Balani Laveena, Malage Somanath, Singh Ashish, Ghosh Nalini Kanta, Nigam Neha
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Ochsner J. 2024 Fall;24(3):233-238. doi: 10.31486/toj.24.0034.
Leiomyomas are benign neoplasms that originate from smooth muscle cells and most commonly occur in soft tissues, the gastrointestinal tract, and the uterus. Leiomyomas of the pancreas are exceptionally rare, with, to our knowledge, only 6 documented cases prior to this report. This case was also challenging because of the young age of the patient and an atypical initial presentation. A 21-year-old male presented with progressive jaundice and severe anemia. Contrast-enhanced computed tomography revealed a heterogeneously hyperenhancing mass in the arterial phase in the head of the pancreas with a double-duct sign. Endoscopic biliary drainage was performed, followed by endoscopic biopsy that revealed a mesenchymal tumor; leiomyoma was confirmed with an immunohistochemical evaluation. The patient underwent pancreaticoduodenectomy, and the histopathologic and immunohistochemical examinations of the resected specimen confirmed the diagnosis of a low-grade leiomyoma arising from the ampulla of Vater. This case not only highlights the rarity of pancreatic leiomyomas and the potential for atypical presentation but also emphasizes the importance of considering leiomyoma in the differential diagnosis, even in young patients, and supports surgical resection as the preferred treatment approach.
平滑肌瘤是起源于平滑肌细胞的良性肿瘤，最常见于软组织、胃肠道和子宫。胰腺平滑肌瘤极为罕见，据我们所知，在本报告之前仅有6例文献记载的病例。该病例也具有挑战性，因为患者年龄较轻且初始表现不典型。一名21岁男性出现进行性黄疸和严重贫血。增强计算机断层扫描显示胰头在动脉期有一个不均匀强化的肿块，伴有双管征。进行了内镜下胆道引流，随后内镜活检显示为间叶性肿瘤；免疫组织化学评估确诊为平滑肌瘤。患者接受了胰十二指肠切除术，切除标本的组织病理学和免疫组织化学检查证实诊断为起源于 Vater壶腹的低级别平滑肌瘤。该病例不仅突出了胰腺平滑肌瘤的罕见性和非典型表现的可能性，还强调了在鉴别诊断中考虑平滑肌瘤的重要性，即使是在年轻患者中，并支持手术切除作为首选治疗方法。
