Flores Rubén Lima, Rossi Ricardo, Castiblanco Adriana, Gallardo Alejandra, Schiappacasse Giancarlo
Department of Digestive and Soft Tissue Oncologic Surgery, Instituto Nacional del Cáncer, Santiago, Chile.
Department of Hepato-bilio-pancreatic Surgery, Faculty of Medicine, Clínica Alemana de Santiago, Santiago, Chile.
Int J Surg Case Rep. 2021 Jul;84:106131. doi: 10.1016/j.ijscr.2021.106131. Epub 2021 Jun 25.
This neoplasm of the pancreas is an uncommon entity, with a frequency of 0.3-2.7% of all pancreatic tumors and even more so the finding of a synchronous lesion of the same histological lineage. For this reason, we report the atypical presentation of a SPNPs through a clinical case, review of the literature and a classification proposal, from the quantitative point of view.
21-year-old patient, with incidental finding of two pancreatic tumors. Surgery included a pyloric preserving pancreatoduodenectomy with pancreatojejunostomy, distal pancreatectomy and central pancreas was preserved. The patient presents low output pancreatic fistula and nosocomial infection, treated with antibiotic therapy, being discharged 29 days after the intervention. Pathological and immunohistochemical analysis consistent with two SPNP.
Its diagnosis is confirmed with the histological study and two synchronic SPNP are a rare entity and for this, or multiple lesions, an attempt should be made of a conservative resection of the parenchyma to minimize pancreatic insufficiency in a frequently young population, and always look for R0 resection, due to its uncertain behavior.
Bifocal SPNP is rare and for this it is utility classify this entity -from the quantitative point of view- into unifocal, bifocal and multifocal for future medical research.
胰腺的这种肿瘤是一种罕见的实体，在所有胰腺肿瘤中占比0.3 - 2.7%，发现同一组织学谱系的同步病变的情况更是如此。因此，我们通过一个临床病例报告胰腺实性假乳头状瘤（SPNPs）的非典型表现，对文献进行综述，并从定量角度提出一种分类建议。
一名21岁患者，偶然发现两个胰腺肿瘤。手术包括保留幽门的胰十二指肠切除术并进行胰空肠吻合术，远端胰腺切除术，保留了胰腺中部。患者出现低流量胰瘘和医院感染，接受抗生素治疗，干预后29天出院。病理和免疫组化分析结果与两个胰腺实性假乳头状瘤相符。
其诊断通过组织学研究得以证实，两个同步的胰腺实性假乳头状瘤是一种罕见的实体，对于这种情况或多个病变，应尝试对实质进行保守切除，以尽量减少在常为年轻人群中的胰腺功能不全，并且由于其行为不确定，始终要寻求R0切除。
双灶性胰腺实性假乳头状瘤很罕见，因此从定量角度将该实体分类为单灶性、双灶性和多灶性对未来医学研究很有用。
