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.