Nishiyama Shigeru, Hisa Takeshi, Sakata Shogo, Ito Yui, Kudo Akiharu, Yamada Takahiro, Osera Shozo, Fukushima Hideki, Hamura Ryoga, Shiozawa Satoshi
Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan.
Department of Digestive Surgery, Saku Central Hospital Advanced Care Center, Nagano, Japan.
Clin J Gastroenterol. 2025 Aug;18(4):746-752. doi: 10.1007/s12328-025-02158-3. Epub 2025 Jun 9.
We report a case in which the progression of focal pancreatic parenchymal atrophy suggested the presence of high-grade pancreatic intraepithelial neoplasia/carcinoma in situ. A 77-year-old man was found to have a pancreatic cyst during a health checkup using transabdominal ultrasound. Contrast-enhanced computed tomography revealed multiple cysts, each measuring ≤ 5 mm, in the pancreatic head and body. Over nine years of intermittent follow-up, imaging showed progressive focal pancreatic parenchymal atrophy extending from the pancreatic head to the body, without changes in the cysts or stenosis or dilatation of the main pancreatic duct. Three-dimensional computed tomography facilitated visualization of the atrophic progression. Transabdominal and endoscopic ultrasound identified a thin pancreatic parenchyma with a surrounding hyperechoic area but no hypoechoic masses. Serial pancreatic juice aspiration cytological examination suggested adenocarcinoma. Surgery was performed, and histopathological examination revealed a 15-mm atrophic region with high-grade pancreatic intraepithelial neoplasia or carcinoma in situ confined to the main pancreatic duct. The lesion extended 5 mm downstream and 10 mm upstream. Even in cases of focal pancreatic parenchymal atrophy without stenosis or dilation of the main pancreatic duct, its progression may indicate high-grade pancreatic intraepithelial neoplasia/carcinoma in situ and warrant serial pancreatic juice aspiration cytology.
我们报告了一例局灶性胰腺实质萎缩进展提示存在高级别胰腺上皮内瘤变/原位癌的病例。一名77岁男性在经腹超声健康检查中发现胰腺囊肿。增强计算机断层扫描显示胰头和胰体有多个囊肿，每个囊肿直径≤5毫米。在九年的间歇性随访中，影像学检查显示局灶性胰腺实质萎缩从胰头向胰体进展，囊肿无变化，主胰管无狭窄或扩张。三维计算机断层扫描有助于观察萎缩进展情况。经腹和内镜超声检查发现胰腺实质变薄，周围有高回声区，但无低回声肿块。连续胰液抽吸细胞学检查提示腺癌。患者接受了手术，组织病理学检查发现一个15毫米的萎缩区域，高级别胰腺上皮内瘤变或原位癌局限于主胰管。病变向下游延伸5毫米，向上游延伸10毫米。即使在主胰管无狭窄或扩张的局灶性胰腺实质萎缩病例中，其进展也可能提示高级别胰腺上皮内瘤变/原位癌，需要进行连续胰液抽吸细胞学检查。
