Tomimaru Yoshito, Ishikawa Osamu, Ohigashi Hiroaki, Eguchi Hidetoshi, Yamada Terumasa, Sasaki Yo, Kishi Kentaro, Takachi Ko, Noura Shingo, Miyashiro Isao, Ohue Masayuki, Yano Masahiko, Imaoka Shingi
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Hepatogastroenterology. 2007 Jul-Aug;54(77):1585-8.
Intraductal papillary-mucinous carcinoma (IPMC) is a recently recognized pancreatic tumor and this is the first report to present two patients with IPMC complicating tumor thrombi in the portal vein. Two women, a 74- and a 55-year-old, each revealed a round, cystic and well-demarcated tumor of the pancreas in an abdominal computed tomography (CT). However, the inner lumen of the splenic and portal veins was insufficiently stained during iv-infusion of the contrast medium, suggesting the presence of tumor thrombi. Owing to this information, the presence of tumor thrombus was investigated and correctly identified during laparotomy, and it was completely removable together with the primary pancreatic tumor. The resected tumors showed expansive growth because mucin and tumor tissues rose up when they were cut. Microscopically, the tumor was diagnosed as adenocarcinoma without ovarian-like stroma, and the final diagnosis of branch type of IPMC was made for the two patients. However, within one postoperative year, both patients developed liver metastasis. Although IPMC is known as having a lower potential for metastasis or invasion, the tumor thrombi can form when it reveals an expansive growth suggesting a high inner pressure. In addition, a higher possibility for subsequent liver metastasis should be anticipated after the tumor forms a thrombus in the portal vein.
导管内乳头状黏液性癌（IPMC）是一种最近才被认识的胰腺肿瘤，本文首次报告了两例IPMC合并门静脉肿瘤血栓的患者。两名女性患者，分别为74岁和55岁，腹部计算机断层扫描（CT）均显示胰腺有一个圆形、囊性且边界清晰的肿瘤。然而，静脉注射造影剂时，脾静脉和门静脉的内腔染色不充分，提示存在肿瘤血栓。基于此信息，术中对肿瘤血栓的存在进行了探查并正确识别，且肿瘤血栓与原发性胰腺肿瘤可一并完全切除。切除的肿瘤呈膨胀性生长，因为切割时黏液和肿瘤组织会隆起。显微镜下，肿瘤被诊断为无卵巢样间质的腺癌，最终两名患者均被诊断为分支型IPMC。然而，术后一年内，两名患者均发生了肝转移。尽管IPMC已知转移或侵袭潜能较低，但当肿瘤呈膨胀性生长提示内部压力较高时，可形成肿瘤血栓。此外，肿瘤在门静脉形成血栓后，应预期有更高的后续肝转移可能性。
