Yamaguchi Tetsuya, Takahashi Hiroshi, Kagawa Ryuzaburo, Takeda Ryoji, Sakata Shingo, Yamamoto Michihiro, Nishizaki Daisuke
Department of Surgery, Rakuwakai-Otowa Hospital, Kyoto, Japan.
Hepatogastroenterology. 2007 Mar;54(74):599-601.
A 72-year-old man presented with several week's abdominal distension and jaundice. Under the tentative diagnosis of pancreatic pseudocyst of 22cm in diameter, a percutaneous drainage was performed. Despite the reduction of the pseudocyst, his serum total bilirubin level was increased. At this time, abdominal computed tomography scan showed a tumor at the uncinate process of the pancreas. After the biliary decompression, a total pancreatectomy with the resection of pseudocyst walls and splenectomy was performed. It was histologically proven to be poorly differentiated ductal adenocarcinoma in combination with osteoclast-like giant cells. The pseudocyst was considered to be due to the stenosis of the main pancreatic duct caused by carcinoma of the uncinate process. Five months later, he died of recurrent carcinomatous peritonitis. Osteoclast-like giant cell tumor is a very rare neoplasm, the origin and prognosis of which still remain obscure. However, it has to be considered in the differential diagnosis of cystic changes of the pancreas, especially of pseudocyst. Furthermore, detailed surveys are needed in cases of pseudocyst of the pancreas without chronic pancreatitis, in order to identify small carcinoma of the pancreas.
一名72岁男性因数周的腹胀和黄疸就诊。在初步诊断为直径22厘米的胰腺假性囊肿后，进行了经皮引流。尽管假性囊肿缩小，但他的血清总胆红素水平却升高了。此时，腹部计算机断层扫描显示胰腺钩突部有一个肿瘤。在进行胆道减压后，实施了全胰切除术，包括切除假性囊肿壁和脾切除术。组织学证实为低分化导管腺癌伴破骨细胞样巨细胞。假性囊肿被认为是由钩突部癌导致主胰管狭窄引起的。五个月后，他死于复发性癌性腹膜炎。破骨细胞样巨细胞瘤是一种非常罕见的肿瘤，其起源和预后仍不清楚。然而，在胰腺囊性病变尤其是假性囊肿的鉴别诊断中必须考虑到它。此外，对于没有慢性胰腺炎的胰腺假性囊肿病例，需要进行详细检查，以发现胰腺小癌。
