Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Division of Diagnostic Pathology, Shizuoka Cancer Center, Shizuoka, Japan.
Clin J Gastroenterol. 2022 Oct;15(5):1006-1011. doi: 10.1007/s12328-022-01675-9. Epub 2022 Jul 27.
Although a granular cell tumor (GCT) can originate in various locations, GCT of the pancreas is a rare entity. We herein report a case of GCT of the pancreas with chronic dilation of the main pancreatic duct (MPD). The patient had been referred to our institution for epigastric pain 12 years ago at 50 years old. Multidetector-row computed tomography (MDCT) had shown dilation of the MPD up to 8 mm in diameter from the pancreatic body to the tail. However, she had refused additional workup and been lost to follow-up. She was referred to our institution at 62 years old, as dilation of the MPD had been noted again. Imaging studies showed that the MPD had become dilated up to 33 mm from the pancreatic body to the tail. MDCT showed a hypovascular nodule (6 mm in diameter) in the pancreatic neck, and the nodule was located at the origin of MPD dilation. Pancreatic cancer was considered as a possible differential diagnosis. Surgical treatment was planned for a therapeutic diagnosis, and distal pancreatectomy with splenectomy and lymphadenectomy was performed. The gross findings of the resected specimen revealed a pale-yellow solid tumor measuring 8 mm in diameter at the pancreatic neck. The histopathologic assessment revealed the tumor to be GCT of the pancreas. The characteristics of GCT of the pancreas, such as a tumor causing stenosis and dilation of the MPD frequently and being too small to detect on imaging studies, may lead to a misleading diagnosis of pancreatic cancer.
虽然颗粒细胞瘤 (GCT) 可起源于多个部位，但胰腺 GCT 是一种罕见的实体瘤。我们在此报告一例胰腺 GCT 合并主胰管 (MPD) 慢性扩张的病例。患者 12 年前，50 岁时因上腹痛就诊于我院。多排螺旋 CT（MDCT）显示从胰体到胰尾 MPD 直径扩张至 8mm。但患者拒绝进一步检查，失访。62 岁时，因再次发现 MPD 扩张就诊于我院。影像学检查显示 MPD 从胰体到胰尾扩张至 33mm。MDCT 显示胰颈有一低血供结节（直径 6mm），结节位于 MPD 扩张的起点。胰头癌被认为是可能的鉴别诊断。为明确诊断，计划行手术治疗，行胰体尾加脾切除术及淋巴结清扫术。切除标本大体观察可见胰颈有一 8mm 大小的灰白色实性肿瘤。组织病理学评估显示肿瘤为胰腺 GCT。胰腺 GCT 的特征，如肿瘤常引起 MPD 狭窄和扩张，且太小而在影像学检查中难以发现，可能导致对胰头癌的误诊。
