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血糖控制不佳的新发糖尿病及其他非典型体征作为胰腺腺癌的早期征象

Poorly Controlled New-Onset Diabetes Mellitus and Other Atypical Signs as an Early Sign of Pancreatic Adenocarcinoma.

作者信息

Cordero Pérez Francisco Josué, Rodríguez López Pablo, Oleaga Gómez Paula, Antona Herranz Marta, Martín Garrido Eva Purificación

机构信息

Department of Internal Medicine, Complejo Asistencial de Zamora, Zamora, ESP.

Department of Medicine, Faculty of Medicine, University of Salamanca, Salamanca, ESP.

出版信息

Cureus. 2024 Jun 13;16(6):e62319. doi: 10.7759/cureus.62319. eCollection 2024 Jun.

DOI:10.7759/cureus.62319
PMID:39006617
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11246101/
Abstract

A 50-year-old man presented with poorly controlled new-onset diabetes mellitus. Six months after diagnosis, episodes of intense abdominal pain with vomiting appeared. Abdominal CT revealed signs of acute pancreatitis with structural changes in the pseudocysts. In the absence of biliary lithiasis or a toxic etiology of acute pancreatitis, the patient progressed unfavorably with increased abdominal pain and fever. Control imaging tests (two and 10 months later) showed the evolution of phlegmonous/necrotic collections, together with portal vein thrombosis and splenomegaly. Given the suggestive signs of possible occult malignancy, such as portal thrombosis, histological analysis of the ascitic fluid revealed a pancreatic adenocarcinoma. Despite the initiation of chemotherapy, the patient died 12 months after diagnosis.

摘要

一名50岁男性因新发糖尿病控制不佳前来就诊。诊断6个月后，出现剧烈腹痛伴呕吐发作。腹部CT显示急性胰腺炎征象及假性囊肿结构改变。在无胆石症或急性胰腺炎中毒病因的情况下，患者病情进展不利，腹痛和发热加剧。对照影像学检查（2个月和10个月后）显示蜂窝织炎/坏死性积液进展，伴有门静脉血栓形成和脾肿大。鉴于存在可能隐匿性恶性肿瘤的提示性征象，如门静脉血栓形成，对腹水进行组织学分析发现胰腺腺癌。尽管开始了化疗，患者在诊断后12个月死亡。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8292/11246101/24df981059a2/cureus-0016-00000062319-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8292/11246101/4908307b6709/cureus-0016-00000062319-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8292/11246101/43274621028b/cureus-0016-00000062319-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8292/11246101/ae05a818b160/cureus-0016-00000062319-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8292/11246101/579dcb91e663/cureus-0016-00000062319-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8292/11246101/24df981059a2/cureus-0016-00000062319-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8292/11246101/4908307b6709/cureus-0016-00000062319-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8292/11246101/43274621028b/cureus-0016-00000062319-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8292/11246101/ae05a818b160/cureus-0016-00000062319-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8292/11246101/579dcb91e663/cureus-0016-00000062319-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8292/11246101/24df981059a2/cureus-0016-00000062319-i05.jpg

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本文引用的文献

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Pancreatic Cancer and Its Mimics.胰腺癌及其类似疾病。
Radiographics. 2023 Nov;43(11):e230054. doi: 10.1148/rg.230054.
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Pancreatic Cystic Lesions and Malignancy: Assessment, Guidelines, and the Field Defect.胰腺囊性病变与恶性肿瘤：评估、指南及领域缺陷。
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Diabetes and pancreatic cancer: Exploring the two-way traffic.糖尿病与胰腺癌：探索双向交通。
World J Gastroenterol. 2021 Aug 14;27(30):4939-4962. doi: 10.3748/wjg.v27.i30.4939.
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Mass-forming pancreatitis versus pancreatic ductal adenocarcinoma: CT and MR imaging for differentiation.肿块型胰腺炎与胰腺导管腺癌的 CT 和 MRI 鉴别诊断
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Pancreatic cancer-associated diabetes mellitus: prevalence and temporal association with diagnosis of cancer.胰腺癌相关糖尿病：患病率及与癌症诊断的时间关联
Gastroenterology. 2008 Jan;134(1):95-101. doi: 10.1053/j.gastro.2007.10.040. Epub 2007 Oct 26.
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Pancreatic ductal adenocarcinomas with cystic features: neither rare nor uniform.具有囊性特征的胰腺导管腺癌：既不罕见也不单一。
Mod Pathol. 2005 Sep;18(9):1157-64. doi: 10.1038/modpathol.3800446.