Early Recurrence of Pleomorphic-Type Anaplastic Pancreatic Carcinoma After Distal Pancreatectomy Causing Delayed-Onset Pancreatic Fistula: A Case Report.

IF 1 Q3 MEDICINE, GENERAL & INTERNAL
Cureus Pub Date : 2025-05-18 eCollection Date: 2025-05-01 DOI:10.7759/cureus.84316
Masahiro Kobayashi, Masaru Matsumura, Yutaka Takazawa, Junichi Shindoh, Masaji Hashimoto
{"title":"Early Recurrence of Pleomorphic-Type Anaplastic Pancreatic Carcinoma After Distal Pancreatectomy Causing Delayed-Onset Pancreatic Fistula: A Case Report.","authors":"Masahiro Kobayashi, Masaru Matsumura, Yutaka Takazawa, Junichi Shindoh, Masaji Hashimoto","doi":"10.7759/cureus.84316","DOIUrl":null,"url":null,"abstract":"<p><p>Pleomorphic-type anaplastic carcinoma of the pancreas is a rare and highly aggressive histological subtype of pancreatic ductal carcinoma. It is characterized by rapid progression and a poor prognosis. Preoperative diagnosis is often challenging due to nonspecific imaging findings and the frequent absence of elevated tumor markers. We present a resected case of pleomorphic-type anaplastic carcinoma of the pancreatic tail, which showed early recurrence in the remnant pancreas, potentially associated with a delayed-onset pancreatic fistula. A 63-year-old man presented with upper abdominal pain. Imaging revealed a cystic lesion in the pancreatic tail. Follow-up imaging showed enlargement of the lesion, and a retention cyst with possible underlying pancreatic carcinoma was suspected. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was not performed due to concerns for cyst rupture. The patient underwent distal pancreatectomy with splenectomy. Histopathological examination confirmed pleomorphic-type anaplastic carcinoma. Although the drain was removed on postoperative day (POD) five due to low amylase levels in the drainage tube, a pancreatic fistula developed on POD 14, resulting in an intractable pancreatic fistula requiring persistent drainage. On POD 53, imaging revealed tumor recurrence in the remnant pancreas, along with peritoneal dissemination and right femoral bone metastasis. Retrospective evaluation of CT on POD 14 showed tumor recurrence compressing the main pancreatic duct, which was suspected to be the cause of the fistula. The patient declined further oncological treatment and died on POD 103. This case highlights the diagnostic and therapeutic challenges of pleomorphic-type anaplastic carcinoma of the pancreas. Early postoperative recurrence can lead to pancreatic stump disruption and the development of intractable pancreatic fistula.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 5","pages":"e84316"},"PeriodicalIF":1.0000,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085788/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cureus","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.7759/cureus.84316","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

Abstract

Pleomorphic-type anaplastic carcinoma of the pancreas is a rare and highly aggressive histological subtype of pancreatic ductal carcinoma. It is characterized by rapid progression and a poor prognosis. Preoperative diagnosis is often challenging due to nonspecific imaging findings and the frequent absence of elevated tumor markers. We present a resected case of pleomorphic-type anaplastic carcinoma of the pancreatic tail, which showed early recurrence in the remnant pancreas, potentially associated with a delayed-onset pancreatic fistula. A 63-year-old man presented with upper abdominal pain. Imaging revealed a cystic lesion in the pancreatic tail. Follow-up imaging showed enlargement of the lesion, and a retention cyst with possible underlying pancreatic carcinoma was suspected. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) was not performed due to concerns for cyst rupture. The patient underwent distal pancreatectomy with splenectomy. Histopathological examination confirmed pleomorphic-type anaplastic carcinoma. Although the drain was removed on postoperative day (POD) five due to low amylase levels in the drainage tube, a pancreatic fistula developed on POD 14, resulting in an intractable pancreatic fistula requiring persistent drainage. On POD 53, imaging revealed tumor recurrence in the remnant pancreas, along with peritoneal dissemination and right femoral bone metastasis. Retrospective evaluation of CT on POD 14 showed tumor recurrence compressing the main pancreatic duct, which was suspected to be the cause of the fistula. The patient declined further oncological treatment and died on POD 103. This case highlights the diagnostic and therapeutic challenges of pleomorphic-type anaplastic carcinoma of the pancreas. Early postoperative recurrence can lead to pancreatic stump disruption and the development of intractable pancreatic fistula.

远端胰腺切除术后多形性间变性胰腺癌早期复发致迟发型胰瘘1例。
胰腺多形性间变性癌是胰腺导管癌中一种罕见且具有高度侵袭性的组织学亚型。它的特点是进展迅速,预后差。术前诊断往往具有挑战性,由于非特异性的影像学发现和肿瘤标志物的频繁缺乏升高。我们报告一例切除的胰尾多形性间变性癌,其在残余胰腺中显示早期复发,可能与延迟性胰瘘有关。男,63岁,上腹部疼痛。影像学显示胰腺尾部一囊性病变。随访影像显示病灶肿大,并怀疑为积液囊肿伴潜在胰腺癌。由于担心囊肿破裂,没有进行内镜超声引导下的细针穿刺(EUS-FNA)。患者行远端胰切除术并脾切除术。组织病理学检查证实为多形性间变性癌。虽然由于引流管中淀粉酶水平低,引流管在术后第5天(POD)被移除,但在第14天胰瘘发生,导致难治性胰瘘需要持续引流。在POD 53上,影像学显示肿瘤在残余胰腺复发,并伴有腹膜播散和右股骨骨转移。回顾性评价CT显示肿瘤复发压迫主胰管,怀疑为瘘管形成的原因。患者拒绝进一步的肿瘤治疗,并于POD 103死亡。本病例强调了胰腺多形性间变性癌的诊断和治疗挑战。术后早期复发可导致胰残端破坏和难治性胰瘘的发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信