Maekawa Hiroshi, Sakurada Mutsumi, Orita Hajime, Sato Koichi
Department of Surgery, Shizuoka Hospital School of Medicine, Juntendo University. Shizuoka, Japan.
JOP. 2011 Mar 9;12(2):162-6.
We report a case of signet-ring cell carcinoma admixed with adenocarcinoma of the ampulla of Vater. Signet-ring cell carcinoma of the ampulla of Vater is rarely encountered in clinical practice.
A 78-year-old man was admitted to our hospital with jaundice. Computed tomography demonstrated dilatation of the biliary tract and an enhanced mass lesion measuring 1.5 cm in the pancreatic head. Endoscopic examination showed a reddish swollen papilla of Vater, and the pathological findings on a biopsy from the papilla suggested signet-ring cell carcinoma. A pancreaticoduodenectomy was performed with a diagnosis of carcinoma of the ampulla of Vater. Postoperative pathological examination showed that the tumor was composed of signet-ring cell carcinoma and tubular adenocarcinoma. The signet-ring cell carcinoma had infiltrated to the duodenal wall and pancreatic parenchyma. Both the signet-ring cell carcinoma and the adenocarcinoma were positive on immunohistochemical staining with 45M1.
Several cases of signet-ring cell carcinoma of the ampulla of Vater have previously been reported. In our case, the histological origin of both signet-ring cell and adenocarcinoma was hypothesized to have been pancreaticobiliary epithelial cells.
我们报告一例 Vater 壶腹印戒细胞癌合并腺癌的病例。Vater 壶腹印戒细胞癌在临床实践中很少见。
一名 78 岁男性因黄疸入院。计算机断层扫描显示胆道扩张，胰头有一个 1.5 厘米的强化肿块病变。内镜检查显示 Vater 乳头红肿，乳头活检的病理结果提示印戒细胞癌。诊断为 Vater 壶腹癌后进行了胰十二指肠切除术。术后病理检查显示肿瘤由印戒细胞癌和管状腺癌组成。印戒细胞癌已浸润至十二指肠壁和胰腺实质。印戒细胞癌和腺癌在 45M1 免疫组化染色中均呈阳性。
此前已有数例 Vater 壶腹印戒细胞癌的报道。在我们的病例中，推测印戒细胞癌和腺癌的组织学起源均为胰胆管上皮细胞。
