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

Abstract

A 58-year-old man hospitalized for upper abdominal pain, was referred to us due to a pancreatic tumorous lesion detected by abdominal ultrasonography (US) and computed tomography (CT). Although serum CEA and CA19-9 were within normal ranges, leucocytosis with eosinophilia was observed and CRP was elevated to 1. 9mg/dl. US showed an ill-defined hypoechoic mass in the pancreatic head and uncinate process, suggesting a hemorrhagic pseudocyst. Endoscopic ultrasonography (EUS) showed a heterogenous hypoechoic lesion with a cystic component. CT showed a low-density tumor with severe adhesion to the superior mesenteric vein (SMV). ERCP showed diffuse stenosis of the pancreatic duct in the pancreatic head, probably due to pancreatitis. Angiography showed slight tumor staining and stenosis of the SMV. Following pancreaticoduodenectomy, pathological examination showed the lesion to be invasive ductal giant cell carcinoma with severe infltration of neutrophils and eosinophils. Preoperative leucocytosis with eosinophilia improved just after surgery, and increase again at recurrence. The patient's postoperative course was uneventful, but the outcome was very poor.