A case of a malignant serous neoplasm of the pancreas with synchronous vascular invasion and metachronous metastases
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CASE REPORT
A case of a malignant serous neoplasm of the pancreas with synchronous vascular invasion and metachronous metastases Munenori Kawai1 · Akihisa Fukuda1 · Akitada Yogo2 · Takumi Kozu3 · Kaoru Taira4 · Tomoko Okuno5 · Tomoyuki Shirase5 · Atsushi Matsumoto6 · Chiharu Kawanami7 · Hiroshi Seno1 Received: 30 July 2020 / Accepted: 20 August 2020 © Japanese Society of Gastroenterology 2020
Abstract Serous neoplasms (SNs) of the pancreas are usually considered benign tumors. However, they rarely manifest malignant behaviors. Here we present a case of malignant SN and review the literature of malignant SN. A 71-year-old woman presented to our hospital with a palpable abdominal mass. Imaging studies revealed a 7 cm mass with a cluster of microcysts having a honeycomb appearance in the head of the pancreas, which invaded the superior mesenteric vein (SMV). After being clinically diagnosed with SN, pancreaticoduodenectomy was performed with resection of limited SMV. Microscopically, the tumor was diagnosed as an SN concomitant with the tumor thrombus in the SMV. Four years after the surgery, two liver tumors and two peritoneal nodules were detected and three of them were surgically resected. All of those lesions had a honeycomb appearance in their cut surfaces and they were microscopically indistinguishable from the originally resected SN. A review of the literature identified 22 cases of malignant metastatic SNs published to date. Even though extremely rare, metachronous metastasis could occur in SNs of the pancreas. Local invasion indicated an increased likelihood of future metastasis. Thus, periodic surveillance should be considered for SNs after resection, especially when they have a local invasion. Keywords Serous neoplasm of the pancreas · Local invasion · Metastasis · Serous cystadenocarcinoma Abbreviations SN Serous neoplasm SCA Serous cystadenoma * Munenori Kawai [email protected]‑u.ac.jp 1
Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Kawahara‑cho, Shogoin, Sakyo‑ku, Kyoto 606‑8507, Japan
2
Division of Hepato‑Biliary‑Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara‑cho, Shogoin, Sakyo‑ku, Kyoto 606‑8507, Japan
3
Department of Surgery, Otsu Red Cross Hospital, 1‑1‑35 Nagara, Otsu, Shiga 520‑0046, Japan
4
Taira Clinic of Gastroenterological Medicine, 3‑33‑1 Tsukinowa, Otsu, Shiga 520‑2152, Japan
5
Department of Pathology, Otsu Red Cross Hospital, 1‑1‑35 Nagara, Otsu, Shiga 520‑0046, Japan
6
Department of Gastroenterology, Tenri Yorozu Sodanjo Hospital, 200 Mishima‑cho, Tenri, Nara 632‑0015, Japan
7
Department of Gastroenterology, Otsu Red Cross Hospital, 1‑1‑35 Nagara, Otsu, Shiga 520‑0046, Japan
SCAC Serous cystadenocarcinoma SMV Superior mesenteric vein CT Computed tomography MRI Magnetic resonance imaging
Introduction The first report of a serous neoplasm (SN) of the pancreas was by Compagno and Oertel in 1978 [1]. SN is an uncommon type of benign c
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