Pancreatic cancer secondary to intraductal papillary mucinous neoplasm with collision between gastric cancer and B-cell lymphoma: A case report

Table 1 Timeline

Time	Events
October 11, 2015	Patient diagnosed with intraductal papillary mucinous neoplasm
November 13, 2017	Patient diagnosed with CA19-9 increased
April 16, 2018	Patient’s EUS examination was revealed a mass in the tail of the pancreas
June 1, 2018	Patient diagnosed with early gastric cancer
July 26, 2018	Patient was treated with endoscopic submucosal dissection
July 31, 2018	ESD resected specimen, pathological diagnosis of submucosal diffuse large B cell lymphoma
February 15, 2019	Patients underwent EUS-FNA were diagnosed with pancreatic cancer
March 7, 2019	Patient underwent surgery for pancreatic cancer
June 5, 2019	CA19-9 returned to normal

CA19-9: Carbohydrate antigen 19-9; EUS: Endoscopic ultrasound; ESD: Endoscopic submucosal dissection; FNA: Fine needle aspiration.

Table 2 Blood test data on admission

	Value	Unit	Reference
Blood count
White blood cells	3.45	103/μL	3.30-8.60
Red blood cells	3.54	106/μL	3.86-4.92
Hemoglobin	11.2	g/dL	11.6-14.8
Platelet	283	103/μL	158-348
Blood coagulation
Prothrombin time	11.8	s	10-13
International normalized ratio	1.03		0.91-1.14
Activated partial thromboplastin time	38.9	s	27.0-39.5
Fibrinogen	327	mg/dL	183-349
Biochemical test
Total protein	6.6	g/dL	6.6-8.1
Albumin	4.0	g/dL	4.1-5.1
Aotal bilirubin	0.6	mg/dL	0.4-1.2
Alkaline phosphatase	210	U/L	106-322
Glutamide transpeptidase	15	U/L	9-32
Lactic dehydrogenase	214	U/L	124-222
Asparatetransaminase	253	U/L	13-30
Alanine aminotransferase	16	U/L	7-30
Blood urea nitrogen	22.0	mg/dL	8-20
Creatinine	0.80	mg/dL	0.46-0.79
C-reactive protein	0.34	mg/dL	0.00-0.14
Natrium	141	mmol/L	138-145
Potassium	4.12	mmol/L	3.6-4.8
Lipase	60.3	U/L	7.1-60
Amylase	152	U/L	44-132
Triglyceride	48	mg/dL	30-149
Blood helicobacter pylori
Helicobacter pylori	< 3	U/m	l0-10
Tumor marker
Carcinoembryonic antigen	4.5	ng/mL	0.0-5.0
Carbohydrate antigen19-9	87.95	U/mL	0.00-37

Table 3 Characteristics of intraductal papillary mucinous neoplasm combined with intrapancreatic and extra-pancreatic malignant tumor

	Size	Clinical type	Pathologic types	Immunohistochemical
IPMN	15 mm × 12 mm	BD-IPMN	Gastric type	MUC1(-), MUC2(-), MUC5AC(+)
PC	15 mm × 10 mm	Nodular type	Invasive ductal carcinoma	P53(-)
EGC	15 mm × 11 mm	0-IIc	Moderately differentiated tubular adenocarcinoma
LM		DLBCL	Diffuse Large B-cell lymphoma	CD20(+), CD(+), EBER-ISH(-)

IPMN: Intraductal papillary mucinous neoplasm; PC: Pancreatic cancer; EGC: Early gastric cancer; LM: Lymphoma; DLBCL: Diffuse large B-cell lymphoma; EBER-ISH: Epstein-Barr virus-encoded RNA in situ hybridization; BD: Branch-duct; MUC: Mucin.