Tachibana Mitsuhiro, Hirota Takayoshi, Hamayasu Hideki, Takeuchi Yu, Tsukamoto Kei, Matsushita Masahiro
Department of Diagnostic Pathology, Shimada General Medical Center, Shimada 427-8502, Shizuoka, Japan.
Division of Pathology and Oral Pathology, Shimada General Medical Center, Shimada 427-8502, Shizuoka, Japan.
Diagnostics (Basel). 2023 Oct 4;13(19):3123. doi: 10.3390/diagnostics13193123.
We report a case of colloid carcinoma (CC) arising from an intestinal-type intraductal papillary mucinous neoplasm with high-grade dysplasia (IPMNHGD) of the pancreas, diagnosed with serial pancreatic juice aspiration cytological examination (SPACE). A rapidly growing intraductal papillary mucinous neoplasm (IPMN) in a 71-year-old Japanese man accelerated his hospitalization in our institute. Clinically, a large, ruptured pancreatic cyst was suspected. Cytologically, several mucin-positive signet-ring cells were scattered in the inflammatory, necrotic, or mucinous background. Signet-ring cells in cell block specimens were immunoreactive for MUC2, MUC5AC, maspin, S100P, and claudin-18. The final cytologic diagnosis was CC arising in an intestinal-type IPMNHGD with intraperitoneal penetration. The patient died two months after an explorative laparotomy. The cytologic diagnosis was achieved through SPACE, and the presence of signet-ring cells was characteristic. Anti-claudin-18.2-specific monoclonal antibody therapy will likely be used to treat patients with IPMNHGD in the future. This case highlights the diagnostic utility of SPACE, with particular emphasis on the characteristic presence of signet-ring cells. Furthermore, it anticipates the potential use of anti-claudin-18.2- specific monoclonal antibody therapy in the management of IPMNHGD patients.
我们报告了一例源于胰腺肠型导管内乳头状黏液性肿瘤伴高级别异型增生（IPMNHGD）的胶样癌（CC），通过系列胰液抽吸细胞学检查（SPACE）确诊。一名71岁日本男性的快速生长的导管内乳头状黏液性肿瘤（IPMN）促使他入住我院。临床上，怀疑是一个大的、破裂的胰腺囊肿。细胞学检查发现，在炎性、坏死或黏液背景中散在有几个黏液阳性印戒细胞。细胞块标本中的印戒细胞对MUC2、MUC5AC、maspin、S100P和claudin-18呈免疫反应。最终细胞学诊断为源于肠型IPMNHGD并伴有腹腔浸润的CC。患者在剖腹探查术后两个月死亡。通过SPACE实现了细胞学诊断，印戒细胞的存在具有特征性。抗claudin-18.2特异性单克隆抗体治疗未来可能会用于治疗IPMNHGD患者。本病例突出了SPACE的诊断效用，特别强调了印戒细胞的特征性存在。此外，它预示了抗claudin-18.2特异性单克隆抗体治疗在IPMNHGD患者管理中的潜在应用。
