Anaplastic Carcinoma of the Pancreas: Is There a Role for Palliative Surgical Procedure?
A 65-year-old male patient presented to our hospital with complaints of abdominal pain and bilious vomiting for 4 weeks. Abdominal pain was present in the left upper quadrant, radiating to the back. Vomiting was bilious, frequent, and profuse. Patient had no history of melena, jaundice, or any significant weight loss. Physical examination revealed an ill-defined, firm mass in the left hypochondrium. Blood investigations were normal except for hypokalemia from copious vomiting. CECT scan of the abdomen showed a 6 × 6 cm heterogenous mass arising from the body and tail region of the pancreas []. It had well defined borders and loss of fat plane with relation to the DJF, suggesting infiltration by the mass []. Peri-pancreatic nodes were seen. A diagnosis of pancreatic carcinoma with nodal metastasis was made. An exploratory laparotomy revealed a large, hard, and fixed mass arising from the distal body and tail of pancreas with infiltration of the DJF. There were large metastatic nodes at superior mesenteric and celiac axis. In view of these findings, the tumor was deemed inoperable. Patient underwent a palliative DJ (third part of duodenum and jejunum) in view of symptomatic obstruction to the DJF. A biopsy was taken from the mass and sent for histological study. The patient made an uneventful recovery. Histopathology revealed pleomorphic giant cell type of AC []. Postoperative palliative chemotherapy was not offered as the patient declined. Patient was well, tolerating both fluids and pureed diet at the clinic visit, 4 months after surgery. Later, he was lost to follow up.