Ban Shinichi, Naitoh Yoshihisa, Ogawa Fumihiro, Shimizu Yoshihiko, Shimizu Michio, Yasumoto Akihiro, Koyama Isamu
Department of Pathology, Saitama Medical School, 38 Morohongo, Moroyama, Iruma, Saitama 350-0495, Japan.
Virchows Arch. 2006 Jul;449(1):112-6. doi: 10.1007/s00428-006-0214-5. Epub 2006 Apr 26.
We present a case of intraductal papillary mucinous neoplasm (IPMN) of the pancreas, demonstrating a process of high-grade transformation of the gastric-type IPMN. An 83-year-old Japanese woman underwent pylorus-preserving pancreatoduodenectomy for removal of a multicystic mass of the pancreas head, which had been followed up for 7 years. The removed tumor was a low-grade gastric-type IPMN spreading in the branch ducts, focally forming an intraluminal nodular lesion. The nodular lesion was comprised of arborizing papillotubular proliferation of cuboidal to columnar epithelia with high-grade atypia, and was characterized by diffuse MUC1 expression and a gastric mucin phenotype (focal MUC5AC and MUC6 expressions). Therefore, the nodular lesion was consistent with the pancreatobiliary-type IPMN, and the present case suggests that the low-grade gastric-type IPMN may progress to a focal intraductal carcinoma over the years, and the pancreatobiliary-type IPMN may be one of the forms of such high-grade transformation of the gastric-type IPMN. One of the cystic lesions was an oligocystic-type serous cystic neoplasm (serous cystadenoma), which might be an incidental concomitance or have a common basis.
我们报告一例胰腺导管内乳头状黏液性肿瘤（IPMN），展示了胃型IPMN的高级别转化过程。一名83岁的日本女性因切除胰头多囊性肿块接受了保留幽门的胰十二指肠切除术，该肿块已随访7年。切除的肿瘤为低级别胃型IPMN，在分支导管内扩散，局部形成腔内结节性病变。结节性病变由具有高级别异型性的立方状至柱状上皮呈树枝状乳头管状增生组成，其特征为弥漫性MUC1表达和胃黏液表型（局灶性MUC5AC和MUC6表达）。因此，结节性病变符合胰胆管型IPMN，本病例提示低级别胃型IPMN可能多年来进展为局灶性导管内癌，且胰胆管型IPMN可能是胃型IPMN这种高级别转化的形式之一。其中一个囊性病变为少囊型浆液性囊性肿瘤（浆液性囊腺瘤），可能是偶然并存或有共同基础。
