Sueyoshi Ryo, Okazaki Tadaharu, Lane Geoffrey J, Arakawa Atsushi, Yao Takashi, Yamataka Atsuyuki
Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Int J Surg Case Rep. 2013;4(1):98-100. doi: 10.1016/j.ijscr.2012.10.001. Epub 2012 Oct 8.
Pancreatic tumor is a rare condition in children, but reasonably common in adults. Histopathology in children also differs from that in adults, with most cases being pancreatoblastoma, solid pseudopapillary tumor, or pancreatic endocrine tumors.
A 14-month-old boy was noticed abdominal distension and referred to our hospital. Laboratory findings revealed leukocytosis and elevation of serum level of C-reactive protein and pancreatic enzymes. Radiological findings at admission were the huge abdominal cyst in abdominal computed tomography. As the levels of pancreatic enzyme elevated synchronous to oral feeding, total parenteral nutrition was needed. Besides radiographically the abdominal lesion changed from multiple large cystic type to multiple microcystic lesion including solid component over time. It was considered different diagnosis was pancreatic blastoma, pancreatic pseudo cyst, and lymphangioma and he was performed operation. The huge multicystic and partially solid tumor arising from the tail of pancreas existed from posterior of stomach to pelvic cavity. The tumor was completely resected without pancreatectomy and residual pancreas can be kept without tumor invasion. Histopathological finding was pancreatic hamartoma.
Pancreatic hamartoma was extremely rare, and only 17 cases were previously reported in the literature. This is the first case that the change of radiographic findings overtime was shown. We reviewed 17 cases (4 cases in children) of pancreatic hamartoma including our case.
Although extremely rare, pancreatic hamartoma should be considered in the differential diagnosis of cystic abdominal mass in children.
胰腺肿瘤在儿童中较为罕见，但在成人中较为常见。儿童的组织病理学也与成人不同，大多数病例为胰腺母细胞瘤、实性假乳头状肿瘤或胰腺内分泌肿瘤。
一名14个月大的男孩被发现腹胀，随后转诊至我院。实验室检查结果显示白细胞增多，血清C反应蛋白和胰腺酶水平升高。入院时的影像学检查结果显示腹部计算机断层扫描发现巨大的腹部囊肿。由于胰腺酶水平与经口喂养同步升高，因此需要进行全胃肠外营养。此外，随着时间的推移，腹部病变在影像学上从多个大囊性类型转变为包括实性成分在内的多个微囊性病变。考虑到不同的诊断可能是胰腺母细胞瘤、胰腺假性囊肿和淋巴管瘤，遂对其进行了手术。起源于胰尾的巨大多囊性和部分实性肿瘤从胃后方延伸至盆腔。肿瘤被完全切除，未进行胰腺切除术，残余胰腺未受肿瘤侵犯。组织病理学检查结果为胰腺错构瘤。
胰腺错构瘤极为罕见，此前文献中仅报道过17例。这是第一例展示了影像学表现随时间变化的病例。我们回顾了包括我们的病例在内的17例胰腺错构瘤（4例儿童病例）。
尽管极为罕见，但在儿童腹部囊性肿块的鉴别诊断中应考虑胰腺错构瘤。
