Origuchi N, Kimura W, Muto T, Esaki Y
First Department of Surgery, Faculty of Medicine, The University of Tokyo, Japan.
Surg Today. 1998;28(12):1261-5. doi: 10.1007/BF02482811.
We present an autopsy case of an 83-year-old Japanese man with a mucin-producing adenocarcinoma accompanied by pancreatolithiasis in the head of the pancreas. He suffered from obstructive jaundice and died of disseminated intravascular coagulation. He did not normally drink alcohol and had no history of chronic pancreatitis. The autopsy findings revealed a mucinous cystic tumor, composed of multiple dilatated branches, in the head of the pancreas. Histological examinations showed papillary adenocarcinoma, which scirrhously infiltrated the distal common bile duct with perineural invasion and lymph node involvement. He was thus diagnosed to have mucin-producing branch-type cancer in the head of the pancreas. The main pancreatic duct was dilated, and the residual pancreatic tissue showed moderate fibrosis and parenchymal atrophy. A stone was observed in a dilated branch of the primary lesion. To the best of our knowledge, there have only been five previously reported cases of mucin-producing tumor associated with pancreatolithiasis. Intraductal calcification is a major characteristic of chronic pancreatitis, but it is clinically important not to misdiagnose cancers associated with pancreatolithiasis such as chronic pancreatitis.
我们报告一例83岁日本男性尸检病例，其胰腺头部有产生黏液的腺癌并伴有胰石症。他患有梗阻性黄疸，死于弥散性血管内凝血。他平时不饮酒，无慢性胰腺炎病史。尸检结果显示胰腺头部有一个黏液性囊性肿瘤，由多个扩张的分支组成。组织学检查显示为乳头状腺癌，呈硬结状浸润远端胆总管，伴有神经周围侵犯和淋巴结受累。因此，他被诊断为胰腺头部产生黏液的分支型癌。主胰管扩张，残余胰腺组织显示中度纤维化和实质萎缩。在原发病变的一个扩张分支中观察到结石。据我们所知，此前仅有5例与胰石症相关的产生黏液肿瘤的报道。导管内钙化是慢性胰腺炎的主要特征，但临床上重要的是不要将与胰石症相关的癌症误诊为慢性胰腺炎。
