Vasculopathy associated with neurofibromatosis type 1 (NF-1) can cause a spontaneous hemothorax, which is an uncommon but life-threatening complication of the disease. We report a case of recurrent rupture of intercostal artery aneurysms in an NF-1 patient. A 40-year-old man with NF-1 suffered from a right spontaneous hemothorax. The bleeding source was not identified by dynamic contrast-enhanced computed tomography (CT), so he was initially treated by conservative therapy. However, repeated contrast CT revealed aneurysms of the right 10th intercostal artery. They were successfully occluded by transcatheter arterial embolization (TAE). Seven months afterward, he presented with sudden lower back pain and was diagnosed with a contralateral spontaneous hemothorax due to a ruptured aneurysm of the left 12th intercostal artery. TAE was successfully performed.

Background Collision tumors are composed of two distinct tumor components. Collision tumors composed of pancreatic ductal adenocarcinoma and malignant lymphoma occurring in the pancreas have not been previously described in the scientific literature. In this case report, we describe a unique patient with a collision tumor composed of pancreatic ductal adenocarcinoma and peri-pancreatic mucosa-associated lymphoid tissue (MALT) lymphoma occurring in the pancreas. Case presentation An 82-year-old woman presented to our hospital complaining of dizziness. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large lymphoid lesion spreading from the peri-pancreatic tissue heading to the hepatic hilar plate, involving the hepatoduodenal ligament and the entire duodenum, also showing a hard tumor in the pancreas head. We performed echo-guided needle biopsies for each tumor and diagnosed a collision tumor composed of pancreatic ductal adenocarcinoma and low-grade B cell lymphoma. The patient underwent pancreaticoduodenectomy. The resected specimen showed an elastic hard tumor, 90 × 75 mm in size, located in the pancreatic head, and a whitish-yellow hard tumor involving the lower bile duct, 31 mm in size, located in the center of the pancreatic head. Pathological and immunohistochemical examination proved that pancreatic ductal adenocarcinoma and MALT lymphoma originating from the peri-pancreatic head collided in the pancreatic head. Conclusions To best of our knowledge, this is the first report of a surgically resected collision tumor of pancreatic ductal adenocarcinoma and MALT lymphoma originating from the peri-pancreatic head. A needle biopsy is useful when inconsistent findings are observed on diagnostic CT and MRI of tumor lesions since there is the possibility of a collision tumor.

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Key Words: superior mesenteric artery embolism, thrombectomy and thrombolysis therapy, long-term complications [Jpn J Gastroenterol Surg. 2019;52(2):95-105]