Nomura Risa, Ikemoto Juri, Ishii Yasutaka, Tatsukawa Yumiko, Nakamura Shinya, Miyamoto Sayaka, Uemura Kenichiro, Takahashi Shinya, Arihiro Koji, Oka Shiro
Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Clin J Gastroenterol. 2025 Jul 2. doi: 10.1007/s12328-025-02169-0.
In the preoperative pathological diagnosis of high-grade pancreatic intraepithelial neoplasia (PanIN), pancreatic juice cytology is commonly used. However, when multiple stenoses are present in the main pancreatic duct (MPD), localizing the tumor can be challenging. Here, we report a case of high-grade PanIN with beaded MPD stenoses and extensive intraepithelial lesions. A 72-year-old man was found to have elevated pancreatic enzymes and cystic MPD dilation on abdominal ultrasonography. Contrast-enhanced computed tomography showed diffuse MPD dilation and localized pancreatic atrophy in the pancreatic head. Magnetic resonance cholangiopancreatography revealed cystic dilation of the MPD in the pancreatic body. Endoscopic ultrasonography showed mild MPD stenosis in the pancreatic head, surrounded by hypoechoic area. Endoscopic retrograde cholangiopancreatography revealed multiple bead-like MPD stenoses in the body of the MPD, and a short stenosis in the pancreatic head. Brush cytology of the MPD stenosis in the pancreatic head revealed malignancy, while lavage cytology from the tail side was suspicious for malignancy. Based on these findings, high-grade PanIN extending from the head to the tail was diagnosed, leading to total pancreatectomy. Histological examination demonstrated extensive intraepithelial neoplastic lesions, with high-grade PanIN corresponding to the MPD stenosis in the pancreatic head.
在高级别胰腺上皮内瘤变（PanIN）的术前病理诊断中，常用胰液细胞学检查。然而，当主胰管（MPD）存在多处狭窄时，肿瘤定位可能具有挑战性。在此，我们报告一例伴有串珠样MPD狭窄和广泛上皮内病变的高级别PanIN病例。一名72岁男性在腹部超声检查中发现胰酶升高和MPD囊性扩张。增强计算机断层扫描显示MPD弥漫性扩张和胰头局限性胰腺萎缩。磁共振胰胆管造影显示胰体部MPD囊性扩张。内镜超声显示胰头轻度MPD狭窄，周围为低回声区。内镜逆行胰胆管造影显示MPD体部有多个串珠样MPD狭窄，胰头有一处短狭窄。胰头MPD狭窄处的刷检细胞学显示为恶性，而胰尾侧的灌洗细胞学检查怀疑为恶性。基于这些发现，诊断为从胰头延伸至胰尾的高级别PanIN，遂行全胰切除术。组织学检查显示广泛的上皮内肿瘤性病变，高级别PanIN与胰头的MPD狭窄相对应。
