Intraductal dissemination of papillary adenocarcinoma of the
Intraductal dissemination of papillary adenocarcinoma of the
复制标题
乳头状腺癌导管内播散
DOI：
10.1111/pin.12131
复制
发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Kanai
中科院分区：
文献类型：
--
作者：
Matsubara A;Nara S;Sekine S;Ojima H;Kosuge T;Shimada K;Kushima R;Kanai
据推测，经胰管、胆管或乳腺管的导管内播散是一种独特的癌细胞扩散形式。然而，缺乏证实这种传播形式的临床证据。在此，我们报告一例壶腹乳头状腺癌，其中强烈建议逆行播散到胰管。一名79岁的女性因壶腹22毫米的微创乳头状腺癌接受了胰十二指肠切除术。在远离壶腹的胰管内发现多发癌灶。7个月后，她接受了胰脏-空肠吻合口复发性乳头状腺癌的第二次手术，显示外生性和扩张性生长进入空肠管腔，并与胰腺体导管内腺癌相连。这些肿瘤均未表现出侵袭性生长，或血管或神经侵犯，它们彼此独立，但具有相同的组织学、免疫组织化学和分子特征；乳头状生长，胰胆表型，基因组杂合性缺失的相同模式，以及kras，TP53和gnas基因无突变。这些结果提示壶腹乳头状腺癌已逆行播散到胰管，并在残余胰腺复发。
It has been speculated that intraductal dissemination, via the pancreatic duct, bile duct, or mammary duct, is a unique form of cancer cell spread. However, clinical evidence to confirm this form of dissemination has been lacking. Here we report a case of papillary adenocarcinoma of the ampulla of Vater in which retrograde dissemination to the pancreatic duct was strongly suggested. A 79‐year‐old woman underwent pancreatoduodenectomy for a 22 mm microinvasive papillary adenocarcinoma of the ampulla. Multiple carcinomasin situwere found in the pancreatic duct distant from the ampulla. Seven months later, she underwent a second operation for a recurrent papillary adenocarcinoma at the pancreato‐jejunal anastomosis showing exophytic and expansive growth into the jejunal lumen that connected to an intraductal adenocarcinoma in the pancreatic body. None of these tumors showed invasive growth, or vascular or neural invasion, being separate from each other but sharing identical histological, immunohistochemical, and molecular features; papillary growth, a pancreatobiliary phenotype, the same pattern of genomic loss of heterozygosity, and no mutation of theKRAS,TP53, andGNASgenes. These results imply that this papillary adenocarcinoma of the ampulla of Vater had disseminated to the pancreatic duct in a retrograde manner and recurred in the remnant pancreas.