Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2021; 9(10): 2400-2408
Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2400
Pancreatic cancer secondary to intraductal papillary mucinous neoplasm with collision between gastric cancer and B-cell lymphoma: A case report
Yu-Hong Ma, Tatsuya Yamaguchi, Tomoki Yasumura, Toru Kuno, Shoji Kobayashi, Takashi Yoshida, Takeshi Ishida, Yasuaki Ishida, Shinya Takaoka, Jiang-Lin Fan, Nobuyuki Enomoto
Yu-Hong Ma, Department of Gastroenterology, Ningxia Hui Autonomous Region People’s Hospital, Yinchuan 750021, Ningxia Hui Autonomous Region, China
Tatsuya Yamaguchi, Tomoki Yasumura, Toru Kuno, Shoji Kobayashi, Takashi Yoshida, Takeshi Ishida, Yasuaki Ishida, Shinya Takaoka, Nobuyuki Enomoto, Department of the First Internal Medicine, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
Jiang-Lin Fan, Department of Molecular Pathology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo 409-3898, Yamanashi, Japan
Author contributions: Enomoto N, Ma YH and Yamaguchi T conceived the report; Ma YH and Yamaguchi T analyzed the data and wrote the manuscript; Kobayashi S and Yoshida T performed the surgery; Ishida Y, Ishida T, and Yasumura T collected the patient information and topical data; Kuno T and Takaoka S managed the data; Fan JL helped with the pathological images; all authors read and approved the final manuscript and agreed to be accountable for all aspects of the report.
Supported by “136 Yucai Project” of Ningxia Hui Autonomous Region People’s Hospital Core Talent Training Fund Sponsorship to study in Japan (to Ma YH).
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tatsuya Yamaguchi, MD, PhD, Doctor, Lecturer, Department of the First Internal Medicine, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo 409-3898, Yamanashi, Japan. ytatsuya@yamanashi.ac.jp
Received: December 18, 2020
Peer-review started: December 18, 2020
First decision: January 7, 2021
Revised: January 16, 2021
Accepted: February 8, 2021
Article in press: February 8, 2021
Published online: April 6, 2021
Abstract
BACKGROUND

Patients with intraductal papillary mucinous neoplasm (IPMN) have an increased risk of pancreatic and extrapancreatic malignancies. Lymphomas are rare extrapancreatic malignancies, and in situ collisions of early gastric cancer and diffuse large B-cell lymphoma (DLBCL) are even rarer. Here, we report the first case of pancreatic cancer comorbid with in situ collision of extrapancreatic malignancies (early gastric cancer and DLBCL) in a follow-up IPMN patient. Furthermore, we have made innovations in the treatment of such cases.

CASE SUMMARY

An 81-year-old Japanese female diagnosed with IPMN developed elevated carbohydrate antigen (CA) 19-9 levels during follow-up. Because her CA19-9 levels continued to rise, endoscopic ultrasound (EUS) was performed and revealed a suspicious lesion at the pancreatic tail. However, lesions in the pancreas were not found by computed tomography, magnetic resonance imaging, or endoscopic retrograde cholangiopancreatography. To make an exact patho-logical diagnosis, EUS-guided fine needle aspiration was performed. To our supprise, early gastric cancer was found in preoperative gastroscopy. The gastric cancer was completely resected through endoscopic submucosal dissection before postoperative pathology identified early adenocarcinoma collided with DLBCL. Subsequent EUS-guided fine needle aspiration provided pathological support for the pancreatic cancer diagnosis, and then laparoscopic distal pancreatectomy and splenectomy were performed. CA19-9 levels returned to normal postoperatively.

CONCLUSION

Endoscopic submucosal dissection is appropriate for submucosal lymphomas in patients intoleratant of chemotherapy. EUS can detect small IPMN-related pancreatic tumors.

Keywords: Stomach neoplasms, Pancreatic intraductal neoplasms, Pancreatic neoplasms, B-cell lymphoma, Treatment, Case report

Core Tip: Since intraductal papillary mucinous neoplasm (IPMN) was defined as an independent disease, its unique characteristics have led to many detailed studies. In particular, IPMN-associated pancreatic cancer and extrapancreatic malignancy are focused on. These cases should be managed timely and optimally to improve outcomes and extend patients’ lives. Diffuse large B-cell lymphoma can appear together with early gastric cancer in IPMN and is usually difficult to diagnose before surgery. We recommend endoscopic submucosal dissection for early gastric cancer with local lymphoma, especially for patients who have concerns about undergoing chemotherapy. We believe that endoscopic ultrasound is superior to computed tomography and magnetic resonance imaging for the follow-up of IPMN to diagnose pancreatic cancer.