Long-term follow-up after intensity-modulated radiation therapy in extramedullary plasmacytoma of pancreas: a case report

胰臟髓外漿細胞瘤接受強度調控放射線治療後的長期追蹤：病例報告

林佳輝(Chia-Hui Lin) ； 林立青(Li-Ching Lin) ； 郭珍妮(Jenny Que)

《放射治療與腫瘤學》 24卷3期 (2017/09) Pp. 247-254

https://doi.org/10.6316/TRO/201724(3)247

摘要

Extramedullary plasmacytoma (EMP) of the pancreas is very rare. Obstructive jaundice is by far the commonest symptom, followed by abdominal pain. About 80% of pancreatic EMPs are located in the head of the pancreas, whilst the remaining 20% are found in the body and/or the tail of the organ. The computed tomography (CT) appearance of pancreatic EMP is typically described as a multilobular solid hypodense mass with homogeneous intravenous contrast enhancement. Endoscopic ultrasonography (EUS)-fine needle aspiration (FNA) has been proven as the most effective means for making a definitive cytological diagnosis of a pancreatic mass. To date, a standardized treatment for EMPs of the pancreas has not been established. Radiotherapy, chemotherapy, and bypass procedures either alone or in combination have been described. Owing to the highly radiosensitive nature of plasma cell tumors, radiotherapy has been suggested as the treatment of choice. There is scarce information about results of intensity-modulated radiation therapy (IMRT) for the treatment of EMP of the pancreas. IMRT can deliver adequate target coverage while minimizing the dose to critical organs. We report a case of EMP of the pancreas treated with IMRT. Our patient remains alive and without recurrence at long-term follow-up (more than five years).

關鍵字

Extramedullary plasmacytoma ； Pancreas ； Intensity-modulated radiation therapy (IMRT)

並列摘要

胰臟髓外漿細胞瘤非常的罕見。最常見的臨床症狀是阻塞性黃疸，第二常見的症狀是腹痛。胰臟髓外漿細胞瘤有百分之八十位於胰臟頭部，另外百分之二十位於胰臟體與胰臟尾部。胰臟髓外漿細胞瘤在電腦斷層攝影裡的特徵是多葉實質低密度腫瘤，經靜脈注射顯影劑後會有均質顯影增強。藉由內視鏡超音波指引細針抽吸技術被證實是用來獲得胰臟腫瘤細胞學確切診斷最有效的方法。至今胰臟髓外漿細胞瘤仍然沒有一個標準的治療方針。放射線治療、化學治療與繞道手術，單獨或合併使用都曾經被報告過。由於漿細胞瘤對放射線相當敏感，因此有被建議是可用來治療漿細胞瘤的選項。強度調控放射線治療被用來治療胰臟髓外漿細胞瘤的相關資料非常稀少。強度調控放射線治療可以把腫瘤包覆的很好，也可把周圍重要器官的放射線劑量降到最低。我們報告一個胰臟髓外漿細胞瘤的個案，是採用強度調控放射線治療。這位病患治療後經過五年以上的長期追蹤，仍然存活且沒有復發的現象。

並列關鍵字

髓外漿細胞瘤 ； 胰臟 ； 強度調控放射線治療