A case of high‐grade pancreatic intraepithelial neoplasia concomitant with type 1 autoimmune pancreatitis: The process underlying both conditions
A case of high‐grade pancreatic intraepithelial neoplasia concomitant with type 1 autoimmune pancreatitis: The process underlying both conditions
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伴有 1 型自身免疫性胰腺炎的高级别胰腺上皮内瘤变一例：这两种情况的潜在过程
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
N. Nakamura
中科院分区：
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作者：
Tomoko Sugiyama;Takuma Tajiri;Shinichiro Hiraiwa;Tomohisa Machida;Hiroyuki Ito;H. Yoshii;Hideki Izumi;E. Nomura;M. Mukai;N. Nakamura
我们报告一例高级别胰腺上皮内瘤变（PanIN）伴发淋巴浆细胞硬化性胰腺炎。患者为一名82岁男性，通过腹部超声检查偶然发现主胰管狭窄。磁共振胰胆管造影进一步显示从胰体到胰尾的胰管突然变窄和远端扩张。在术前诊断为导管内乳头状粘液性肿瘤的情况下进行了远端胰腺切除术。手术标本的肉眼检查显示边界不清的白色-灰色区域和明显的胰腺萎缩，而组织学分析检测到主胰管和一些分支管的小（直径<5 mm）囊性扩张以及胰腺萎缩伴纤维化和腺泡细胞脂肪替代。我们还检测到不同大小的乳头状突起、融合的腺体和柱状导管上皮的散在局灶性乳头状增生，包括具有细长、轻度深染核的细胞，与高级别PanIN一致。此外，我们观察到明显的淋巴浆细胞浸润，导管周围的故事状纤维化，闭塞性静脉炎。免疫组织化学染色显示大量免疫球蛋白G4阳性浆细胞，提示1型自身免疫性胰腺炎（AIP）。高级别PanIN和显著的淋巴浆细胞浸润（AIP的典型特征）的共存表明前者作为致癌过程与后者作为免疫反应之间存在密切关联。
We report a case of high‐grade pancreatic intraepithelial neoplasia (PanIN) concomitant with lymphoplasmacytic sclerosing pancreatitis. The patient was an 82‐year‐old man in whom narrowing of the main pancreatic duct was detected incidentally by abdominal ultrasonography. Magnetic resonance cholangiopancreatography further revealed abrupt narrowing plus distal dilatation of the duct, from the pancreatic body to the tail. Distal pancreatectomy was performed under a preoperative diagnosis of intraductal papillary‐mucinous neoplasm. Macroscopic examination of the surgical specimen showed an ill‐demarcated, white‐gray area and prominent pancreatic atrophy, while histological analysis detected small (<5 mm in diameter) cystic dilatations of the main pancreatic duct and some branch ducts plus pancreatic atrophy with fibrosis and fatty replacement of acinar cells. We also detected variously sized papillary projections, fused glands, and scattered focal papillary proliferation of columnar ductal epithelium comprising cells with elongated, mildly hyperchromatic nuclei, consistent with high‐grade PanIN. In addition, we observed marked lymphoplasmacytic infiltration, periductal storiform fibrosis, and obliterative phlebitis. Immunohistochemical staining revealed abundant immunogloblin G4‐positive plasma cells, indicative of type 1 autoimmune pancreatitis (AIP). The coexistence of high‐grade PanIN and marked lymphoplasmacytic infiltration, typical of AIP, point to a close association between the former, as a carcinogenic process, and the latter, as an immune response.