CASE 830: PANCREATIC CANCER and a REVIEW of the PERITONEAL CARCINOMATOSIS, Dr PHAN THANH HẢI, Dr TRẦN NGÂN CHÂU, MEDIC MEDICAL CENTER, HCMC, VIETNAM

A 58 year-old man with epigastric pain and flatulence for one month.

Ultrasound detected a # 21x27mm hypoechoic tumor of the pancreatic body and peritoneal carcinomatosis [PC]: a large amount # 4 liters of malignant ascites, metastatic lymph nodes and peritoneal cake.

Lab data showed raised CA 19-9 : 807 U/mL and CA 125: 95.7U/mL

MSCT confirmed the peritoneal carcinomatosis.

Surgery was done for the peritoneal node biopsy. The result was an adenocarcinoma grade 2 metastasis with the pancreatic origin.

Surgical report noted many  # 10mm nodes seeding on the peritoneum that made retractile the  epiploon and the mesentery. There was a #80 mm hard mass seemed to be the primary tumor at the mesenteric root of the transverse colon.

Histoimmunologic staining:CK7. CA 19-9 (+), CK 20 (+) localized, CDX2,  SATB2 (-). That were in correlation to adenocarcinoma grad 2 metastase to the peritoneum with the origin of the pancreas.

DISCUSSION :

Ultrasound detects easily the PC but difficultely finds out the origin of the PC.

There were 3 published cases of extraovarian primary PC,

2 published cases of malignant mesothelioma,

1 published case of mucinous carcinoma (unknown the origin),

In total, 5 cases of not having the origin, 1 case of unknown the origin. (pls. view cases 128, 164, 298, 332, 448).