Sakata Shogo, Hisa Takeshi, Ito Yui, Nishiyama Shigeru, 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. doi: 10.1007/s12328-025-02202-2.
In this report, we present an 80-year-old man referred for evaluation of a pancreatic mass detected by transabdominal ultrasonography during health screening. Additional examinations revealed severe, long-segment focal atrophy from the pancreatic head to the body, appearing as a cord-like hypoechoic lesion on transabdominal and endoscopic ultrasonography. Although cytological examination of pancreatic juice was recommended, the patient opted for a follow-up. Three years later, a hypoechoic mass with upstream main pancreatic duct dilatation developed in the atrophic region. Cytological examination of pancreatic juice revealed adenocarcinoma, and pancreaticoduodenectomy was performed. Histopathology revealed Stage IIB invasive ductal carcinoma and carcinoma in situ within the atrophic region. Retrospective review showed that focal atrophy was present on transabdominal ultrasonography 11 years before the invasive carcinoma mass appeared, progressing without main pancreatic duct dilatation until its development. During follow-up of focal atrophy, early diagnosis of carcinoma in situ or microinvasive carcinoma before main pancreatic duct dilatation is crucial. The present case suggests that severe, long-segment focal pancreatic parenchymal atrophy can be detected by transabdominal ultrasonography and that carcinoma in situ within the focal pancreatic parenchymal atrophy may progress to invasive carcinoma.
在本报告中，我们介绍了一名80岁男性，他因健康筛查期间经腹部超声检查发现胰腺肿块而前来评估。进一步检查发现从胰头到胰体有严重的长节段局灶性萎缩，在经腹部和内镜超声检查中表现为条索状低回声病变。尽管建议对胰液进行细胞学检查，但患者选择了随访。三年后，萎缩区域出现了一个伴有主胰管上游扩张的低回声肿块。胰液细胞学检查显示为腺癌，并进行了胰十二指肠切除术。组织病理学显示为IIB期浸润性导管癌和萎缩区域内的原位癌。回顾性分析显示，在浸润性癌肿块出现前11年，经腹部超声检查就已发现局灶性萎缩，在主胰管扩张出现之前，其一直进展且无主胰管扩张。在局灶性萎缩的随访过程中，在主胰管扩张之前对原位癌或微浸润癌进行早期诊断至关重要。本病例表明，经腹部超声检查可检测到严重的长节段胰腺实质局灶性萎缩，且局灶性胰腺实质萎缩内的原位癌可能进展为浸润性癌。
