Sakamoto H, Kitano M, Komaki T, Imai H, Kamata K, Kimura M, Takeyama Y, Kudo M. Small invasive ductal carcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm. World J Gastroenterol 2009; 15(43): 5489-5492 [PMID: 19916181 DOI: 10.3748/wjg.15.5489]
Corresponding Author of This Article
Masayuki Kitano, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama 589-8511, Japan. m-kitano@med.kindai.ac.jp
Article-Type of This Article
Case Report
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Hiroki Sakamoto, Masayuki Kitano, Takamitsu Komaki, Hajime Imai, Ken Kamata, Masatoshi Kudo, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama 589-8511, Japan
Masatomo Kimura, Department of Pathology, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama 589-8511, Japan
Yoshifumi Takeyama, Department of Surgery, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama 589-8511, Japan
Author contributions: Sakamoto H and Kitano M contributed equally to this work; Sakamoto H, Kitano M, Komaki T, Imai H, Kamata K and Kudo M clinically managed the patient and discussed the EUS and MRCP follow-up; Takeyama Y performed the surgery; Kimura M diagnosed the histology; Sakamoto H, Kitano M and Kudo M wrote the paper.
Supported by The Japan Society for Promotion of Science; The Research and Development Committee Program of The Japan Society of Ultrasonics in Medicine; Japan Research Foundation for Clinical Pharmacology; Japanese Foundation for Research and Promotion of Endoscopy
Correspondence to: Masayuki Kitano, MD, PhD, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama 589-8511, Japan. m-kitano@med.kindai.ac.jp
Telephone: +81-72-3660221 Fax: +81-72-3672880
Received: September 7, 2009 Revised: October 12, 2009 Accepted: October 19, 2009 Published online: November 21, 2009
Abstract
Endoscopic ultrasonography (EUS) is a highly sensitive diagnostic method for the detection of small pancreatic carcinomas. Recently, there have been some reports describing the utility of contrast-enhanced harmonic EUS (CEH-EUS) which uses sonographic contrast agent for differentiation of a pancreatic mass. This report describes a case of small adenocarcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm (IPMN) in which investigation by EUS took place every 6 mo and diagnosis was made accurately by additional CEH-EUS during the follow-up of the branch duct IPMN. A 68-year-old female was admitted to our hospital because of a branch duct IPMN in the pancreatic body. She had been followed-up by EUS every 6 mo. However, after 2 years EUS demonstrated a low echoic area distinct from the branch duct IPMN which was vaguely discernible by EUS, and accurate sizing and differential diagnosis were considered difficult on the EUS imaging. CH-EUS with Sonazoid revealed a hypovascular tumor and we suspected small pancreatic carcinoma. The histopathological diagnosis was adenocarcinoma (10 mm) in the pancreatic tail, distinct from the branch duct IPMN of the pancreatic body. EUS and CEH-EUS may play an important role in the correct diagnosis of small pancreatic tumors, including synchronous and metachronous occurrence of IPMN and ductal adenocarcinoma of the pancreas.
