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

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World Journal of Clinical Cases 2021年第10期9卷 2400-2408页

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 Department of Gastroenterology Ningxia Hui Autonomous Region People’s HospitalYinchuan 750021Ningxia Hui Autonomous RegionChina Department of the First Internal Medicine Faculty of MedicineUniversity of YamanashiChuo 409-3898YamanashiJapan Department of Molecular Pathology Interdisciplinary Graduate School of Medicine and EngineeringUniversity of YamanashiChuo 409-3898YamanashiJapan

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.

关键词： Stomach neoplasms Pancreatic intraductal neoplasms Pancreatic neoplasms B-cell lymphoma Treatment Case report

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