Two cases of pancreatic ductal adenocarcinoma with intrapancreatic metastasis

Abstract

There are no standardized diagnostic criteria for intrapancreatic metastasis of pancreatic ductal adenocarcinoma (PDAC). Here, we report two cases of patients with PDAC who were pathologically diagnosed as harboring intrapancreatic metastasis. In both cases, the main lesions were located in the pancreatic body, and no other lesion was detected preoperatively. The patients were diagnosed with pancreatic body cancers and distal pancreatectomy was performed. Pathological findings revealed microscopic cancer nests, which had connections to neither the main lesion nor the premalignant lesion in the pancreatic tail parenchyma. In both cases, the histological type of the daughter lesion was quite similar to that of the main lesion. Hence, we diagnosed the daughter lesions as metastatic foci in the pancreas. Although intrapancreatic metastasis of PDAC has been regarded as a poor prognostic factor, few reports of intrapancreatic metastasis are available. This article reports two such cases and provides a review of the literature.

Keywords: Carcinoma; Pancreatic ductal; Neoplasm micrometastasis; Recurrence; Carcinogenesis

Core tip: Although intrapancreatic metastasis (IPM) of pancreatic ductal adenocarcinoma has been regarded as a poor prognostic factor, few reports of IPM are available. Furthermore, the diagnostic criteria and the clinicopathological significance of IPM still need to be clarified. It should be remembered that IPM is present at a constant rate, and may be located in the remnant pancreas or in resected specimens other than the main lesion. IPM could be a cause of early recurrence. Here, we have presented two cases of IPM and provided suggestions regarding the foundation of the diagnosis of IPM.