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Natural History of Pancreatic Ductal Adenocarcinoma Diagnosed During Observation of Other Organ Cancers

Yutaka Okagawa, Tomohiro Kondo, Yasushi Tsuji, Toshizo Takayama, Shutaro Oiwa, Masahiro Yoshida, Hideyuki Ihara, Tetsuya Sumiyoshi, Michiaki Hirayama, Hitoshi Kondo

(Department of Gastroenterology, Tonan Hospital, Sapporo, Hokkaido, Japan)

Am J Case Rep 2019; 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.

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