Kabashi Serbeze, Dedushi Kreshnike, Ramadani Naser, Mucaj Sefedin, Hoxhaj Asrtrit, Jerliu Naim
Faculty of Medicine, Pristine University, Pristine City 10000, Kosovo.
Department of Radiology, Diagnostic Centre, UCCK, Pristine City 10000, Kosovo.
World J Oncol. 2016 Feb;7(1):13-16. doi: 10.14740/wjon954w. Epub 2016 Apr 3.
The purpose of this case report is to demonstrate the clinical symptoms and laboratory changes that have occurred very late and were very few in number even the imaging studies performed at that time showed an intensive local tumor growth associated with the wide infiltration of the both adjacent and distant upper abdominal structures. A 71-year-old male patient who was a chronic alcohol abuser and ex smoker (quit smoking 8 years earlier) presented with symptoms of mild pain on epigastric region that irradiated toward the back and significant weight loss. The initial ultrasonography (US) examination was performed, followed by the lab tests and multidetector computed tomography (MDCT) examination. The diagnostic studies confirmed the presence of the pancreatic's body mass. The ordered laparoscopic evaluation established definitive diagnosis. Initial US examination showed heterogeneous pseudo-cystic changes and slight edema of the pancreatic parenchyma associated with the multiple oval hyperechogenic lesions of liver - the signs highly suggestive of secondary metastatic deposits. The other imaging findings that were obtained with the use of the MDCT confirmed the presence of an expansive primary process of the body of the pancreas associated with the secondary metastatic changes in liver. In addition, the consecutive lymphadenopathy was revealed along hepatoduodenal ligament, retropancreatic region and intraperitoneal compartment. Tumor markers resulted with the high values of the AFP of 2.3, CA19-9 of 423.0 U/mL, and CEA of 219.0 ng/mL. The specimen of the tumor tissue taken during laparoscopic biopsy was sent for histologic examination and the final result was "metastatic adenocarcinoma of pancreas". Pancreatic body carcinoma has always been associated with poor prognosis because diagnosis is made at the advanced stage of the disease. Therefore, poor prognosis might be improved if early diagnosis could be made. Recent researches confirmed genetic predisposition for this disease at certain group of patients and this "high risk" group has to be followed up with regular imaging studies and lab analysis.
本病例报告的目的是展示很晚才出现且数量极少的临床症状和实验室检查变化，即便当时进行的影像学研究显示局部肿瘤生长强烈，且伴有上腹部邻近和远处结构的广泛浸润。一名71岁男性患者，有长期酗酒史且曾吸烟（8年前戒烟），出现上腹部轻度疼痛并向后背部放射以及显著体重减轻的症状。首先进行了超声（US）检查，随后进行了实验室检查和多排螺旋计算机断层扫描（MDCT）检查。诊断性研究证实胰腺体部有肿块。经安排的腹腔镜评估确立了明确诊断。最初的超声检查显示胰腺实质存在异质性假囊性改变和轻度水肿，伴有肝脏多个椭圆形高回声病变，这些迹象高度提示继发性转移瘤。使用MDCT获得的其他影像学结果证实胰腺体部存在扩展性原发病变，并伴有肝脏继发性转移改变。此外，在肝十二指肠韧带、胰后区域和腹腔内发现了连续性淋巴结病。肿瘤标志物结果显示甲胎蛋白（AFP）为2.3、糖类抗原19-9（CA19-9）为423.0 U/mL、癌胚抗原（CEA）为219.0 ng/mL，均为高值。腹腔镜活检时获取的肿瘤组织标本送去做组织学检查，最终结果为“胰腺转移性腺癌”。胰腺体部癌一直与预后不良相关，因为该病在晚期才得以诊断。因此，如果能早期诊断，预后不良情况可能会得到改善。最近的研究证实特定患者群体对此病存在遗传易感性，对于这个“高风险”群体必须定期进行影像学研究和实验室分析随访。
