Case Report
A 78-year-old man was hospitalized with upper abdominal pain.
Gastrointestinal endoscopy showed a 0-IIc lesion on the lesser curvature
of the stomach, at the angulus; biopsy revealed signet ring cell
carcinoma. Abdominal computed tomography (CT) and magnetic resonance
cholangiopancreatography (MRCP) showed
that the main pancreatic duct in
the body and tail of the pancreas was dilated, but neither scan revealed
a lesion consistent with a tumor (Fig 1, Fig 2).
Endoscopic ultrasonography (EUS)
and intraductal ultrasonography revealed stenosis of the main pancreatic
duct with dilation of the caudal pancreatic duct in the body of the
pancreas, but they also did not show any mass (Fig
3). The results of endoscopic
retrograde cholangiopancreatography (ERCP) with pancreatic juice
cytology favored malignancy but did not reveal adenocarcinoma. We
performed SPACE by placing a 4-Fr αtype nasopancreatic tube (Gadelius
Medical, Tokyo, Japan). Three of the 6 cytologic specimens revealed
adenocarcinoma (Fig 4). The preoperative diagnosis was stage IA gastric
cancer (cT1bN0M0) with stage 0 cancer of the pancreatic body (TisN0M0).
We performed total gastrectomy and distal pancreatectomy with
splenectomy. Histopathologic examination found PanIN-3 with lymphocyte
infiltration throughout the pancreas, including the tail, with dilation
of the caudal pancreatic duct. The postoperative diagnosis was stage 0
pancreatic body cancer (TisN0M0) and stage IA gastric cancer (T1bN0M0)
(Fig 5).
The patient required enteral nutrition via a feeding tube for
malnutrition after surgery. Two months after surgery, he was discharged
in good general condition, although his history of malnutrition
precluded the use of adjuvant chemotherapy. There was no evidence of
recurrence at his most recent follow-up appointment, 2 years after
surgery.