Introduction: To summarize the characteristics of cystic pancreatic adenocarcinoma, and to improve the general understanding of the imaging and pathologic features, and other pancreatic cystic diseases are compared for differential diagnosis. Method: This study included patients treated in our hospital from Jan, 2000 to Dec, 2014 due to pancreatic neoplasm. The imaging data and diagnostic imaging reports showed that in the cases that were diagnosed as pancreatic carcinoma there were cystic performance and "cystic mass". Result: Among the 485 cases of pancreatic carcinoma, 37 patients had cystic characteristics, accounting for 7.6%. 37 cases were all underwent surgical exploration. Based on preoperative imaging and gross pathological results, the cystic lesions were divided into the following four types : cyst with thin wall type (8cases); cyst with thick wall type (9cases); cystic-solid type (15 cases), and duct dilated type (5 cases). Pathological examination revealed that 29 cases were pancreatic ductal adenocarcinoma, which was moderately or poorly differentiated; and the other 8 cases were rare types of pancreatic carcinoma. Conclusion: Pancreatic ductal adenocarcinoma and its variants may have cystic features. When analyzing preoperative imaging findings of pancreatic cystic mass, the characteristics of the cystic pancreatic ductal adenocarcinoma should be fully taken into account to make differential diagnosis.
Tumors of the body and tail of the pancreas are often more aggressive than tumors of the head and would have often undergone metastatic spread to other organs at the time of diagnosis. Most patients with carcinoma of the body and tail of the pancreas present at a late stage. Surgery is only indicated in those patients in whom there is no evidence of metastatic spread. Surgery is often not possible in cancers of the body and tail of the pancreas if the tumor invades celiac artery. Controversy exists regarding the margin status impact of microscopic resection margin involvement (R1) after pancreaticoduodenectomy (PD) for PDAC. There are reports indicating the rate of R1 resections increases significantly after PD if pathological examination is standardized. In this report, we present the case of a 56-year-old female who had undergone lateral pancreaticojejunostomy for chronic pancreatitis 8 years ago, but has now developed malignancy of the body and tail of the pancreas involving multiple organs. This patient underwent en bloc resection involving: 1. distal pancreatectomy with jejunal loop (lateral pancreaticojejunostomy) resection; 2. splenectomy; 3. left nephrectomy; 4. total gastrectomy; and 5. segmental colectomy with reconstruction by esophagojejunostomy, jejunojejunostomy, and colocolic anastomosis. The infrequent occurrence of tumor in the distal gland and advanced tumor stage at the time of diagnosis have both combined to produce therapeutic nihilism/dilemma in the minds of many surgeons. This report highlights the decision on how much to the push limits for multi-organ resection (en bloc resection with distal pancreatectomy, gastrectomy, splenectomy, colectomy, nephrectomy) with the intent of achieving R0 status in spite of the complexity of surgery in selected patients.
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