Ochi K, Hasuoka H, Mizushima T, Matsumura N, Harada H
Department of Laboratory Medicine, Okayama University Medical School, Japan.
Am J Gastroenterol. 1998 Aug;93(8):1366-8. doi: 10.1111/j.1572-0241.1998.419_W.x.
We report a 74-yr-old woman who was referred to our hospital because of abdominal fullness. ERP showed a questionable irregularity of the main pancreatic duct at the body. Examination of pure pancreatic juice was positive for K-ras point mutation at codon 12 and negative for cytology. Because neither US nor CT showed apparent lesions in the pancreas, we decided to follow up the patient with serial ERP and pure pancreatic juice studies at 3-month intervals. No changes had been seen up to 18 months later, when cytology was conclusive for malignancy with an apparent stenosis of the main pancreatic duct at the body. Distal pancreatectomy with splenectomy was performed. A round mass, 12 mm in diameter, was found in the body, which proved to be an adenocarcinoma at histological examination. No extrapancreatic extension and metastases were noted. Although positive K-ras point mutation has been reported in some cases of adenoma or mucinous cell hyperplasia of the pancreas and chronic pancreatitis, our case, along with previous reports, indicated the importance of testing K-ras point mutation in pure pancreatic juices for the diagnosis of pancreatic cancer at an early stage.
我们报告了一位74岁的女性，她因腹部饱胀被转诊至我院。内镜逆行胰胆管造影（ERP）显示胰体部主胰管有可疑的不规则改变。纯胰液检查显示第12密码子的K-ras点突变呈阳性，细胞学检查呈阴性。由于超声（US）和计算机断层扫描（CT）均未显示胰腺有明显病变，我们决定每3个月对患者进行一次系列ERP和纯胰液检查以进行随访。直至18个月后均未见变化，此时细胞学检查确诊为恶性肿瘤，胰体部主胰管明显狭窄。遂行远端胰腺切除术加脾切除术。在胰体部发现一个直径12毫米的圆形肿块，组织学检查证实为腺癌。未发现胰外侵犯和转移。尽管在胰腺腺瘤或黏液细胞增生以及慢性胰腺炎的某些病例中已报道有K-ras点突变阳性，但我们的病例以及先前的报道均表明，检测纯胰液中的K-ras点突变对于早期诊断胰腺癌具有重要意义。
