Okagawa Yutaka, Kondo Tomohiro, Tsuji Yasushi, Takayama Toshizo, Oiwa Shutaro, Yoshida Masahiro, Ihara Hideyuki, Sumiyoshi Tetsuya, Hirayama Michiaki, Kondo Hitoshi
Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan.
Department of Clinical Oncology, Tonan Hospital, Sapporo, Hokkaido, Japan.
Am J Case Rep. 2019 Jul 23;20:1080-1084. doi: 10.12659/AJCR.917197.
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is a rapidly progressive malignancy that exhibits an extremely poor prognosis, with most cases diagnosed at an advanced stage. To date, few reports have explored the natural history of PDAC, and the period leading up to the detection of PDAC as a tumor with contrast-enhanced computed tomography (CECT) remains unclear. Here, we report 3 PDAC cases diagnosed incidentally by repeating imaging examinations during observation of other organ cancers. CASE REPORT Two patients were undergoing postoperative follow-up for colorectal cancer; owing to the elevation of serum CA19-9 or dilatation of the main pancreatic duct, both cases were finally diagnosed with PDAC. Another patient was administered neoadjuvant chemotherapy for a gastrointestinal stromal tumor; the fluorodeoxyglucose uptake in the pancreas with fluorodeoxyglucose positron emission tomography for the treatment assessment led to the diagnosis of PDAC. All patients underwent frequent CECT for assessment of other diseases, and PDAC became visible with CECT within 3-4 months of the appearance of indirect findings of PDAC. CONCLUSIONS The period leading up to the detection of PDAC as a tumor with CECT was approximately 3-4 months. These cases suggest that additional imaging examinations should be performed when the indirect findings of PDAC are noted. This report adds value to the literature by elucidating the natural course of PDAC.
胰腺导管腺癌（PDAC）是一种进展迅速的恶性肿瘤，预后极差，大多数病例在晚期才被诊断出来。迄今为止，很少有报告探讨PDAC的自然病史，并且在通过对比增强计算机断层扫描（CECT）检测到PDAC作为肿瘤之前的时间段仍不清楚。在此，我们报告3例在观察其他器官癌症期间通过重复影像学检查偶然诊断出的PDAC病例。病例报告：两名患者正在接受结肠癌术后随访；由于血清CA19-9升高或主胰管扩张，这两例最终均被诊断为PDAC。另一名患者因胃肠道间质瘤接受新辅助化疗；用于治疗评估的氟脱氧葡萄糖正电子发射断层扫描显示胰腺摄取氟脱氧葡萄糖，从而诊断为PDAC。所有患者均因评估其他疾病而频繁接受CECT检查，在出现PDAC间接征象后的3-4个月内，PDAC通过CECT变得可见。结论：通过CECT检测到PDAC作为肿瘤之前的时间段约为3-4个月。这些病例表明，当注意到PDAC的间接征象时，应进行额外的影像学检查。本报告通过阐明PDAC的自然病程为文献增添了价值。
