A case of anaplastic ductal carcinoma of the pancreas (giant cell type) with intraabdominal hemorrhage

Abstract

A 84-year-old woman reporting abdominal pain was found in abdominal ultrasonography and computed tomography to have fluid collected in the abdominal cavity and a tumor in the pancreas tail. Exploratory needle aspiration showed blood, necessitating emergency surgery under a diagnosis of intraabdominal hemorrhage. During surgery, we found bleeding from a dilated vein in the greater omentum and a whitish tumor in the pancreas tail. We ligated the bleeding site and conducted a biopsy of the tumor. The pathological diagnosis was giant-cell anaplastic ductal carcinoma characterized by noncohesive sarcoma-like growth and bizarre mono- and multinucleated giant cells showing partial phagocytosis. Magnetic resonance imaging showed an inhomogenous mass with central necrosis. Angiography showed tumor encasement and hypervascularity. A month later, lung and liver metastases were observed, and the woman died 15 months postoperatively of cancerous cachexia. Some 49 cases, including ours, have been reported in the Japanese literature. Many tumors were huge, with an average diameter of 76 mm. Imaging findings were characterized by hypervascularity on angiography and a relatively high incidence of cystic components in tumors. The prognosis is poor in many cases because patients are often not precisely diagnosed until the disease was in an advanced stage.