Multicentric pancreatic intraepithelial neoplasias (PanINs) presenting with the clinical features of chronic pancreatitis
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- 作者：Takayuki Aimoto (1)
Eiji Uchida (1)
Yoshiharu Nakamura (1)
Akira Matsushita (1)
Akira Katsuno (1)
Kazumitsu Chou (1)
Masao Kawamoto (1)
Zenya Naito (2)
Takashi Tajiri (1) - 关键词：Pancreatic intraepithelial neoplasia (PanIN) ; Intraductal papillary mucinous neoplasm (IPMN) ; Multicentricity ; Total pancreatectomy
- 刊名：Journal of Hepato-Biliary-Pancreatic Sciences
- 出版年：2008
- 出版时间：September 2008
- 年：2008
- 卷：15
- 期：5
- 页码：549-553
- 全文大小：520KB
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11. Takaori K, Kobayashi Y, Matsusue S, Matsui K, Yamamoto T. Clinicopathological features of pancreatic intraepithelial neoplasias and their relationship to intraductal papillary-mucinous tumors. J Hepatobiliary Pancreat Surg 2003;10:125鈥?36. CrossRef - 作者单位：Takayuki Aimoto (1)
Eiji Uchida (1)
Yoshiharu Nakamura (1)
Akira Matsushita (1)
Akira Katsuno (1)
Kazumitsu Chou (1)
Masao Kawamoto (1)
Zenya Naito (2)
Takashi Tajiri (1)
1. Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
2. Department of Pathology, Nippon Medical School, Tokyo, Japan
文摘
A 46-year-old woman was readmitted to our hospital in August 2005 because of severe abdominal pain and nausea. Computed tomography demonstrated a huge cystic lesion in the retroperitoneal space behind the hepatoduodenal ligament and lesser peritoneal cavity. Endoscopic retrograde pancreatography revealed communication between the dilated main pancreatic duct and a pseudocyst. The condition was preoperatively diagnosed as chronic pancreatitis associated with a pseudocyst or an intraductal papillary mucinous neoplasm without mucin hypersecretion. The patient underwent a distal pancreatectomy with splenectomy. The pathologic diagnosis was multicentric pancreatic intraepithelial neoplasia (PanIN), and histological examination revealed a positive surgical margin around the remnant pancreas. Four months after the surgery, the patient underwent a total pancreatectomy. Macroscopic observation revealed diffuse fibrosis of the pancreatic parenchyma compatible with chronic pancreatitis. Histological examination revealed a constellation of noninvasive intraductal neoplasias with high-grade atypia, diffusely distributed in the small pancreatic ducts of the resected pancreas. Localized fibrosis and cystic dilation of the small ducts were detected in a lobule of exocrine glands draining into a ductule involved by PanIN lesions in the head of the pancreas. In summary, multicentric PanIN lesions are associated with lobular atrophy of the pancreatic parenchyma and chronic pancreatitis-like changes that follow. Total pancreatectomy may be recommended for patients with multicentric precursor lesions throughout the entire pancreas.