Fukuda Junko, Tanaka Sachiko, Ishida Nobuko, Ioka Tatsuya, Ikezawa Kenji, Takakura Rena, Nakao Miho, Ohkawa Kazuyoshi, Katayama Kazuhiro, Nagata Shigenori
Department of Gastrointestinal Cancer Screening and Surveillance, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 541-8567, Japan.
Ishida Internal Medicine Clinic, Himeji, Japan.
J Med Ultrason (2001). 2018 Oct;45(4):617-622. doi: 10.1007/s10396-018-0870-5. Epub 2018 Feb 22.
A patient with slight dilatation of the main pancreatic duct was followed-up with ultrasonography every 6 months as a high-risk case of pancreatic cancer. Twelve years later, a faint hypoechoic area 13 mm in diameter was first detected on the body of the pancreas. Contrast-enhanced ultrasonography revealed a well-demarcated hypoenhanced area 8 mm in diameter and a hyperenhanced area with an unclear margin. The former was suspected to be a small pancreatic cancer lesion, and the latter to be focal pancreatitis accompanying cancer. However, contrast-enhanced dynamic CT did not suggest any tumor, diagnosis of adenocarcinoma was confirmed with pancreatic juice cytology through endoscopic retrograde pancreatography. Surgical resection was performed, and the lesion was pathologically diagnosed as invasive ductal carcinoma as follows: pTS1 (1.0 cm), infiltrative type (pT1), stage IA. When comparing the images from contrast-enhanced ultrasonography with the pathological findings, the hypoenhanced area corresponded to ductal adenocarcinoma, and the hyperenhanced area to focal pancreatitis. Contrast-enhanced ultrasonography was able to reveal detailed information on the focal lesion in the pancreas, and it was effective for the early diagnosis of pancreatic cancer.
一名主胰管轻度扩张的患者作为胰腺癌高危病例，每6个月接受一次超声检查随访。12年后，首次在胰腺体部检测到一个直径13毫米的微弱低回声区。超声造影显示一个边界清晰、直径8毫米的低增强区和一个边界不清的高增强区。前者怀疑是小胰腺癌病灶，后者怀疑是伴癌的局灶性胰腺炎。然而，增强动态CT未提示任何肿瘤，通过内镜逆行胰胆管造影术获取的胰液细胞学检查确诊为腺癌。进行了手术切除，病变经病理诊断为浸润性导管癌，具体如下：pTS1（1.0厘米），浸润型（pT1），IA期。将超声造影图像与病理结果进行比较时，低增强区对应导管腺癌，高增强区对应局灶性胰腺炎。超声造影能够揭示胰腺局灶性病变的详细信息，对胰腺癌的早期诊断有效。
