A case of pancreatic cancer in the dorsal pancreas of pancreas divisum

A 70-year-old man complaining of epigastric discomfort and jaundice was admitted to our hospital in November 2013. Enhanced abdominal CT scan revealed a 2.5×3.0 cm-sized mass and enlargement of abdominal lymph nodes and left adrenal gland. MRCP showed obstruction of the dorsal pancreatic duct in the pancreatic head and distal bile duct. There was no visualization of the ventral pancreatic duct. Endoscopic pancreatography via the major duodenal papilla showed a short pancreatic duct with partial acinar filling, and pancreatography via the minor duodenal papilla revealed a stenosis in the dorsal pancreatic duct. There was no communication between the ventral and dorsal pancreatic ducts. Brushing cytology of the bile duct was adenocarcinoma. The diagnosis was pancreatic cancer (T4N1M1 Stage IVb) in the dorsal pancreas of pancreas divisum, and the patient underwent chemotherapy. Of our 69 cases of pancreas divisum, 6 cases (9%) had pancreatic cancer, and the cancer occurred from the dorsal pancreas in all cases. As longstanding stasis of pancreatic juice in the dorsal pancreatic duct caused by the relative stenosis of the minor duodenal papilla might be a factor that promotes pancreatic carcinoma, we should pay heed to changes of the dorsal pancreatic duct in individuals with pancreas divisum.