Synchronous primary epithelial tumors of the pancreas

Abstract

Introduction: Pancreatic incidentalomas are diagnosed at increased rates due to advanced pancreatic imaging. Coexistence of such lesions with another pancreatic pathology, however, is uncommon and their management might be perplexed by the anatomical location and the histological features of the lesion.

Presentation of case: A patient with obstructive jaundice was diagnosed with adenocarcinoma of the pancreatic head and underwent routine pancreatic imaging (CT) which revealed the coexistence of a small cystic lesion at the pancreatic body. Further investigation with MRCP and ERCP was unable to confirm a benign lesion and total pancreatoduodenectomy was performed. Histological examination showed a rare type of mixed serous-mucinous cystadenoma of borderline malignancy at the pancreatic body coexistent with an adenocarcinoma of the pancreatic head.

Discussion: Coexistence of a peripheral pancreatic cystic tumor with a ductal adenocarcinoma of the pancreatic head is a very rare incidence in medical literature. The management of the peripheral lesion is not straightforward and there can be uncertainty as to the extent of the pancreatic resection that may be required.

Conclusion: Appropriate preoperative imaging has a significant impact on the definitive management of synchronous pancreatic tumors. Implications of a common pathogenetic pathway are also raised for this rare occurrence of two primary epithelial pancreatic tumors.

Fig. 1

Synchronous pancreatic tumors. A solid mass at the pancreatic head (white arrow) and a small hypodense cystic lesion at the lateral border of the pancreatic body (yellow arrow) are visible on abdominal CT scan. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Magnetic resonance cholangiopancreatography (MRCP) showing a dilated main pancreatic duct in close relationship to the lesion of the pancreatic body, without excluding a possible communication between them. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

(a) Ductal adenocarcinoma of the pancreatic head with tubular structures (HE ×20; inset HE ×100). (b) Borderline mixed serous–mucinous cystadenoma of the pancreatic body (HE ×20; inset HE ×100).