Poorly differentiated ductal adenocarcinoma of the pancreas with rapid progression in a young man.

Pancreatic cancer in young adults is very rare. We report a case of young-onset poorly differentiated pancreatic ductal adenocarcinoma with rapid progression and poor prognosis in a 31-year-old Japanese man with no obvious family history of malignancy. Preoperative examinations revealed a mass lesion in the body of the pancreas, accompanied by a slightly dilated main pancreatic duct distal to the mass lesion. Pancreatic cancer with acute pancreatitis was suspected because of an elevation of serum pancreatic enzyme and tumor marker, along with imaging findings. Distal pancreatectomy with resection of the common hepatic artery and splenectomy along with lymph node dissection was performed. Microscopically, the tumor was mainly composed of poorly differentiated ductal adenocarcinoma. The postoperative course was uneventful, but the patient had multiple liver metastases 2 months postoperatively, in spite of adjuvant chemotherapy, and died 8 months postoperatively. This case may represent a rare instance of young-onset poorly differentiated ductal adenocarcinoma with rapid progression and may indicate potential risk factors of pancreatic cancer in young adults.

An unusual case of undifferentiated carcinoma in situ with osteoclast-like giant cells of the pancreas.

OBJECTIVES: We report an unusual case of undifferentiated carcinoma in situ with osteoclast-like giant cells (UC with OGCs) in a 68-year-old Japanese woman. METHODS: Preoperative examinations revealed an unidentifiable mass lesion within the main pancreatic duct (MPD) in the pancreatic head, accompanied by a dilated MPD distal to the mass lesion, which was suspected to be an intraductal papillary-mucinous neoplasm of the main-duct type with acute pancreatitis because of an increased serum amylase level. A pancreaticoduodenectomy was performed. RESULTS: A pencil-like tumor occupied the lumen of the MPD of the pancreatic head without a visible pancreatic parenchymal mass. The intraductal tumor included a sheet of spindle cells intermingled with scattered OGCs and pleomorphic giant cells. A poorly developed glandular pattern was occasionally observed at the tumor periphery. These findings were consistent with conventional UC with OGCs. However, extraductal invasion was not found in an extensive histopathologic examination, although focal intraductal spreading into the epithelium of the first branch of the MPD was observed. CONCLUSIONS: Undifferentiated carcinoma with OGCs usually exhibits an invasive tumor at diagnosis and is associated with a poor outcome, but the patient is alive without recurrence 22 months after surgery. To our knowledge, this is the first reported case of UC in situ without evident extraductal invasion in English literature.