Khurram Ruhaid, Khamar Rahul, Husain Aatif Amir, Khawaja Zohaib, Lunat Raees
Royal Free Hospital, Royal Free London NHS Foundation Trust, Pond St, Hampstead NW3 2QG, London, UK.
St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed St, Paddington W2 1NY, London, UK.
Radiol Case Rep. 2020 Nov 29;16(2):289-294. doi: 10.1016/j.radcr.2020.11.018. eCollection 2021 Feb.
The synchronous presentation of multifocal pancreatobiliary tumors is a rare occurrence and can prove to be a significant diagnostic and therapeutic challenge. We describe the case of a 70-year-old female who presented with a 2-week history of jaundice, reduced appetite, and mild epigastric discomfort of insidious onset. Radiological evaluation with computed tomography and magnetic resonance imaging demonstrated features consistent with a hilar cholangiocarcinoma , also known as a Klatskin tumor, involving both the cystic duct and gallbladder neck. In addition to this, a pancreatic neoplasm with associated splenic vein occlusion and metastatic deposits in the liver and lung were identified. The patient was managed with percutaneous transhepatic external biliary drainage and stenting by interventional radiology. Cytology results from the brushings obtained from the aforementioned procedure were nondiagnostic. Core biopsies were performed of the pancreatic lesion; the histopathological results of which were in keeping with pancreatic ductal adenocarcinoma . The patient was scheduled for chemotherapy however unfortunately deteriorated clinically prior to commencement. This case highlights the diagnostic and management challenges of synchronous pancreatobiliary malignancies.
多灶性胰胆肿瘤的同步出现较为罕见，可能构成重大的诊断和治疗挑战。我们描述了一例70岁女性患者，她有2周的黄疸病史，食欲减退，以及隐匿起病的轻度上腹部不适。计算机断层扫描和磁共振成像的影像学评估显示出与肝门部胆管癌（也称为Klatskin瘤）相符的特征，累及胆囊管和胆囊颈部。除此之外，还发现了一个伴有脾静脉闭塞以及肝和肺转移灶的胰腺肿瘤。患者接受了经皮经肝外胆管引流术，并由介入放射科进行了支架置入。上述操作所取刷片的细胞学检查结果无法确诊。对胰腺病变进行了核心活检；组织病理学结果符合胰腺导管腺癌。患者原计划接受化疗，但不幸的是在开始化疗前临床病情恶化。该病例突出了同步性胰胆恶性肿瘤的诊断和管理挑战。
