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Case Report
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Korean J Med. 2014;86(5):598-602. Published online May 1, 2014.
DOI: https://doi.org/10.3904/kjm.2014.86.5.598
- 작은 크기에서 현저한 주췌관 확장과 췌장실질 위축을 동반한 신경내분비종
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원성현1, 홍승모2, 김명환1, 박상우1, 최윤식1, 장일영1, 김형중3
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1울산대학교 의과대학 서울아산병원 내과
2울산대학교 의과대학 서울아산병원 병리과
3울산대학교 의과대학 서울아산병원 영상의학과
- A Small Pancreatic Neuroendocrine Tumor with Marked Pancreatic Duct Dilatation and Parenchymal Atrophy
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Sunghyun Won1, Seung-Mo Hong2, Myung-Hwan Kim1, Sangwoo Park1, Yunsik Choi1, Il-Young Jang1, Hyoung Jung Kim3
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1Departments of Internal Medicine University of Ulsan College of Medicine, Seoul, Korea
2Departments of Pathology University of Ulsan College of Medicine, Seoul, Korea
3Departments of Radiology University of Ulsan College of Medicine, Seoul, Korea
- Corresponding author: Myung-Hwan Kim ,Tel: +82-2-3010-3183, Fax: +82-2-3010-0824, Email: mhkim@amc.seoul.kr
- Received: August 14, 2013; Revised: August 19, 2013 Accepted: September 13, 2013.
- 췌장 신경내분비종양은 작은 크기에서도 췌관의 협착에 의한 상류쪽 주췌관의 확장을 동반할 수 있다. 췌관을 직접 침범하지 않고도 췌관의 협착이 발생할 수 있으며 특징적으 로 세로토닌 면역염색에서 양성을 보이는 경우가 많다. CT 에서 조영증강되는 종괴가 있으면서 주췌관의 확장과 췌장 실질의 위축이 동반될 경우, 일단 췌장선암의 존재 여부를 확인하는 것이 가장 중요하지만 췌장 신경내분비종양도 감 별진단에 포함해야 한다. 그리고 세로토닌 분비 췌장 신경내 분비종양 가능성을 고려하여 추가 면역화학염색이 필요함을 생각할 수 있다.
߽ɾ :췌장신경내분비종양; 췌관확장; 세로토닌
- Abstract
- Pancreatic ductal adenocarcinomas often cause marked pancreatic duct dilatation and associated parenchymal atrophy. We present the case of a small pancreatic neuroendocrine tumor with upstream pancreatic duct dilatation and severe parenchymal atrophy. A small enhancing tumor was observed at the head of the pancreas on computed tomography (CT). Endoscopic ultrasonographyguided fine-needle aspiration was negative for malignancy. We performed a pylorus-preserving pancreatoduodenectomy since we could not exclude the presence of pancreatic ductal adenocarcinoma. The pathological and immunohistochemical examination revealed a serotonin-positive neuroendocrine tumor, measured 1.0 × 0.5 cm. The pathological specimen was remarkable for the marked stromal fibrosis in the area of the tumor, which resulted in narrowing of the main pancreatic duct. Here, we report a rare small pancreatic neuroendocrine tumor, the CT image of which resembled that of pancreatic ductal adenocarcinoma, in which the expression of serotonin and associated fibrosis might be a possible mechanism for the marked main pancreatic duct dilatation. (Korean J Med 2014;86:598-602)
Keywords :Pancreatic duct dilatation, Pancreas neuroendocrine tumor, Serotonin
