Susumu Ohwada1, Amika Moro2, Nair Amit2, Kazunari Sasaki2, Shinji Sakurai3, Atsuko Takada-Owada4, Masaru Izumi5, Yuhei Nakano6, Yasushige Kashima6, Hideki Matsuyama6. 1. Center of Gastroenterology and Oncology, IMS Ota Chuo General Hospital, 875-1 Higashi-imaizumicho, Ota, 373-8513, Japan. go.go.ohwada@gmail.com. 2. Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA. 3. Department of Pathology, Gunma CHUO General Hospital, Gunma, Japan. 4. Department of Pathology, Dokkyo Medical University Hospital, Tochigi, Japan. 5. Department of Surgery, Sudo Hospital, Gunma, Japan. 6. Center of Gastroenterology and Oncology, IMS Ota Chuo General Hospital, 875-1 Higashi-imaizumicho, Ota, 373-8513, Japan.
Abstract
BACKGROUND: Ascertaining the origin of large tumors located in the region of the pancreas head and adjacent mesocolon can pose a challenge preoperatively. En bloc pancreatoduodenectomy with hemicolectomy is often required towards curative tumor resection (R0) of malignant tumors in this region. CASE PRESENTATION: Herein we report a case of a 48-year-old man with two contiguous masses each 5 cm in size, located in the pancreatic head. The masses were detected incidentally by abdominal ultrasonography at an annual health check. Endoscopic biopsies revealed inflammation with no malignancy. Cross-sectional imaging showed the tumor direct invasion of the uncinate process of the pancreas, and the third portion of the duodenum. Based on imaging, a malignant submucosal tumor originating from mesenchymal cells in the mesentery of the transverse colon was made preoperatively. The mass required en bloc pancreatoduodenectomy, right hemicolectomy, and resection of the superior mesenteric vein. The final pathology was carcinosarcoma of the transverse colon. The patient survived 18 years after surgery without recurrence. CONCLUSIONS: Malignant tumors located in the region of the pancreas head should be considered for an en bloc curative tumor resection and adjuvant chemotherapy treatments offered that might be beneficial for carcinosarcoma.
BACKGROUND: Ascertaining the origin of large tumors located in the region of the pancreas head and adjacent mesocolon can pose a challenge preoperatively. En bloc pancreatoduodenectomy with hemicolectomy is often required towards curative tumor resection (R0) of malignant tumors in this region. CASE PRESENTATION: Herein we report a case of a 48-year-old man with two contiguous masses each 5 cm in size, located in the pancreatic head. The masses were detected incidentally by abdominal ultrasonography at an annual health check. Endoscopic biopsies revealed inflammation with no malignancy. Cross-sectional imaging showed the tumor direct invasion of the uncinate process of the pancreas, and the third portion of the duodenum. Based on imaging, a malignant submucosal tumor originating from mesenchymal cells in the mesentery of the transverse colon was made preoperatively. The mass required en bloc pancreatoduodenectomy, right hemicolectomy, and resection of the superior mesenteric vein. The final pathology was carcinosarcoma of the transverse colon. The patient survived 18 years after surgery without recurrence. CONCLUSIONS:Malignant tumors located in the region of the pancreas head should be considered for an en bloc curative tumor resection and adjuvant chemotherapy treatments offered that might be beneficial for carcinosarcoma.
Entities:
Keywords:
Carcinosarcoma; Pancreatoduodenectomy with hemicolectomy; Region of pancreas head
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