胰腺导管内乳头状黏液肿瘤的CT诊断

目的 探讨胰腺导管内乳头状黏液肿瘤的CT和MRI表现,分析其诊断要点。方法 回顾性分析12例经手术切除和病理学证实的胰腺导管内乳头状黏液肿瘤的临床、CT和MRI资料。结果 （1）分支胰管型7例,均位于胰头和钩突,CT和MRI主要表现为分叶状或葡萄串样囊性病变,其间可见分隔,增强后囊性区域无强化,囊壁和分隔可强化。（2）混合型5例,4例为胰头或钩突分支胰管扩张合并主胰管扩张;1例同时伴有胰体分支胰管扩张,扩张的主胰管直径为4～7mm。（3）该病多发于老年人,临床主要表现为腹痛和胰腺炎。结论 胰腺导管内乳头状黏液肿瘤有相对特征性的影像学表现,CT和MRI对其诊断有重要价值。     

A case of pancreatic acinar cell carcinoma with a giant liver metastasis successfully treated with combination of gemcitabine and peroral S-1

Pancreatic acinar cell carcinoma is rare, and its incidence is less than 1% of all the malignant pancreatic tumors. Little is reported on effectiveness of chemotherapy. We report a 64-year-old male patient with pancreatic acinar cell carcinoma and a giant metastatic liver tumor, which responded to combination chemotherapy with gemcitabine(GEM)and peroral S-1 administration. The patient had upper abdominal pain and hypervascular tumors in liver(15 cm in diameter)and pancreas tail (3 cm in diameter), which were detected by an enhanced abdominal computed tomography(CT)scan, and was admitted for further examination. Abdominal angiography, FDG-positron emission tomography(PET), and liver tumor biopsy led to a diagnosis of pancreatic acinar cell carcinoma in the pancreas tail with liver metastasis. The patient was then treated with combination chemotherapy, which consisted of intravenous infusion of GEM and peroral administration of S-1, and the metastatic liver tumor was markedly reduced(partial response in RECIST). Although the prognosis of patients with unresectable pancreatic acinar cell cancers is generally unfavorable, it is suggested that the GEM/S- 1 combination chemotherapy is effective for these patients' treatment.     

A Case of Pancreatic Intraepithelial Neoplasia That Was Difficult to Diagnose Preoperatively

A 63-year-old female patient presented to a local physician with pain in her back and epigastric region. An abdominal computed tomography (CT) scan revealed a pancreatic tumor, and the patient was referred to our hospital. Multiple imaging studies that included ultrasonography (US), CT, MRI, and endoscopic US revealed a cystic lesion 3–4 cm in size with node-like projections in the body of the pancreas. The distal main pancreatic duct was also found to be dilated. Endoscopic retrograde pancreatography revealed an irregular stenosis of the main pancreatic duct proximal to the cystic lesion, and malignancy was suspected. The patient was preoperatively diagnosed with pancreatic ductal carcinoma concomitant with intraductal papillary mucinous carcinoma, and a distal pancreatectomy was performed. Rapid pathological diagnosis during surgery revealed positive surgical margins for pancreatic intraepithelial neoplasia (PanIN). Further resection was performed twice, her surgical margin was positive and total pancreatectomy was ultimately conducted. Histopathological findings revealed diffuse microinvasive cancerous lesions corresponding to PanIN-2 (moderate dysplasia) to PanIN-3 (carcinoma in situ) throughout the pancreas. PanIN involves microlesions of the ductal epithelium that may precede pancreatic cancer. Ascertaining changes in PanIN using images provided by diagnostic modalities such as CT and US is challenging. Ductal stenosis and distal cystic lesions resulting from atrophy and fibrosis of pancreatic tissue were noted around PanIN. Considering the possibility of PanIN, a precancerous lesion during differential diagnosis will help to improve early detection and prognosis for patients with pancreatic cancer.Key Words: Pancreatic intraepithelial neoplasia, Pancreas cancer, Pancreatic duct stenosis, Pancreatic cyst, Diagnosis     

A case of pancreatic serous cystadenoma obstructing the distal pancreatic duct.

We present a case of resected serous cystadenoma of the pancreas inducing marked dilatation of the main distal pancreatic duct. A 68-year-old woman, previously diagnosed with chronic pancreatitis, presented with upper abdominal pain. Abdominal US revealed a highly echoic mass in the pancreas. A CT scan disclosed a low density mass in the pancreas and dilatation of the main peripheral pancreatic duct. The mass demonstrated homogeneous and high signal intensity on T2-weighted magnetic resonance imaging (MRI). Selective abdominal arteriography showed the mass strained by the celiac artery. The tumor markers were CEA (2.4 ng/ml) and CA19-9 (6.1 U/ml). After the diagnosis of serous cystadenoma of the pancreas, the patient underwent distal pancreatectomy and splenectomy. The tumor (2.5 cm in diameter) consisted of grayish-white nodules and occupied the body of the pancreas. The tail of the pancreas was atrophic. Histopathological examination of the specimen showed a multilocular lesion containing numerous cysts with the inner surfaces evenly lined by one layer of cuboid or flat epithelial cells which stained positive for periodic acid-Schiff (PAS), evidencing serous cystadenoma. The patient is doing quite well one and a half years after the operation.     

Microcarcinoma of the pancreas: report of a case

A 53-year-old man complaining of vertigo initially consulted a nearby hospital. While undergoing a medical examination, which included abdominal ultrasonography and a CT scan, a dilatation of the pancreatic duct was found. The patient was then admitted to our hospital for a more thorough examination. Laboratory findings revealed an elevated elastase-1 level and a DM-pattern of 75 g-OGTT. ERP showed a localized constriction in the main pancreatic duct and diffuse dilatations of the distal main duct. A cytologic examination revealed no malignant cells in the pancreatic juice. Even so, though a carcinoma was not confirmed, a pancreaticoduodenectomy was performed, since a carcinoma of the pancreas head was suspected. A histological examination of the resected specimen uncovered a nonfunctioning islet cell carcinoma, 8 mm in diameter. This case was considered fortunate, in that an early stage pancreatic cancer, adjacent to the main duct, had been detected by imaging diagnoses.     

胰腺导管内黏蛋白性乳头状瘤CT、MRI诊断及鉴别诊断（附6例报告)

目的:探讨胰腺导管内黏蛋白性乳头状瘤CT、MRI表现特点及诊断价值。方法:6例经手术和病理证实的胰腺导管内黏蛋白性乳头状瘤均行CT平扫及增强检查。4例行MRI检查,其中2例行MRI增强扫描。结合文献,回顾性分析其临床表现及CT、MRI征象表现。结果:本组患者主胰管型5例,混合型1例。CT表现:主要表现为胰腺主胰管或分支胰管不规则扩张,呈分叶状囊性表现,其中4例显示壁结节。增强扫描肿瘤实性部分轻度强化。MRI扫描:胰腺导管不规则扩张,T1WI扩张胰管呈均匀低信号,2例扩张囊壁上见结节样隆起呈等信号。T2WI扩张胰管呈高信号,壁结节显示不清。压脂T1WI扫描肿瘤结节显示清楚。增强扫描肿瘤结节中度强化。结论:CT、MRI对胰腺导管内黏蛋白性乳头状瘤的诊断具有重要价值。     

Adenosquamous cell carcinoma arising from the papilla major

A 47-year-old man was admitted to hospital with complaint of general fatigue. Shortly before the admission a suspected obstructive jaundice was diagnosed at a local hospital. On admission, the physical examination was significant for jaundice; total bilirubin was 6.43 mg/dl. The tumor marker CA19-9 was 2056 U/ml. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and showed dilatation of common bile duct and main pancreatic duct, accompanied with an endoscopic naso-biliary drainage (ENBD) in order to reduce the jaundice. The duodenoscopy showed enlarged and deformed papilla. Hypotonic duodenography showed a filling defect at the medial side of the second portion of the duodenum. Ultrasonography (US) showed a hyperechoic lesion, sized 15 mm in diameter, at the pancreas head with dilatation of biliary tract and main pancreatic duct. An abdominal enhanced CT scan showed a mass sized 15 mm at the lower edge of the common bile duct. A selective hepatic arteriography showed no special finding. We performed a pancreatoduodenectomy with dissection of the lymph nodes. The tumor, sized 22x15x20 mm, was white colored and solid on the papilla. Histopathological inspection of the specimen showed an adenosquamous cell carcinoma of the bile duct in the papilla. The tumor was found to infiltrate the neighboring pancreas and to contain metastasis in lymph nodes in the hepatoduodenal ligament, post pancreaticoduodenal and para-aortic lymph nodes. This is the first report on a case of adenosquamous carcinoma of the papilla major.     

Rapid growth of mucinous cystic adenoma of the pancreas following pregnancy

A 25-yr-old woman delivered a healthy child by cesarean section. At 8 mo postpartum, she became aware of an upper abdominal tumor. Abdominal computed tomography and upper abdominal ultrasonography revealed a large cystic mass in the body of the pancreas. Endoscopic retrograde pancreatography showed no connection between the main pancreatic duct and the cystic lesion. The patient underwent tumor resection at 11 mopostpartum. Pathological examination of the tumor revealed mucin-producing columnar epithelial cells lining the cystic wall with ovarian-type stromal tissue and no findings indicative of malignancy, giving a diagnosis of mucinous cystic adenoma of the pancreas. Immunohistochemical studies revealed positive staining for progesterone receptor but not for estrogen receptor in the stromal cell nuclei. Postpartum rapid growth of a benign mucinous cystic neoplasm might be linked to the production of female sex hormones during lactation.     

Biliopancreatic fistula and abscess formation in the bursa omentalis associated with intraductal papillary mucinous cancer of the pancreas

We describe an unusual case of biliopancreatic fistula, free perforation, and subsequent abscess formation within the lesser peritoneal sac associated with intraductal papillary mucinous carcinoma (IPMC). A 71-year-old man presented with general fatigue and loss of appetite that had persisted for 1 month. Abdominal computed tomography (CT) revealed findings consistent with an intraductal papillary mucinous neoplasm (IPMN) of the pancreas, accompanied by abscess formation in the bursa omentalis. Gastrointestinal fiberscopy revealed a swollen papilla of Vater expanded by sticky mucus, and a communication between the pancreatic duct and bile duct was demonstrated by the injection of indigo carmine solution into the pancreatic duct. Percutaneous transhepatic abscess drainage (PTAD) was performed on the day of admission. After this procedure, the patient was managed for 1 month and supported nutritionally with glycemic control for diabetes mellitus. After admission, the patient had an episode of obstructive jaundice that was treated by retrograde biliary drainage. Pancreaticoduodenectomy with lymph node dissection was then performed. Pathological examination revealed IPMN with patchy, scattered carcinoma of the pancreatic head and uncinate process with the formation of a biliopancreatic fistula. Bile duct epithelium in the area of the biliopancreatic fistula demonstrated atypical papillary epithelium suggestive of tumor invasion.     

胰腺癌多层螺旋CT影像学表现

目的分析胰腺癌的多层螺旋cT影像学表现。方法对66例胰腺癌患者行多层螺旋CT多期容积扫描并薄层重建,分析肿瘤分布、形态、大小、密度、CT增强表现、与周围血管的关系、周围脂肪受侵情况、淋巴结及其他脏器转移情况。结果肿瘤分布于胰腺头及钩突27例,颈部12例,体部19例,尾部10例。肿瘤大小为1．0—3．0cm12例,3．0cm以上54例。63例形态不规则。平扫低密度14例,等密度50例,高密度0例,混合密度2例。动脉期无强化49例,中等度强化15例,明显强化2例。门静脉期轻度强化13例,中等度强化且强化不均匀63例。45例胰腺导管扩张,21例胰腺导管无扩张。57例胰腺周围脂肪间隙不清楚。胰腺周围、腹腔、腹膜后淋巴结转移有无转移33例,无转移33例。39例患者发生肝脏、肺等远处脏器转移。61例不同程度累及胰周血管。结论胰腺癌的多层螺旋CT表现为：肿瘤常分布于胰头及钩突,形态不规则,多数大于3．0cm,胰腺导管扩张常见,平扫大多数为等密度,增强动脉期多数为无强化,门静脉期轻中度强化,周围脂肪间隙及胰周血管多受累。     

Pancreatic carcinoma coexistent with pancreatic pseudocyst which penetrated into the stomach

We report a case of pancreatic adenocarcinoma coexisting with a pancreatic pseudocyst, which showed gradual disappearance during preoperative examinations. The patient, an 83-year-old woman, had upper abdominal and back pain, and abdominal computed tomography (CT), on December 6, 1997, revealed an 11.0 ≧ 5.8 cm cystic mass in the pancreas. On December 11, abdominal magnetic resonance imaging showed that the cyst had reduced in size to 3.8 ≧ 2.4 cm, and was enveloped in a large solid tumor. Repeat abdominal CT, on January 5, 1998, showed disappearance of the cystic lesion, while an obvious pancreatic tumor had invaded the posterior wall of the stomach and the left adrenal gland. Distal pancreatectomy combined with total gastrectomy and left adrenal glandectomy were performed on January 7, 1998. Histological examination revealed a moderately differentiated ductal adenocarcinoma with an abscess in the tumor, which had developed a fistula to the ulceration of the stomach. The large cyst presented on admission seemed to have penetrated into the stomach, and had disappeared within 1 month. Received: June 28, 1999 / Accepted: February 28, 2000     

胰管内黏液乳头状瘤的MSCT和MRCP表现

Objective:To study the multi-slice CT(MSCT) and magnetic resonance cholangio-pancreatography(MRCP) features of intraductal papillary mucinous tumor(IPMT) of the pancreas.Methods:The clinical information,laboratory val-ues,imaging features and pathological findings of 8 cases were reviewed.Results:There were 6 males and 2 females with average 71.3 years old in this series.These lesions involved pancreatic branch ducts or main duct.Among them,2 cases were involved in the pancreatic uncinate process,1 case in the pancreatic head,1 in the pancreatic body,2 in the pancreatic tail and 2 cases involved multiple pancreatic duct.The common complaint was chronic upper abdominal pain.The imaging features included cystic lesion and it's association with the dilated pancreatic main duct,and bulging of the duodenal papilla.Mucin plug,septa or mural nodule were found in these cystic lesions.5 cases were confirmed with endoscopic retrograde cholangio-pancreatography(ERCP).3 cases had undergone surgery.Pathological findings of the 3 cases were adenoma,adenocarcinoma and borderline tumor,respectively.Conclusion:The MSCT and MRCP features of IPMT are somewhat characteristic,and the correct diagnosis can be made with the combination of clinical features.Diameter of branch duct ≥ 3 cm with multiple or large mural nodules,or severe dilated main duct indicates the probability of malignant IPMT.     

A case of intraductal mucinous neoplasms with the whole main pancreatic duct dilation treated via segment pancreatectomy

The patient was a 77-year-old woman. She was diagnosed as intraducal papillary mucinous neoplasms (IPMN). She refused an operation for 3 years. After all, a nodule in the main pancreatic duct was pointed out, she agreed and was referred to us. Her past history showed pacemaker implantation for third-degree atrioventricular block, and no impaired glucose tolerance. Abdominal CT showed a dilated whole pancreatic duct and a multilocular cystic tumor. Endoscopic retrograde pancreatography showed a marked dilation of the main pancreatic duct. We diagnosed as main duct IPMN. Intraoperative US showed no nodule in pancreatic duct, and there was no suspicious lesion of invasive cancer. We performed segmental pancreatectomy between the left side of common bile duct and the pancreas tail. The tumor was resected with clear margins. Both cut-ends of the main pancreatic duct were anastomosed to a jejunal loop. The postoperative course was excellent. She was discharged on day 16. The glycemic control was good, she needed no treatment for diabetes. Total pancreatectomy has many problems such as insulin and pancreatic polypeptide deficiency, hypoglycemia, malabsorption, diarrhea and liver dysfunction. We avoided total pancreatectomy so that her quality of life was maintained. Still a careful follow -up is required.     

胰腺癌多层螺旋CT诊断的研究进展

胰腺癌是最常见的原发性胰腺恶性肿瘤。症状没有特异性,一般包括腹痛、黄疸、没有食欲、体重减轻、恶心和呕吐。胰腺癌在CT上多表现为边界不清的含实质成分的肿块并伴有胰管的扩张;肿瘤通常较小,没有钙化;在注射造影剂后,肿块显像的强化程度低于周围正常胰腺实质;肿块为卵圆形、圆形或表现为分叶状,多有局部浸润。这些特点有助于胰腺癌和其他胰腺肿瘤的鉴别诊断。     

肿块型胰腺淋巴瘤的CT诊断及鉴别

目的 分析肿块型胰腺淋巴瘤的CT表现,以提高诊断水平.方法 回顾性分析9例经病理或临床随访证实的肿块型胰腺淋巴瘤的CT和临床资料.结果 9例肿瘤均为单发,位于胰头部5例、颈体部3例、尾部1例;呈不规则分叶状7例,椭圆形2例;最大径约2.3～7.6 cm,平均4.9 cm.CT平扫肿瘤边界欠清,呈等或略低密度,CT值平均36.5 HU.增强扫描动脉期轻度强化,静脉期呈轻或中度持续强化,7例均匀强化,2例强化不均.5例肿瘤包绕邻近血管,类似“血管漂浮征”.所有肿瘤未见钙化,未见明显胰管增宽,2例出现胆总管轻度增宽.腹腔或腹膜后多发肿大淋巴结6例,增强较均匀一致,中等强化.结论 CT对肿块型胰腺淋巴瘤的诊断及鉴别具有较大价值.     

胰腺实性假乳头状瘤:MDCT诊断及鉴别

目的 探讨胰腺实性假乳头状瘤的多排螺旋CT(multi-detector computer tomography,MDCT)诊断价值.方法 回顾性分析11例经手术病理证实的胰腺实性假乳头状瘤的临床资料及MDCT表现.结果 11例临床多表现为上腹部胀痛不适,所有病例均无黄疸.CT表现为胰腺单发囊实性类圆形肿块,最大直径约5.5～13.6 cm,平均8.6 cm;肿瘤位于胰头部3例,胰体部2例,胰尾部6例.平扫肿瘤呈不均匀的较低密度,边界较清,3例肿块内可见钙化;动态增强后肿瘤实性成分呈不均匀的轻至中度进行性强化,弱于正常胰腺组织强化,囊变坏死区无强化,10例见较完整包膜,7例可见肿瘤与胰腺间呈“喇叭口”样界面.所有病例均无胆管及胰管扩张,未见腹腔及腹膜后肿大淋巴结.结论 胰腺实性假乳头状瘤多见于较年轻女性,好发于胰头、尾部,MDCT对其有较大诊断价值.     

Intraductal tubular carcinoma of the pancreas: case report with review of literature

A 67-year-old man presented with leg edema. Laboratory data showed elevated blood glucose and carbohydrate antigen (CA) 19-9 levels, and anemia. Further imaging studies revealed a relatively clear-margined tumor totally occupying the main pancreatic duct (MPD) from the head to the tail of the pancreas (maximum diameter 10 cm) without mucin hypersecretion. Total pancreatectomy with splenectomy and regional lymphadenectomy were performed. Intraductal tubular carcinoma (ITC) was diagnosed by immunohistochemical staining and electron microscopic examination. Previous reports showed that this tumor is characterized by slow growth, with a favorable prognosis and intraductal nodular growth occupying the MPD and no macroscopic mucus. Whether ITC should be distinguished from other types of pancreatic neoplasm is controversial, and the accumulation of more ITC cases and multi-institutional analysis are necessary to establish the diagnostic criteria and characteristics of this histological entity.     

Non-functional pancreatic endocrine carcinoma with multiple liver metastases--a case report

A 60-year-old woman was admitted to our hospital because of upper abdominal discomfort and body weight loss. Abdominal CT showed multiple liver tumors with early enhancement and delayed washout. There were no abnormal findings in other organs. IVR-CT showed hypervascular masses, but it is not a typical tumor staining of HCC. To obtain the diagnosis, we performed laparoscopic partial liver resection in the left lateral segment. Histological examination suggested a primary hepatic carcinoid a tumor. But primary hepatic carcinoid tumor is comparatively rare, so we underwent further examinations. Two months later after the liver resection, the tumor of pancreatic tail was detected by CT and MRI. We could obtain the diagnosis of pancreatic endocrine tumor by EUS-FNA. We conducted a distal pancreatectomy with splenectomy and partial colonic resection. She had no symptom related to neuroendocrinology. The final diagnosis was non-functional endocrine carcinoma of pancreas. After that, we added extended right hepatic lobectomy with radiofrequency ablation in left lobe. The woman remains alive without a recurrence after the surgery.     

胰腺腺泡细胞癌的CT表现

背景与目的：胰腺腺泡细胞癌(acinar cell carcinoma of the pancreas,ACCP)是一种罕见的胰腺恶性肿瘤,相关的影像学报道较少。该研究旨在探讨ACCP的CT表现。方法：收集自2011年1月-2014年1月经手术病理证实为ACCP的9例患者资料,回顾性分析其CT征象。结果：在9例ACCP患者中,肿块最大径均值为52 mm,肿瘤边缘不清的6例(66.7%),外生型生长者有6例(66.7%),强化程度低于正常胰腺组织者8例(88.9%),强化不均者6例(66.7%),累及血管者7例(77.8%),淋巴结转移者5例(55.6%),无出现肝转移病例,仅1例出现胰管扩张。结论：较大体积的乏血供胰腺肿块,内部异质性明显,呈外生型生长而无显著胰管扩张时,提示ACCP的可能。     

胰腺腺鳞癌24例临床诊治分析

目的:探讨胰腺腺鳞癌的临床病理特征及诊治经验。方法:回顾性分析我院2006年12月至2018年11月收治的24例胰腺腺鳞癌患者的临床资料。并进行随访,截止到2019年3月31日,失访2例,失访病人采用截尾数据处理。结果:24例患者中男性16例,女性8例,平均年龄为（60.2±9.2）岁。15例（62.5%）患者因上腹痛、腹胀腹泻就诊,4例（16.7%）患者因皮肤巩膜黄染、皮肤瘙痒就诊,2例（8.3%）患者因腹胀伴腰痛就诊,1例（4.2%）患者因腰背痛就诊,1例（4.2%）患者因黑便乏力就诊,1例（4.2%）患者因体检发现胰腺占位就诊。所有患者术前检查均证实为胰腺占位。超声提示胰腺内见肿物,轮廓不规则,边界欠清晰,肿瘤向周围组织呈蟹足样浸润,内呈低回声不均匀,肿瘤坏死液化呈现无回声区。CT提示胰腺可见不规则低密度灶,边界不清,增强扫描病灶呈弱强化,其强化程度明显低于周围胰腺实质。磁共振提示胰腺可见稍长T1、稍长T2信号肿块,边界模糊,增强扫描弱强化,强化欠均匀。术中明确肿瘤位于胰头及钩突部14例（58.3%）,胰体尾部10例（41.7%）。肿瘤长径平均为5.1 cm（2.3~10 cm）。TNM分期:Ⅰb期8例（33.3%）,Ⅱa期12例（50.0%）,Ⅱb期1例（4.2%）,Ⅲ期3例（12.5%）。所有患者均行手术治疗,行胰十二指肠切除术14例,胰体尾、脾切除术10例。术后随访22例,失访2例,平均生存时间为21.3个月（1~58个月）,随访截止时有8例患者存活。结论:胰腺腺鳞癌是一种罕见的恶性肿瘤,临床表现缺乏特异性,术前影像学表现提示恶性可能,确诊依赖病理学诊断,其具有嗜神经性,手术后结合化疗、放疗仍是目前主要的治疗手段。