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Pseudotumorous Pancreatitis-Sonographic Presentations
偽腫瘤性胰臟炎－超音波的表徵
摘要
偽腫瘤性胰臟炎屬於慢性胰臟炎的一種少見類型，通常為反覆發作，無鈣化的慢性胰臟炎，在型態上與胰臟腫瘤十分相似。手術前的診斷十分重要，但是通常無法做到。 本文收集10個偽腫瘤性胰臟炎的病例，回溯性的分析其超音波影像表現，並扼要描述其電腦斷層掃瞄（8例）和內視鏡逆行性膽胰道造影（5例）的結果。這10個病例中，有9例的胰臟腫塊位於胰臟頭部，1例位於胰臟尾部。其中大部份的腫塊皆呈現低回音區(8/10)。有1例的胰頭腫塊內可見鈣化。胰頭部腫塊伴隨胰管擴張的現象可見於5個病例，而腫塊呈現不規則突出狀的現象則見於2個病例。所有病例的最後診斷皆是慢性胰臟炎，其中8例接受剖腹探查，而經由病理證實，2例接受長期臨床追蹤而確定。 偽腫瘤性胰臟炎確實造成診斷及治療的困擾。絕大多數病例的超音波影像與胰臟惡性腫瘤無法區分。因此，病人常因為”可切除的胰臟腫瘤”的診斷而接受原可避免的手術。雖然，已有文獻報告超音波是診斷率最高的非介入性檢查，但為了要獲得手術前的確切診斷，進一步結合臨床表徵、影像學發現及生化學檢查結果的研究，仍是有待努力的方向。
並列摘要
Pseudotumorous pancreatitis is an unusual variety of chronic pancreatitis. It can be defined as a chronic, usually relapsing and noncalcifying, pancreatitis which resembles pancreatic neoplasia. It is of great importance to differentiate these two diseases before operation although always impossible. In this study, we retrospectively ananlyzed the sonographic features of 10 cases of pseudotumorous pancreatitis. Other radiologic studies, such as CT scan and endoscopic retrograde cholangiopancreaticography, were briefly presented. They all revealed focal masses in the pancreas: 9 in the pancreatic head and 1 in the tail. The echotexture of these focal masses were mostly hypoechoic (8/10). Pancreatic head mass associated with dilatation of the main pancreatic duct, the so-called binomial sign for diagnosis of pancreatic cancer, was seen in 5 cases. Lobulation and irregular contour, also signs of pancreatic cancer, were noted in 2 cases. Chronic pancreatitis was diagnosed in all cases either by laparotomy and histologic confirmation (8/10) or long-term follow-up (2/10). Pseudotumorous pancreatitis presents a considerable problem of diagnosis and management. Its sonographic pictures are indistinguishable from those of pancreatic carcinoma in most cases. Most of the patients receive laparotomy under the impression of resectable pancreatic tumor. Ultrasonography is a non-invasive test with the highest rate of correct diagnosis. Further research for obtaining definite non-operative diagnosis is necessary.