Ueda T, Ku Y, Kanamaru T, Hasegawa Y, Kuroda Y, Saitoh Y
First Department of Surgery, Kobe University School of Medicine, Japan.
Surg Today. 1996;26(5):357-60. doi: 10.1007/BF00311607.
The incidence of acinar cell carcinoma has been reported to be about 1% of all pancreatic neoplasms, and pancreatic cancer combined with tumor growth extending into the portal vein is a rare condition. We herein report a case of acinar cell carcinoma of the pancreas with a tumor thrombus extending into the main portal trunk. Preoperative imaging of the portal vein, consisting of computed tomography (CT), magnetic resonance imaging (MRI), and angiography, revealed an oval shadow defect in the main portal trunk along with an irregular mass in the pancreatic head. At operation, we confirmed a tumor thrombus extending from a tumor in the pancreatic head into the main portal trunk via the pancreatoduodenal veins. A pancreatoduodenectomy combined with partial resection of the portal vein was thus performed under a temporary portal vein shunt from the ileocecal vein to the umbilical vein. Immunohistochemical examination for alpha 1-antichimotrypsin and electron microscopic examination confirmed the diagnosis of acinar cell carcinoma of the pancreas with a tumor thrombus in the portal vein. Surgical excision combined with portal vein resection may therefore improve the prognosis of selected patients with portal tumor thrombus.
据报道，腺泡细胞癌的发病率约占所有胰腺肿瘤的1%，而胰腺癌合并肿瘤生长延伸至门静脉是一种罕见情况。我们在此报告一例胰腺腺泡细胞癌伴有肿瘤血栓延伸至门静脉主干的病例。门静脉的术前影像学检查，包括计算机断层扫描（CT）、磁共振成像（MRI）和血管造影，显示门静脉主干有椭圆形阴影缺损，同时胰头部有不规则肿块。手术中，我们证实肿瘤血栓从胰头部的肿瘤经胰十二指肠静脉延伸至门静脉主干。因此，在从回盲静脉到脐静脉的临时门静脉分流下，进行了胰十二指肠切除术联合门静脉部分切除术。α1 -抗糜蛋白酶的免疫组织化学检查和电子显微镜检查证实了胰腺腺泡细胞癌伴门静脉肿瘤血栓的诊断。因此，手术切除联合门静脉切除可能会改善部分伴有门静脉肿瘤血栓患者的预后。
