Tajiri Takuma, Tate Genshu, Ohike Nobuyuki, Kunimura Toshiaki, Mitsuya Toshiyuki, Morohoshi Toshio
Department of Pathology, Showa University Fujigaoka Hospital, Yokohama, Japan.
Hepatogastroenterology. 2005 May-Jun;52(63):745-8.
A 76-year-old woman was admitted to our hospital after increased transaminase, hepato-biliary enzyme levels, and tumor markers were found. Abdominal contrast computed tomography revealed a mass (20 x 18 mm) in the uncus of the pancreas. Magnetic resonance cholangiopancreatography showed an abrupt narrowing with the dilatation of the peripheral main pancreatic duct (MPD) in the pancreatic head. Endoscopic retrograde cholangiopancreatography showed only dilatation of the lower bile duct; insertion of the cannula was not seen because the MPD was obstructed. The patient underwent a Whipple-pancreatoduodenectomy. Histopathological and immunohistochemical examinations led to a diagnosis of sequential progression and intraductal spread of invasive ductal adenocarcinoma of the pancreas arising from around the main pancreaticduct. Interestingly, the intraductal spread was approximately 20 mm to the point where the carcinoma began to infiltrate. To the best of our knowledge, there have been no other reported cases of such broad intraductal spread, indicating that noninvasive lesions that replace the normal epithelia can be broader than those reported previously.
一名76岁女性在发现转氨酶、肝胆酶水平及肿瘤标志物升高后入住我院。腹部增强计算机断层扫描显示胰腺钩突有一肿块（20×18mm）。磁共振胰胆管造影显示胰头外周主胰管扩张伴突然狭窄。内镜逆行胰胆管造影仅显示低位胆管扩张；由于主胰管梗阻，未见插管情况。该患者接受了惠普尔胰十二指肠切除术。组织病理学和免疫组化检查诊断为源于主胰管周围的胰腺浸润性导管腺癌的序贯进展和导管内播散。有趣的是，导管内播散至癌开始浸润处约20mm。据我们所知，此前尚无其他关于如此广泛导管内播散的报道病例，表明取代正常上皮的非侵袭性病变可能比先前报道的更广泛。
