Adenosquamous Carcinoma of the Pancreas That Had Penetrated Into the Stomach and Transverse Colon: A Case Report

Abstract

We report the case of pancreatic adenosquamous carcinoma (PASC) that had penetrated into the stomach and transverse colon. A 55-yearold male presented to our hospital with general fatigue, melena, and left flank pain. He had no relevant medical history. A laboratory analysis upon arrival revealed marked anemia with a red blood cell count of 13.3 × 10 4 /μL and a hemoglobin level of 3.6 g/dL. There was tenderness over the upper abdomen and a palpable mass on his left upper abdomen. He was admitted for further examination of his severe anemia and abdominal symptoms. Contrast-enhanced computed tomography revealed multiple liver masses and a 10 cm sized tumor in the pancreas tail involving the gastric wall and transverse colon. Upper gastroendoscopy revealed a 4 cm sized elevated tumor with a central depression in the greater curvature of the middle gastric body. Colonoscopy revealed an ulcerative tumor extending from the splenic flexure to the mid transverse colon. Endoscopic biopsied specimens revealed adenosquamous cell carcinoma. From these findings, the diagnosis of PASC in the pancreatic tail invading into the stomach and transverse colon at an advanced stage IV was established. His anemia was treated by the administration of red blood cell concentration (RCC). Although chemotherapy was planned after his malnutrition improved, his circulatory condition worsened on day 20. Despite 10 units of RCC, his anemia did not improve and he died from circulatory insufficiency on day 23. An autopsy revealed PASC in the pancreas tail measuring 14 cm that had penetrated into the gastric wall and transverse colon. A massive amount of blood was discovered in the stomach. His death was caused by massive bleeding from the invaded lesions of the stomach. Adenosquamous carcinoma, consisting of adenocarcinoma and squamous cell carcinoma, is characterized by its aggressive proliferation and poor prognosis. To date, consensuses in the management of PASC have not been established. Further accumulation of knowledge about this carcinoma is required.

Pancreatic Adenosquamous Carcinoma Presenting as a Gastric Lesion

“… 5 PASC in the pancreatic tail have been reported to cause gastric wall invasion and splenic infarcts from splenic vein and artery encasement, as in our patient. 1 , 6 By contrast, symptoms for when PASC is in the head of pancreas have been described as causing obstructive jaundice and pancreatitis. 1 As demonstrated in our case, when gastric invasion is involved, a histopathologic diagnosis may additionally be made on endoscopic biopsies, which speaks to the importance of considering PASC when performing endoscopy on patients with nonspecific gastrointestinal symptoms.…”

Rapidly Progressing Anaplastic Carcinoma of the Pancreas with Mucoepidermoid Carcinoma: An Autopsy Case Report

“…In a previous report on 9 patients with pancreatic carcinoma, the median doubling time was 144 days ( 14 ). Pathologically, the doubling time of pancreatic carcinoma with squamous component is 81.8 days, whereas that with an adenomatous component is 166.3 days ( 15 ). In the present case, the doubling time was 25 days, so the tumor grew rapidly and finally ruptured.…”