A 78-year-old man’s confrontation with pancreatic cancer took a devastating turn when he was diagnosed with pancreatic ductal adenocarcinoma in the remnant pancreas following surgery for acinar cell carcinoma. This highly unusual case, with only a handful known in medical literature, has prompted a need for further studies to understand the pathogenesis of such occurrences. Detailed in the Journal of Nippon Medical School, this case underscores the formidable challenge pancreatic cancer poses and the persistent vigilance required in post-operative patient surveillance.
Incidence and Diagnosis
The initial chapter in the patient’s medical struggle began when he was diagnosed with acinar cell carcinoma of the pancreas, a relatively rare form of pancreatic neoplasm categorized as disease stage IA (pT1, pN0, M0), indicating early discovery with no regional lymph node invasion or metastasis. A subtotal stomach-preserving pancreaticoduodenectomy, often referred to as a Whipple procedure, was performed in an attempt to achieve a curative resection.
In the 22 months following his surgery, the patient’s cancer antigen 19-9 levels—tumor markers for pancreatic cancer—began to show a gradual increase. Computed tomography scans revealed two solid tumors, measuring 1.1 and 2.1 cm in diameter, at the site of the remnant pancreas. An endoscopic ultrasound fine-needle aspiration biopsy confirmed a grim reality: the emergence of pancreatic ductal adenocarcinoma (PDAC), starkly distinguished from his earlier acinar cell carcinoma by the absence of trypsin immunoreactivity in the tumor cells.
Treatment and Outcome
Faced with the prospects of engaging in a second bout against pancreatic cancer, the patient declined curative resection. Instead, chemoradiotherapy was chosen as the course of treatment. Unfortunately, the patient succumbed to the disease 28 months post the initial surgery.
This case report, entitled “Pancreatic Ductal Adenocarcinoma in Remnant Pancreas after Pancreaticoduodenectomy for Acinar Cell Carcinoma: A Case Report,” was shared by the medical community with the intention of casting a spotlight on such rare occurrences and inviting further investigation. The DOI for the publication is 10.1272/jnms.JNMS.2018_86-501.
Implications for Clinical Practice and Research
The development of PDAC after resection for a different type of pancreatic cancer is an extremely rare event. This particular case provides impetus for the medical field to understand the possible genetic or environmental factors that could lead to such a scenario. It also highlights the importance of long-term follow-up and monitoring for patients who have undergone surgical resections for pancreatic neoplasms.
Notably, the predilection for the occurrence of a second, distinct type of pancreatic cancer post-resection raises questions concerning the origin of PDAC in these patients. Is there a field cancerization effect at play, where the entire pancreas is at an elevated risk for carcinogenic transformation, or are these subsequent cancers a result of residual microscopic disease that evades detection during initial treatment protocols?
Limitations and Future Directions
Due to the rarity of such cases, large-scale studies are challenging to conduct. However, compiling and analyzing additional cases from around the world could provide more substantive insights into the mechanisms of PDAC development post-resection. Such research would be invaluable in guiding post-operative monitoring strategies and potential prophylactic interventions for patients at risk.
Conclusions
The report of a case involving PDAC in a remnant pancreas post-pancreaticoduodenectomy for acinar cell carcinoma has surfaced crucial concerns to be addressed by the medical fraternity. While the patient’s battle with this lethal disease ended in tragedy, his case serves as a motivation for ongoing research and advancements in the field of pancreatic cancer.
References
1. Nishimura, S., et al. (2019). Pancreatic Ductal Adenocarcinoma in Remnant Pancreas after Pancreaticoduodenectomy for Acinar Cell Carcinoma: A Case Report. Journal of Nippon Medical School, 86(5), 279-283. doi: 10.1272/jnms.JNMS.2018_86-501
2. Siegel, R. L., Miller, K. D., & Jemal, A. (2020). Cancer statistics, 2020. CA: A Cancer Journal for Clinicians, 70(1), 7-30.
3. Ryan, D. P., Hong, T. S., & Bardeesy, N. (2014). Pancreatic adenocarcinoma. The New England Journal of Medicine, 371(11), 1039-1049.
4. Conroy, T., & Bachet, J. B. (2019). Current standards and new innovative approaches for treatment of pancreatic cancer. European Journal of Cancer, 57, 10-22.
5. Kamisawa, T., Wood, L. D., Itoi, T., & Takaori, K. (2016). Pancreatic cancer. Lancet (London, England), 388(10039), 73-85.
Keywords
1. Pancreatic Ductal Adenocarcinoma
2. Acinar Cell Carcinoma
3. Pancreaticoduodenectomy
4. Pancreatic Cancer Surveillance
5. Pancreatic Neoplasms Secondary Cancer