Heresbach D, Raoul J L, Robert I, Zachar D, Siproudhis L, Le Berre N, Ramée M P, Bretagne J F, Gosselin M
Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes.
Gastroenterol Clin Biol. 1992;16(12):999-1005.
Villous neoplasms of the main pancreatic duct are uncommon. Two cases of neoplasm of the main cephalic pancreatic duct in 61- and 42-year-old patients presenting with long standing (10 and 12 years) history of abdominal pain are reported. In both cases, duodenal fistula was present and mucus was observed by endoscopy at the fistula and major papilla levels. Endoscopic retrograde pancreatography showed a stricture of the main pancreatic duct in the pancreatic head. In one case, with incomplete stricture, pancreatic ducts disclosed typical features of chronic obstructive pancreatitis and contained mucus casts. Histologic examination of total and proximal duodenopancreatectomy showed a villous neoplastic pattern with focal malignant changes within the main pancreatic duct. The adjacent pancreatic tissue showed signs of stromal invasion without lymph node or nervous infiltration. Glandular parenchyma was atrophic in the pancreatic body and tail, with extensive fibrosis, and the pancreatic duct depicted signs of nonpapillary hyperplasia. Histochemical study disclosed a predominant sialomucin secretion by villous adenoma and sulfomucin secretion by epithelial cells lining the accessory or main caudal pancreatic ducts. These results lead us to suggest a possible relationship between villous adenoma of ducts and pancreatic adenocarcinoma.
主胰管绒毛状肿瘤并不常见。本文报告了2例发生于主胰管头部的肿瘤，患者分别为61岁和42岁，均有长达10年和12年的腹痛病史。2例患者均存在十二指肠瘘，在内镜检查时于瘘口和主乳头处均观察到黏液。内镜逆行胰胆管造影显示胰头主胰管狭窄。其中1例为不完全狭窄，胰管呈现出慢性阻塞性胰腺炎的典型特征，并可见黏液栓。全胰十二指肠切除术的组织学检查显示，主胰管内呈现绒毛状肿瘤模式，并伴有局灶性恶性改变。相邻胰腺组织有间质浸润迹象，但无淋巴结或神经浸润。胰体和胰尾的腺实质萎缩，伴有广泛纤维化，胰管呈现非乳头样增生迹象。组织化学研究显示，绒毛状腺瘤主要分泌涎黏蛋白，而副胰管或主胰管尾端内衬上皮细胞分泌硫黏蛋白。这些结果使我们推测导管绒毛状腺瘤与胰腺腺癌之间可能存在关联。
