Miyata Takashi, Takamura Hiroyuki, Kin Ryosuke, Nishiki Hisashi, Hashimoto Akifumi, Fujii Yoritaka, Miura Seiko, Fujita Jun, Kaida Daisuke, Tomita Yasuto, Nakamura Naohiko, Fujita Hideto, Kinami Shinichi, Ueda Nobuhiko, Kosaka Takeo
Department of General and Digestive Surgery, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan.
J Surg Case Rep. 2020 Jul 14;2020(7):rjaa155. doi: 10.1093/jscr/rjaa155. eCollection 2020 Jul.
A 48-year-old woman was admitted to our hospital because of upper abdominal pain. Computer tomography showed an enhancing mass in the pancreatic body, dilation of the main pancreatic duct (MPD) and a filling defect within the splenic vein. On the basis of the preoperative diagnosis of pancreatic body cancer, distal pancreatectomy was scheduled. The pancreas was divided along the left edge of the gastroduodenal artery; however, frozen pathological examination of the pancreatic stump was tumor positive, and therefore a total pancreatectomy was performed. The lesion was a white expansive nodular mass that had spread into the MPD and protruded into the splenic vein. A pathological diagnosis of non-functioning neuroendocrine tumor (NET) was made. In general, imaging findings of disruption of the MPD and tumor vein thrombus are characteristics of pancreatic ductal adenocarcinoma, but are uncommon in NET. However, NET should be included in the differential diagnosis for such patients.
一名48岁女性因上腹部疼痛入院。计算机断层扫描显示胰体有强化肿块、主胰管扩张以及脾静脉内有充盈缺损。基于胰体癌的术前诊断，计划行胰体尾切除术。沿着胃十二指肠动脉左缘将胰腺离断；然而，胰腺残端的冰冻病理检查显示肿瘤阳性，因此进行了全胰切除术。病变为白色膨胀性结节状肿块，已蔓延至主胰管并突入脾静脉。病理诊断为无功能性神经内分泌肿瘤（NET）。一般来说，主胰管中断和肿瘤静脉血栓形成的影像学表现是胰腺导管腺癌的特征，但在NET中并不常见。然而，对于此类患者，鉴别诊断应包括NET。
