Yasumoto Makiko, Okabe Yoshinobu, Sugiyama Gen, Naito Yoshiki, Nakayama Masamichi, Hisaka Toru, Ishikawa Hiroto, Horiuchi Hiroyuki, Kunou Yukiko, Ushijima Tomoyuki, Ishida Yusuke, Tsuruta Osamu, Torimura Takuji
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Department of Pathology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Clin J Gastroenterol. 2018 Feb;11(1):87-91. doi: 10.1007/s12328-017-0798-0. Epub 2017 Dec 21.
The patient was a 51-year-old woman who, while undergoing a thorough health checkup, was found to have a tumor (measuring 60 mm in diameter) in the tail of the pancreas by abdominal ultrasonography. Contrast-enhanced computed tomography revealed delayed contrast enhancement; the tumor also contained numerous low-absorption areas showing poor contrast enhancement. On magnetic resonance imaging, the tumor was visualized as having high signal intensity areas inside the tumor on T2-weighted images. Positron emission tomography revealed an abnormal accumulation in the area corresponding to the tumor. Endoscopic ultrasonography (EUS) revealed a relatively hyperechoic solid area, with a number of echo-free areas of various sizes that assumed a honeycomb appearance. EUS-guided fine needle aspiration was carried out targeting the solid area within the tumor, which led to a diagnosis of pancreatic neuroendocrine tumor (PNET). Histopathological examination of the resected specimen revealed that the tumor was composed of numerous cysts of various sizes and solid components. The cysts contained no evidence of necrosis or bleeding. Immunohistochemically, the cystic as well as solid components were CD56 (+), synaptophysin (+) and chromogranin A (+) with MIB1 labeling index of 5%. On the basis of these findings, the final diagnosis was PNET (G2).
该患者为一名51岁女性，在进行全面健康检查时，通过腹部超声检查发现胰腺尾部有一个肿瘤（直径60毫米）。增强计算机断层扫描显示造影剂延迟增强；肿瘤还包含许多低吸收区域，显示造影剂增强不佳。在磁共振成像中，肿瘤在T2加权图像上显示为肿瘤内部有高信号强度区域。正电子发射断层扫描显示在与肿瘤相对应的区域有异常积聚。内镜超声检查（EUS）显示一个相对高回声的实性区域，有许多大小不一的无回声区域，呈蜂窝状外观。针对肿瘤内的实性区域进行了EUS引导下的细针穿刺活检，结果诊断为胰腺神经内分泌肿瘤（PNET）。对切除标本的组织病理学检查显示，肿瘤由许多大小不一的囊肿和实性成分组成。囊肿内无坏死或出血迹象。免疫组织化学检查显示，囊性和实性成分均为CD56（+）、突触素（+）和嗜铬粒蛋白A（+），MIB1标记指数为5%。根据这些发现，最终诊断为PNET（G2）。
