Takagi Yutaka, Hatori Takashi, Itano Osamu, Shinoda Masahiro, Kato Atsushi, Nitori Nobuhiro, Kato Fumihiko, Kato Ayu, Nakao Atsushi, Tamura Takuya, Uemura Shuichiro, Miyazaki Masaru, Aida Shinsuke
Digestive Disease Center, International University of Health and Welfare, Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan.
Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda, Narita, Chiba Prefecture, 286-0124, Japan.
Clin J Gastroenterol. 2022 Apr;15(2):505-512. doi: 10.1007/s12328-021-01570-9. Epub 2022 Jan 11.
Pancreatic serous neoplasms are rare tumors that are usually benign. However, histopathological differentiation between benign (serous cystadenoma) and malignant (serous cystadenocarcinoma) lesions is difficult. We present the case of a patient with pancreatic serous cystadenocarcinoma that was diagnosed with liver metastasis 7 years after the resection of the primary serous neoplastic lesion. A woman in her 60 s was diagnosed with pancreatic serous cystadenoma based on imaging and histopathological examination findings. The tumor was resected, and the patient was followed up every 6 months to monitor tumor progression. At 7 years after the resection of the primary lesion, liver tumors showing marked flare-like contrast enhancements were detected on arterial phase computed tomography findings and on dynamic magnetic resonance imaging findings acquired 60 s after the administration of a contrast agent. Laparoscopic segmental hepatectomy of S4 and S6 was performed to resect these tumors. Histopathological examination revealed that these tumors were metastatic and developed from the primary lesion. Therefore, a diagnosis of serous cystadenocarcinoma was confirmed. The flare-like contrast enhancement around the metastatic liver lesions on computed tomography and dynamic magnetic resonance images may be an indicator of serous cystadenocarcinoma with liver metastasis that could assist in diagnosis.
胰腺浆液性肿瘤是罕见的肿瘤，通常为良性。然而，良性（浆液性囊腺瘤）和恶性（浆液性囊腺癌）病变之间的组织病理学鉴别很困难。我们报告一例胰腺浆液性囊腺癌患者，其在原发性浆液性肿瘤病变切除7年后被诊断为肝转移。一名60多岁的女性根据影像学和组织病理学检查结果被诊断为胰腺浆液性囊腺瘤。肿瘤被切除，患者每6个月接受一次随访以监测肿瘤进展。在原发性病变切除7年后，在动脉期计算机断层扫描结果以及注射造影剂60秒后获得的动态磁共振成像结果中，检测到肝脏肿瘤呈现明显的火焰状对比增强。进行了S4和S6段的腹腔镜肝段切除术以切除这些肿瘤。组织病理学检查显示这些肿瘤是转移性的，由原发性病变发展而来。因此，确诊为浆液性囊腺癌。计算机断层扫描和动态磁共振图像上转移性肝病变周围的火焰状对比增强可能是浆液性囊腺癌伴肝转移的一个指标，有助于诊断。
