Resectable carcinoma of the pancreatic head developing 7 years and 4 months after distal pancreatectomy for carcinoma of the pancreatic tail

Abstract

A 67-year-old woman was referred with an abnormal finding on an abdominal echogram but presented with no symptoms; a pancreatic
tail tumor was detected by ultrasonography. Biochemical examinations showed slight elevation of serum carcinoembryonic antigen
level. The lesion was resected by tail and body pancreatectomy and her postoperative course was uneventful. Seven years and
4 months after the initial operation, however, her serum level of carbohydrate antigen 19-9 was found to be elevated, and
a recurrence of pancreatic cancer was suspected. Examinations revealed a mass in the head of the remnant pancreas. The lesion
was radically resected by total remnant pancreatectomy. Histological examinations showed that the initial tumor was a well
differentiated tubular adenocarcinoma, while the second tumor was characterized as a moderately differentiated tubular adenocarcinoma.
The surgical margins of the distal pancreatectomy specimen were free of atypical cells. Therefore, the position of the second
lesion diminished the likelihood that it had developed by intrapancreatic metastasis. This suggests that the second carcinoma
in the head of the pancreas may have been a second primary lesion.