Coexistence of annular pancreas with carcinoma in the dorsal part of pancreas divisum: diagnostic value of magnetic resonance cholangiopancreatography

Abstract

We report on the incidental observation of a pancreas divisum coexistent with an annular pancreas in a 88-year-old woman presenting with jaundice due to a pancreatic carcinoma. This case report discusses the embryologic hypotheses underlying this peculiar association, highlights the capacities of imaging techniques to depict them, and enhances the performance of magnetic resonance imaging.

Pancreaticoduodenectomy for pancreas carcinoma occurring in the annular pancreas: report of a case

“…In these cases, ERCP may not always be successful, due to technical difficulty in some cases, particularly in cases with the duodenal ulcer and/or stenosis of the descending part of the duodenum [ 13 ]. In most cases, multi-slice CT shows the circumferential pancreatic parenchyma around the descending part of the duodenum [ 13 , 14 ]; however, in some cases, this imaging method may lead to misinterpretation as a thickening of the duodenum [ 15 ]. With this in mind, magnetic resonance imaging (MRI) and MRCP are useful for understanding anomalies observed in the pancreatic anatomy [ 13 , 15 , 16 ].…”

“…Among the cases reported in the literature, only five have been reported to involve the annular pancreas [ 12 , 15 , 20 – 22 ]. Among them, three cases were located in the pancreas head, one case in the pancreas body, and one case existed diffusely in the pancreas; however, there were no cases with existing carcinoma in the annular pancreas, except the present case.…”

An annular pancreas associated with carcinoma of the papilla of Vater: report of a case

“…In the surgical cases of annular pancreas reviewed by Yogi et al [14], 9 (8.5%) of the 106 cases displayed a pancreaticobiliary malignancy (5 ampullary carcinomas, 2 pancreatic carcinomas, and 2 cholangiocarcinomas). Among the cases reported in the English literature, the most common pancreaticobiliary neoplasia associated with an annular pancreas was ampullary carcinoma (6 cases) ( Table 1) [15][16][17][18][19], followed by pancreatic carcinoma (5 cases) [20][21][22][23][24], cholangiocarcinoma (2 cases) [12,25], insulinoma (1 case) [26], and mucinous cystic neoplasm (MCN) (1 case) [27]. The chronic obstruction caused by an annular pancreas has been postulated to prompt continuous exfoliation of cells in the region of the ampulla and rapid mucosal turnover, facilitating dysplastic changes and metaplasia in that region [17].…”

Is there a causal relation between pancreas divisum and pancreatic cancer?

“…A total of 26 cases of pancreatic cancer associated with pancreas divisum have been reported in Japan. 9 The location in which the tumor developed was the dorsal pancreas in 25 cases and the ventral pancreas in one case; that just the case in the ventral pancreas might be included in the results reported by Nishino et al 8 In an English series, seven cases of pancreatic cancer [10][11][12][13][14][15] and eight cases of IPMN 9,14,16-21 associated with pancreas divisum have been reported, and the tumors developed in the dorsal pancreas except one IPMN in the ventral pancreas. 9 This preponderance in the dorsal pancreas might not be fully accounted for by the larger volume of the dorsal pancreas.…”