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Poorly differentiated ductal adenocarcinoma of the pancreas with rapid progression in a young man

  • Koji Tezuka
  • Tomoharu Ishiyama
  • Akiko Takeshita
  • Hidekazu Matsumoto
  • Akira Jingu
  • Jiro Kikuchi
  • Hideyuki Yamaya
  • Rintaro Ohe
  • Tetsuya Ishizawa
Case Report
  • 238 Downloads

Abstract

Pancreatic cancer in young adults is very rare. We report a case of young-onset poorly differentiated pancreatic ductal adenocarcinoma with rapid progression and poor prognosis in a 31-year-old Japanese man with no obvious family history of malignancy. Preoperative examinations revealed a mass lesion in the body of the pancreas, accompanied by a slightly dilated main pancreatic duct distal to the mass lesion. Pancreatic cancer with acute pancreatitis was suspected because of an elevation of serum pancreatic enzyme and tumor marker, along with imaging findings. Distal pancreatectomy with resection of the common hepatic artery and splenectomy along with lymph node dissection was performed. Microscopically, the tumor was mainly composed of poorly differentiated ductal adenocarcinoma. The postoperative course was uneventful, but the patient had multiple liver metastases 2 months postoperatively, in spite of adjuvant chemotherapy, and died 8 months postoperatively. This case may represent a rare instance of young-onset poorly differentiated ductal adenocarcinoma with rapid progression and may indicate potential risk factors of pancreatic cancer in young adults.

Keywords

Young Pancreatic cancer Poorly differentiated ductal adenocarcinoma Acute pancreatitis 

Abbreviations

SEER

Surveillance, epidemiology, and end results

PDAC

Pancreatic ductal adenocarcinoma

CT

Computed tomography

DUPAN-2

Duke pancreatic monoclonal antigen type 2

CEA

Carcinoembryonic antigen

CA19-9

Carbohydrate antigen 19-9

SPan-1

S-pancreatic antigen-1

HbA1c

Glycated hemoglobin

MPD

Main pancreatic duct

MRCP

Magnetic resonance cholangiopancreatography

EUS

Endoscopic ultrasonography

ERCP

Endoscopic retrograde cholangiopancreatography

ENPD

Endoscopic nasopancreatic drainage

PanIN

Pancreatic intraepithelial neoplasia

MLH1

MutL homolog 1

MSH

MutS homolog

PMS2

Postmeiotic segregation increased 2

ZEB1

Zinc finger E-box-binding homeobox 1

HNPCC

Hereditary non-polyposis colon cancer

HBOC

Hereditary breast and ovarian cancer syndrome

FAMMM

Familial atypical multiple mole melanoma

FAP

Familial adenomatous polyposis

ALDH

Aldehyde dehydrogenase

EMT

Epithelial–mesenchymal transition

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human rights and animal statements

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Koji Tezuka
    • 1
  • Tomoharu Ishiyama
    • 1
  • Akiko Takeshita
    • 2
  • Hidekazu Matsumoto
    • 1
  • Akira Jingu
    • 1
  • Jiro Kikuchi
    • 1
  • Hideyuki Yamaya
    • 1
  • Rintaro Ohe
    • 3
  • Tetsuya Ishizawa
    • 4
  1. 1.Department of SurgeryYamagata Prefectural Shinjo HospitalShinjoJapan
  2. 2.Department of SurgeryOkitama Public General HospitalKawanishiJapan
  3. 3.Department of Pathological DiagnosticsYamagata University Faculty of MedicineYamagataJapan
  4. 4.Department of GastroenterologyYamagata University Faculty of MedicineYamagataJapan

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