- 期刊
Mucinous Cystic Neoplasm of the Pancreas: Cysto-Ductectatic Variant Type in a Chinese Patient
黏液性胰臟囊狀腫瘤：囊狀胰管擴張型－病例報告
摘要
胰臟囊狀腫瘤，約佔所有胰臟腫瘤的百分之五以下，其中又以黏液性囊狀腫瘤佔了最大的比例。黏液性胰臟腫瘤的分類在最近拾年間相當的混淆不清，其中漸被大家所接受的就是所謂黏液分泌過剩型胰臟腫瘤（癌）[Mucin-Hypersecreting Neoplasm of the Pancreas, MHNP]。MHNP細分成三大型：MHNP第一型是胰管擴張型，又稱主胰管型。第二型為囊狀胰管擴張型，又稱胰管分枝型。第三型即是Compagno等所敘述的囊狀型，又稱外圍型，是最常見的一型。本文報告一例較罕見的MHNP第二型，病人為一70歲之男性，主訴是脂肪便及在二年內體重減輕達15公斤。後經腹部超音波發現在胰頭部位有一巨大之囊狀病灶，並與擴張之主胰管相連，再經逆行性膽胰道攝影術及腹部電腦斷層掃描確定，遂診斷為MHNP第二型。病人後來接受modified Whipple's手術，術後診斷與病理報告都與術前判斷相符。第二型MHNP並不常見，報告最多的是日本人，本例為中國人之首例。本文將就本病例之臨床特點、診斷要領以及分類等提出討論。
並列摘要
A case of mucin-hypersecreting neoplasm of the pancreas (MHNP) of cystoductectatic type (type II) in a 70-year-old Chinese man is presented. Preoperative diagnosis was made with modern imaging modalities, which revealed a cystic lesion communicating with the diffusely dilated main pancreatic duct in the region of the pancreatic head. Papillary excrescences corresponding to the tumor projection were noted in the cystic component. Duodenoscopy disclosed excretion of mucin through the patulous papilla of Vater. The patient was treated with a modified Whipple's procedure. A cystic tumor with papillary growth was successfully resected. Pathological examination disclosed a well-differentiated adenocarcinoma in a thick-wall cystic tumor that was classified as cysto-dectectatic (type II) mucin-hypersecreting neoplasm of the pancreas. Mucin-hypersecreting neoplasm of the pancreas, especially the type II variant, is very rare. The majority of them have been reported in the Japanese literature. However, they have rarely been reported in the western literature, and have never been reported in Chinese. Classification of MHNP is still controversial and has thus resulted in many confusing synonyms. In this paper, clinical classification and the spectrum of MHNP are also discussed.
延伸閱讀
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