Open AccessCHALLENGES IN THE DIAGNOSIS AND SURGICAL MANAGEMENT OF AN UNCINATE PROCESS ADENOCARCINOMA IN A PREVIOUSLY HEALTHY YOUNG ADULT
Author(s) -
Ioana Popa,
Mircea Dediu,
Victor Florescu
Publication year - 2018
Publication title -
journal of surgical sciences
Language(s) - English
Resource type - Journals
eISSN - 2457-5364
pISSN - 2360-3038
DOI - 10.33695/jss.v5i3.230
Subject(s) - medicine , radiology , pancreaticoduodenectomy , adenocarcinoma , emergency department , lymphadenectomy , general surgery , jaundice , cancer , surgery , pancreas , psychiatry
Despite the increasing numbers of young adults being diagnosed with aggressive forms ofpancreatic cancer, there is still insufficient data regarding the evolution patterns for early stagepredictors. However, a correct and timely diagnosis is of major importance in the management andthe outcome for pancreatic cancer patients.We are reporting the case of a 39 year old male whopresented 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 inconclusiveparaclinical test results, the significantly elevated value of conjugated bilirubin being the onlysignaled abnormality. During the following two weeks, a number of basic and advanced imaginginvestigations were carried out due to insufficient information offered by the clinical andparaclinical investigations. During admission, EUS ( endoscopic ultrasonography) identifies animprecisely delimited hypoechoic mass, confirmed by MRCP (Magnetic Resonance Cholangio-Pancreatography) as an uncinate process nodule. The patient is informed about the pancreaticcancer diagnosis treatment options and prognosis. Surgical management of the uncinate processmass is decided and a Cephalic Pancreaticoduodenectomy (Traverso-Longmire) is performed withpara-aortic and para-caval lymphadenectomy. The patient is discharged 17 days postoperatively,without complications; due to the histopathological diagnosis of poorly differentiated pancreaticduct adenocarcinoma, the multidisciplinary oncological meeting set the indication for combinedchemotherapy and radiotherapy. Diagnosing pancreatic cancer in young adults without specificsymptoms or a prior condition is a challenging task, more so with the limited resources and meansof investigation in an emergency hospital. In conlusion, EUS had the highest sensibility whileMRCP had the highest specificity after normal endoscopy and inconclusive abdominalultrasonography and CT scan. Another predictor of probability for an uncinate process tumor isassociated with the high-low variations of direct bilirubin levels during antispasticity medication.