Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
Pancreatology. 2012 Jan-Feb;12(1):23-6. doi: 10.1016/j.pan.2011.12.007. Epub 2011 Dec 11.
We present the first reported case of intraductal polypoid growth (IPG) variant of pancreatic acinar cell carcinoma (ACC) metastasizing to the intrahepatic bile duct. A 58-year-old Japanese woman had previously presented with obstructive jaundice and a 7.0 cm mass in the pancreatic head. She underwent biliary drainage for 2 months followed by pancreatectomy. Histological examination revealed a carcinoma with acinar pattern, immunohistochemically positive for trypsin, and acinar cell carcinoma was diagnosed. IPGs were prominent in the main pancreatic duct and its tributaries, extending into the intrapancreatic bile duct with tumor casts in the lumen. Imaging examinations 6 years later revealed a growing lesion within the intrahepatic bile duct. Needle biopsy examination suggested metastasis of ACC, and she underwent chemoradiation therapy and partial hepatectomy. Histological examination demonstrated ACC confined to the intrahepatic bile duct. The localization of metastasis and slow growth may indicate indolent biologic behavior of the IPG variant.
我们报告了首例胰腺腺泡细胞癌（ACC）发生于胆管内的导管内息肉样生长（IPG）变体转移至肝内胆管的病例。一名 58 岁日本女性曾因阻塞性黄疸和胰头部 7.0 cm 肿块就诊。她接受了 2 个月的胆道引流，随后进行了胰切除术。组织学检查显示具有腺泡模式的癌，免疫组织化学染色胰蛋白酶阳性，诊断为腺泡细胞癌。主胰管及其分支中突出存在 IPG，延伸至胰内胆管，管腔中有肿瘤铸型。6 年后的影像学检查显示肝内胆管内的病变在生长。针吸活检检查提示 ACC 转移，她接受了化疗和放疗以及部分肝切除术。组织学检查显示 ACC 局限于肝内胆管。转移的定位和缓慢生长可能表明 IPG 变体具有惰性的生物学行为。
