Tajima Yoshitsugu, Kuroki Tamotsu, Tsuneoka Noritsugu, Kitasato Amane, Adachi Tomohiko, Mishima Takehiro, Kosaka Taiichiro, Kanematsu Takashi
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Am J Surg. 2008 Nov;196(5):e50-2. doi: 10.1016/j.amjsurg.2007.10.013. Epub 2008 May 29.
The appropriate management for patients with multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas involving the entire pancreatic gland remains unclear. We present a 66-year-old woman who underwent pylorus-preserving pancreaticoduodenectomy for a branch-duct intraductal papillary mucinous carcinoma demonstrating a grape-like multilocular cyst, 35 mm in diameter, in the head of the pancreas along with numerous number of small branch-duct IPMNs in the whole pancreas. Histologically, the multifocal cystic lesions were lined by a single row of columnar mucin-containing epithelial cells without atypia. The patient has been doing well without any recurrence during 9-year follow-up after surgery. Surgical removal of the prominent lesions suspicious of malignancy and a close observation of the remaining lesions in the remnant pancreas may be a reasonable treatment plan for patients with multifocal branch-duct IPMNs involving the entire pancreatic gland.
对于累及整个胰腺的多灶性分支导管内乳头状黏液性肿瘤（IPMNs）患者的恰当管理仍不明确。我们报告一名66岁女性，她因分支导管内乳头状黏液癌接受了保留幽门的胰十二指肠切除术，该肿瘤在胰头表现为一个直径35毫米的葡萄状多房囊肿，同时在整个胰腺还有大量小的分支导管IPMNs。组织学上，多灶性囊性病变由单层含黏液的柱状上皮细胞排列而成，无异型性。该患者术后9年随访期间情况良好，无任何复发。对于累及整个胰腺的多灶性分支导管IPMNs患者，手术切除可疑恶性的突出病变并密切观察残余胰腺中的其余病变可能是一个合理的治疗方案。
