A Case of Remnant Pancreatic Invasive Ductal Carcinoma within Seven Months Post Resection for Primary Intraductal Papillary Mucinous Carcinoma

Hideki Takakura, Michio Ueda, Tetsuya Shimizu, Kenichi Matsuo, Kazutomo Takeda, Kuniya Tanaka, Yasushi Ichikawa, Itaru Endo, Shinji Togo and Hiroshi Shimada

Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine

A 59-year-old man undergoing pancreatic resection twice in 7 months for primary IPMC and remnant pancreatic ductal carcinoma was found in abdominal computed tomography to have a pancreatic head tumor during admission diabetus mellitus treatment. We conducted pancreatoduodenectomy for the branched IPMC. A histopathological study revealed minimally invasive IPMC and the negative margin of the pancreatic duct. Tumor markers gradually rose from 4 month after initial surgery, and a tumor in the remnant pancreas was identified by CT 6 months after that. We conducted total remnant pancreatecomy for recurrent IPMC. The recurrent tumor consisted of moderately differentiated adenocarcinoma with highly invasive growth, without intraductal adenoma on papillary proliferation. Primary IPMC showed both MUC1 and MUC2 to be positive but K-ras was mutation-negative, where as the secondary carcinoma showed MUC1 positive but MUC2 negative and K-ras mutation positive. We concluded that the two cancers were different origin.

Key words
intraductal papillary mucinous carcinoma, remnant pancreatic ductal carcinoma, MUC

Reprint requests
Hideki Takakura Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine
3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 JAPAN

Accepted
May 21, 2008

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