Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
Abdom Radiol (NY). 2020 Jul;45(7):2244-2248. doi: 10.1007/s00261-020-02425-6.
Pancreatic hamartoma is a rare benign tumor. Its preoperative diagnosis is challenging. We present a case of pancreatic hamartoma whose radiological-pathological correlation was evaluated in detail. A 53-year-old man was referred to our institution for diagnosis and treatment. Contrast-enhanced computed tomography (CT) and magnetic resonance image revealed a 3.5 cm long tumor arising from the head of the pancreas with cystic and solid components, the latter of which was gradually and inhomogeneously enhanced in the delayed phase. Fluorodeoxyglucose (FDG) positron emission tomography/CT revealed slight FDG uptake in the solid component. Histologically, a number of pancreatic lobule-like structures, which were mainly composed of aggregates of small ducts embedded in concentric fibrous stroma with no apparent islets or peripheral nerves, were observed in the solid component, whereas multiple dilated ducts were seen in the cystic region. The solid component also contained a narrow area of edematous fibrous stroma with low vessel density, which corresponded with the unenhanced part in the inhomogeneously enhanced solid component. There was no remarkable cytological atypia throughout the mass. A pathological diagnosis of pancreatic hamartoma was made. The radiological findings agree well with the pathological findings. When a pancreatic tumor is of the solid type, preoperatively diagnosing it as pancreatic hamartoma is not possible. However, when a pancreatic tumor with cystic and solid components is inhomogeneously enhanced in contrast-enhanced studies, a diagnosis of pancreatic hamartoma can be considered.
胰腺错构瘤是一种罕见的良性肿瘤。术前诊断具有挑战性。我们报告了一例胰腺错构瘤的病例，详细评估了其影像学-病理学相关性。一名 53 岁男性因诊断和治疗被转至我院。对比增强 CT 和磁共振成像显示，胰腺头部有一个 3.5 厘米长的肿瘤，具有囊性和实性成分，后者在延迟期逐渐呈不均匀增强。氟代脱氧葡萄糖（FDG）正电子发射断层扫描/CT 显示实性成分中 FDG 摄取轻微。组织学上，实性成分中观察到许多胰腺小叶样结构，主要由嵌入同心纤维基质中的小导管聚集组成，无明显胰岛或周围神经，囊性区域可见多个扩张的导管。实性成分还包含一个狭窄的水肿性纤维基质区域，血管密度低，与不均匀增强的实性成分中的未增强部分相对应。整个肿块无明显细胞学异型性。病理诊断为胰腺错构瘤。影像学发现与病理发现相符。当胰腺肿瘤为实性类型时，术前诊断为胰腺错构瘤是不可能的。然而，当具有囊性和实性成分的胰腺肿瘤在对比增强研究中呈不均匀增强时，可考虑胰腺错构瘤的诊断。
