Медицинская литература. Новинки

 

 

 

 

 

 

Возможности методов визуализации для определения объема вмешательства при мультифокальных внутрипротоковых папиллярных муцинозных опухолях поджелудочной железы (Kлиническое наблюдение)

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В статье представлено клиническое наблюдение за пациентом с мультифокальными, внутрипротоковыми папиллярными муцинозными опухолями (ВПМО) боковых ветвей поджелудочной железы, локализующимися в области головки и тела. Сравнивая данные, полученные с помощью различных диагностических методов (КТ, МРТ, МРХПГ, и эндоскопическое УЗИ), мы нашли, что МРХПГ явился наиболее точным методом, позволившим обнаружить все 8 опухолей в области головки и тела железы; также мы констатировали их связь с ветвями главного панкреатического протока, что подтвердилось в ходе гистологического исследования. Возможности остальных методик оказались ограниченными. Данное клиническое наблюдение демонстрирует важность МРХПГ для планирования объема хирургического вмешательства при мультифокальных ВПМО боковых ветвей.

Ключевые слова:
Внутрипротоковая папиллярная муцинозная опухоль боковых ветвей, МРПХГ, эндосонография, МСКТ, резекция поджелудочной железы.

Литература:
1. Adsay NV. The ''new kid on the block'': intraductal papillary
mucinous neoplasms of the pancreas. Current concepts
and controversies. Surgery. 2003;133:459-463.
2. Tanaka M., Chari S., Adsay V., Fernandez9del Castillo C.,
Falconi M., Shimizu M., Yamaguchi K., Yamao K.,
Matsuno S. International Consensus Guidelines for
Management of Intraductal Papillary Mucinous
Neoplasms and Mucinous Cystic Neoplasms of the
Pancreas Pancreatology 2006;6:17932.
3. Bernard P, Scoazec JY, Joubert M, et al. Intraductal papillary-mucinous tumors of the pancreas: predictive criteria
of malignancy according to pathological examination of
53 cases. Arch Surg. 2002;137:127491278.
4. Doi R, Fujimoto K, Wada M, et al. Surgical management of
intraductal papillary mucinous tumor of the pancreas.
Surgery. 2002;132:80985.
5. Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary
mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann Surg.
2001;234:3139322.
6. Choi BS, Kim TK, Kim AY, Kim KW, Park SW, Kim PN, Ha
HK, Lee MG, Kim SC: Differential diagnosis of benign and
malignant intraductal papillary mucinous tumors of the
pancreas: MR cholangio9pancreatography and MR
angiography. Korean J Radiol 2003; 4: 1579162.
7. Kitagawa Y, Unger TA, Taylor S, Kozarek RA, Traverso LW:
Mucus is a predictor of better prognosis and survival in
patients with intraductal papillary mucinous tumor of the
pancreas.J Gastrointest Surg 2003; 7: 12919.
8. Kobari M, Egawa S, Shibuya K, Shimamura H, Sunamura
M, Takeda K, Matsuno S, Furukawa T: Intraductal papillary
mucinous tumors of the pancreas comprise 2 clinical subtypes: differences in clinical characteristics and surgical
management. Arch Surg 1999; 134: 11319 1136.
9. Matsumoto T, Aramaki M, Yada K, Hirano S, Himeno Y,
Shibata K, Kawano K, Kitano S: Optimal management of
the branch duct type intraductal papillary mucinous neoplasms of the pancreas. J Clin Gastroenterol 2003; 36:
2619265.
10. Pelaez9Luna M., Chari S.T., Smyrk T.C. Takahashi N.,
Clain J.E., Levy M.J., Pearson R.K., Petersen B.T,
Topazian M.D., Vege S.S., Kendrick M., Farnell M.B. Do
consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy?
A study of 147 patients.
11. Salvia R, Fernandez9del Castillo C, Bassi C, Thayer SP,
Falconi M, Mantovani W, Pederzoli P, Warshaw AL: Main
duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and longterm survival following resection. Ann Surg 2004; 239: 678-687.
12. Sohn TA, Yeo CJ, Cameron JL, Hruban RH, Fukushima N,
Campbell KA, Lillemoe KD: Intraductal papillary mucinous
neoplasms of the pancreas: an updated experience. Ann
Surg 2004; 239: 7889799.
13. Sugiyama M, Izumisato Y, Abe N, Masaki T, Mori T, Atomi Y:
Predictive factors for malignancy in intraductal papillary9
mucinous tumors of the pancreas. Br J Surg 2003; 90:
12449 1249.
14. Terris B, Ponsot P, Paye F, Hammel P, Sauvanet A, Molas
G, Bernades P, Belghiti J, Ruszniewski P, Flejou JF:
Intraductal papillary mucinous tumors of the pancreas
confi ned to secondary ducts show less aggressive patho9
logic features as compared with those involving the main
pancreatic duct. Am J Surg Pathol 2000; 24: 137-1377.
15. Chari ST, Yadav D, Smyrk TC, et al. Study of recurrence
after surgical resection of intraductal papillary mucinous
neoplasms of the pancreas. Gastroenterology.
2002;123:150091507.
16. Falconi M, Salvia R, Bassi C, Zamboni G, Talamini G,
Pederzoli P: Clinicopathological features and treatment of
intraductal papillary mucinous tumour of the pancreas. Br
J Surg 2001; 88: 3769381.
17. Sugiyama M, Atomi Y: Intraductal papillary mucinous
tumors of the pancreas: imaging studies and treatment
strategies. Ann Surg 1-98; 228: 685-6-1.
18. Yamaguchi K, Ohuchida J, Ohtsuka T, Nakano K, Tanaka
M: Intraductal papillary9mucinous tumor of the pancreas
concomitant with ductal carcinomas of the pancreas.
Pancreatology 2002; 2: 4849490.
19. Cellier C, Cuillerier E, Palazzo L, et al. Intraductal papillary
and mucinous tumors of the pancreas: accuracy of preoperative computed tomography, endoscopic retrograde
pancreatography and endoscopic ultrasonography, and
long9term outcome in a large surgical series. Gastrointest
Endosc 1998; 47:42949.
20. Yamaguchi K, Ogawa Y, Chijiiwa K, Tanaka M. Mucinhypersecreting tumors of the pancreas: assessing the
grade of malignancy preoperatively. Am J Surg 1996;
171:4279431.
21. Taouli B, Vilgrain V, O'Toole D, Vullierme MP, Terris B,
Menu Y. Intraductal papillary mucinous tumors of the pancreas: features with multimodality imaging. J Comput
Assist Tomogr 2002; 26: 2239231.
22. Fukukura Y, Fujiyoshi F, Hamada H, et al. Intraductal papillary mucinous tumors of the pancreas: comparison of helical CT and MR imaging. Acta Radiol 2003; 44:4649471.
23. Procacci C, Graziani R, Bicego E, et al. Intraductal mucinproducing tumors of the pancreas: imaging findings.
Radiology 1996; 198:2499257.
24. Ohta T, Nagakawa T, Akiyama T, et al. The ''duct-ectatic''
variant of mucinous cystic neoplasms of the pancreas:
clinical and radiologic studies of seven cases. Am J
Gastroenterol 1992; 87:300-304.
25. Yasunari Yamada, Hiromu Mori and Shunro Matsumoto.
Intraductal papillary mucinous neoplasms of the pancreas: correlation of helical CT and dynamic MR imaging
features with pathologic findings. Abdominal Imaging.
26. Kanazumi N, Nakao A, Kaneko T, et al. Surgical treatment
of intraductal papillary9mucinous tumors of the pancreas.
Hepatogastroenterology 2001; 48:967-971.
27. Izuishi K, Nakagohri T, Konishi M, et al. Spatial assessment
by magnetic resonance cholangiopancreatography for
preoperative imaging in partial pancreatic head resection.
Am J Surg 2001; 182:188-1-1.
28. Koito K, Namieno T, Ichimura T, et al. Mucin-producing
pancreatic tumors: comparison of MR cholangiopancreatography with endoscopic retrograde cholangiopancreatography. Radiology 1998; 208:231-237.
29. Fukukura Y, Fujiyoshi F, Sasaki M, et al. HASTE MR cholangiopancreatography in the evaluation of intraductal papillary mucinous tumors of the pancreas. J Comput Assist
Tomogr 1999; 23:301-305.

The Ability of Different Visualization Modalities to Predict the Extent of Pancreatic Resection for Multifocal Intraductal Papillary Mucinous Neoplasms (Case Report)

The report describes a case of the patient's management with eight multifocal branch duct IPMNs located in the pancreatic head and body. Comparing the data obtained by the diagnostic methods (CT, MRI, MRCP, and endo US), we have found MRCP to be the most precise method enabling the detection of all the eight benign tumors in the pancreatic head and body; we also confirmed their connection to the branches of the main pancreatic duct and anticipated the resection border, which coincided with intra9operative and pathological findings. Other diagnostic methods showed their limitations in the case. This case report shows the potential importance of MRCP for the preoperative planning of the extent of a surgical procedure for multifocal branch duct IPMNs.

Keywords:
Intraductal papillary mucinous neoplasms, multifocal branch duct IPMN, pancreatic resection, MRCP