Mori Hideki, Hanada Keiji, Minami Tomoyuki, Yano Shigeki, Fukuhara Motomitsu, Maruyama Hirotsugu, Shimizu Akinori, Hirano Naomichi, Hino Fumiaki, Amano Hironobu, Yonehara Shuji
Department of Gastroenterology, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan.
Department of Surgery, Onomichi General Hospital, 1-10-23, Hirahara, Onomichi, 722-8508, Japan.
Clin J Gastroenterol. 2018 Aug;11(4):320-326. doi: 10.1007/s12328-018-0833-9. Epub 2018 Feb 13.
A previously healthy 52-year-old man was referred to our hospital for further evaluation of main pancreatic duct dilatation. The preoperative work-up was consistent with intraductal papillary mucinous carcinoma (IPMC) derived from a mixed type intraductal papillary mucinous neoplasm (IPMN), because multilocular cysts with enhancing thickened pancreatic head walls and dilated pancreatic ducts lined with dysplastic mucinous epithelium, with papillary proliferation from the pancreatic body to the tail, were observed; in addition, the pancreatic juice cytology was class V, which is suggestive of adenocarcinoma. Total pancreatectomy was performed because a definite mass was not found before surgical resection and the tumors could have spread to the tail. The pathological diagnosis was mixed adenoneuroendocrine carcinoma of the pancreatic head. IPMN with high- or low-grade dysplasia was not observed anywhere in the pancreatic duct. The pancreatic ductal adenocarcinoma consisted of large caliber malignant glands with intraluminal flat or papillary structures; therefore, we were unable to recognize a definite pancreatic mass before surgical resection, and suspected an IPMC derived from a mixed type IPMN.
一名此前身体健康的52岁男性因主胰管扩张被转诊至我院作进一步评估。术前检查结果与源自混合型导管内乳头状黏液性肿瘤（IPMN）的导管内乳头状黏液性癌（IPMC）相符，因为观察到多房囊肿，胰头壁增厚且有强化，胰管扩张，内衬发育异常的黏液上皮，从胰体到胰尾有乳头状增生；此外，胰液细胞学检查为V级，提示腺癌。由于手术切除前未发现明确肿块且肿瘤可能已扩散至胰尾，遂行全胰切除术。病理诊断为胰头混合性腺神经内分泌癌。在胰管内任何部位均未观察到伴有高级别或低级别发育异常的IPMN。胰腺导管腺癌由大口径恶性腺体组成，管腔内有扁平或乳头状结构；因此，我们在手术切除前未能识别出明确的胰腺肿块，并怀疑是源自混合型IPMN的IPMC。
