Takasawa Osamu, Fujita Naotaka, Noda Yutaka, Kobayashi Go, Ito Kei, Horaguchi Jun, Obana Takashi, Endo Takuro, Nakahara Kazunari, Ishida Kazuhiko, Seno Shigeharu, Yonechi Makoto, Suzuki Takashi, Hirasawa Dai, Sugawara Toshiki, Ohira Tetsuya, Onochi Kengo, Harada Yoshihiro, Unakami Hiroyuki, Sawai Takashi
Department of Gastroenterology, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai 983-0824, Japan.
J Gastroenterol. 2007 Dec;42(12):957-61. doi: 10.1007/s00535-007-2115-z. Epub 2007 Dec 25.
The aim of this study was to evaluate histopathologically the frequency, direction, and length of intraductal spread (IS) along the main pancreatic duct from the main tumor of small pancreatic cancer.
Resected specimens from 20 cases of pTS1 (histologically 2 cm or less in diameter) pancreatic cancer (September 1983 to December 2005) were examined histopathologically. As controls, 40 resected specimens from cases of pTS2 (more than 2 cm and less than 4 cm in diameter) or larger sized pancreatic cancer (pTS2<or=) were examined in the same manner. The specimens were evaluated histopathologically as to (1) the prevalence of IS, (2) the direction and length of IS, and (3) the positive rates of transpapillary cytology of pure pancreatic juice (TPC) and biopsy of the main pancreatic duct (TPB), performed preoperatively.
IS was observed in 45% of pTS1 and 13% of pTS2<or= cases. In 88% of cases of pTS1, IS was observed in the direction of the ampullary side. In 40% of cases of pTS2<or=, IS toward the ampullary side was seen. The mean length of IS in pTS1 and pTS2<or= cases was 11.8 mm and 7.2 mm, respectively. Positive rates of TPC and TPB in pTS1 cases were 70% and 75%, respectively, and in pTS2<or= cases, 50% and 44%, respectively.
The frequency of IS was high in pTS1 cases, which suggests there is potential for improvement in establishing the histocytological diagnosis of small pancreatic cancer via the transpapillary approach with the development of adequate tools.
本研究旨在通过组织病理学评估小胰腺癌主肿瘤沿主胰管的导管内扩散（IS）的频率、方向和长度。
对20例pTS1期（组织学直径2 cm或更小）胰腺癌（1983年9月至2005年12月）的切除标本进行组织病理学检查。作为对照，以相同方式检查了40例pTS2期（直径大于2 cm且小于4 cm）或更大尺寸胰腺癌（pTS2≤）病例的切除标本。对标本进行组织病理学评估，内容包括：（1）IS的发生率；（2）IS的方向和长度；（3）术前进行的纯胰液经乳头细胞学检查（TPC）和主胰管活检（TPB）的阳性率。
pTS1期病例中45%观察到IS，pTS2≤期病例中13%观察到IS。pTS1期病例中88%观察到向壶腹侧的IS。pTS2≤期病例中40%观察到向壶腹侧的IS。pTS1期和pTS2≤期病例中IS的平均长度分别为11.8 mm和7.2 mm。pTS1期病例中TPC和TPB的阳性率分别为70%和75%，pTS2≤期病例中分别为50%和44%。
pTS1期病例中IS的频率较高，这表明随着合适工具的开发，通过经乳头途径建立小胰腺癌组织细胞学诊断有改进的潜力。
