title: Minute invasive ductal carcinoma of the residual pancreas after distal pancreatectomy for intraductal papillary-mucinous tumor.
abstract: Our report describes a 66-yr-old man who underwent surgical resection of the pancreas twice within a period of 3 yr for primary and recurrent intraductal papillary mucinous tumors (IPMTs). During the second operation, a minute invasive ductal carcinoma (IDC) was accidentally discovered in the resected specimen of the residual pancreas. The similarity and continuity between this IDC and recurrent IPMT were not recognized histologically. A solid tumor was found in the hepatoduodenal ligament 3 mo after the second operation. We performed a third operation, performing laparotomy and intra-operative radiotherapy, but could not extirpate the tumor. A biopsy specimen obtained from the tumor during this third operation revealed adenocarcinoma, and the patient later died because of tumor progression. We immunohistochemically analyzed the expression of HER-2/neu, Smad4, p16, p21, p53, mucin immunophenotypes and the Ki-67 labeling index in this series of pancreatic-duct neoplasias. Overexpression of HER-2/neu and loss of Smad4 were detected in the minute IDC, which was very different from the immunohistochemical features of both the primary and recurrent IPMTs. The IDC also showed a MUC1-positive/MUC2-negative phenotype. Therefore, we suggest that de novo IDC may occur in IPMT patients, especially those with multiple tumor recurrence. The present case may be helpful in understanding the pathogenesis of pancreatic duct lesions.
authors.affiliation: First Department of Surgery, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan. ikkum@med.id.yamagata-u.ac.jp
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Moriya
authors.forename: Wataru
authors.initials: W
authors.lastname: Kimura
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Sakurai
authors.forename: Shuho
authors.initials: S
authors.lastname: Semba
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ozawa
authors.forename: Ichiro
authors.initials: I
authors.lastname: Hirai
authors.forename: Akira
authors.initials: A
authors.lastname: Fuse
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery*; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D008297:Male; D009364:Neoplasm Recurrence, Local; D016609:Neoplasms, Second Primary / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*
chemical_list: D014408:Biomarkers, Tumor