Kwon Hyung Jun
Department of Surgery, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea.
Ann Hepatobiliary Pancreat Surg. 2017 Nov;21(4):237-242. doi: 10.14701/ahbps.2017.21.4.237. Epub 2017 Nov 30.
Gastrointestinal tumors (GISTs) of the pancreas are extremely rare with limited individual case reports and small number of case series. Herein, we report a case of pancreatic extragastrointestinal stromal tumor (EGIST) along with literature review. A 64-year-old female patient was referred to us for treatment of an abdominal mass detected by ultrasonographic examination. The tumor was located in the periamullary region. Under a preoperative diagnosis of a duodenal GIST, we performed a pylorus preserving pancreatoduodenectomy for this lesion. Laboratory examination results were within normal ranges. On pathologic gross examination, the tumor measured at 7 cm in its greatest dimension almost entirely involved the pancreatic head. Its cut surface was rubbery and white. It was surrounded by a thin pseudocapsule and well demarcated. Histopathological examination of the specimen showed a cellular lesion with compressed pancreatic tissue at peripheral. Mitotic count was 5 per 50 high-power fields. Immunohistochemically, neoplastic cells were positive for antibodies against C-KIT (CD117), CD 34, and vimentin. However, smooth-muscle actin reactions with antibodies against S-100 or desmin were negative. Based on above findings, the tumor was finally diagnosed as GISTs originating from the pancreas. The patient has been followed up postoperatively for 72 months. There is no evidence of recurrence. Here we report this case of pancreatic EGIST presenting as a solid neoplasm along with literature review of cases previously described. Our review on pancreatic EGISTs is limited and insufficient to make a conclusion regarding its clinical features. Those manifested large masses tended to have an aggressive biological and clinical behavior. Thus, pancreatic EGISTs need to be carefully differentiated. Adequate surgical intervention is necessary for pancreatic EGISTs.
胰腺胃肠道肿瘤（GISTs）极为罕见，仅有有限的个案报道和少量病例系列。在此，我们报告一例胰腺胃肠道外间质瘤（EGIST）并进行文献复习。一名64岁女性患者因超声检查发现腹部肿块前来我院治疗。肿瘤位于壶腹周围区域。术前诊断为十二指肠GIST，我们对该病变实施了保留幽门的胰十二指肠切除术。实验室检查结果均在正常范围内。病理大体检查显示，肿瘤最大径为7 cm，几乎完全累及胰头。其切面呈橡胶样白色。肿瘤被一层薄假包膜包裹，界限清晰。标本的组织病理学检查显示为细胞性病变，外周胰腺组织受压。每50个高倍视野有5个核分裂象。免疫组织化学检查显示，肿瘤细胞对抗C-KIT（CD117）、CD34和波形蛋白的抗体呈阳性。然而，抗平滑肌肌动蛋白、抗S-100或抗结蛋白的反应均为阴性。基于上述发现，该肿瘤最终被诊断为起源于胰腺的GISTs。患者术后随访72个月，无复发迹象。在此，我们报告这例表现为实性肿瘤的胰腺EGIST病例，并对先前描述的病例进行文献复习。我们对胰腺EGISTs的综述有限，不足以就其临床特征得出结论。那些表现为较大肿块的病例往往具有侵袭性生物学行为和临床行为。因此，胰腺EGISTs需要仔细鉴别。对于胰腺EGISTs，充分的手术干预是必要的。
