Inagaki Mitsuhiro, Watanabe Kazunori, Yoshikawa Daitaro, Suzuki Shigeki, Ishizaki Akira, Matsumoto Kakuya, Haneda Masakazu, Tokusashi Yoshihiko, Miyokawa Naoyuki, Sato Sotaro, Kasai Shinichi
Department of Surgery, Asahikawa Medical College, 2-1-1-1 Midorigaoka-Higashi, Asahikawa 078-8510, Japan.
J Hepatobiliary Pancreat Surg. 2007;14(3):318-23. doi: 10.1007/s00534-006-1140-2. Epub 2007 May 29.
The intraductal growth of nonfunctioning pancreatic endocrine tumors (NFPTs) is considered to be rare, and in our survey of the English-language literature, we found only three cases to have been described previously. We herein report the case of a 36-year-old man with a malignant NFPT that uniquely grew within the lumen of the main pancreatic duct (MPD) and completely obstructed the MPD, as shown by endoscopic retrograde pancreatography (ERP). Endoscopic ultrasonography clearly detected the tumor with intraductal growth. In addition, positron emission tomography (PET), using 18F-fluorodeoxyglucose (FDG) and computed tomography (CT) with the same scanner (FDG-PET/CT) showed enhanced uptake of FDG in the tumor. A pylorus-preserving pancreaticoduodenectomy and regional lymphadenectomy were performed under the preoperative diagnosis of an NFPT. Microscopically, positive immunoreactions for synaptophisin and vasoactive intestinal peptide indicated neuroendocrine differentiation of the tumor, while in addition, metastasis to a lymph node along the common hepatic artery was also observed. The patient has survived for 6 months after the surgery without any evidence of recurrence or metastasis. Both ERP and FDG-PET/CT were thus found to be useful for predicting the malignant potential of an NFPT in the preoperative diagnosis.
无功能胰腺内分泌肿瘤（NFPTs）的导管内生长被认为较为罕见，在我们对英文文献的检索中，仅发现此前有3例相关报道。我们在此报告1例36岁男性的恶性NFPT病例，该肿瘤独特地生长在主胰管（MPD）管腔内，并完全阻塞了MPD，内镜逆行胰胆管造影（ERP）显示了这一情况。内镜超声清晰地检测到了具有导管内生长的肿瘤。此外，使用18F - 氟脱氧葡萄糖（FDG）的正电子发射断层扫描（PET）和同一台扫描仪进行的计算机断层扫描（CT）（FDG - PET/CT）显示肿瘤内FDG摄取增加。在术前诊断为NFPT的情况下，实施了保留幽门的胰十二指肠切除术和区域淋巴结清扫术。显微镜下，突触素和血管活性肠肽的阳性免疫反应表明肿瘤具有神经内分泌分化，此外，还观察到沿肝总动脉的淋巴结转移。该患者术后已存活6个月，无任何复发或转移迹象。因此，ERP和FDG - PET/CT在术前诊断中均被发现对预测NFPT的恶性潜能有用。
