Pancreatic cancer secondary to intraductal papillary mucinous neoplasm with collision between gastric cancer and B-cell lymphoma: A case report

作     者：Yu-Hong Ma Tatsuya Yamaguchi Tomoki Yasumura Toru Kuno Shoji Kobayashi Takashi Yoshida Takeshi Ishida Yasuaki Ishida Shinya Takaoka Jiang-Lin Fan Nobuyuki Enomoto 

作者机构：Department of GastroenterologyNingxia Hui Autonomous Region People’s HospitalYinchuan 750021Ningxia Hui Autonomous RegionChina Department of the First Internal MedicineFaculty of MedicineUniversity of YamanashiChuo 409-3898YamanashiJapan Department of Molecular PathologyInterdisciplinary Graduate School of Medicine and EngineeringUniversity of YamanashiChuo 409-3898YamanashiJapan 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2021年第9卷第10期

页      面：2400-2408页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

基　　金：Supported by“136 Yucai Project”of Ningxia Hui Autonomous Region People’s Hospital Core Talent Training Fund Sponsorship to study in Japan(to Ma YH). 

主　　题：Stomach neoplasms Pancreatic intraductal neoplasms Pancreatic neoplasms B-cell lymphoma Treatment Case report 

摘      要：BACKGROUND Patients with intraductal papillary mucinous neoplasm(IPMN)have an increased risk of pancreatic and extrapancreatic malignancies.Lymphomas are rare extrapancreatic malignancies,and in situ collisions of early gastric cancer and diffuse large B-cell lymphoma(DLBCL)are even rarer.Here,we report the first case of pancreatic cancer comorbid with in situ collision of extrapancreatic malignancies(early gastric cancer and DLBCL)in a follow-up IPMN patient.Furthermore,we have made innovations in the treatment of such cases.CASE SUMMARY An 81-year-old Japanese female diagnosed with IPMN developed elevated carbohydrate antigen(CA)19-9 levels during follow-up.Because her CA19-9 levels continued to rise,endoscopic ultrasound(EUS)was performed and revealed a suspicious lesion at the pancreatic tail.However,lesions in the pancreas were not found by computed tomography,magnetic resonance imaging,or endoscopic retrograde cholangiopancreatography.To make an exact pathological diagnosis,EUS-guided fine needle aspiration was performed.To our supprise,early gastric cancer was found in preoperative gastroscopy.The gastric cancer was completely resected through endoscopic submucosal dissection before postoperative pathology identified early adenocarcinoma collided with DLBCL.Subsequent EUS-guided fine needle aspiration provided pathological support forthe pancreatic cancer diagnosis, and then laparoscopic distal pancreatectomy andsplenectomy were performed. CA19-9 levels returned to normal postoperatively.CONCLUSION Endoscopic submucosal dissection is appropriate for submucosal lymphomas inpatients intoleratant of chemotherapy. EUS can detect small IPMN-relatedpancreatic tumors.