Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Mar 28, 2008; 14(12): 1958-1960
Published online Mar 28, 2008. doi: 10.3748/wjg.14.1958
Growth process of small pancreatic carcinoma: A case report with imaging observation for 22 months
Takeshi Hisa, Hiroki Ohkubo, Satoshi Shiozawa, Hiroki Ishigame, Masato Takamatsu, Masayuki Furutake, Bunsei Nobukawa, Koichi Suda
Takeshi Hisa, Masato Takamatsu, Masayuki Furutake, Department of Internal Medicine, Saku Central Hospital, Nagano 384-0301, Japan
Hiroki Ohkubo, Department of Surgery, Saku Central Hospital, Nagano 384-0301, Japan
Satoshi Shiozawa, Hiroki Ishigame, Department of Clinical Pathology, Saku Central Hospital, Nagano 384-0301, Japan
Bunsei Nobukawa, Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
Koichi Suda, Department of Pathology, Tokyo-West Tokusyukai Hospital, Tokyo, Japan
Correspondence to: Takeshi Hisa, MD, PhD, Department of Internal Medicine, Saku Central Hospital, 197 Usuda, Saku, Nagano 384-0301, Japan.
Telephone: +81-267-823131
Fax: +81-267-829638
Received: September 20, 2007
Revised: December 8, 2007
Published online: March 28, 2008

This report describes serial observations of the growth process of a small invasive ductal carcinoma (IDC) of the pancreas from imaging studies. Histopathological studies showed IDC with macroscopic retention cysts proximal to an intraductal papillary-mucinous adenoma with mild atypia of the branch duct type in the pancreatic body, with no relation between the two lesions. IDC was demonstrated as an extremely low-echoic mass resembling a cyst with an unclear margin on the initial endoscopic ultrasonography. We misinterpreted the low-echoic mass as a benign intraductal mucinous-papillary neoplasm (IPMN) based on findings of other imaging studies, and the patient was followed-up. The mass increased from 7 mm to 13 mm in diameter over 22 mo, and remained smaller than 10 mm in diameter for about 420 d. The tumor volume doubling time was 252 d. The Ki67 labeling index was 15.9%, similar to that described in previous reports. Hence, IDC may grow slowly while remaining small.

Keywords: Invasive ductal carcinoma, Pancreas, Intraductal papillary-mucinous neoplasm, Endoscopic ultrasonography, Tumor volume doubling time