Seki Hiroaki, Yasui Nobutaka, Shimada Akihiko, Matsumoto Hidetoshi
Dept. of Surgery, Keiyu Hospital.
Gan To Kagaku Ryoho. 2018 Feb;45(2):269-272.
We herein report a 75-year-old woman who presented with an intraductal papillary mucinous carcinoma(IPMC)who was treated with surgical resection 4 years after the initial diagnosis was made. She previously underwent a high anterior resection of the rectum for rectal cancer at 71 years of age. Preoperative CT revealed a multilocular cystic mass measuring 6 cm in size in the body of the pancreas, which was considered benign. We followed up the intraductal papillary mucinous neoplasm(IPMN) by using annual CT imaging for 4 years. CT revealed a gradual increase in the size of the mass and the development of an intramural nodule in the IPMN. Endoscopic retrograde pancreatography revealed dilatations of the main pancreatic duct communicating with the multilocular cystic lesion. The cytology of the pancreatic juice demonstrated class III b. We therefore diagnosed the patient as having IPMC and performed total pancreatectomy. The postoperative course was uneventful without any recurrence. To our knowledge, only few reports have described the natural history of IPMNs. This resected case of IPMC is rare on the basis of our observation of the natural history of an IPMN using long-term imaging studies.
我们在此报告一名75岁女性，她最初被诊断为导管内乳头状黏液性癌（IPMC），在确诊4年后接受了手术切除治疗。她曾在71岁时因直肠癌接受了直肠前切除术。术前CT显示胰腺体部有一个大小为6厘米的多房囊性肿块，当时被认为是良性的。我们通过每年进行CT成像对导管内乳头状黏液性肿瘤（IPMN）进行了4年的随访。CT显示肿块大小逐渐增加，且IPMN内出现了壁内结节。内镜逆行胰胆管造影显示主胰管扩张并与多房囊性病变相通。胰液细胞学检查显示为III b级。因此，我们诊断该患者患有IPMC，并进行了全胰切除术。术后过程顺利，无任何复发。据我们所知，仅有少数报告描述了IPMN的自然病程。基于我们使用长期影像学研究对IPMN自然病程的观察，这例接受手术切除的IPMC病例较为罕见。
