Itatsu Keita, Sano Tsuyoshi, Hiraoka Nobuyoshi, Ojima Hidenori, Takahashi Yu, Sakamoto Yoshihiro, Shimada Kazuaki, Kosuge Tomoo
Hepato-Biliary and Pancreatic Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
J Gastroenterol. 2006 Jul;41(7):702-5. doi: 10.1007/s00535-006-1821-2.
A 50-year-old woman presented with intermittent diarrhea and upper abdominal pain. Laboratory data showed elevated serum amylase and elastase-I levels. Further image studies revealed a small, well-defined nodular lesion (8 mm in diameter) without mucin hypersecretion in the main pancreatic duct (MPD) of the pancreatic head and subsequent dilatation of the distal main pancreatic duct. A pylorus-preserving pancreatoduodenectomy with regional lymphadenectomy was performed. Microscopically, the tumor was an intraductal tubular carcinoma (ITC) in a tubular adenoma, suggesting direct histologic evidence of the adenoma-carcinoma sequence in intraductal tubular tumors, differing from previous reports of ITCs describing de novo-like development. The prognosis for ITC patients is sometimes dismal; therefore, early detection and appropriate surgical resection are mandatory to achieve long-term survival in ITC patients. MPD dilatation is a crucial sign and clue enabling the early detection of tiny pancreatic tumors.
一名50岁女性出现间歇性腹泻和上腹部疼痛。实验室检查数据显示血清淀粉酶和弹性蛋白酶-I水平升高。进一步的影像学研究发现胰头主胰管（MPD）内有一个小的、边界清晰的结节性病变（直径8毫米），无黏液高分泌，随后远端主胰管扩张。实施了保留幽门的胰十二指肠切除术及区域淋巴结清扫术。显微镜下，肿瘤为管状腺瘤内的导管内管状癌（ITC），提示导管内管状肿瘤中腺瘤-癌序列的直接组织学证据，这与之前描述为新发样发展的ITC报告不同。ITC患者的预后有时很差；因此，早期检测和适当的手术切除对于ITC患者实现长期生存至关重要。主胰管扩张是早期发现微小胰腺肿瘤的关键征象和线索。
