Takahashi Koji, Mikata Rintaro, Tsuyuguchi Toshio, Kumagai Junichiro, Nakamura Masato, Iino Yotaro, Shingyoji Ayako, Yamato Mutsumi, Ohyama Hiroshi, Kusakabe Yuko, Yasui Shin, Sugiyama Harutoshi, Kishimoto Takashi, Nakatani Yukio, Kato Naoya
Department of Gastroenterology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
Department of Molecular Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan.
Clin J Gastroenterol. 2018 Jun;11(3):193-199. doi: 10.1007/s12328-018-0821-0. Epub 2018 Jan 27.
A 68-year-old woman was referred to our hospital for the treatment of bile duct stone, pancreatic tumor, and pancreatic cysts. First, bile duct stone was removed using endoscopic retrograde cholangiopancreatography. By abdominal contrast-enhanced computed tomography, a 12-mm diameter tumor was found in the pancreatic body. The tumor was isodense compared with the surrounding pancreatic parenchyma in the non-contrast phase and poorly enhanced in the arterial phase; it exhibited gradual enhancement from the portal vein phase to the late phase. Numerous pancreatic cysts were also observed by contrast-enhanced computed tomography. By magnetic resonance imaging, the tumor was hypointense in T1-weighted images, isointense in T2-weighted images, and hyperintense in diffusion-weighted images. By magnetic resonance cholangiopancreatography, the main pancreatic duct was not dilated, and pancreatic cysts communicated with the main pancreatic duct. The pancreatic cysts were diagnosed as branch-type intraductal papillary mucinous neoplasm. Histopathologic assessment of the specimens obtained by endoscopic ultrasound-guided fine-needle aspiration revealed the tumor as benign pancreatic granular cell tumor. The patient was followed up without surgical resection. On contrast-enhanced computed tomography at 6 months after admission, the tumor did not show any changes in diameter or characteristics.
一名68岁女性因胆管结石、胰腺肿瘤和胰腺囊肿被转诊至我院治疗。首先,通过内镜逆行胰胆管造影术清除胆管结石。经腹部增强计算机断层扫描,在胰体部发现一个直径12毫米的肿瘤。在非增强期,该肿瘤与周围胰腺实质密度相等,动脉期强化不佳;从门静脉期到延迟期呈逐渐强化。增强计算机断层扫描还观察到许多胰腺囊肿。通过磁共振成像,该肿瘤在T1加权图像上呈低信号,在T2加权图像上呈等信号,在扩散加权图像上呈高信号。通过磁共振胰胆管造影,主胰管未扩张,胰腺囊肿与主胰管相通。胰腺囊肿被诊断为分支型导管内乳头状黏液性肿瘤。经内镜超声引导下细针穿刺获取的标本进行组织病理学评估,结果显示该肿瘤为良性胰腺颗粒细胞瘤。该患者未进行手术切除,而是接受随访。入院6个月后的增强计算机断层扫描显示,肿瘤的直径和特征均无变化。