Soplid and Papillary Epithelial Neoplasm of the Pancreas: Case Report

胰臟實質及乳頭狀上皮腫瘤是少有的胰臟腫瘤，好發於年輕女性及青少年。一般而言，此腫瘤是良性或低度惡性腫瘤，有不錯之預後。在文獻上，只有少數惡性或轉移之病例報告。我們報告一少有高度惡性病例。一位二十歲女性於入院前兩周有黃疸，食慾不振，飯後嘔吐的表現。身體檢查時於左上腹及右下腹可觸摸到不規則的腫塊，電腦斷層在骨盆腔，膀胱上部，腸繫膜，大網膜及肝下有大小不等的腫塊並有鈣化之現象，經皮穿肝膽管攝影檢查發現顯影劑於總肝管處中斷，胰管攝影檢查顯影劑於胰臟頭部中斷。腹腔鏡檢查分別從大網膜及骨盆腔取出一公分大腫塊，病理組織切片確認是胰臟實質及乳頭狀上皮腫瘤。在文獻中，少有病例以如此高度侵犯性表現。因此我們須清楚認知這種表現可能發生在胰臟實質及乳頭狀上皮腫瘤。
Solid and papillary epithelial neoplasm of the pancreas is a rare pancreatic tumor, and it occurs most in young females and adolescents. Generally it behaves either as a benign or low grade maligant neoplasm and its nature indicates a favorable prognosis. We present a rare advanced case. A 20-year-old woman initially presented with progressive jaundice, anorexia, poor intake, and post-prandial vomiting two weeks prior to admission.Two iII-defined masses were palpable over the left upper abdomen and right iliac fossa on physical examination. Anemia and jaundice were also noted. Abdominal computed tomography showed multiple masses at the Douglas pouch, supra-urinary bladder, mesentery, omentum and lesser sac. Percutaneous transhepatic cholangiography demonstrated termination at the common hepatic duct and endoscopic retrograde pancreatography revealed abrupt disruption of the pancreatic duct at the pancreatic head. Laparoscopy was performed and two masses of 1cm in size were sent for pathologic examination. Histopathologic examination showed proliferation of solid sheets of monotonous cells arranged in a pseudopapillary pattern. The tumor was identified as a solid?pseudopapillary tumor of the pancreas. The patient was treated with chemotherapy but the tumor mass enlarged progressively, which was identified in the follow-up abdominal computed tomography. She started to take chinese herb for treatment and was regularly followed up at our clinics for nealy one year. Rare cases present with advanced disease initially as in our patient. It is important to recognize such an unusual presentation may occur in patients with solid and papillary epithelial neoplasms of the pancreas.