Pleomorphic carcinoma of the pancreas: reappraisal of surgical resection
Pleomorphic carcinoma of the pancreas: reappraisal of surgical resection
复制标题
胰腺多形性癌：手术切除的重新评估
DOI：
10.1111/j.1572-0241.1998.351_e.x
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发表时间：
1998
影响因子：
9.8
通讯作者：
M. Tanaka
中科院分区：
文献类型：
--
作者：
K. Yamaguchi;K. Nakamura;S. Shimizu;K. Yokohata;T. Morisaki;K. Chijiiwa;M. Tanaka
摘要多形性癌是胰脏外分泌癌的一种罕见变异。本文旨在重新评价胰腺多形性癌的手术切除。回顾了4例日本多形性胰腺癌患者的临床病理学表现，并与24例日本胰腺腺癌患者进行了比较，以阐明多形性癌可能的手术意义。4例患者中，3例为女性，1例为男性，年龄分别为64岁、65岁、66岁和74岁。两个癌位于胰腺的头部，一个在体部，另一个在尾部。超声检查显示一个边界清晰的低回声肿块，大小为5-10 cm，所有患者的中心坏死区。电脑断层显示一低密度肿瘤，边缘锐利，内部结构不均匀。在血管造影上，三个肿瘤是血供丰富，另一个是血供不足。所有患者均观察到广泛的血管包裹。2例行胰管切除术，2例行胰体尾切除术。2例患者在手术切除后1个月发生多发性肝转移，1例在1个月和另1例在2个月局部复发，导致胰腺切除术后2个月（2例患者）或3个月（2例患者）死亡。4例多形性胰腺癌和24例胰腺腺癌的显著鉴别特征是平均直径（6.6 ± 1.3 cm vs 3.5 ± 0.3 cm，p= 0.0007），肿瘤边缘（4种多形性癌中的扩张性与24种腺癌中的21种中的浸润性，p= 0.003）和血管造影显示的血管分布（4种多形性癌中3种血管过多，23种腺癌中21种血管过少，p= 0.013）。4例多形性癌患者的1年和3年生存率分别为0%和0%，而24例胰腺腺癌患者的1年和3年生存率分别为42%和13%（p < 0.0001）。这些结果表明，临床过程中的多形性胰腺癌患者是如此之差，即使在手术切除，多形性胰腺癌是不是一个候选人，胰腺切除术，尽管其局部扩张性增长。
Pleomorphic carcinoma is a rare variant of pancreatic exocrine carcinoma. The aim of this communication is to reappraise surgical resection of pleomorphic carcinoma of the pancreas. Clinicopathological findings of four Japanese patients with pleomorphic carcinoma of the pancreas were reviewed and compared with those of 24 Japanese patients with adenocarcinoma of the pancreas to clarify possible surgical implications of pleomorphic carcinoma. Of the four patients, three were female and one male, aged 64, 65, 66, and 74 yr, respectively. Two carcinomas were located in the head of the pancreas, one in the body, and the other in the tail. Ultrasonography demonstrated a well defined hypoechoic mass measuring 5–10 cm, with central necrotic area in all of the patients. Computed tomography showed a low density tumor with sharp margin and heterogenous internal structure in all. On angiography, three tumors were hypervascular and another was hypovascular. Extensive vascular encasement was observed in all. Pancreatoduodenectomy was done in two patients and distal pancreatectomy in the other two. Multiple liver metastases occurred 1 month after surgical resection in two patients and local recurrence 1 month in one and 2 months in the other, leading to death either 2 (2 patients) or 3 months (2 patients) after pancreatectomy. Significantly differentiating features of the four pleomorphic carcinomas of the pancreas and the 24 adenocarcinomas of the pancreas were the mean diameter (6.6 ± 1.3 cm vs 3.5 ± 0.3 cm, p= 0.0007), margin of the tumor (expansive in the four pleomorphic carcinomas versus infiltrative in 21 of the 24 adenocarcinomas, p= 0.003) and vascularity on angiography (hypervascular in three of the four pleomorphic carcinomas versus hypovascular in 21 of the 23 adenocarcinomas, p= 0.013). The 1-yr and 3-yr survival rates of the four patients with pleomorphic carcinoma were 0% and 0%, whereas those of the 24 patients with adenocarcinoma of the pancreas were 42% and 13%, respectively (p < 0.0001). These findings suggest that the clinical course of patients with pleomorphic carcinoma of the pancreas is so poor even after surgical resection that pleomorphic carcinoma of the pancreas is not a candidate for pancreatectomy despite its locally expansive growth.