Carter Robert R, Woodall Charles E, McNally Megan E, Talboy Glenn E, Lankachandra Kamani M, Van Way Charles W
Department of Surgery, University of Missouri, Kansas City, Missouri, USA.
Am Surg. 2008 Apr;74(4):338-40.
This report is a case of a 58-year-old woman with a mixed ductal-endocrine carcinoma of the pancreas and a synchronous carcinoma-in-situ of the common bile duct. She presented with intractable itching from obstructive jaundice. Magnetic resonance imaging scan showed dilated intrahepatic biliary and common bile ducts. Endoscopic retrograde cholangiopancreatography revealed an ulcerated lesion of the ampulla. Biopsies from this lesion showed adenocarcinoma. Subsequently, pancreatoduodenectomy was performed for the diagnosis of peri-ampullary carcinoma. Gross examination revealed a 2-cm irregular, ulcerated lesion obstructing the distal 0.5 cm of the common bile duct within the head of the pancreas. On histopathological examination, it was discovered that this lesion contained two separate neoplasms: papillary carcinoma-in-situ of the intraparenchymal portion of the common bile duct and a mixed ductal-endocrine carcinoma of the pancreas. Mixed ductal-endocrine carcinoma of the pancreas is very rare. Finding it in conjunction with a synchronous, overlying papillary carcinoma carcinoma-in-situ of the common bile duct has not been previously described.
本报告介绍了一例58岁女性患者，患有胰腺导管-内分泌混合癌，并伴有胆总管同步原位癌。她因梗阻性黄疸出现顽固性瘙痒。磁共振成像扫描显示肝内胆管和胆总管扩张。内镜逆行胰胆管造影显示壶腹部有溃疡病变。该病变活检显示为腺癌。随后，为诊断壶腹周围癌进行了胰十二指肠切除术。大体检查发现一个2厘米的不规则溃疡病变，阻塞了胰头内胆总管远端0.5厘米处。组织病理学检查发现，该病变包含两个独立的肿瘤：胆总管实质内部分的乳头状原位癌和胰腺导管-内分泌混合癌。胰腺导管-内分泌混合癌非常罕见。此前尚未有过在同一病例中发现其与胆总管同步的、覆盖其上的乳头状原位癌并存的报道。
