Ohwada Susumu, Moro Amika, Amit Nair, Sasaki Kazunari, Sakurai Shinji, Takada-Owada Atsuko, Izumi Masaru, Nakano Yuhei, Kashima Yasushige, Matsuyama Hideki
Center of Gastroenterology and Oncology, IMS Ota Chuo General Hospital, 875-1 Higashi-imaizumicho, Ota, 373-8513, Japan.
Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Surg Case Rep. 2021 Mar 25;7(1):76. doi: 10.1186/s40792-021-01159-x.
Ascertaining the origin of large tumors located in the region of the pancreas head and adjacent mesocolon can pose a challenge preoperatively. En bloc pancreatoduodenectomy with hemicolectomy is often required towards curative tumor resection (R0) of malignant tumors in this region.
Herein we report a case of a 48-year-old man with two contiguous masses each 5 cm in size, located in the pancreatic head. The masses were detected incidentally by abdominal ultrasonography at an annual health check. Endoscopic biopsies revealed inflammation with no malignancy. Cross-sectional imaging showed the tumor direct invasion of the uncinate process of the pancreas, and the third portion of the duodenum. Based on imaging, a malignant submucosal tumor originating from mesenchymal cells in the mesentery of the transverse colon was made preoperatively. The mass required en bloc pancreatoduodenectomy, right hemicolectomy, and resection of the superior mesenteric vein. The final pathology was carcinosarcoma of the transverse colon. The patient survived 18 years after surgery without recurrence.
Malignant tumors located in the region of the pancreas head should be considered for an en bloc curative tumor resection and adjuvant chemotherapy treatments offered that might be beneficial for carcinosarcoma.
术前确定位于胰头及相邻结肠系膜区域的大肿瘤的起源可能具有挑战性。对于该区域的恶性肿瘤，往往需要行胰十二指肠切除术联合半结肠切除术以实现根治性肿瘤切除（R0）。
在此，我们报告一例48岁男性病例，其胰头有两个相邻的肿块，每个肿块大小为5厘米。这些肿块在年度健康检查时通过腹部超声偶然发现。内镜活检显示为炎症，无恶性病变。横断面成像显示肿瘤直接侵犯胰腺钩突和十二指肠第三部。基于影像学检查，术前诊断为起源于横结肠系膜间叶细胞的恶性黏膜下肿瘤。该肿块需要行胰十二指肠切除术、右半结肠切除术及肠系膜上静脉切除术。最终病理结果为横结肠癌肉瘤。患者术后存活18年，无复发。
对于位于胰头区域的恶性肿瘤，应考虑行根治性肿瘤整块切除及辅助化疗，这可能对癌肉瘤有益。
