Yamaguchi K, Nakamura K, Yokohata K, Shimizu S, Chijiiwa K, Tanaka M
Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan.
Int J Pancreatol. 1997 Dec;22(3):227-31. doi: 10.1007/BF02788389.
We would like to recommend detailed examination of the pancreas including cytology of the pancreatic juice in patients with pancreatic cyst to find possible concomitant early pancreatic carcinoma. Further study is necessary to determine whether there is a rational relationship between mucinous cystadenoma of the pancreas and pancreatic adenocarcinoma.
Two cases of in situ carcinoma of the pancreas first detected with pancreatic cyst as a diagnostic clue are reported. Cytologic examination of the pancreatic juice was positive for malignancy in both cases, and pancreatic cyst and in situ carcinoma were located independently.
Case 1: Ultrasonography (US) and computed tomography (CT) in a 54-yr-old Japanese man with a known gastric cancer revealed a pancreatic cyst. Endoscopic retrograde cholangiopancreatography (ERCP) showed a cyst in the tail of the pancreas, and cytology of the pure pancreatic juice revealed adenocarcinoma. Intraoperatively, the pancreas was cut along the portal vein, and cytology of the pancreatic juice from the pancreas distal to the cutting line showed adenocarcinoma. Resection of the body and tail of the pancreas was performed together with total gastrectomy. Histopathologically, the cyst was mucinous cystadenoma, and the surrounding pancreatic ducts and ductules showed epithelial dysplasia of moderate-to-severe degree having foci of unequivocal in situ carcinoma. No stromal invasion was seen. Case 2: A 55-yr-old Japanese man with known hepatocellular carcinoma was diagnosed as having pancreatic cyst in the tail of the pancreas on US and CT. ERCP showed a pancreatic cyst, and cytology of the pancreatic juice highly suggested adenocarcinoma. Distal pancreatectomy and splenectomy were performed. Histopathologic diagnosis of pancreatic cyst was mucinous cystadenoma. The pancreatic ductule 2 cm proximal to the pancreatic cyst showed carcinoma in situ. The diagnostic clue of in situ carcinoma of the pancreas in these two cases was a cystic lesion of the pancreas detected by check-up US and CT of known carcinoma of the stomach and liver. Cytology of the pancreatic juice was also positive for malignancy. In situ carcinoma of the pancreas was found to be independent of the cysts because of the different locations and divergent histopathologic natures of the two lesions.
我们建议对胰腺囊肿患者进行包括胰液细胞学检查在内的详细胰腺检查，以发现可能并存的早期胰腺癌。有必要进一步研究胰腺黏液性囊腺瘤与胰腺腺癌之间是否存在合理的关联。
报告了两例以胰腺囊肿为诊断线索首次发现的胰腺原位癌病例。两例患者的胰液细胞学检查均显示恶性，且胰腺囊肿与原位癌独立存在。
病例1：一名54岁的日本男性，已知患有胃癌，超声检查（US）和计算机断层扫描（CT）显示胰腺有一个囊肿。内镜逆行胰胆管造影（ERCP）显示胰腺尾部有一个囊肿，纯胰液细胞学检查显示为腺癌。术中，沿门静脉切开胰腺，切割线远端胰腺的胰液细胞学检查显示为腺癌。行胰体尾切除术并同时行全胃切除术。组织病理学检查显示，囊肿为黏液性囊腺瘤，周围胰管和小胰管显示中度至重度上皮发育异常，有明确的原位癌灶。未见间质浸润。病例2：一名55岁的日本男性，已知患有肝细胞癌，超声和CT检查诊断为胰腺尾部囊肿。ERCP显示胰腺囊肿，胰液细胞学检查高度提示为腺癌。行远端胰腺切除术和脾切除术。胰腺囊肿的组织病理学诊断为黏液性囊腺瘤。胰腺囊肿近端2 cm处的小胰管显示原位癌。这两例胰腺原位癌的诊断线索是在对已知胃癌和肝癌进行超声和CT检查时发现的胰腺囊性病变。胰液细胞学检查也显示恶性。由于两个病变的位置不同和组织病理学性质不同，发现胰腺原位癌与囊肿无关。
