Pancreatic carcinoma in fibrocalcific pancreatic diabetes: An eastern India perspective
DP, 43-year-old man with diabetes since 24 years age, initially on oral hypoglycemic drugs with switch to premixed insulin use for last 2 years due to persistently uncontrolled blood glucose, presented to the diabetic clinic with anorexia, weight loss for 6 months, and painful swelling of left leg for last 7 days. There was no history of ketoacidosis. Examination was significant for low body mass index (BMI) 16.9 kg/m2, pallor, hepatomegaly, and non-pitting edema of left leg with erythema. Homan's and Moses's sign were positive. Ultrasonography (USG) Doppler of left leg confirmed thrombosis of popliteal, anterior tibial, posterior tibial, and common peroneal veins of the left leg. Ultrasonography abdomen revealed calcific pancreatitis with mass in the tail of pancreas. Computerized tomography (CT) abdomen revealed atrophic pancreas with dilated main and accessory pancreatic duct with multiple calculi in the head, body, and tail of pancreas along with 38 mm × 38 mm × 32 mm mass in the tail of pancreas []. Multiple target lesions were seen in the right lobe of liver, largest measuring 1.5 cm. He had no history of pain abdomen, steatorrhea, or chronic diarrhea. Serum CA19- 9 was elevated (828.8 U/L; normal <40). True-cut biopsy from right lobe of liver revealed moderately differentiated adenocarcinoma. A diagnosis of metastatic pancreatic carcinoma with deep venous thrombosis (DVT) was made in a patient with fibrocalcific pancreatic diabetes (FCPD). DVT improved with heparin and aspirin over 7 days. He died of cachexia and pneumonia 2 months later.