Kyriazi Maria A, Arkadopoulos Nikolaos, Stafyla Vaia K, Yiallourou Anneza I, Dafnios Nikolaos, Theodosopoulos Theodosios, Kairi-Vassilatou Evi, Smyrniotis Vassilios
Department of Surgery, Areteion Hospital, University of Athens, Greece and 2Department of Pathology, Areteion Hospital,University of Athens, Greece.
Cases J. 2009 Apr 28;2:6481. doi: 10.1186/1757-1626-0002-0000006481.
Pancreatic tumors usually display either a ductal, an acinar or an endocrine differentiation. Mixed exocrine and endocrine pancreatic tumors are extremely rare. There have been a few reports of the rare entity of mixed acinar-endocrine carcinoma of the pancreas, where the endocrine cells represent more than 30% of the tumor. We herein describe a case of such a pancreatic tumor in an asymptomatic patient.
A 74-year-old male patient with no evident clinical symptoms was referred for surgical resection of a large mass located on the pancreatic head, which was confirmed by an abdominal U/S, CT and MRI. FNA of the mass under endoscopic ultrasound guidance showed the cytology specimen to comprise of cells with morphological and immunohistochemical characteristics of endocrine pancreatic neoplasms. The patient underwent a modified Whipple's procedure and his post-operative course was uneventful. Pathological examination of the tumor revealed a mixed acinar-endocrine carcinoma of the pancreas.
Mixed tumors of the pancreas are extremely rare and their clinical features and pathogenesis remain unclear. The endocrine component seems to influence their prognosis favorably.Therefore, aggressive surgical therapy remains the only well established line of treatment for these tumors. Further accumulation of clinical cases will help clarify the clinical course and the optimal therapy for these unusual tumors.
胰腺肿瘤通常表现为导管、腺泡或内分泌分化。胰腺混合性外分泌和内分泌肿瘤极为罕见。已有少数关于胰腺腺泡-内分泌混合癌这一罕见实体的报道，其中内分泌细胞占肿瘤的30%以上。我们在此描述一例无症状患者的此类胰腺肿瘤病例。
一名74岁男性患者，无明显临床症状，因胰头部巨大肿块接受手术切除，腹部超声、CT和MRI确诊。在内镜超声引导下对肿块进行细针穿刺抽吸活检，细胞学标本显示细胞具有胰腺内分泌肿瘤的形态学和免疫组化特征。患者接受了改良Whipple手术，术后恢复顺利。肿瘤病理检查显示为胰腺腺泡-内分泌混合癌。
胰腺混合性肿瘤极为罕见，其临床特征和发病机制尚不清楚。内分泌成分似乎对其预后有有利影响。因此，积极的手术治疗仍然是这些肿瘤唯一已确立的治疗方法。临床病例的进一步积累将有助于阐明这些不寻常肿瘤的临床病程和最佳治疗方法。
