CASE REPORT
JOP. J Pancreas (Online) 2006; 7(5):473-477.
Pancreatic Carcinoma Recurrence in the Remnant Pancreas after a Pancreaticoduodenectomy
Raffaele Dalla Valle1, Cristina Mancini2, Pellegrino Crafa2, Rodolfo Passalacqua3
1Department of Surgery and Transplantation and 2Department of Pathology, University of Parma. Parma, Italy. 3Department of Oncology, Cremona Hospital. Cremona, Italy
ABSTRACT
Context We report a rare case of a repeated pancreatic resection in the remnant distal pancreas 18 months after a Whipple R0 procedure.
Case report In September 2003, a 63-year-old man underwent a Whipple procedure with an extended lymphadenectomy, portal vein resection and direct reconstruction for pancreatic cancer. In September 2004, the tumor marker level increased and MR revealed a tumor in the remnant pancreas. There were no findings of invasion into the surrounding tissue or distant metastasis. After three months of systemic chemotherapy and a radiological reevaluation (PET and CT) in March 2005, we removed the remnant pancreas. Histopathologically, the tumor was classified as a ductal adenocarcinoma like the tumor which had been removed during the first operation, with infiltration of peripancreatic adipose tissue and a segmentary tract of the transverse mesocolon, without lymph node metastasis.
Conclusions There are very few reports of pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy in the literature. In most of these cases, it is difficult to assess whether the remnant pancreatic cancer is a recurrence or a second primary cancer. In our patient, the first hypothesis seems to be more realistic due to the brief recurrence-free survival period. Otherwise the high rate of multicentricity in pancreatic cancer may also explain the development of a secondary cancer in the remnant pancreas, even though the interval was relatively brief.
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Keywords Carcinoma, Pancreatic Ductal; Pancreatectomy; Pancreaticoduodenectomy
Correspondence Raffaele Dalla Valle: r.dalval@unipr.it