Pancreatic Intraductal Ultrasonography (IDUS) Allows Early Diagnosis of Pancreatic Carcinoma in Situ: A Case Report

Q. Ly; M. Rünzi; J. Menzel; K. U. Rehbehn; A. Zimmermann; M. W. Büchler; H. Friess

doi:10.1055/s-2003-39658

Endoscopy, Inhaltsverzeichnis

Endoscopy 2003; 35(6): 534-537
DOI: 10.1055/s-2003-39658

Case Report

Pancreatic Intraductal Ultrasonography (IDUS) Allows Early Diagnosis of Pancreatic Carcinoma in Situ: A Case Report

Q. Ly¹ , M. Rünzi² , J. Menzel³ , K. U. Rehbehn² , A. Zimmermann⁴ , M. W. Büchler¹ , H. Friess¹

¹Dept. of General Surgery, University of Heidelberg, Germany, and Dept. of Visceral and Transplantation Surgery, Inselspital, University of Berne, Switzerland
²Dept. of Gastroenterology and Metabolism, Essen South Hospital, Catholic Hospital Essen, Germany
³Dept. of Medicine B, University of Münster, Münster, Germany
⁴Institute of Pathology, Inselspital, University of Berne, Switzerland

Abstract

A 66-year-old woman was admitted with diarrhea, weight loss, slight recurrent abdominal pain, and raised serum amylase and lipase. Lactose intolerance was diagnosed, and treatment was begun. The symptoms diminished. However, slight back pain and elevated serum amylase and lipase levels persisted. A pancreatic tumor was then suspected. Ultrasound, spiral computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance cholangiopancreatography (MRCP) examinations were inconclusive. Endoscopic retrograde cholangiopancreatography (ERCP) showed a slight narrowing of the pancreatic duct within the pancreatic body, and endoscopic ultrasound (EUS) revealed a 10 mm intrapancreatic lesion. Finally, intraductal ultrasonography (IDUS) reliably identified a small pancreatic tumor. The tumor was resected, and histology confirmed a well-differentiated adenocarcinoma in situ (UICC stage 0, TisN0M0). This case shows that using high-resolution imaging techniques such as EUS plus IDUS, small malignant pancreatic lesions can be detected at an early stage, when curative action is possible.

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References

1 Greenlee R T, Murray T, Boldon S, Wingo P A. Cancer statistics. CA Cancer J Clin. 2000; 50 7-33
2 Friess H, Kleeff J, Kulli C. et al . The impact of different types of surgery in pancreatic cancer. Eur J Surg Oncol. 1999; 25 124-131
3 Trede M, Schwall G, Saeger H D. Survival after pancreatoduodenectomy: 118 consecutive resections without an operative mortality. Ann Surg. 1990; 211 447-458
4 Baumel H, Huguier M, Manderscheid J C. et al . Results of resection for cancer of the exocrine pancreas: a study from the French Association of Surgery. Br J Surg. 1994; 81 102-107
5 Büchler M W, Friess H, Schultheiss K H. et al . A randomized controlled trial of adjuvant immunotherapy (murine monoclonal antibody 494/32) in resectable pancreatic cancer. Cancer. 1991; 68 1507-1512
6 Neoptolemos J P, Dunn J A, Stocken D D. et al . Adjuvant chemoradiotherapy and chemotherapy in resectable pancreatic cancer: a randomised controlled trial. Lancet. 2001; 358 1576-1585
7 Korc M, Chandrasekar B, Yamanaka Y. et al . Overexpression of the epidermal growth factor receptor in human pancreatic cancer is associated with concomitant increase in levels of epidermal growth factor and transforming growth factor alpha. J Clin Invest. 1992; 90 1353-1360
8 Friess H, Yamanaka Y, Büchler M W. et al . Enhanced expression of transforming growth factor beta isoforms in pancreatic cancer correlates with decreased survival. Gastroenterology. 1993; 105 1846-1856
9 Zhu Z W, Friess H, diMola F F. et al . Nerve growth factor expression correlates with perineural invasion and pain in human pancreatic cancer. J Clin Oncol. 1999; 17 2419-2428
10 Kern S E. Molecular genetic alterations in ductal pancreatic adenocarcinomas. Med Clin North Am. 2000; 84 691-695
11 Bramhall S R, Allum W H, Jones A G. et al . Treatment and survival in 13 560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study. Br J Surg. 1995; 82 111-115
12 Büchler M W, Friess H, Klempa I. et al . Role of octreotide in the prevention of postoperative complications following pancreatic resection. Am J Surg. 1992; 163 125-131
13 Friess H, Beger H G, Sulkowski U. et al . Randomized controlled multicentre study of the prevention of complications by octreotide in patients undergoing surgery for chronic pancreatitis. Br J Surg. 1995; 82 1270-1273
14 Büchler M W, Friess H, Wagner M. et al . Pancreatic fistula after pancreatic head resection. Br J Surg. 2000; 87 883-889
15 Furukawa T, Naitoh Y, Tsukamoto Y. et al . New technique using intraductal ultrasonography for the diagnosis of diseases of the pancreatobiliary system. J Ultrasound Med. 1992; 11 607-612
16 Yazumi S, Takahashi R, Tojo M. et al . Intraductal US aids detection of carcinoma in situ in a patient with a choledochal cyst. Gastrointest Endosc. 2001; 53 233-236
17 Furukawa T, Oohashi K, Yamao K. et al . Intraductal ultrasonography of the pancreas: development and clinical potential. Endoscopy. 1997; 29 561-569
18 Menzel J, Domschke W. Gastrointestinal miniprobe sonography: the current status. Am J Gastroenterol. 2000; 95 605-616
19 Tamada K, Ido K, Ueno N. et al . Assessment of portal vein invasion by bile duct cancer using intraductal ultrasonography. Endoscopy. 1995; 27 573-578
20 Rösch T. Staging of pancreatic cancer: analysis of literature results. Gastrointest Endosc Clin North Am. 1995; 5 735-739

H. Friess, M.D.

Dept. of General Surgery, University of Heidelberg

Im Neuenheimer Feld 110 · 69120 Heidelberg · Germany

Fax: + 49-6221-56-6903

eMail: helmut_friess@med.uni-heidelberg.de