Intraduodenal wall recurrence 11 years after distal pancreatectomy for pancreatic ductal adenocarcinoma

Abstract

Although late recurrence of pancreatic ductal adenocarcinoma (PDAC) is rare, it has been observed in local or regional lymph nodes, as well as in the liver, lung, or peritoneum. We report the first case of intraduodenal wall recurrence 11 years after distal pancreatectomy for PDAC.

Keywords: Intraduodenal wall recurrence; Late recurrence; Pancreatic ductal adenocarcinoma.

Fig. 1

Esophagogastroduodenoscopy showed circumferential stenosis from the bulb of the duodenum that did not permit passage of the scope (A). The computed tomography scan showed thickening of the circumferential duodenal wall (B, D, triangle). Upper gastrointestinal series showed circumferential stenosis in the descending part of the duodenum (C, triangle)

Fig. 2

Surgical specimen from pancreatoduodenectomy and macroscopic cross-sections of the pancreatic duct. Macroscopically, there was no obvious mucosal lesion or ulcer in the duodenum (A). Note the firm, whitish lesion in the deeper submucosal layer of the duodenal wall in the cross sections (B)

Fig. 3

Histologic and immunohistochemical mucin (MUC) -1 and cytokeratin 7 (CK7) comparison between previous distal pancreatectomy (11 years before) and the present pancreatoduodenectomy. Histologically, both the previous and present specimens exhibited atypical tubular glands of varying sizes with fibrous desmoplasia. The morphologic features in the present case closely resembled those observed in the previous case. Immunohistochemically, adenocarcinoma cells from both specimens demonstrated positive staining for CK7 and MUC-1, indicating a consistent immunophenotypic pattern characteristic of pancreatic ductal adenocarcinoma