Intraductal tubular carcinoma in an adenoma of the main pancreatic duct of the pancreas head
Intraductal tubular carcinoma in an adenoma of the main pancreatic duct of the pancreas head
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DOI：
10.1007/s00535-006-1821-2
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发表时间：
2006-06-01
影响因子：
6.3
通讯作者：
Kosuge, Tomoo
中科院分区：
文献类型：
--
作者：
Itatsu, Keita;Sano, Tsuyoshi;Kosuge, Tomoo
一位50岁女性，因间歇性腹泻及上腹痛就诊。实验室数据显示血清淀粉酶和弹性蛋白酶-I水平升高。进一步的影像学研究显示，胰头的主胰管（MPD）中有一个小的、边界清楚的结节性病变（直径8 mm），无粘蛋白高分泌，随后远端主胰管扩张。进行保留幽门的胰管切除术和区域淋巴结切除术。显微镜下，肿瘤是一个管内管状癌（ITC）的管状腺瘤，这表明直接的组织学证据的腺瘤-癌序列的管内管状肿瘤，不同于以前的报告ITCs描述的新生样发展。ITC患者的预后有时是令人沮丧的，因此，早期发现和适当的手术切除是强制性的，以实现ITC患者的长期生存。MPD扩张是早期发现胰腺微小肿瘤的重要标志和线索。
A 50-year-old woman presented with intermittent diarrhea and upper abdominal pain. Laboratory data showed elevated serum amylase and elastase-I levels. Further image studies revealed a small, well-defined nodular lesion (8 mm in diameter) without mucin hypersecretion in the main pancreatic duct (MPD) of the pancreatic head and subsequent dilatation of the distal main pancreatic duct. A pylorus-preserving pancreatoduodenectomy with regional lymphadenectomy was performed. Microscopically, the tumor was an intraductal tubular carcinoma (ITC) in a tubular adenoma, suggesting direct histologic evidence of the adenoma-carcinoma sequence in intraductal tubular tumors, differing from previous reports of ITCs describing de novo-like development. The prognosis for ITC patients is sometimes dismal; therefore, early detection and appropriate surgical resection are mandatory to achieve long-term survival in ITC patients. MPD dilatation is a crucial sign and clue enabling the early detection of tiny pancreatic tumors.