Abstract：
Synchronous primary pancreatic ductal adenocarcinoma (PDAC) is very rare and can be formed either through multicentric carcinogenesis or intrapancreatic metastasis. We report the case of an 80-year-old man with a history of type 2 diabetes mellitus who presented with abdominal pain and weight loss. Laboratory tests showed elevated levels of blood glucose and CA 19-9, and Computed Tomography revealed two hypoenhancing lesions in the head and tail of the pancreas. Endoscopic ultrasound, which is the imaging method of choice for pancreatic cancer, was performed with a fine needle biopsy, and the cytological analysis diagnosed PDAC in both lesions. The patient underwent total pancreatectomy, and pathologic evaluation revealed synchronous primary PDAC with moderate to poor differentiation in the head and tail in the setting of IPMN (intraductal papillary mucinous neoplasia) and chronic pancreatitis. After his recovery from postoperative pulmonary embolism, the patient was discharged home with sufficient glycemic control. Multifocal PDAC occurs more often when precursor lesions, such as IPMN, pre-exist. The optimal treatment for multiple lesions spread all over the pancreas is total pancreatectomy. Diabetes mellitus is a serious complication of total pancreatectomy (new-onset or type 3c), but overall, long-term survival has been significantly improved.
摘要：
同步原发性胰腺导管腺癌（PDAC）非常罕见，可以通过多中心癌变或胰腺内转移形成。我们报告了一例有2型糖尿病病史的80岁男性，其表现为腹痛和体重减轻。实验室检查显示血糖和CA19-9水平升高，计算机断层扫描显示胰腺头部和尾部有两个增强不足的病变。超声内镜,这是胰腺癌的首选成像方法，是用细针活检进行的，和细胞学分析诊断PDAC在两个病变。病人接受了全胰腺切除术,病理评估显示，在IPMN（导管内乳头状黏液瘤）和慢性胰腺炎的情况下，头部和尾部的同步原发性PDAC具有中等至较差的分化。术后肺栓塞恢复后,患者出院,血糖得到充分控制.多灶性PDAC更经常发生在前兆病变时，比如IPMN,预先存在。对遍布胰腺的多个病变的最佳治疗是全胰腺切除术。糖尿病是全胰腺切除术（新发或3c型）的严重并发症，但总的来说,长期生存率显著提高。
