Diffuse Type Pancreatic Ductal Adenocarcinoma: The Linitis Plastica Type of the Pancreas

Abstract

Pancreatic malignant tumors are diverse and characterized by aggressive nature with high mortality rates. Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic malignant tumors and accounts for approximately 90% of pancreatic malignancies. A subtype of PDAC, diffuse type PDAC (DTP), is a very rare and underreported tumor, known for its aggressive traits. Although little data are available about this tumor subtype characteristics, it usually presents with distinct features that are different from the known ones in PDAC. Herein, we present a case of a 61-year-old male patient, who presented with abdominal discomfort, weight loss and newly diagnosed diabetes mellitus. An abdominal computed tomography (CT) scan showed an ill-defined mass at the uncinate process with diffuse dilatation of the main pancreatic duct. Endoscopic ultrasound (EUS)-guided fine-needle biopsy showed cellular atypia suspicious for malignancy. The patient underwent total pancreatectomy with Roux-en-Y reconstruction. His postoperative course was uneventful. The final histopathological report showed well-differentiated diffuse ductal adenocarcinoma involving the pancreatic head, neck and body.

Keywords: Diffuse type pancreatic ductal adenocarcinoma; Linitis plastica; Mortality; Surgery.

Figure 1

An axial cross-sectional CT scan of the abdomen showing hypodense lesion at the head of pancreas (short arrow) with a dilated main pancreatic duct (long arrow). CT: computed tomography.

Figure 2

A coronal sectional abdominal CT scan showing an ill-defined hypodense lesion at the uncinate process of the pancreas (arrow). CT: computed tomography.