Microinvasion of high-grade pancreatic intraepithelial neoplasia.
Microinvasion of high-grade pancreatic intraepithelial neoplasia.
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DOI：
10.1159/000346693
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发表时间：
2013-01
影响因子：
0.6
通讯作者：
Tomita Y
中科院分区：
文献类型：
--
作者：
Kawada N;Uehara H;Takada R;Yamai T;Fukutake N;Katayama K;Takenaka A;Nagata S;Tomita Y
高级别胰腺上皮内瘤变（PanIN-3）被认为是浸润性导管癌（IDC）的前驱病变。然而，尚未获得PanIN-3侵入胰腺导管上皮基底膜之外（即PanIN-3变为IDC的时刻）的组织学证据。这可能是因为PanIN是显微镜下的乳头状或扁平病变，很少出现临床症状，并且在影像学检查中无法检测到。另一方面，大多数IDCs被发现在晚期与大规模入侵。在该报告中，PanIN-3阻塞了几个分支胰管，随后引起胰腺炎，其出现临床症状，并在成像研究中可检测为胰腺肿块。一位65岁的女性被转介到我们的机构，进一步检查她的反复胰腺炎。腹部超音波显示胰脏体部有一直径13毫米的低回声肿块，但主胰管（MPD）上游无扩张。内窥镜逆行胰管造影显示胰体部MPD中有一个长度为2 mm的狭窄段。胰液细胞学检查显示为腺癌，并进行了胰尾切除术。切除的标本显示胰体中有一直径15 mm的白色肿块，经组织学检查确定为胰腺炎。PanIN-3的乳头状生长主要见于分支导管。每个PanIN-3分别位于分支导管中，在它们之间的MPD中具有正常上皮。在三个相邻的分支导管中，显微镜下观察到PanIN-3侵入基底膜之外。
High-grade pancreatic intraepithelial neoplasia (PanIN-3) is recognized as a precursor lesion of invasive ductal carcinoma (IDC). However, histological evidence that PanIN-3 invades beyond the basement membrane of pancreatic ductal epithelium, that is, the moment PanIN-3 becomes IDC, has not been captured yet. This may be because PanINs which are microscopic papillary or flat lesion rarely develop clinical symptoms and are not detectable on imaging examination. On the other hand, most IDCs were found in the advanced stage with massive invasion. In this report, PanIN-3 obstructed several branch pancreatic ducts and subsequently caused pancreatitis which developed clinical symptom and was detectable as a pancreatic mass in imaging studies. A 65-year-old woman was referred to our institution for further examination of her repeated pancreatitis. Abdominal ultrasound revealed a low echoic mass of 13 mm in diameter in the pancreatic body without upstream dilatation of the main pancreatic duct (MPD). Endoscopic retrograde pancreatography showed a strictured segment of 2 mm in length in the MPD at the pancreatic body. Cytological examination of pancreatic juice revealed adenocarcinoma and distal pancreatectomy was performed. A resected specimen revealed a whitish mass of 15 mm in diameter in the pancreatic body, which was identified as pancreatitis by histological examination. Papillary growth of PanIN-3 was seen mainly in the branch ducts. Each PanIN-3 was located separately in the branch ducts with normal epithelia in the MPD between them. In three adjacent branch ducts, PanIN-3 was observed to be invading microscopically beyond the basement membrane.