsuo6Taichi Terai7Yuichiro Kohara8Takeshi Sakata9Yuji Nitta10Kohei Morita11Masayuki Sho12Department of Surgery, Nara Medical UniversityDepartment of Surgery, Nara Medical UniversityDepartment of Surgery, Nara Medical UniversityDepartment of Surgery, Nara Medical UniversityDepartment of Surgery, Nara Medical UniversityDepartment of Surgery, Nara Medical UniversityDepartment of Surgery, Nara Medical UniversityDepartment of Surgery, Nara Medical UniversityDepartment of Surgery, Nara Medical UniversityDepartment of Surgery, Nara Medical UniversityDepartment of Diagnostic Pathology, Nara Medical UniversityDepartment of Diagnostic Pathology, Nara Medical UniversityDepartment of Surgery, Nara Medical UniversityAbstract Background Pancreatic lipomas (PLs) arising from the adipose tissue in the pancreatic parenchyma are rare among pancreatic tumors. Coexisting pancreatic ductal adenocarcinoma (PDAC) and PLs have not been previously reported. Herein, we report a case of PDAC arising from the pancreatic parenchyma with chronic pancreatitis compressed by a large PL. Case presentation The patient was a 69-year-old male. He had been diagnosed with a PL using computed tomography (CT) 12 years previously. The tumor had been slowly growing and was followed up carefully because of the possibility of well-differentiated liposarcoma. During follow-up, laboratory data revealed liver damage and slightly elevated levels of inflammatory markers. Contrast-enhanced CT revealed the previously diagnosed 12 cm pancreatic head tumor and an irregular isodensity mass at the upper margin of the tumor that invaded and obstructed the distal common bile duct. Magnetic resonance cholangiopancreatography demonstrated no specific findings in the main pancreatic duct. Based on these imaging findings, the patient underwent endoscopic retrograde biliary drainage and bile duct brushing cytology, which revealed indeterminate findings. The differential diagnosis of the tumor at that time was as follows: (1) pancreatic liposarcoma (focal change from well-differentiated to dedifferentiated, not lipoma), (2) distal cholangiocarcinoma, and (3) pancreatic cancer. After the cholangitis improved, a pancreatoduodenectomy was performed. Histologically, hematoxylin–eosin staining revealed moderately differentiated PDAC compressed by proliferating adipose tissue. The adipose lesion showed homogeneous adipose tissue with no evidence of sarcoma, which led to a diagnosis of lipoma. Additionally, extensive fibrosis of the pancreatic parenchyma and atrophy of the acinar cells around the lipoma was suggestive of chronic pancreatitis. The pathological diagnosis was PDAC (pT2N0M0 pStage Ib) with chronic pancreatitis and PL. The postoperative course was uneventful, and the patient was discharged on the 15th day after surgery. The patient received adjuvant chemotherapy and has remained recurrence-free for more than 6 months. Conclusions PL may be associated with the development of PDAC in the surrounding inflammatory microenvironment of chronic pancreatitis. In cases of growing lipomas, careful radiologic surveillance may be needed not only for the possibility of liposarcoma but also for the coincidental occurrence of PDAC.https://doi.org/10.1186/s40792-023-01720-wPancreatic ductal adenocarcinomaPancreatic lipomaPancreatic liposarcomaChronic pancreatitis |
| spellingShingle | Seiji Nakahara Shunsuke Doi Satoshi Nishiwada Satoshi Yasuda Minako Nagai Kota Nakamura Yasuko Matsuo Taichi Terai Yuichiro Kohara Takeshi Sakata Yuji Nitta Kohei Morita Masayuki Sho Pancreatic ductal adenocarcinoma arising from the pancreatic parenchyma compressed by a huge pancreatic lipoma: a case report Surgical Case Reports Pancreatic ductal adenocarcinoma Pancreatic lipoma Pancreatic liposarcoma Chronic pancreatitis |
| title | Pancreatic ductal adenocarcinoma arising from the pancreatic parenchyma compressed by a huge pancreatic lipoma: a case report |
| title_full | Pancreatic ductal adenocarcinoma arising from the pancreatic parenchyma compressed by a huge pancreatic lipoma: a case report |
| title_fullStr | Pancreatic ductal adenocarcinoma arising from the pancreatic parenchyma compressed by a huge pancreatic lipoma: a case report |
| title_full_unstemmed | Pancreatic ductal adenocarcinoma arising from the pancreatic parenchyma compressed by a huge pancreatic lipoma: a case report |
| title_short | Pancreatic ductal adenocarcinoma arising from the pancreatic parenchyma compressed by a huge pancreatic lipoma: a case report |
| title_sort | pancreatic ductal adenocarcinoma arising from the pancreatic parenchyma compressed by a huge pancreatic lipoma a case report |
| topic | Pancreatic ductal adenocarcinoma Pancreatic lipoma Pancreatic liposarcoma Chronic pancreatitis |
| url | https://doi.org/10.1186/s40792-023-01720-w |
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