• Takeshi Mori, Atsushi Yamaguchi, Toshio Kuwai, Hirotaka Kouno, Noriaki Matsuura, Naoyuki Toyota, Shin Nakahira, Kazuya Kuraoka, and Hiroshi Kohno.
• Department of Gastroenterology.
• Medicine (Baltimore). 2020 Oct 16; 99 (42): e22645e22645.

RationalePancreatic cancer (PC) has the worst prognosis among all carcinomas. However, patients with carcinoma in situ (CIS) of the pancreas, usually, have a good prognosis. Many previous reports have mentioned the high frequency of fibrosis around CIS. In some cases, the fibrosis is detected on endoscopic ultrasonography (EUS), but there are few past reports of fibrosis detected on computed tomography (CT).Patient ConcernsWe encountered a case of fibrosis around CIS detected by CT. A 74-year-old man was being followed for chronic hepatitis C. On a contrast-enhanced CT (CE-CT), a space-occupied lesion (7 mm in size) in the pancreatic head was identified in the delayed phase.DiagnosisIt was shown to be a hypo echoic lesion in EUS, and EUS-fine-needle aspiration was performed. Cytological examination revealed abnormal cells suspicious for a neuroendocrine tumor.InterventionsConsequently, a pancreaticoduodenectomy was performed. Histopathological examination showed CIS in the branch duct with 10 mm of fibrosis around CIS. The fibrotic area corresponded to the mass detected by preoperative CE-CT.OutcomesHe had no relapse of PC but died 2 years later from another cause.LessonsThis case highlights the importance of identifying the enhanced area in the delayed phase on CE-CT, as this can be fibrosis around CIS.

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