Hayashi Yoshiro, Maruo Hirotoshi, Koakutsu Toru, Oobayashi Miku, Shibasaki Yasushi, Shoji Tsuyoshi, Yamazaki Masanori, Hirayama Kazuhisa
Dept. of Surgery, Shizuoka City Shimizu Hospital.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2255-2257.
A 67-year-old man visiting our hospital with the chief complaint of sudden upper abdominal pain was diagnosed with acute pancreatitis. Based on computed tomography findings, intraductal papillary mucinous neoplasm(IPMN)was suspected as the cause of the pancreatitis and detailed examination was conducted following its alleviation. Endoscopic retrograde and magnetic resonance cholangiopancreatography showed marked dilation of the main pancreatic duct, with a mural nodule inside the main pancreatic duct at the pancreatic head. Main duct IPMN was diagnosed and pancreaticoduodenectomy was performed 3 months after the onset of acute pancreatitis. The histopathological findings showed a tumor proliferating in a mold pattern in the lumen of the dilated main pancreatic duct, resulting in a diagnosis of intraductal papillary mucinous carcinoma(IPMC). The presence of IPMN should be considered as a cause of acute pancreatitis; if findings suggestive of IPMN are found on imaging, detailed examinations and treatment are needed in consideration of the potential for malignancy following alleviation of pancreatitis.
一名67岁男性因突发上腹部疼痛前来我院就诊，被诊断为急性胰腺炎。根据计算机断层扫描结果，怀疑导管内乳头状黏液性肿瘤（IPMN）是胰腺炎的病因，并在病情缓解后进行了详细检查。内镜逆行胰胆管造影和磁共振胰胆管造影显示主胰管明显扩张，胰头处主胰管内有一个壁结节。诊断为主胰管IPMN，并在急性胰腺炎发病3个月后进行了胰十二指肠切除术。组织病理学检查结果显示，肿瘤在扩张的主胰管腔内呈铸型生长，诊断为导管内乳头状黏液癌（IPMC）。应考虑IPMN作为急性胰腺炎的病因；如果影像学检查发现提示IPMN的表现，在胰腺炎缓解后，应考虑到潜在的恶性可能性，进行详细检查和治疗。
