Muraki Takashi, Kim Grace E, Reid Michelle D, Mittal Pardeep, Bedolla Gabriela, Memis Bahar, Pehlivanoglu Burcin, Freedman Alexa, Erbarut Seven Ipek, Choi Hyejeong, Kooby David, Maithel Shishir K, Sarmiento Juan M, Krasinskas Alyssa, Adsay Volkan
Departments of *Pathology and Laboratory Medicine §Radiology ∥Epidemiology **Surgery, Emory University School of Medicine, Atlanta, GA †Department of Gastroenterology, Shinshu University School of Medicine, Nagano, Japan ‡Department of Pathology, University of California San Francisco, San Francisco, CA ¶Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey #Department of Pathology, University of Ulsan, Ulsan, Republic of Korea.
Am J Surg Pathol. 2017 Oct;41(10):1347-1363. doi: 10.1097/PAS.0000000000000919.
Clinicopathologic characteristics of paraduodenal (groove) pancreatitis (PDP) remain to be fully unraveled. In this study, 47 PDPs with preoperative enhanced images available were subjected to detailed comparative analysis in conjunction with pathologic findings. PDP were predominantly in males (3:1) with a mean age of 50 years, and 60% had a preoperative diagnosis of cancer. Mean lesional size was 3.1 cm. Three distinct subtypes were identified by imaging. Solid-tumoral (type-1) with groove-predominant (type-1A, 36%) forming a distinct solid band between the duodenum and pancreas often with histologic microabscesses (69% vs. 33% in others), and pancreas-involving (type-1B, 19%) forming a pseudotumoral mass spanning into the head-groove area, always diagnosed preoperatively as "cancer," but often lacked parenchymal atrophy of the body (44% vs. 92%). Cyst-forming (type-2) had groove-predominant (type-2A, 15%), often accompanied by Brunner gland hyperplasia, and pancreas-predominant (type-2B, 15%) were in younger (mean: 44 y) females (57% vs. 18%) and had less alcohol/tobacco abuse (50/33% vs. 81/69%). Ill-defined (type-3; 15%) often had main pancreatic duct dilatation (mean: 5.6 vs. 2.8 mm). The capricious presentations of PDP could be attributed to variable effects of different mechanistic and precipitative etiopathogenetic factors such as disturbed accessory duct outflow (dilated Santorini duct, 87%), aggravated by alcohol (77%) with superimposed stasis in the main ampulla (previous cholecystectomy, 47%; choledocholithiasis, 9%), strictured Wirsung duct (68%), and some likely exacerbated by ischemia (hypertension [59%], tobacco abuse [64%], arteriosclerosis in the tissue [23%]). In conclusion, our study identified 3 distinct types of PDP and each may reflect different pathogenetic contributing factors.
十二指肠旁（沟）胰腺炎（PDP）的临床病理特征仍有待充分阐明。在本研究中，对47例有术前增强影像的PDP病例结合病理结果进行了详细的对比分析。PDP患者以男性为主（3:1），平均年龄50岁，60%的患者术前被诊断为癌症。病灶平均大小为3.1厘米。通过影像学确定了三种不同的亚型。实性肿瘤型（1型）以沟为主（1A型，36%），在十二指肠和胰腺之间形成一条明显的实性带，常伴有组织学微脓肿（69%，其他类型为33%），以及累及胰腺型（1B型，19%），形成跨越头部沟区的假肿瘤性肿块，术前常被诊断为“癌症”，但通常缺乏体部实质萎缩（44%，其他类型为92%）。囊肿形成型（2型）以沟为主（2A型，15%），常伴有Brunner腺增生，以及以胰腺为主型（2B型，15%），患者为年轻女性（平均44岁）（57%，其他类型为18%），酒精/烟草滥用较少（50/33%，其他类型为81/69%）。边界不清型（3型；15%）常伴有主胰管扩张（平均：5.6对2.8毫米）。PDP多变的表现可能归因于不同机制和促发病因因素的不同作用，如副胰管流出受阻（Santorini导管扩张，87%），酒精加重（77%），主壶腹叠加淤滞（既往胆囊切除术，47%；胆总管结石，9%），Wirsung导管狭窄（68%），还有一些可能因缺血而加重（高血压[59%]，烟草滥用[64%]，组织动脉硬化[23%]）。总之，我们的研究确定了三种不同类型的PDP，每种类型可能反映不同的致病因素。
