A Case of Ductal Dysplasia of the Pancreas A Possible Prerequisite for Pancreatic Cancer

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The precise pathobiology of precursor lesions, which develop into pancreatic adenocarcinoma, remains controversial. Recently, we encountered a patient with dysplastic lesion of the pancreas; a case in which a precursor lesion of the pancreatic carcinoma may have been documented. The patient was a 73-year-old female with epigastric discomfort. As part of a general check-up, she underwent abdominal ultrasound, which revealed the pancreatic duct in the pancreatic body to be slightly indented. Computed tomography (CT) scan revealed mild dilatation of the main pancreatic duct and a small low-density area (less than 1 cm in diameter). Endoscopic retrograde cholangiopancreatography (ERCP) showed the irregularity in the body of the main pancreatic duct. Under general anesthesia, resection of the distal portion of the pancreas was performed with splenic conservation. Pathological examination revealed focal hyperplastic epithelium of the pancreatic duct with moderate dysplasia. Expression of the proliferating cell nuclear antigen (PCNA) in the lesion was observed, indicating a slightly proliferative nature. Mutant p53 protein was slightly expressed in the lesion. As is seen in this case, ductal hyperplasia of the pancreas might represent precursor lesions, and constitute part of a continuous development spectrum evolving into ductal adenocarcinoma of the pancreas with accumulation of genetic alterations.
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