Heresbach D, Robert I, Le Berre N, Raoul J L, Siproudhis L, Bretagne J F, Ramée M P, Gosselin M
Service d'Hépato-Gastroentérologie, CHU Pontchaillou, Rennes.
Gastroenterol Clin Biol. 1993;17(12):968-71.
Cystadenomas and cystadenocarcinomas are the most common cystic tumors of the pancreas. Their inner lining contains neuroendocrine cells that may, in rare cases, produce a systemic syndrome. Similarly, digestive or pancreatic endocrine tumors have been reported in association with cystic tumors of the pancreas. We report a case of cystadenocarcinoma of the pancreas head, associated with a serous cystadenoma and an endocrine tumor of the body of the pancreas. In a 70 year old patient, jaundiced due to obstruction of the extra-hepatic bile ducts, the abdominal ultrasound and CT scan showed a hypoechogenic hypodense lesion of the pancreas head resulting in an enlargement of the common bile duct and pancreatic duct. Echoendoscopy confirmed the diagnosis and gave additional information; it showed that the cephalic lesion was heterogeneous, with anechogene spaces separated by coarse echogenic septae associated to a solid contingent. Also detected by echoendoscopy was a cystic lesion containing thin septae and a contiguous hypoechogenic nodule of the body of the pancreas. Histology of the specimen following total pancreatectomy revealed a cephalic cystadenocarcinoma associated with a serous cystadenoma and a non-secreting endocrine tumor of the body region. This observation highlights the usefulness of echoendoscopy in the work-up of cystic lesions of the pancreas; indeed, the tumors of the body of the pancreas were not detected by others methods. Furthermore, there are reports in literature on endocrine secretion syndromes secondary to digestive endocrine tumors or neuroendocrine cells in the lining of cystic tumors of the pancreas.
囊腺瘤和囊腺癌是胰腺最常见的囊性肿瘤。其内层含有神经内分泌细胞，在罕见情况下可能产生全身综合征。同样，有报道称消化性或胰腺内分泌肿瘤与胰腺囊性肿瘤有关。我们报告一例胰头囊腺癌，伴有胰腺体部的浆液性囊腺瘤和内分泌肿瘤。在一名因肝外胆管梗阻而黄疸的70岁患者中，腹部超声和CT扫描显示胰头有一个低回声低密度病变，导致胆总管和胰管扩张。超声内镜检查证实了诊断并提供了更多信息；它显示头部病变不均匀，有无回声区被粗大的回声间隔分隔，伴有实性成分。超声内镜检查还发现胰腺体部有一个含薄间隔的囊性病变和一个相邻的低回声结节。全胰切除术后标本的组织学检查显示，胰头囊腺癌伴有浆液性囊腺瘤和体部非分泌性内分泌肿瘤。这一观察结果突出了超声内镜在胰腺囊性病变检查中的有用性；事实上，胰腺体部的肿瘤通过其他方法未被检测到。此外，文献中有关于胰腺囊性肿瘤内衬中的消化性内分泌肿瘤或神经内分泌细胞继发的内分泌分泌综合征的报道。
