背景:慢性胰腺炎(CP)是发生胰腺导管腺癌(PDAC)的危险因素。此外,因导管内乳头状黏液性肿瘤(IPMN)而进行部分胰腺切除术的患者也可导致PDAC。相比之下,IPMN是一种独特的疾病实体,独立于CP,很少有报告说CP是IPMN的原因。据我们所知,这是在1例慢性酒精性胰腺炎患者中,首例以9年和半年为间隔的总管IPMN和PDAC发生异时的临床病例报告.
方法:根据实验室检查结果和临床症状,一名50岁的男性有长期的酒精性胰腺炎和肝炎复发病史超过十年,被诊断为另一次急性胰腺炎发作。该患者接受了保留幽门的胰十二指肠切除术(PPPD),原因是胰头主管道有一个小的结节性病变,并被诊断为主管IPMN低度发育不良和相关的纤维化CP。九年半后,一名59岁男子在3个月内减重7公斤,并被诊断患有新发糖尿病。
方法:患者被诊断为异时,分化良好的PDAC伴有CP。
方法:患者接受了根治性顺行模块化胰脾切除术(RAMPS),治疗残余胰腺小结节。
结果:患者健康44个月,在包括实验室检查在内的临床随访检查中没有肿瘤复发的迹象,肿瘤标志物,和成像研究。
结论:通过将新出现的临床症状和体征与仔细的放射学检查相关联,可以早期诊断慢性胰腺炎患者的异时性胰腺肿瘤。
BACKGROUND: Chronic pancreatitis (CP) is a risk factor for developing pancreatic ductal adenocarcinoma (PDAC). In addition, a patient with partial pancreatectomy for intraductal papillary mucinous neoplasm (IPMN) can also lead to PDAC. In contrast, IPMN is a distinct disease entity, independent of CP, and there have been few
reports that CP is the cause of IPMN. To the best of our knowledge, this is the first clinical
case report of the metachronous occurrence of main-duct IPMN and PDAC with a 9 and half-year interval in a patient with chronic alcoholic pancreatitis.
METHODS: A 50-year-old man with a long medical history of recurrent alcoholic pancreatitis and hepatitis over a decade was diagnosed with another episode of acute pancreatitis based on laboratory findings and clinical symptoms. The patient underwent pylorus-preserving pancreaticoduodenectomy (PPPD) for a small nodular lesion in the main duct of the pancreatic head and was diagnosed with main-duct IPMN low-grade dysplasia and associated fibrosing CP. Nine and a half years later, a 59-year-old man lost 7 kg over 3 months and was diagnosed with new-onset diabetes mellitus.
METHODS: The patient was diagnosed with metachronous, well-differentiated PDAC with concomitant CP.
METHODS: The patient underwent radical antegrade modular pancreatosplenectomy (RAMPS) for a small nodular mass in the remnant pancreas.
RESULTS: The patient was healthy for 44 months without evidence of tumor recurrence during clinical follow-up examinations including laboratory findings, tumor marker, and imaging studies.
CONCLUSIONS: Early diagnosis of metachronous pancreatic neoplasia in a patient with chronic pancreatitis could be made by correlating newly developed clinical symptoms and signs with careful radiological examinations.