Masayuki Shibata, Toru Mats
A 66-year-old man was referred to our hospital due to carbohydrate antigen 19-9 (CA19-9) elevation. Further examination revealed no obvious malignancy, but abdominal enhanced computed tomography (CT) showed soft tissue density around the celiac axis and superior mesenteric artery (SMA). Although pancreatic cancer was considered as a possible diagnosis, there was no clear evidence within the pancreas itself. Furthermore the patient was observed without intervention. Another abdominal enhanced CT performed 10 months later showed a dilated pancreatic duct in the tail of the pancreas, along with a low density area measuring 10 mm in the body of the pancreas. Endoscopic ultrasound guided-fine needle aspiration (EUSFNA) led to a diagnosis of pancreatic cancer. In the present case, the tumor in the pancreas was inconspicuous, but it might be characterized by extensive extrapancreatic invasion.