Bedoui Riadh, Nouira Ramzi, Najah Nabil, Dziri Chadli
Service de Chirurgie B, Hôpital Charles Nicolle, Tunis, Tunisie.
Tunis Med. 2010 Jun;88(6):445-8.
Most of pancreatic cysts are in fact pseudocysts. Only 10 to 20% are real cystic tumors. Intraductal papillary mucinous tumors of the pancreas represent nearly 15% of them.
To illustrate, by an observation, the difficulties to diagnose a cystic tumor of the pancreas.
We report the case of a 55 year old woman complaining of epigastric pain for one month with an elevated pancreatic enzymes level. Ultrasonography and computed tomography scan showed two cystic formations measuring 6 and 7 cm localized respectively in the head and the body of the pancreas. The diagnosis of pancreatic pseudocysts was maintained. The appearance of a jaundice made us think about a pseudocyst's compression of the common bile duct. A cysto-gastric anastomosis was made. The recurrence of the jaundice associated to diabetes and a general state deterioration led to the practice of magnetic resonance cholangiopancreatography. It revealed an intraductal papillary mucinous tumor of the pancreas affecting secondary ducts. The presence of a peritoneal carcinosis led to therapeutic abstention.
The diagnosis of intraductal papillary mucinous tumor of the pancreas must be referred to in case of pancreatic cystic tumor without extrapancreatic necrosis. This kind of tumor can simulate a pancreatic pseudocyst.
大多数胰腺囊肿实际上是假性囊肿。只有10%至20%是真正的囊性肿瘤。胰腺导管内乳头状黏液性肿瘤占其中近15%。
通过一例观察病例说明胰腺囊性肿瘤诊断的困难。
我们报告一例55岁女性，主诉上腹部疼痛1个月，胰腺酶水平升高。超声检查和计算机断层扫描显示胰腺头部和体部分别存在两个大小为6厘米和7厘米的囊性结构。维持胰腺假性囊肿的诊断。黄疸的出现使我们考虑假性囊肿压迫胆总管。进行了囊肿-胃吻合术。黄疸复发并伴有糖尿病和全身状况恶化，于是进行了磁共振胰胆管造影。结果显示为胰腺导管内乳头状黏液性肿瘤累及二级导管。存在腹膜癌转移导致放弃治疗。
对于无胰腺外坏死的胰腺囊性肿瘤，必须考虑胰腺导管内乳头状黏液性肿瘤的诊断。这类肿瘤可酷似胰腺假性囊肿。
