Reddi Deepti M, Scherpelz Kathryn P, Lerma Angelica, Shriki Jabi, Virgin Jeffrey
Department of Pathology, University of Washington Medical Center, 1959 N.E. Pacific Street, Box 356100, Room NE110, Seattle, WA 98195-6100, USA.
Department of Pathology, Veteran Affairs Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108, USA.
Case Rep Pathol. 2018 Jun 13;2018:1784548. doi: 10.1155/2018/1784548. eCollection 2018.
Hernia sacs are a common anatomic pathology specimen, which rarely contain malignancy. We present a case of rapidly growing pancreatic adenocarcinoma, which initially presented as metastasis to an umbilical hernia sac. The patient was a 55-year-old male with a two-year history of umbilical hernia. Two months prior to herniorrhaphy, the hernia became painful and the patient experienced nausea and weight loss. The gross examination did not reveal distinct lesions. Microscopically, the hernia sac was diffusely infiltrated by moderately differentiated adenocarcinoma, which was positive for CK7 and pancytokeratin and negative for TTF-1, CK20, PSA, and CDX2. Clinical laboratory tests found elevated levels of CA 19-9 and CEA. Computed tomography scan with intravenous contrast showed a 5 cm ill-defined and hypoattenuating mass involving the pancreatic tail and body, as well as numerous ill-defined lesions in the liver and peritoneal carcinomatosis. The patient had an earlier noncontrast computed tomography scan four months prior to the surgery, which did not detect any lesions in the abdomen. This case highlights the importance of intravenous contrast with computed tomography for the evaluation of pancreatic lesions and also emphasizes the importance of thorough histologic evaluation of hernia sacs for the detection of occult malignancy.
疝囊是一种常见的解剖病理学标本，很少含有恶性肿瘤。我们报告一例快速生长的胰腺腺癌病例，该病例最初表现为转移至脐疝囊。患者为一名55岁男性，有两年脐疝病史。在疝修补术前两个月，疝变得疼痛，患者出现恶心和体重减轻。大体检查未发现明显病变。显微镜下，疝囊被中分化腺癌弥漫浸润，CK7和全细胞角蛋白呈阳性，TTF-1、CK20、PSA和CDX2呈阴性。临床实验室检查发现CA 19-9和CEA水平升高。静脉注射造影剂的计算机断层扫描显示一个5厘米边界不清、低密度的肿块累及胰尾和胰体，以及肝脏中许多边界不清的病变和腹膜癌。患者在手术前四个月进行了一次早期非增强计算机断层扫描，未发现腹部有任何病变。该病例强调了静脉注射造影剂的计算机断层扫描对评估胰腺病变的重要性，也强调了对疝囊进行全面组织学评估以检测隐匿性恶性肿瘤的重要性。
