Miyakawa S, Horiguchi A, Hayakawa M, Ishihara S, Miura K, Horiguchi Y, Imai H, Mizoguchi Y, Kuroda M
Second Department of Gastroenterological Surgery, Fujita Health University, Toyoake, Japan.
J Gastroenterol. 1996 Dec;31(6):889-93. doi: 10.1007/BF02358621.
We report a 66-year-old man who had a cystic intraductal papillary adenocarcinoma containing a papillary adenoma, in the head of the pancreas and a coexistent invasive, well differentiated solid tubular adenocarcinoma in the tail of the pancreas. He was hospitalized with acute epigastralgia. Computed tomography demonstrated a multilocular cystic mass in the head of the pancreas and a solid tumor in the tail. Endoscopic retrograde pancreatography showed mucin secretion from an enlarged papilla of Vater, marked dilatation of the main pancreatic duct in the head and body, cystic dilatation of the uncinate branch, and irregular narrowing of the main pancreatic duct in the tail. Total pancreatectomy was performed. Between the cystic tumor and the solid tumor there was a distance of 4.8 cm of normal pancreatic parenchyma and duct, recognized both grossly and microscopically. The patient died 35 months after the operation. At autopsy, peritonitis carcinomatosa was found in the abdominal cavity. Microscopically, disseminated nodules were also well differentiated tubular adenocarcinoma. The apparent anatomic separation of these two tumors within the pancreas is extremely unusual.
我们报告一例66岁男性，其胰腺头部有一个包含乳头状腺瘤的囊性导管内乳头状腺癌，同时胰腺尾部存在并存的浸润性、高分化实性管状腺癌。他因急性上腹痛入院。计算机断层扫描显示胰腺头部有一个多房囊性肿块，尾部有一个实性肿瘤。内镜逆行胰胆管造影显示， Vater壶腹乳头增大并有黏液分泌，胰头和胰体部主胰管明显扩张，钩突支呈囊性扩张，胰尾主胰管不规则狭窄。遂行全胰切除术。在囊性肿瘤和实性肿瘤之间，肉眼和显微镜下均可见4.8 cm的正常胰腺实质和导管。患者术后35个月死亡。尸检时，腹腔内发现癌性腹膜炎。显微镜下，播散性结节也是高分化管状腺癌。这两种肿瘤在胰腺内明显的解剖学分离极为罕见。
