Tezuka Koji, Ishiyama Tomoharu, Takeshita Akiko, Matsumoto Hidekazu, Jingu Akira, Kikuchi Jiro, Yamaya Hideyuki, Ohe Rintaro, Ishizawa Tetsuya
Department of Surgery, Yamagata Prefectural Shinjo Hospital, 12-55 Wakabacho, Shinjo, 996-0025, Japan.
Department of Surgery, Okitama Public General Hospital, 2000 Nishi-Otsuka, Higashi-Okitama-gun, Kawanishi, Yamagata, 992-0601, Japan.
Clin J Gastroenterol. 2018 Oct;11(5):417-423. doi: 10.1007/s12328-018-0859-z. Epub 2018 Apr 16.
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.
青年胰腺癌非常罕见。我们报告一例31岁无明显恶性肿瘤家族史的日本男性发生的青年起病的低分化胰腺导管腺癌，其进展迅速且预后不良。术前检查发现胰体有一肿块病变，肿块病变远端的主胰管轻度扩张。由于血清胰酶和肿瘤标志物升高以及影像学表现，怀疑为伴有急性胰腺炎的胰腺癌。实施了远端胰腺切除术，同时切除肝总动脉并进行脾切除术及淋巴结清扫。显微镜下，肿瘤主要由低分化导管腺癌组成。术后过程顺利，但尽管进行了辅助化疗，患者术后2个月出现多处肝转移，术后8个月死亡。该病例可能代表了青年起病的低分化导管腺癌进展迅速的罕见情况，可能提示青年胰腺癌的潜在危险因素。
