Fujimoto Yuji, Tomimaru Yoshito, Tamura Hiromi, Noguchi Kozo, Nagase Hirotsugu, Hamabe Atsushi, Hirota Masashi, Oshima Kazuteru, Tanida Tsukasa, Kawase Tomono, Morita Shunji, Imamura Hiroshi, Iwazawa Takashi, Akagi Kenzo, Yamamoto Masashi, Nishida Tsutomu, Adachi Shiro, Dono Keizo
Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Osaka 560-8565, Japan.
Department of Pathology, Toyonaka Municipal Hospital, Toyonaka, Osaka 560-8565, Japan.
Oncol Lett. 2017 Jul;14(1):153-158. doi: 10.3892/ol.2017.6130. Epub 2017 May 5.
A 74-year-old male was admitted to Departments of Surgery, Toyonaka Municipal Hospital (Osaka, Japan) for treatment of a pancreatic tumor. Contrast enhanced computed tomography (CT) revealed a mass with small cystic lesions in the pancreatic head and body. Fluorodeoxyglucose-positron emission tomography/CT revealed an abnormal uptake of fluorodeoxyglucose, corresponding to the mass lesions. Upper gastrointestinal endoscopy revealed rough mucosa near the opening of the accessory pancreatic duct, and the mucosa biopsy exhibited adenocarcinoma with no mucin observed. The preoperative diagnosis was pancreatic intraductal tubulopapillary neoplasm (ITPN) with cancerous lesions, and a total pancreatectomy with splenectomy was performed. The resected tissue specimen revealed a solid tumor occupying the entire pancreas with intraductal growth into the main pancreatic duct. Histological examination revealed high-grade dysplastic cells in a tubulopapillary growth pattern without overt mucin production beyond the pancreatic duct. Immunohistochemical staining analysis of the tumor was positive for cytokeratin (CK)7, CK19 and mucin (MUC)1, and negative for MUC2, MUC5AC, MUC6 and caudal type homeobox 2. The tumor was finally diagnosed as pancreatic ITPN with associated invasive cancer. The patient remains well without evident recurrence nine months post-surgery. ITPN is a rare type of epithelial neoplasm of the pancreas, and is characterized by intraductal tubulo-papillary growth, ductal differentiation, limited intracellular mucin production, and cellular dysplasia. The present case report may contribute to improved understanding of how to effectively treat patients with ITPN.
一名74岁男性因胰腺肿瘤入住丰中市立医院（日本大阪）外科接受治疗。增强计算机断层扫描（CT）显示胰头和胰体有一个伴有小囊性病变的肿块。氟脱氧葡萄糖正电子发射断层扫描/CT显示氟脱氧葡萄糖摄取异常，与肿块病变相对应。上消化道内镜检查显示副胰管开口附近黏膜粗糙，黏膜活检显示为腺癌，未见黏液。术前诊断为伴有癌性病变的胰腺导管内管状乳头状肿瘤（ITPN），遂行全胰切除术加脾切除术。切除的组织标本显示一个实性肿瘤占据整个胰腺，并向主胰管内生长。组织学检查显示，肿瘤呈管状乳头状生长模式，有高级别发育异常细胞，胰管外无明显黏液产生。肿瘤的免疫组织化学染色分析显示细胞角蛋白（CK）7、CK19和黏液（MUC）1呈阳性，而MUC2、MUC5AC、MUC6和尾型同源盒2呈阴性。该肿瘤最终被诊断为伴有侵袭性癌的胰腺ITPN。患者术后9个月情况良好，无明显复发。ITPN是一种罕见的胰腺上皮性肿瘤，其特征为导管内管状乳头状生长、导管分化、细胞内黏液产生有限以及细胞发育异常。本病例报告可能有助于增进对如何有效治疗ITPN患者的理解。
