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

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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.

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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

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Authors and Affiliations

  1. Department of Surgery, Yamagata Prefectural Shinjo Hospital, 12-55 Wakabacho, Shinjo, 996-0025, Japan

    Koji Tezuka, Tomoharu Ishiyama, Hidekazu Matsumoto, Akira Jingu, Jiro Kikuchi & Hideyuki Yamaya

  2. Department of Surgery, Okitama Public General Hospital, 2000 Nishi-Otsuka, Higashi-Okitama-gun, Kawanishi, Yamagata, 992-0601, Japan

    Akiko Takeshita

  3. Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan

    Rintaro Ohe

  4. Department of Gastroenterology, Yamagata University Faculty of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan

    Tetsuya Ishizawa

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  1. Koji Tezuka
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Correspondence to Tomoharu Ishiyama.

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

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

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Tezuka, K., Ishiyama, T., Takeshita, A. et al. Poorly differentiated ductal adenocarcinoma of the pancreas with rapid progression in a young man. Clin J Gastroenterol 11, 417–423 (2018). https://doi.org/10.1007/s12328-018-0859-z

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  • DOI: https://doi.org/10.1007/s12328-018-0859-z

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