Imataki Hiromitsu, Okuno Masataka, Miyake Hideo, Nagai Hidemasa, Yoshioka Yuichiro, Yuasa Norihiro, Fujino Masahiko
Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan.
Department of Pathology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, 453-8511, Japan.
Clin J Gastroenterol. 2022 Apr;15(2):484-492. doi: 10.1007/s12328-022-01613-9. Epub 2022 Mar 1.
We encountered a rare case of a pancreatic head tumor protruding into the portal vein, later diagnosed histopathologically as primary leiomyosarcoma of the portal vein. A 59-year-old woman visited our hospital because of an elevated amylase level during a medical checkup. Computed tomography showed a moderately contrasted, well-defined mass of 35-mm diameter in the pancreatic head with protrusion into the portal vein. Endoscopic ultrasonography revealed a well-defined and hypoechoic mass. Fluorodeoxyglucose-positron emission tomography showed a high accumulation of fluorodeoxyglucose in the pancreas head. We performed a subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection. Gross findings of the fixed specimen showed a white solid, multinodular mass in the pancreatic parenchyma with protrusion into the portal vein. Histopathological examination showed proliferation of spindle-shaped eosinophilic cells with intricate bundle-like growth, indicating leiomyosarcoma. Examining the tumor location and invasion suggested portal vein as the origin. Although portal vein primary leiomyosarcoma is rare, leiomyosarcoma should be considered as a differential diagnosis in pancreatic head tumors with protrusion into the portal vein. Precise macroscopic and histopathological examinations can help determine the definitive diagnosis and origin of leiomyosarcoma.
我们遇到了一例罕见的胰头肿瘤突入门静脉的病例，经组织病理学诊断为门静脉原发性平滑肌肉瘤。一名59岁女性因体检时淀粉酶水平升高前来我院就诊。计算机断层扫描显示胰头有一个直径35毫米、对比度中等、边界清晰的肿块，突入门静脉。内镜超声检查显示一个边界清晰的低回声肿块。氟脱氧葡萄糖正电子发射断层扫描显示胰头有高浓度的氟脱氧葡萄糖聚集。我们进行了保留胃的胰十二指肠次全切除术并切除门静脉。固定标本的大体检查显示胰腺实质内有一个白色实性、多结节状肿块，突入门静脉。组织病理学检查显示梭形嗜酸性细胞增殖，呈复杂的束状生长，提示为平滑肌肉瘤。检查肿瘤位置和侵犯情况提示门静脉为起源部位。尽管门静脉原发性平滑肌肉瘤罕见，但对于突入门静脉的胰头肿瘤，应将平滑肌肉瘤作为鉴别诊断之一。精确的大体和组织病理学检查有助于确定平滑肌肉瘤的明确诊断和起源。
