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Chatterjee A, Sharma N, Singh A, Franklin M, Garg R, Chahal P. Synchronous Pancreatic Masses. ACG Case Rep J 2023; 10:e01037. [PMID: 37091201 PMCID: PMC10118356 DOI: 10.14309/crj.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Any mass lesion in the pancreas usually raises the possibility of undiagnosed pancreatic cancer. With the advancement of imaging modalities, we are seeing an increasing number of incidental findings, some of which may be clinically significant. When dealing with incidental pancreatic findings, it is critical to keep a broad differential in mind in addition to ruling out pancreatic malignancy. We present 3 rare cases of patients with 2 or more synchronous solid masses in the pancreas caused by pancreatic cancer, type 1 autoimmune pancreatitis, and sarcoidosis.
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Affiliation(s)
- Arjun Chatterjee
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Neha Sharma
- Department of Internal Medicine, University Health, San Antonio, TX
| | - Amandeep Singh
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Matthew Franklin
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH
| | - Rajat Garg
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Prabhleen Chahal
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
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Chen J, Zhu MY, Huang YH, Zhou ZC, Shen YY, Zhou Q, Fei MJ, Kong FC. Synchronous primary duodenal papillary adenocarcinoma and gallbladder carcinoma: A case report and review of literature. World J Clin Cases 2022; 10:9790-9797. [PMID: 36186218 PMCID: PMC9516900 DOI: 10.12998/wjcc.v10.i27.9790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/20/2022] [Accepted: 08/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Synchronous primary cancers (SPCs) have become increasingly frequent over the past decade. However, the coexistence of duodenal papillary and gallbladder cancers is rare, and such cases have not been previously reported in the English literature. Here, we describe an SPC case with duodenal papilla and gallbladder cancers and its diagnosis and successful management.
CASE SUMMARY A 68-year-old Chinese man was admitted to our hospital with the chief complaint of dyspepsia for the past month. Contrast-enhanced computed tomography of the abdomen performed at the local hospital revealed dilatation of the bile and pancreatic ducts and a space-occupying lesion in the duodenal papilla. Endoscopy revealed a tumor protruding from the duodenal papilla. Pathological findings for the biopsied tissue revealed tubular villous growth with moderate heterogeneous hyperplasia. Surgical treatment was selected. Macroscopic examination of this surgical specimen revealed a 2-cm papillary tumor and another tumor protruding by 0.5 cm in the gallbladder neck duct. Intraoperative rapid pathology identified adenocarcinoma in the gallbladder neck duct and tubular villous adenoma with high-grade intraepithelial neoplasia and local canceration in the duodenal papilla. After an uneventful postoperative recovery, the patient was discharged without complications.
CONCLUSION It is essential for clinicians and pathologists to maintain a high degree of suspicion while evaluating such synchronous cancers.
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Affiliation(s)
- Jing Chen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Ming-Yuan Zhu
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yan-Hua Huang
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Zhong-Cheng Zhou
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Yi-Yu Shen
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Quan Zhou
- Department of Pathology, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Ming-Jian Fei
- Department of Pathology, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Fan-Chuang Kong
- Department of General Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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Vial I, Kausar A. A rare case of concomittant pancreatic adenosquamous and neuroendocrine tumours. J Surg Case Rep 2022; 2022:rjac377. [PMID: 35991843 PMCID: PMC9386458 DOI: 10.1093/jscr/rjac377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
Only two cases of concomitantly occurring adenosquamous and neuroendocrine tumours (NET) have been reported in the literature. We report a case where both NET and adenosquamous are simultaneously occurring. A 42-year-old lady was hospitalized following painless jaundice and loss of weight. Computer tomography scan showed 3.0 x 2.9 cm hypo enhancing and hypovascular mass in the uncinate/head process. Another hypervascular mass was seen in the body of the pancreas. Pathological examination showed that the lesion in the uncinate process/neck of pancreas was an adenosquamous in the main pancreatic duct intraductal papillary mucinous neoplasm. The second tumour was a NET measuring 36 mm with no metastatic involvement. These findings suggested concurrently occurring but separated adenocarcinoma and NET tumours. This is the third case in the literature where both NET and adenosquamous are happening concomitantly, and the previous two other cases are also reviewed in the article.
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Affiliation(s)
- Izziddine Vial
- Correspondence address. Department of General Surgery, East Lancashire NHS Trust, Royal Blackburn Hospital, Haslingden Rd, Blackburn BB2 3HH, UK. Tel: +44 7709770702; E-mail:
| | - Ambareen Kausar
- Department of General Surgery, East Lancashire NHS Trust, Royal Blackburn Hospital, Blackburn, UK
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Aaquist T, Dembic M, Thomassen M, de Stricker K, Bertelsen M, Christensen LG, Mortensen MB, Detlefsen S. Synchronous detection of pancreatic adenocarcinoma and paraganglioma in a Whipple resection specimen. Pathol Res Pract 2021; 226:153590. [PMID: 34454393 DOI: 10.1016/j.prp.2021.153590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 08/14/2021] [Indexed: 01/17/2023]
Abstract
We report a case of a pancreatic ductal adenocarcinoma (PDAC) presenting synchronously with a paraganglioma (PGL) in a Whipple reaction specimen. The patient was a 72-year-old female with a history of breast and vulvar cancer. The simultaneous occurrence of two synchronous tumours in the pancreas was striking. Due to the presence of PGL and multiple meta- and synchronous tumours, the patient was referred to genetic counselling. Tumour tissue from the vulvar carcinoma, the PDAC and the PGL was analysed by targeted next-generation sequencing (NGS) of 161 cancer-related genes and by whole exome sequencing (WES). Peripheral blood was also examined by NGS and WES. These genetic analyses revealed germline polymorphisms in AXIN2 (NM_004655.4:c 0.2272 G>A; p.Ala758Thr), BRCA2 (NM_000059.3:c.9976 A>T; p.Lys3326Ter), NCOR1 (NM_006311.4:c 0.6544 G>A; p.Ala2182Thr) and SPTA1 (NM_003126.3:c 0.373 G>A; p.Ala125Thr) and somatic mutations of KRAS (NM_033360.3;c 0.35 G>A; p.Gly12Asp) and TP53 (NM_000546.5; c.602delT; p.Leu201CysfsTer46) in the PDAC and of TP53 (NM_000546.5; c 0.733 G>A; p.Gly245Ser) and TERT (NM_198253.2; c.-124 C>T; promotor region) in the vulvar carcinoma. Breast carcinoma tissue was not available for genetic analysis. The results of the genetic analyses did not explain the presence of multiple tumours in this patient, despite a slightly increased risk of breast cancer associated with the identified BRCA2 polymorphism. To our knowledge, this is the first report of the synchronous occurrence of PDAC and PGL. This case emphasizes the importance of thorough macroscopic examination of pancreatic resection specimens, as coexisting neoplasms may otherwise be missed.
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Affiliation(s)
- Trine Aaquist
- Department of Pathology, Odense University Hospital, Odense, Denmark; Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Maja Dembic
- Department of Clinical Genetics, Odense University Hospital, Odense, Denmark; Department of Mathematics and Computer Science (IMADA), University of Southern Denmark, Odense, Denmark
| | - Mads Thomassen
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | - Karin de Stricker
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Mette Bertelsen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | | | - Michael Bau Mortensen
- Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital, Odense, Denmark; Odense Pancreas Center (OPAC), Odense University Hospital, Odense, Denmark; Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
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Viti M, Lombardi PM, Marinelli M, Onorati M, D'Urbano C. Ampullary Adenocarcinoma with Incidental Pancreatic Neuroendocrine Tumor: Report of an Extremely Rare Case and Review of Literature. Cureus 2019; 11:e6143. [PMID: 31886078 PMCID: PMC6907710 DOI: 10.7759/cureus.6143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Periampullary neoplasms are a heterogeneous group of tumors arising within 2 cm of the ampulla of Vater. Neuroendocrine tumors can originate throughout the entire body, from neuroendocrine cells. These neoplasms exhibit deep differences, according to their origin and biological behavior. We describe a case of a 79-year-old man who underwent pancreaticoduodenectomy for adenocarcinoma of the ampulla of Vater after proper staging. At gross histology, an incidental pancreatic neuroendocrine tumor was also documented. Despite two synchronous neoplasms, the patient survived 34 months with no evidence of recurrence at follow-up. The synchronous presence of a second primitive tumor in patients affected by a neuroendocrine tumor is reported in the literature; incidence is variable and the most common site is the gastrointestinal tract. Diagnostic workup for ampullary neoplasms includes abdominal computed tomography (CT) scan, magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). These investigations infrequently may detect subcentimetric lesions. We believe this case is currently extremely rare. Preoperative diagnosis of synchronous PanNET would not have changed our approach since surgical therapy represents the gold standard in resectable ampullary neoplasms, and it has a primary role in the prognosis of the present patient.
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Affiliation(s)
- Matteo Viti
- General Surgery, G. Salvini Hospital Garbagnate Milanese, Asst Rhodense, Garbagnate Milanese, ITA
| | - Pietro Maria Lombardi
- General Surgery, G. Salvini Hospital Garbagnate Milanese, Asst Rhodense, Garbagnate Milanese, ITA
| | - Mattia Marinelli
- General Surgery, G. Salvini Hospital Garbagnate Milanese, Asst Rhodense, Garbagnate Milanese, ITA
| | - Monica Onorati
- Pathology, G. Salvini Hospital Garbagnate Milanese, Asst Rhodense, Garbagnate Milanese, ITA
| | - Corrado D'Urbano
- General Surgery, G. Salvini Hospital Garbagnate Milanese, Asst Rhodense, Garbagnate Milanese, ITA
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Abstract
RATIONALE Adenocarcinoma and neuroendocrine tumors are a very rare combination of double primary pancreas tumor. PATIENT CONCERNS A Whipple operation was initially performed on a 64-year-old man to remove an adenocarcinoma. Four years after the operation, surveillance- computed tomography revealed abnormal findings of the pancreas. Recurrent adenocarcinoma and neuroendocrine tumor involving different sites of the remnant pancreas were simultaneously detected and characterized on computed tomography and magnetic resonance imaging. DIAGNOSES The patient was diagnosed with recurrent adenocarcinoma and neuroendocrine tumor in the post-operative pancreas. INTERVENTIONS Radical pancreatosplenectomy was performed. The patient underwent subsequent chemotherapy and radiotherapy. OUTCOMES No tumor recurrence was found during the 5 years of follow-up visits. LESSONS The possibility of multiple primary tumors of different histological origin should be considered when multiple different pancreatic lesions are detected on images. Computed tomography (CT) and magnetic resonance imaging (MRI) play key roles in the management of multiple tumors in the pancreas.
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Affiliation(s)
- Hee Jeong Kim
- Department of Radiology, Dankook University Hospital, Chungnam, Cheonan-si
| | - Mi-hyun Park
- Department of Radiology, Dankook University Hospital, Chungnam, Cheonan-si
| | - Byungseok Shin
- Department of Radiology, Chungnam National University College of Medicine, Daejeon, South Korea
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Abstract
Cancer of the pancreas (CaP) is a dismal, uncommon, systemic malignancy. This article updates an earlier experience of actual long-term survival of CaP in patients treated between 1991 to 2000, and reviews the literature. Survival is expressed as actual, not projected, survival.
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De Silva WSL, Pathirana AA, Prematilleke I, Rajapakse SAPD, Hettiarachchi PSH, Manawasinghe DS, Dassanayake BK. Two synchronous malignant tumors of the pancreas: a case report. J Med Case Rep 2017; 11:84. [PMID: 28347353 PMCID: PMC5368926 DOI: 10.1186/s13256-017-1244-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Only a limited number of multiple synchronous primary malignancies of the pancreas have been reported in the medical literature. We report a case of two solid malignant tumors of the pancreas diagnosed preoperatively. Case presentation We describe a 65-year-old Sri Lankan woman who presented with progressive obstructive jaundice. Initial contrast-enhanced computed tomography imaging detected a malignant tumor at the tail of her pancreas. A second tumor of the pancreatic head was detected with integrated imaging using multidetector computed tomography and multimodal magnetic resonance imaging. She underwent total pancreaticoduodenectomy and splenectomy. Gross examination of the specimen confirmed the presence of two separate tumors. Histology of the ampullary tumor showed pancreatic-type adenocarcinoma and the tumor in the tail of her pancreas showed a colloid-type adenocarcinoma. Conclusion The possibility of multiple primary malignant solid tumors of different types with malignant potential has to be considered even without background pathology when managing multiple tumors in the pancreas.
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Affiliation(s)
- W S L De Silva
- Post Graduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - A A Pathirana
- Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Colombo, Sri Lanka
| | - I Prematilleke
- Department of Pathology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Colombo, Sri Lanka
| | - S A P D Rajapakse
- Department of Pathology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Colombo, Sri Lanka
| | | | - D S Manawasinghe
- Post Graduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
| | - B K Dassanayake
- Post Graduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
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