Murakami Yoshiaki, Yokoyama Takashi, Yokoyama Yujiro, Kanehiro Tetsuya, Uemura Kenichiro, Sasaki Masaru, Morifuji Masahiko, Sueda Taijiro
Department of Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, 734-8551 Hiroshima, Japan.
J Gastroenterol. 2003;38(12):1171-5. doi: 10.1007/s00535-003-1226-4.
Adenosquamous carcinoma of the pancreas is a rare tumor which has a less favorable prognosis than common ductal cell carcinoma of the pancreas, and a definite preoperative diagnosis of this tumor is quite difficult. We herein report two cases of this rare variant. The patients were a 41-year-old man (patient 1) and a 67-year-old woman (patient 2). Patient 1 had a hypoechoic mass measuring 3 cm in the uncus of the pancreas, while patient 2 had a huge mass, measuring 8 cm, in the tail of the pancreas. Patient 2 was successfully diagnosed preoperatively as having an adenosquamous carcinoma, by cytological examination of the pure pancreatic juice obtained by endoscopic retrograde pancreatic juice aspiration. A pylorus-preserving pancreatoduodenectomy was performed for patient 1, and a distal pancreatectomy with resection of the spleen and the left kidney was performed for patient 2. Subsequent pathological findings of these two tumors revealed adenosquamous carcinoma of the pancreas. K- ras point mutation, p53 overexpression, and telomerase activity in both tumor specimens were detected by the mutant allele specific amplification method, immunohistochemical staining, and telomeric repeat amplification protocol assay, respectively. The two patients died of recurrent disease 5 and 4 months, respectively, after surgery. Cytological examination of pure pancreatic juice is a useful modality for the preoperative diagnosis of this tumor, and frequent molecular alterations may be associated with the poor prognosis of adenosquamous carcinoma of the pancreas.
胰腺腺鳞癌是一种罕见肿瘤，其预后比常见的胰腺导管细胞癌更差，术前明确诊断这种肿瘤相当困难。我们在此报告两例这种罕见变体。患者分别是一名41岁男性（患者1）和一名67岁女性（患者2）。患者1在胰腺钩突部有一个3厘米的低回声肿块，而患者2在胰尾部有一个8厘米的巨大肿块。通过对经内镜逆行胰液抽吸获得的纯胰液进行细胞学检查，患者2术前成功诊断为腺鳞癌。对患者1实施了保留幽门的胰十二指肠切除术，对患者2实施了包括切除脾脏和左肾的远端胰腺切除术。这两个肿瘤随后的病理检查结果均显示为胰腺腺鳞癌。分别通过突变等位基因特异性扩增法、免疫组化染色和端粒重复序列扩增法检测了两个肿瘤标本中的K-ras点突变、p53过表达和端粒酶活性。两名患者分别在术后5个月和4个月死于疾病复发。纯胰液的细胞学检查是术前诊断这种肿瘤的一种有用方法，频繁的分子改变可能与胰腺腺鳞癌的不良预后有关。
