We present a case of invasive carcinoma of the pancreas derived from intraductal papillary adenocarcinoma without mucin hypersecretion
in a 65-year-old man with a 45-year history of alcohol abuse and a 2-year follow-up of chronic pancreatitis. Two years previously,
in May 1998, he was admitted for investigation of abdominal pain. Computed tomography (CT) showed diffuse dilation of the
main pancreatic duct with atrophy of the pancreatic parenchyma. Endoscopic retrograde pancreatography (ERP) showed a diffusely
dilated main pancreatic duct with irregular side branches in the head of the pancreas. Chronic alcoholic pancreatitis was
diagnosed on the basis of the pancreatography findings. The patient was readmitted for investigation of progressive weight
loss in August 2000. Serum CA19-9 levels were markedly elevated (750 U/ml) and CT showed enlargement of the head and body
of the pancreas. ERP showed irregularity of the main pancreatic duct in the head of the pancreas, and the distal main pancreatic
duct (which was dilated on initial ERP examination) was interrupted in the body of the pancreas. Suspected pancreatic carcinoma
was diagnosed, and pylorus-preserving pancreatoduodenectomy was performed. Frozen section examination of the cut end of the
pancreas revealed ductal carcinoma, and total pancreatoduodenectomy with portal vein resection was performed. Histologically,
the resected tumor was diagnosed as an invasive carcinoma derived from intraductal papillary adenocarcinoma without mucin
hypersecretion. We recommend observing changes in the pancreatic duct on pancreatography to diagnose invasive carcinoma of
the pancreas derived from intraductal papillary adenocarcinoma in a resectable state.
Key words Invasive carcinoma derived from intraductal papillary adenocarcinoma - Chronic pancreatitis - Intraductal papillary adenocarcinoma without mucin hypersecretion
Received: February 6, 2002 / Accepted: June 10, 2002
Offprint requests to: S. Ariizumi