Miyata Takeshi, Takenaka Mamoru, Omoto Shunsuke, Kamata Ken, Minaga Kosuke, Yamao Kentaro, Imai Hajime, Kudo Masatoshi
Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Oncology. 2017;93 Suppl 1:98-101. doi: 10.1159/000481240. Epub 2017 Dec 20.
Repeated pancreatic juice cytology via endoscopic nasopancreatic drainage (ENPD) has a high diagnostic yield and might be useful for the diagnosis of early-stage pancreatic cancer. A 67-year-old man presented with a pancreatic cyst occasionally detectable in the body of the pancreas by ultrasonography (US). No obvious pancreatic tumor was detected by US, computed tomography (CT), magnetic resonance cholangiopancreatography, and endoscopic ultrasound (EUS) (although the latter did reveal a weak, low echoic area). Endoscopic retrograde pancreatography showed irregular narrowing of the main pancreatic duct (MPD) at the pancreatic body. Pancreatic juice cytology was also performed, but did not give evidence of a malignancy. Therefore, the patient was followed up. CT and EUS performed after 3 months showed the same findings as did endoscopic retrograde pancreatography; however, the results of repeated pancreatic juice cytology performed via ENPD tube revealed a suspected malignancy on 2 of 6 occasions. Therefore, we performed a central pancreatectomy. Histopathological examination of a resected specimen revealed carcinoma in situ in the narrow MPD at the body of the pancreas. In the current case, repeated pancreatic juice cytology via ENPD was effective. A weak low echoic area around the MPD stricture on EUS might be related to the inflammatory change accompanying carcinoma in situ of the pancreas.
通过内镜下鼻胰管引流（ENPD）反复进行胰液细胞学检查具有较高的诊断率，可能有助于早期胰腺癌的诊断。一名67岁男性患者，超声检查（US）偶尔在胰体部发现一个胰腺囊肿。US、计算机断层扫描（CT）、磁共振胰胆管造影和内镜超声（EUS）均未发现明显的胰腺肿瘤（尽管EUS显示有一个微弱的低回声区）。内镜逆行胰胆管造影显示胰体部主胰管（MPD）不规则狭窄。也进行了胰液细胞学检查，但未发现恶性证据。因此，对该患者进行随访。3个月后进行的CT和EUS检查结果与内镜逆行胰胆管造影相同；然而，通过ENPD管反复进行胰液细胞学检查，6次中有2次结果显示疑似恶性。因此，我们进行了胰体尾切除术。切除标本的组织病理学检查显示胰体部狭窄的MPD原位癌。在本例中，通过ENPD反复进行胰液细胞学检查是有效的。EUS上MPD狭窄周围微弱的低回声区可能与胰腺原位癌伴随的炎症改变有关。
