Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama 589-8511, Japan.
World J Gastroenterol. 2009 Nov 21;15(43):5489-92. doi: 10.3748/wjg.15.5489.
Endoscopic ultrasonography (EUS) is a highly sensitive diagnostic method for the detection of small pancreatic carcinomas. Recently, there have been some reports describing the utility of contrast-enhanced harmonic EUS (CEH-EUS) which uses sonographic contrast agent for differentiation of a pancreatic mass. This report describes a case of small adenocarcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm (IPMN) in which investigation by EUS took place every 6 mo and diagnosis was made accurately by additional CEH-EUS during the follow-up of the branch duct IPMN. A 68-year-old female was admitted to our hospital because of a branch duct IPMN in the pancreatic body. She had been followed-up by EUS every 6 mo. However, after 2 years EUS demonstrated a low echoic area distinct from the branch duct IPMN which was vaguely discernible by EUS, and accurate sizing and differential diagnosis were considered difficult on the EUS imaging. CH-EUS with Sonazoid revealed a hypovascular tumor and we suspected small pancreatic carcinoma. The histopathological diagnosis was adenocarcinoma (10 mm) in the pancreatic tail, distinct from the branch duct IPMN of the pancreatic body. EUS and CEH-EUS may play an important role in the correct diagnosis of small pancreatic tumors, including synchronous and metachronous occurrence of IPMN and ductal adenocarcinoma of the pancreas.
内镜超声检查（EUS）是一种高度敏感的诊断方法，可用于检测小胰腺癌。最近，有一些报道描述了对比增强谐波 EUS（CEH-EUS）的应用，该方法使用超声造影剂来区分胰腺肿块。本报告描述了一例与分支胰管内乳头状黏液性肿瘤（IPMN）不同的小胰腺腺癌病例，在该病例中，EUS 每 6 个月进行一次检查，在分支胰管 IPMN 的随访中，通过额外的 CEH-EUS 准确诊断。一名 68 岁女性因胰体部的分支胰管 IPMN 而入院。她一直通过 EUS 进行每 6 个月一次的随访。然而，2 年后，EUS 显示出一个与分支胰管 IPMN 不同的低回声区域，该区域通过 EUS 隐约可见，在 EUS 成像上难以进行准确的测量和鉴别诊断。使用 SonoVue 的 CEH-EUS 显示出一个低血流肿瘤，我们怀疑是小胰腺癌。组织病理学诊断为胰尾腺癌（10 毫米），与胰体部的分支胰管 IPMN 不同。EUS 和 CEH-EUS 可能在小胰腺肿瘤的正确诊断中发挥重要作用，包括 IPMN 和胰腺导管腺癌的同时和异时发生。
