Madelung Ann Brinch, Detlefsen Sönke
1 Department of Pathology, Odense University Hospital, Odense, Denmark.
Int J Surg Pathol. 2018 Sep;26(6):551-557. doi: 10.1177/1066896918766245. Epub 2018 Apr 6.
Simultaneous presence of pancreatic serous cystic neoplasms and neuroendocrine neoplasms is rare. We present a case with the incidental finding of a duodenal neuroendocrine tumor (NET) with 2 lymph node metastases in a Whipple resection specimen performed to remove a pancreatic cystic neoplasm that postoperatively turned out to represent a serous cystic neoplasm (SCN). The patient was a 75-year-old female. She presented with loss of appetite and weight. Preoperative contrast-enhanced computed tomography scan of the abdomen showed a multicystic lesion in the head of pancreas. On histologic examination of the resection specimen, a pancreatic SCN was found, and in addition in 2 peripancreatic lymph nodes, metastases from a NET. Further examination of the resected specimen revealed a duodenal NET. Review of the literature revealed only one prior study with 4 cases of pancreatic SCN associated with a duodenal NET. In 1 of the 4 cases, the patient had von Hippel-Lindau disease. Our report emphasizes the importance of careful examination of pancreatic resection specimens including the peripancreatic lymph nodes also when dealing with SCNs, as coexisting and more malignant tumors may otherwise be missed.
胰腺浆液性囊性肿瘤和神经内分泌肿瘤同时存在的情况较为罕见。我们报告一例，在为切除胰腺囊性肿瘤而进行的胰十二指肠切除标本中偶然发现十二指肠神经内分泌肿瘤（NET）伴2处淋巴结转移，术后该胰腺囊性肿瘤病理结果显示为浆液性囊性肿瘤（SCN）。患者为一名75岁女性，表现为食欲不振和体重减轻。术前腹部增强计算机断层扫描显示胰腺头部有一个多囊性病变。对切除标本进行组织学检查时，发现了胰腺SCN，此外在2个胰腺周围淋巴结中发现了NET转移灶。对切除标本的进一步检查发现了十二指肠NET。文献回顾显示，此前仅有一项研究报道了4例胰腺SCN合并十二指肠NET的病例。在这4例病例中的1例，患者患有冯·希佩尔-林道病。我们的报告强调，在处理SCN时，仔细检查胰腺切除标本（包括胰腺周围淋巴结）非常重要，否则可能会漏诊并存的更具恶性的肿瘤。
