Growth process of small pancreatic carcinoma: A case report with imaging observation for 22 months

Abstract

This report describes serial observations of the growth process of a small invasive ductal carcinoma (IDC) of the pancreas from imaging studies. Histopathological studies showed IDC with macroscopic retention cysts proximal to an intraductal papillary-mucinous adenoma with mild atypia of the branch duct type in the pancreatic body, with no relation between the two lesions. IDC was demonstrated as an extremely low-echoic mass resembling a cyst with an unclear margin on the initial endoscopic ultrasonography. We misinterpreted the lowechoic mass as a benign intraductal mucinous-papillary neoplasm (IPMN) based on findings of other imaging studies, and the patient was followed-up. The mass increased from 7 mm to 13 mm in diameter over 22 mo, and remained smaller than 10 mm in diameter for about 420 d. The tumor volume doubling time was 252 d. The Ki67 labeling index was 15.9%, similar to that described in previous reports. Hence, IDC may grow slowly while remaining small.

Distant metastasis occurs late during the genetic evolution of pancreatic cancer

“…To estimate the timing, we first used Ki67 labeling to determine the proliferation rate of seven samples of normal duct epithelium from surgically resected pancreata of individuals without pancreatic cancer as well as of each index metastasis. Ki67-positive nuclei constituted an average of 0.4% of normal ductal cells, while an average of 16.3% of cancer cells within the index metastasis lesions were Ki67-positive, consistent with prior estimates 9 - 10 ( Supplementary Table 4 ). Based on these data plus that from sequencing of the index lesions, we derived estimates for three critical times in tumor evolution: T 1 - the time between tumor initiation and the birth of the cell giving rise to the parental clone; T 2 - the subsequent time required for the birth of the cell that gave rise to the index metastasis; and T 3 – the time between the dissemination of this cell and the patients’ death ( Fig.…”

Pancreatic Duct Stricture That Rapidly Progressed to Pancreatic Ductal Adenocarcinoma and Formed a Mass within 3 Months: A Case Report

“…Similarly, only one study reported on the natural growth rate of a small pancreatic ductal adenocarcinoma of 7 mm. It took 22 months for this mass to increase from 7 to 13 mm, and the patient then underwent surgical resection [ 7 ] (Table 2 ).…”

“…Therefore, there are few follow-up reports on pancreatic carcinoma in situ with PD stricture and small pancreatic ductal adenocarcinoma less than 10 mm in size, and the natural growth rate of these tumors remains unclear. There is only one report describing the natural growth rate of pancreatic carcinoma in situ till date [ 6 ], as well as one follow-up report of the natural growth rate of small pancreatic ductal adenocarcinomas less than 10 mm in size [ 7 ]. Hence, reports of close follow-ups in cases of PD stricture, suspected to be carcinoma in situ, and observation of the natural growth rate are important.…”

How Early Can Pancreatic Cancer Be Recognized A Case Report and Review of the Literature

“…It takes over 29 months for this cancer to grow into an invasive carcinoma measuring 1 cm in diameter [ 5 ]. In small invasive pancreatic carcinoma, the tumor volume doubling time was reported to be 252 days [ 6 ]. These findings make it possible to detect the small pancreatic cancer during the relatively long, silent, and most importantly curable period using certain screening methods [ 7 ] and provide a significant extension of time to perform effective treatment.…”