Martínez de Juan Fernando, Reolid Escribano María, Martínez Lapiedra Carmen, Maia de Alcantara Fernanda, Caballero Soto María, Calatrava Fons Ana, Machado Isidro
Gastroenterology and Digestive Endoscopy Department, Valencian Institute of Oncology, 46009 Valencia, Spain.
Digestive Surgery Department, Valencian Institute of Oncology, 46009 Valencia, Spain.
World J Gastrointest Oncol. 2017 Sep 15;9(9):390-396. doi: 10.4251/wjgo.v9.i9.390.
A 69-year-old woman from a kindred with familial atypical multiple mole melanoma and carrier of a germline mutation in , presented with abdominal pain caused by a solid-cystic pancreatic mass. The patient had an abdominal computed tomography three years before in which there was no evidence of pancreatic lesion. The endoscopic ultrasound guided fine needle aspiration showed adenocarcinoma with squamous component. After surgical resection the final diagnosis was adenosquamous pancreatic carcinoma (ASPC) arising in an intraductal papillar mucinous neoplasm (IPMN). Adenosquamous carcinomas are uncommon in the pancreas and have rarely been described in association with IPMNs. It has worse prognosis than the ordinary pancreatic ductal adenocarcinoma and some distinct features. We review the clinical, imaging, pathologic and molecular aspects of ASPC. Differential diagnosis with contamination, squamous metaplasia and pancreatic metastases from a distant squamous carcinoma is discussed. Besides, the case is an accelerated model of the adenoma (IPMN)-carcinoma sequence probably due to the germline mutation. Somatic mutations are common events in the early steps of sporadic pancreatic cancer, but germline mutation carriers have a significantly higher risk of pancreatic carcinoma.
一名来自患有家族性非典型多发性痣黑色素瘤家族的69岁女性,携带一种种系突变,因实性囊性胰腺肿块导致腹痛就诊。患者三年前进行过腹部计算机断层扫描,当时未发现胰腺病变。内镜超声引导下细针穿刺显示为伴有鳞状成分的腺癌。手术切除后最终诊断为导管内乳头状黏液性肿瘤(IPMN)中发生的腺鳞癌(ASPC)。腺鳞癌在胰腺中并不常见,很少有与IPMN相关的描述。它的预后比普通胰腺导管腺癌更差,且有一些独特特征。我们回顾了ASPC的临床、影像学、病理和分子方面。讨论了与污染、鳞状化生以及远处鳞状癌胰腺转移的鉴别诊断。此外,该病例可能由于种系突变,是腺瘤(IPMN)-癌序列的加速模型。体细胞突变是散发性胰腺癌早期阶段的常见事件,但种系突变携带者患胰腺癌的风险显著更高。