Nakazawa Akiko, Kogure Ryota, Mitsui Tetsuya, Miyata Yoichi, Ninomiya Riki, Komagome Masahiko, Maki Akira, Beck Yoshifumi
Dept. of Hepato-Biliary-Pancreatic Surgery, Saitama Medical Center, Saitama Medical University.
Gan To Kagaku Ryoho. 2018 Dec;45(13):2087-2089.
We report a case of pancreatic metastasis of pulmonary pleomorphic carcinoma with duodenal invasion after left lower lobectomy. A 65-year-old male underwent left lower lobectomy for left lung cancer in 2016. The final pathological finding was a diagnosis is of pleomorphic carcinoma, pT2bN0M0, stageⅡA. The patient rejected postoperative chemotherapy for 10 months after lung surgery, and he was admitted to our hospital with poor oral intake. CT revealed that the tumor was located in the 2nd part of the duodenum, was about 7 cm in diameter, and was suspected to invade the superior mesenteric vein (SMV). Gastroendoscopy revealed whole-circumference stenosis at the 2nd part of the duodenum. The biopsy was suspicious of duodenal metastasis from pulmonary pleomorphic carcinoma. We scheduled pancreaticoduodenectomy with reconstruction of the portal vein. Regarding the intraoperative findings, the tumor was palpated at the 2nd part of the duodenum, and the tumor invaded the transverse colon and right urinary duct. The SMV had been invaded from the gastro-colic trunk to the root of the ileocolic vein. Therefore, pancreaticoduodenectomy, reconstruction of the portal vein with replacement of the graft of the left external iliac vein, right hemicolectomy, and right ureteral resection were performed. Regarding the pathological findings, the tumor existed in the pancreatic parenchyma and invaded the duodenal mucosa. The tumor cells were similar to those in a previous pulmonary pleomorphic carcinoma. The final pathological diagnosis was pancreatic metastases from pulmonary pleomorphic carcinoma. Surgical reports of metastatic pancreatic tumor have been observed sporadically; however, those reports were of pancreatic metastasis of renal cancer, and there are few reports of resection of pancreatic metastasis. This is a very valuable case of pancreatic metastasis from pulmonary pleomorphic carcinoma that could be resected.
我们报告一例左下肺叶切除术后发生十二指肠侵犯的肺多形性癌胰腺转移病例。一名65岁男性于2016年因左肺癌接受左下肺叶切除术。最终病理结果诊断为多形性癌，pT2bN0M0，ⅡA期。该患者在肺手术后拒绝术后化疗10个月，因经口摄入量减少入院。CT显示肿瘤位于十二指肠第二部，直径约7 cm，怀疑侵犯肠系膜上静脉（SMV）。胃镜检查显示十二指肠第二部全周狭窄。活检怀疑为肺多形性癌十二指肠转移。我们计划行胰十二指肠切除术并重建门静脉。关于术中发现，在十二指肠第二部可触及肿瘤，肿瘤侵犯横结肠和右输尿管。SMV从胃结肠干至回结肠静脉根部均受侵犯。因此，实施了胰十二指肠切除术、用左髂外静脉移植片置换重建门静脉、右半结肠切除术和右输尿管切除术。关于病理结果，肿瘤存在于胰腺实质并侵犯十二指肠黏膜。肿瘤细胞与之前的肺多形性癌相似。最终病理诊断为肺多形性癌胰腺转移。转移性胰腺肿瘤的手术报告偶尔可见；然而，那些报告是关于肾癌胰腺转移的，很少有胰腺转移瘤切除的报告。这是一例非常有价值的可切除的肺多形性癌胰腺转移病例。
