Toyama Nobuyuki, Kamiyama Hidenori, Suminaga Yoshihisa, Namai Kazuyuki, Ota Masahiro, Konishi Fumio
Department of Surgery, Jichi Medical School, Omiya Medical Center, 1-847 Amanuma-cho, Saitama 330-8503, Japan.
J Gastroenterol. 2004 Jan;39(1):76-80. doi: 10.1007/s00535-003-1250-4.
We report a case of pancreas head carcinoma associated with fat replacement of the body and tail. A 68-year-old man presented with obstructive jaundice and was admitted to our hospital. Ultrasonography and computed tomography showed pancreas head tumor with a neighboring cystic lesion and fatty replacement of parenchyma of the pancreas body and tail. By endoscopic retrograde pancreatography, abruption of the main pancreatic duct and the presence of an accessory duct were detected. After percutaneous transhepatic biliary drainage, pancreatoduodenectomy was successfully performed. At laparotomy, the pancreas head was easily dissected from the replaced fatty tissue of the body and tail without continuity of the ductal system or parenchyma. Microscopic examination revealed the existence of an infiltrating ductal adenocarcinoma and a neighboring. cyst in the pancreas head. The dorsal exocrine pancreas was completely replaced by the fat tissues, in which viable Langerhans' islets were scattered. The patient's postoperative course was uneventful, and exogenous insulin administration was unnecessary for the maintenance of normal blood sugar level. Acquired fat replacement of the body and tail of the pancreas is an uncommon disorder, mimicking congenital agenesis of the dorsal pancreas. Though the mechanism is controversial, obstruction of the main pancreatic duct by a cystic lesion or carcinoma in the pancreas head is a possible cause of fatty degeneration of the pancreatic parenchyma.
我们报告一例胰头癌合并胰体尾脂肪替代的病例。一名68岁男性因梗阻性黄疸入院。超声和计算机断层扫描显示胰头肿瘤，伴有邻近的囊性病变以及胰体尾实质脂肪替代。经内镜逆行胰胆管造影术检测到主胰管中断及副胰管存在。经皮经肝胆管引流术后，成功施行胰十二指肠切除术。手术中，胰头很容易从被脂肪替代的胰体尾组织中分离出来，胰管系统和实质均无连续性。显微镜检查显示胰头存在浸润性导管腺癌及一个邻近囊肿。背侧外分泌胰腺完全被脂肪组织替代，其中散在有存活的胰岛。患者术后恢复顺利，维持正常血糖水平无需外源性胰岛素治疗。获得性胰体尾脂肪替代是一种罕见疾病，类似先天性背侧胰腺发育不全。尽管其机制存在争议，但胰头的囊性病变或癌导致主胰管梗阻可能是胰腺实质脂肪变性的一个原因。
