Synchronous Pancreatic Ductal Adenocarcinoma in the Head and Tail, a Double Trouble: A Case Report and Literature Review
Daniel Paramythiotis,
Georgia Fotiadou,
Eleni Karlafti,
Ioanna Abba Deka,
Georgios Petrakis,
Elisavet Psoma,
Xanthippi Mavropoulou,
Filippos Kyriakidis,
Smaro Netta,
Stylianos Apostolidis
Affiliations
Daniel Paramythiotis
First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
Georgia Fotiadou
First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
Eleni Karlafti
Emergency Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
Ioanna Abba Deka
Pathology Department, University General Hospital of Thessaloniki AHEPA, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Georgios Petrakis
Pathology Department, University General Hospital of Thessaloniki AHEPA, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Elisavet Psoma
Radiology Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
Xanthippi Mavropoulou
Radiology Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
Filippos Kyriakidis
Second Chemotherapy Department, Theagenio Cancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece
Smaro Netta
First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
Stylianos Apostolidis
First Propaedeutic Surgery Department, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece
Synchronous primary pancreatic ductal adenocarcinoma (PDAC) is very rare and can be formed either through multicentric carcinogenesis or intrapancreatic metastasis. We report the case of an 80-year-old man with a history of type 2 diabetes mellitus who presented with abdominal pain and weight loss. Laboratory tests showed elevated levels of blood glucose and CA 19-9, and Computed Tomography revealed two hypoenhancing lesions in the head and tail of the pancreas. Endoscopic ultrasound, which is the imaging method of choice for pancreatic cancer, was performed with a fine needle biopsy, and the cytological analysis diagnosed PDAC in both lesions. The patient underwent total pancreatectomy, and pathologic evaluation revealed synchronous primary PDAC with moderate to poor differentiation in the head and tail in the setting of IPMN (intraductal papillary mucinous neoplasia) and chronic pancreatitis. After his recovery from postoperative pulmonary embolism, the patient was discharged home with sufficient glycemic control. Multifocal PDAC occurs more often when precursor lesions, such as IPMN, pre-exist. The optimal treatment for multiple lesions spread all over the pancreas is total pancreatectomy. Diabetes mellitus is a serious complication of total pancreatectomy (new-onset or type 3c), but overall, long-term survival has been significantly improved.
