Carcinoma of the uncinate process of the pancreas with a peculiar clinical manifestation

Abstract

A total of 119 Japanese patients with pancreas head carcinoma were treated in the Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan, from January 1976 to December 1991. Three of the 119 patients had carcinoma in the uncinate process, with a 2.5% incidence of pancreas head carcinoma. Those three cases consisted of two men, one 55 and one 72 yr old, and one 62-yr-old woman. Two patients developed abdominal pain, whereas another was vomiting; no patients were icteric. Hypotonic duodenography showed an irregular mucosa of the inner area of the third portion of the duodenum in two and an obstruction of the duodenum in one. Drip infusion cholangiography and/or endoscopic retrograde cholangiopancreatography revealed no abnormality of the biliary tract or pancreatic ducts in any of the three. Ultrasonography showed a hypoechoic mass in the uncinate process in three, and computed tomography showed a low-density mass in the uncinate process in two with a displacement of the superior mesenteric vessels toward the anterior. Angiography showed encasement of the pancreatoduodenal arcade in three, the dorsal pancreatic artery in two, and the middle colic artery in two. No neovascularity or tumor staining was present. Two patients underwent a pancreatoduodenectomy, and the other had a bypass operation (gastrojejunostomy). The histopathologic diagnosis was well-differentiated adenocarcinoma, mucinous carcinoma, and adenosquamous carcinoma, respectively. Two patients died from local recurrence and/or distant metastasis 5 and 6 months after a radical resection, and the other died 3 months after clinical diagnosis. Peculiar clinicopathologic features of these patients with pancreas carcinoma arising in the uncinate process are reported herein, and the clinical problems of this disorder are briefly discussed.