Main-duct intraductal papillary mucinous adenoma of the pancreas with a large mural nodule
Main-duct intraductal papillary mucinous adenoma of the pancreas with a large mural nodule
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DOI：
10.1007/s10147-007-0677-7
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发表时间：
2007-10-01
影响因子：
3.3
通讯作者：
Kataoka, Hiroaki
中科院分区：
文献类型：
--
作者：
Nagaike, Koki;Chijiiwa, Kazuo;Kataoka, Hiroaki
导管内乳头状黏液性肿瘤是一种越来越被认识的胰腺良性和恶性肿瘤。术前区分良性和恶性IPMN仍然很困难。据报道，恶性肿瘤的预测因素是主胰管的大小，囊性肿瘤和壁结节。我们在此报告一个50岁女性的病例，在扩张的主胰管（直径16毫米）中发现一个大的壁结节（30毫米），通过超声，计算机断层扫描和内窥镜逆行胰胆管造影术。由于内镜超声检查（EUS）和胰管内超声检查（IDUS）也发现了主胰管的巨大壁结节和扩张，因此认为主胰管IPMN具有恶性潜能。因此，进行保留幽门的胰管切除术和淋巴结清扫术。切除的导管内肿瘤呈息肉状，有一个宽柄，包括增生的含粘蛋白的柱状上皮细胞，乳头状结构，没有恶性特征。最后诊断为胰腺导管内乳头状黏液性腺瘤。在这种情况下，壁结节的大小和最终诊断表明，引入一种新的分子生物学方法可能是必要的主管道IPMN的精确术前诊断和适当的手术治疗。
Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized entity representing a spectrum of benign and malignant neoplasms of the pancreas. Preoperative distinction between benign and malignant IPMNs remains difficult. Reported predictive factors for malignancy are size of the main pancreatic duct, cystic neoplasm, and mural nodule. We report herein the case of a 50-year-old woman in whom a large mural nodule (30mm) in the dilated main pancreatic duct (16mm in diameter) was detected by ultrasonography, computed tomography, and endoscopic retrograde cholangiopancreatography. Because the large mural nodule and dilatation of the main pancreatic duct were also detected by endoscopic ultrasonography (EUS) and intraductal ultrasonography (IDUS), the main-duct IPMN was considered to have malignant potential. Thus, pylorus-preserving pancreaticoduodenectomy with lymph node dissection was performed. The resected intraductal tumor appeared polypoid with a broad stalk and comprised a proliferation of mucin-containing columnar epithelial cells with papillary structures without malignant features. The final diagnosis was intraductal papillary mucinous adenoma of the pancreas. The size of the mural nodule and the final diagnosis in this case suggest that the introduction of a novel molecular-biological approach might be necessary for the precise preoperative diagnosis of main-duct IPMN and adequate surgical treatment.