RESUMO
The patient, a 56-year-old woman, was found during routine checkup to have a disorder of hepatic function. Abdominal ultrasonography showed an ill-defined hypoechoic mass in the head and body of the pancreas; however, no blood-flow signal was observed within the tumor on Doppler ultrasonography. Abdominal computed tomography showed a low-density area in the arterial and portal venous phases. The lesion was visualized as an area of low signal intensity on both T1- and T2-weighted magnetic resonance images, whereas fluorodeoxyglucose positron emission tomography showed fluorodeoxyglucose accumulation in the tumor. Although a preoperative diagnosis was difficult to make, a rapid cytologic examination revealed evidence of a pancreatic endocrine tumor, and subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection was performed. Histopathological examination showed tumor cell nests scattered in abundant fibrotic tissue; the tumor cells had proliferated in a cord-like fashion and showed immunostaining for chromogranin A. Staining for fibroblast activation protein α was seen in the fibroblastic cells contained within the fibrous stroma surrounding the tumor cell nests, whereas both the fibroblastic cells in the tumor and those in the stroma showed a high rate of staining for thrombospondin. We presume that tumor-associated fibroblasts were involved in the fibrosis of the tumor stroma.
Assuntos
Imagem de Difusão por Ressonância Magnética , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Citodiagnóstico , Feminino , Fibrose , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Ultrassonografia DopplerRESUMO
The patient, a 56-year-old woman, was found during routine checkup to have a disorder of hepatic function. Abdominal ultrasonography showed an ill-defined hypoechoic mass in the head and body of the pancreas; however, no blood-flow signal was observed within the tumor on Doppler ultrasonography. Abdominal computed tomography showed a low-density area in the arterial and portal venous phases. The lesion was visualized as an area of low signal intensity on both T1- and T2-weighted magnetic resonance images, whereas fluorodeoxyglucose positron emission tomography showed fluorodeoxyglucose accumulation in the tumor. Although a preoperative diagnosis was difficult to make, a rapid cytologic examination revealed evidence of a pancreatic endocrine tumor, and subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection was performed. Histopathological examination showed tumor cell nests scattered in abundant fibrotic tissue; the tumor cells had proliferated in a cord-like fashion and showed immunostaining for chromogranin A. Staining for fibroblast activation protein α was seen in the fibroblastic cells contained within the fibrous stroma surrounding the tumor cell nests, whereas both the fibroblastic cells in the tumor and those in the stroma showed a high rate of staining for thrombospondin. We presume that tumor-associated fibroblasts were involved in the fibrosis of the tumor stroma.
Assuntos
Diagnóstico por Imagem/métodos , Fibroblastos/patologia , Pâncreas/patologia , Neoplasias Pancreáticas/diagnóstico , Biomarcadores Tumorais/metabolismo , Antígeno CD56/metabolismo , Cromogranina A/metabolismo , Endopeptidases , Feminino , Fibroblastos/metabolismo , Fibrose , Gelatinases/metabolismo , Humanos , Imuno-Histoquímica , Proteínas de Membrana/metabolismo , Pessoa de Meia-Idade , Pâncreas/metabolismo , Pâncreas/cirurgia , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Fosfopiruvato Hidratase/metabolismo , Serina Endopeptidases/metabolismo , Trombospondinas/metabolismoRESUMO
We describe an effective technique for the low-pressure continuous suction of bile and pancreatic juice from the hepatic duct and jejunal limb after major hepatectomy with pancreatoduodenectomy (PD). After hepatectomy and PD, reconstruction is performed by a modification of Child's method. A pancreaticojejunostomy is completed with interrupted sutures between the pancreatic duct and mucosa, without inserting a stent. During hepaticojejunostomy, a 10-F silicone drain with side channels (Blake Silicone Drain; Ethicon, Somerville, NJ, USA) is placed within the hepatic duct via the stump of the jejunal limb to drain bile and pancreatic juice. The drain is connected to a continuous suction device and low suction pressure is started. We found that the low-pressure continuous suction of bile and pancreatic juice from the hepatic duct and jejunal limb was very effective after major hepatectomy with PD.
