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A 60-year-old man presented to our hospital with abdominal pain. Enhanced abdominal computed tomography (CT) revealed awell-demarcated, low-density tumor in the tail of the pancreas (●" Fig.1). 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed high uptake in the tumor (standardized uptake value 17) (●" Fig.2). Colonoscopy revealed a mass in the descending colon causing marked stenosis (●" Fig.3). Consistent with this finding, the colonoscope could not pass through the obstructed segment. CT colonography revealed an apple-core lesion in the descending colon (●" Fig.4), and histological examination of the biopsy samples revealed poorly differentiated adenocarcinoma. A few days later, the patient was admitted with abdominal pain due to acute large-bowel obstruction. Emergency distal pancreatectomy, left hemicolectomy, and partial adrenalectomy and lymph node dissectionwere carried out.Gross examinationof the resected specimen showed a submucosal tumor of the colon with the majority of the tumor residing in the pancreas (●" Fig.5). The patient was diagnosed as having anaplastic pancreatic cancer with osteoclast-like giant cells. Postoperative follow-up at 2 years showed no recurrence. High accumulation of FDG in FDG-PET is somewhat rare in pancreatic ductal adenocarcinoma due to the scattered distribution of cancer cells [1]. Thus, pancreatic tumors with high uptake should be considered atypical. Anaplastic pancreatic carcinoma is a solid-type tumor with poor prognosis; however, the presence of osteoclast-like giant cells is associated with relatively good prognosis [2]. Acute abdominal pain due to large-bowel obstruction is a rare symptom of pancreatic cancer, and only four cases have been reported to date [3], all of whom died within several months. Thus, extended resection is not recommended in patients with pancreatic cancer presenting with large-bowel obstruction. However, in patients with colonic obstruction due to pancreatic cancer and atypical radiological findings, aggressive surgery should be considered to improve prognosis. Endoscopy_UCTN_Code_CCL_1AD_2AJ

Large-bowel obstruction caused by pancreatic tail cancer