CHALLENGES IN THE DIAGNOSIS AND SURGICAL MANAGEMENT OF AN UNCINATE PROCESS ADENOCARCINOMA IN A PREVIOUSLY HEALTHY YOUNG ADULT

  • Ioana T. Popa "Dunărea de Jos" University of Medicine and Pharmacy, Galați
  • M. Dediu "Saint Pantelimon" Clinical Emergency Hospital, Bucharest, Romania
  • V. Florescu "Saint Pantelimon" Clinical Emergency Hospital, Bucharest, Romania
Keywords: whipple, pancreatic cancer, uncinate process, adenocarcinoma, CBP obstruction

Abstract

Despite the increasing numbers of young adults being diagnosed with aggressive forms of
pancreatic cancer, there is still insufficient data regarding the evolution patterns for early stage
predictors. However, a correct and timely diagnosis is of major importance in the management and
the outcome for pancreatic cancer patients.We are reporting the case of a 39 year old male who
presented to the emergency department on the Easter holiday evening with visible signs of jaundice,
no abdominal pain and no history of disease. The patient was admitted due to inconclusive
paraclinical test results, the significantly elevated value of conjugated bilirubin being the only
signaled abnormality. During the following two weeks, a number of basic and advanced imaging
investigations were carried out due to insufficient information offered by the clinical and
paraclinical investigations. During admission, EUS ( endoscopic ultrasonography) identifies an
imprecisely delimited hypoechoic mass, confirmed by MRCP (Magnetic Resonance Cholangio-
Pancreatography) as an uncinate process nodule. The patient is informed about the pancreatic
cancer diagnosis treatment options and prognosis. Surgical management of the uncinate process
mass is decided and a Cephalic Pancreaticoduodenectomy (Traverso-Longmire) is performed with
para-aortic and para-caval lymphadenectomy. The patient is discharged 17 days postoperatively,
without complications; due to the histopathological diagnosis of poorly differentiated pancreatic
duct adenocarcinoma, the multidisciplinary oncological meeting set the indication for combined
chemotherapy and radiotherapy. Diagnosing pancreatic cancer in young adults without specific
symptoms or a prior condition is a challenging task, more so with the limited resources and means
of investigation in an emergency hospital. In conlusion, EUS had the highest sensibility while
MRCP had the highest specificity after normal endoscopy and inconclusive abdominal
ultrasonography and CT scan. Another predictor of probability for an uncinate process tumor is
associated with the high-low variations of direct bilirubin levels during antispasticity medication.

Published
2018-12-19
How to Cite
[1]
I. Popa, M. Dediu, and V. Florescu, “CHALLENGES IN THE DIAGNOSIS AND SURGICAL MANAGEMENT OF AN UNCINATE PROCESS ADENOCARCINOMA IN A PREVIOUSLY HEALTHY YOUNG ADULT”, JSS, vol. 5, no. 3, pp. 160-166, Dec. 2018.
Section
Articles