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[胰胆管合流异常患者胆囊癌胆囊切除术后五年发生异时性导管内乳头状黏液性癌]

[Metachronous intraductal papillary mucinous carcinoma five years after cholecystectomy for gallbladder cancer in a patient with pancreaticobiliary maljunction].

作者信息

Ikeda Ailee, Matsumoto Kazuyuki, Kato Hironari, Tanaka Noriyuki, Ako Soichiro, Muro Shinichiro, Uchida Daisuke, Tomoda Takeshi, Horiguchi Shigeru, Okada Hiroyuki

机构信息

Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.

Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.

出版信息

Nihon Shokakibyo Gakkai Zasshi. 2019;116(3):241-248. doi: 10.11405/nisshoshi.116.241.

Abstract

A 71-year-old female with non-dilated pancreaticobiliary maljunction (PBM) and gallbladder polypoid lesions underwent laparoscopic cholecystectomy. Histological examination of the polypoid lesions revealed gallbladder cancer. Five years after cholecystectomy, gradual dilatation of the main pancreatic duct (MPD) led to the identification of a papillary tumor growing in the MPD of the pancreatic head. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Pathological examination revealed a papillary tumor with focal invasion to the MPD. Immunohistochemically, the tumor cells were positive for MUC1 and MUC5AC and negative for MUC2. Therefore, the definitive diagnosis was pancreatobiliary-type intraductal papillary mucinous carcinoma. This case emphasizes the significance of surveillance for potential cancer of the pancreas as well as the biliary tract in patients with PBM.

摘要

一名71岁女性,患有非扩张型胰胆管合流异常(PBM)和胆囊息肉样病变,接受了腹腔镜胆囊切除术。对息肉样病变进行组织学检查发现为胆囊癌。胆囊切除术后5年,主胰管(MPD)逐渐扩张,导致在胰头的MPD中发现一个乳头状肿瘤生长。遂进行了保留部分胃的胰十二指肠切除术。病理检查显示为乳头状肿瘤,有局灶性侵犯MPD。免疫组化检查显示,肿瘤细胞MUC1和MUC5AC呈阳性,MUC2呈阴性。因此,最终诊断为胰胆管型导管内乳头状黏液性癌。该病例强调了对PBM患者胰腺以及胆道潜在癌症进行监测的重要性。

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