Ruptured Anaplastic Pancreatic Carcinoma With Liver Metastasis: A Case Report

Abstract

A 65-year-old female with no relevant medical history visited our hospital with complaints of general fatigue and unlocalized abdominal pain. Non-contrast computed tomography revealed a tumor in the pancreatic tail, a diffusely swollen liver with obtuse vessel structure, and ascites above the liver surface and around the gallbladder. She went into cardiac arrest immediately after admission for further investigation of the tumor. Despite cardiopulmonary resuscitation, her spontaneous circulation could not be restored. An autopsy conducted with the consent of her family revealed 2,000 mL hemorrhagic ascites in the peritoneal cavity, a tumor measuring 4 × 2 × 2 cm in the pancreatic tail, accompanied by bleeding, and multiple sponge-like liver metastases. Microscopic examination of the pancreatic tumor and liver metastases revealed proliferation of sarcomatoid atypical cells (comprising spindle, pleomorphic, and giant cells) accompanied by red blood cells, necrosis, and fibrosis. Immunohistochemistry staining of the tumor was positive for cytokeratin (CK) AE1/AE3 and CK 7 and negative for CK 20. Thus, a diagnosis of anaplastic pancreatic carcinoma (APC), pleomorphic type, was established. From the autopsy findings, her death was concluded to be due to a hemorrhagic shock resulting from the ruptured APC. APC is a rare carcinoma among pancreatic malignancies and has a poor prognosis with rapid proliferation. Here we present an autopsy case of APC with multiple liver metastases where APC ruptured in the intraperitoneal cavity.