Hamada Takeomi, Nanashima Atsushi, Hiyoshi Masahide, Ikenoue Makoto, Imamura Naoya, Yano Koichi, Fujii Yoshiro, Kubota Yoshimasa, Ban Tesshin, Kawakami Hiroshi, Sato Yuichiro
Division of Hepato-biliary-pancreas Surgery, Department of Surgery, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan.
Division of Hepato-biliary-pancreas Surgery, Department of Surgery, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan; Division of Endoscopy, University of Miyazaki Hospital, 5200 Kihara Kiyotake, Miyazaki, 889-1692, Japan, Japan.
Int J Surg Case Rep. 2018;42:274-279. doi: 10.1016/j.ijscr.2017.12.040. Epub 2018 Jan 8.
This is a case report on the advances in preoperative endoscopic-guided fine-needle-aspiration (FNA) diagnosis for pancreatic carcinoma to achieve a curative operation even in patients who have a history of total gastrectomy.
A 65-year-old man, who underwent total gastrectomy for gastric cancer 13 years ago, had discomfort in the left lateral abdomen. A 3-cm hypovascular mass accompanying a large distal pseudocyst in the pancreatic tail was observed on computed tomography. Endoscopic ultrasonography via elevation of the jejunal loop on esophago-jejunostomy also revealed similar lesions, and FNA for the proximal-side hypoechoic mass was successful. The cytological diagnosis with immunohistochemistry was acinar cell carcinoma of the pancreas. Distal pancreatectomy with splenectomy was successfully performed. Histology of the resected specimen also showed the acinar cell carcinoma, similar with preoperative cytology, which involved the splenic vein and had extra-pancreatic extension but no lymph node metastasis. The tumor stage was IIA by the 2009 UICC classification. He had no tumor relapse on imaging follow-up until 12 months after the operation.
There have been marked technical advancements in endoscopic ultrasonography-guided diagnosis, including FNA, even in patients with prior digestive tract surgery. However, the risk of complication is still a concern. Accurate histological diagnosis is useful in the field of pancreatic surgery, especially in cases of rare or small malignant lesions.
Curative pancreatectomy was possible in a case of acinar cell carcinoma, a rare pancreatic malignancy, which was diagnosed by preoperative endoscopic FNA diagnosis via esophago-jejunostomy after previous total gastrectomy.
本文是一例关于术前内镜引导下细针穿刺抽吸（FNA）诊断胰腺癌进展的病例报告，目的是即使在有全胃切除病史的患者中也能实现根治性手术。
一名65岁男性，13年前因胃癌接受了全胃切除术，现左侧腹部不适。计算机断层扫描显示胰尾有一个3厘米的低血管肿块，并伴有一个大的远端假性囊肿。通过食管空肠吻合术处空肠袢的抬高进行内镜超声检查，也发现了类似病变，对近端低回声肿块进行FNA成功。免疫组织化学的细胞学诊断为胰腺腺泡细胞癌。成功实施了远端胰腺切除术加脾切除术。切除标本的组织学检查也显示为腺泡细胞癌，与术前细胞学检查相似，肿瘤侵犯脾静脉并伴有胰腺外浸润，但无淋巴结转移。根据2009年国际抗癌联盟（UICC）分类，肿瘤分期为IIA期。术后12个月的影像学随访未发现肿瘤复发。
即使在有既往消化道手术史的患者中，内镜超声引导下的诊断技术，包括FNA，也有了显著进展。然而，并发症风险仍然是一个问题。准确的组织学诊断在胰腺外科领域很有用，尤其是在罕见或小的恶性病变病例中。
对于一例腺泡细胞癌（一种罕见的胰腺恶性肿瘤）患者，通过术前经食管空肠吻合术的内镜FNA诊断，成功实施了根治性胰腺切除术。
