Department of Radiology, P. Pederzoli Hospital, Via Monte Baldo 24, 37019, Peschiera del Garda, Italy.
Department of General and Pancreatic Surgery, Pancreas Institute, G.B. Rossi Hospital, Piazzale L.A. Scuro, 10, 37134, Verona, Italy.
Abdom Radiol (NY). 2018 Mar;43(3):613-619. doi: 10.1007/s00261-017-1243-z.
While abutment, encasement or vessel occlusion are identified in most patients with a pancreatic tumor, tumor thrombosis is an uncommon finding. In particular, there are no description in the literature of tumor thrombosis associated with ductal adenocarcinoma, the most common pancreatic tumor. On the other hand, surgical series reveal that tumor thrombosis is associated with about 5% of pancreatic neuroendocrine neoplasms (PanNENs), and literature data suggest that this finding is frequently underreported on pre-operative imaging examinations. Tumor thrombosis may be clinically relevant, causing splenoportomesenteric hypertension, possibly responsible for life-threatening upper gastrointestinal bleeding. Bland thrombosis caused by direct infiltration of peri-pancreatic vessels frequently determines surgical unresectability, even in neuroendocrine tumors; on the opposite, tumor thrombosis associated with PanNENs do not exclude surgery per se, even though both morbidity and mortality can be increased by such condition. Considering the favorable prognosis of PanNENs and the frequent need to treat tumor thrombosis in order to prevent complications or to relieve symptoms, it is of paramount importance for radiologists the knowledge of the variety of findings associated with tumor thrombosis in PanNENs.
虽然大多数胰腺肿瘤患者都存在吻合口、包裹或血管闭塞，但肿瘤血栓形成并不常见。特别是，文献中没有描述与最常见的胰腺肿瘤——导管腺癌相关的肿瘤血栓形成。另一方面，外科系列研究表明，肿瘤血栓形成与大约 5%的胰腺神经内分泌肿瘤（PanNENs）有关，文献数据表明，这种发现在前瞻性影像学检查中经常被漏报。肿瘤血栓形成可能具有临床相关性，导致脾门静脉高压，可能导致危及生命的上消化道出血。由胰周血管直接浸润引起的单纯性血栓常导致手术无法切除，即使是神经内分泌肿瘤也是如此；相反，与 PanNENs 相关的肿瘤血栓本身并不排除手术，尽管这种情况会增加发病率和死亡率。鉴于 PanNENs 的良好预后以及为了预防并发症或缓解症状而经常需要治疗肿瘤血栓的需要，对于放射科医生来说，了解与 PanNENs 相关的肿瘤血栓形成的各种表现至关重要。
