Kimura Karen, Koizumi Kazuya, Masuda Sakue, Makazu Makomo, Kubota Jun, Kawahara Toshiyasu, Yamaue Hiroki, Teshima Shinichi
Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
Pancreatic Cancer Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan.
Clin J Gastroenterol. 2025 Aug;18(4):753-759. doi: 10.1007/s12328-025-02159-2. Epub 2025 Jun 25.
A 78-year-old woman presented with epigastric pain and underwent contrast-enhanced abdominal computed tomography (CT), which revealed a mass in the ampullary region. Endoscopic ultrasonography (EUS) and retrograde cholangiopancreatography (ERCP) confirmed a papillary lesion with a contrast defect in the bile duct. An initial biopsy suggested an adenoma. Owing to the extent of the lesion, surgery was recommended; however, the patient opted for follow-up. After five months, CT and EUS revealed significant tumor growth, raising the suspicion of malignancy. Consequently, subtotal stomach-preserving pancreatoduodenectomy was performed, and postoperative pathology confirmed an intra-ampullary papillary tubular neoplasm (IAPN) with low-grade dysplasia. IAPN is noninvasive and consists of the growth of the ductal epithelium, which is equivalent to adenoma or low-grade adenocarcinoma. Although it is generally characterized by slow growth owing to its noninvasive nature, this case was unique in that it showed rapid progression. Despite being a low-grade IAPN, this case represents a rare instance of rapid enlargement within five months. This case underscores the importance of vigilant monitoring of low-grade IAPN, given its potential for accelerated growth.
一名78岁女性因上腹部疼痛就诊，接受了腹部增强计算机断层扫描（CT），结果显示壶腹区域有一个肿块。内镜超声检查（EUS）和逆行胰胆管造影（ERCP）证实为乳头病变，胆管内有造影剂充盈缺损。初步活检提示为腺瘤。鉴于病变范围，建议进行手术；然而，患者选择了随访观察。五个月后，CT和EUS显示肿瘤显著生长，怀疑为恶性肿瘤。因此，实施了保留胃的胰十二指肠次全切除术，术后病理证实为壶腹内乳头管状肿瘤（IAPN）伴低级别发育异常。IAPN为非侵袭性，由导管上皮生长组成，相当于腺瘤或低级别腺癌。尽管由于其非侵袭性通常生长缓慢，但该病例的独特之处在于其进展迅速。尽管是低级别IAPN，但该病例是五个月内迅速增大的罕见情况。鉴于低级别IAPN有加速生长的可能，该病例强调了对其进行密切监测的重要性。
