A Case of Collision Carcinoma of the Pancreas: Invasive Ductal Carcinoma and Endocrine Carcinoma

Takahiro Terashi, Hideki Ijichi, Seiji Maruyama, Rinshun Shimabukuro, Yuichi Kobayashi¹⁾, Kouji Joko¹⁾, Shinji Yoshioka²⁾, Shigetoshi Murata²⁾, Yumi Oshiro³⁾ and Takashi Nishizaki

Department of Surgery, Department of Hepato-Biliary-Pancreatic Medicine¹⁾, Department of Radiology²⁾ and Department of Pathology³⁾, Matsuyama Red Cross Hospital

Pancreatic collision carcinoma with invasive ductal and endocrine carcinoma has not, to our knowledge, been reported previously, and we report a case here. A 63-year-old woman for elevated serum CA19-9 and ALT, during chronic hepatitis C follow-up was found in abdominal enhanced computed tomography (CT) to have swelling pancreatic body-to-tail and two nearby low attenuated nodules of 8 and 5 mm. T2-weighted magnetic resonance imaging (MRI) confirmed swelling and the two nodules as solid lesions. Endoscopic retrograde cholangiopancreatography (ERCP) showed the main pancreatic duct to be stenotic along 10 mm of the pancreas. Positron-emission tomography-computed tomography (PET-CT) showed a low attenuated lesion 30 mm in diameter, and FDG uptake at the pancreas, suggesting pancreatic cancer and necessitating distal pancreatectomy, splenectomy, and lymph node dissection. Resected specimens included a hard elastic 2.0×2.0 cm tumor with a white, solid surface. Histological examination confirmed collision carcinoma of moderately to poorly differentiated tubular adenocarcinoma and poorly differentiated endocrine carcinoma. The noncancerous pancreas tail lesion was chronic pancreatitis. Preoperative diagnosis of pancreatic collision carcinoma was difficult, because typical radiological carcinoma findings were not evident.

Key words
pancreas, collision carcinoma, endocrine carcinoma

Reprint requests
Takahiro Terashi Department of Surgery, Matsuyama Red Cross Hospital
1 Bunkyo-cho, Matsuyama, 790-8524 JAPAN

Accepted
May 27, 2009

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