Сложности дифференциальной диагностики кистозного новообразования поджелудочной железы: клинический пример

Коваленко Д.Д., Пронина Г.М., Быстровская Е.В. и др. Сложности дифференциальной диагностики кистозного новообразования поджелудочной железы: клинический пример. Consilium Medicum. 2018; 20 (8): 53–57. DOI: 10.26442/2075-1753_2018.8.53-57

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Kovalenko D.D., Pronina G.M., Bystrovskaya E.V. et al. Difficulties in differential diagnosis of cystic pancreatic neoplasm: clinical case. Consilium Medicum. 2018; 20 (8): 53–57. DOI: 10.26442/2075-1753_2018.8.53-57

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Аннотация

Протоковая аденокарцинома (ПАК) составляет 90% всех новообразований поджелудочной железы и является 4-й по частоте причиной смертности в структуре онкологических заболеваний в западном мире и 5-й – в России. ПАК может быть представлена опухолью с наличием кистозной полости внутри или с наличием прилежащей кистозной структуры вне новообразования. Приводим клиническое наблюдение пациентки с кистозно-солидным новообразованием поджелудочной железы, при котором использование контрастного усиления под контролем эндоскопической ультрасонографии (CH-EUS) позволило определить тактику лечения. CH-EUS значительно увеличивает информативность метода, расширяет возможности дифференциальной диагностики заболеваний панкреатобилиарной зоны. На сегодняшний день актуальной задачей является оценка диагностической точности и определение места контрастного усиления в диагностическом алгоритме обследования пациентов с заболеваниями поджелудочной железы.

Ключевые слова: протоковая аденокарцинома поджелудочной железы, кистозное новообразование, эндоскопическая ультрасонография, контрастное усиление, поджелудочная железа.

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Pancreatic ductal adenocarcinoma (PDA) accounts for 90% of all pancreatic neoplasms and is the fourth leading cause of cancer-related death in the western world and sixth – in Russia. PDAs may demonstrate intratumoral cystic features or accompany peritumoral non-neoplastic cystic lesions. We present the clinical case of the patient with cystic-solid lesion of pancreas, the use of contrast-enhanced harmonic EUS (CH-EUS) helped in determining the tactics of treatment. CH-EUS significantly increases the informativeness of the method, extends the possibilities of differential diagnostics of the pancreatobiliary diseases. Now assessment of diagnostic accuracy and determining the place of contrast enhancement in the diagnostics pancreatic diseases are considered the most relevant tasks.

Key words: pancreatic ductal adenocarcinoma, cystic lesions, endoscopic ultrasonography, contrast enhancement.

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________________________________________________

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA: Cancer J Clin 2016; 66: 7–30.
2. Assotsiatsiia onkologov Rossii, Rossiiskoe obshchestvo klinicheskoi onkologii. Klinicheskie rekomendatsii: Rak podzheludochnoi zhelezy. 2017; 6–7. [in Russian]
3. Cho HW, Choi JY, Kim MJ et al. Pancreatic tumors: emphasis on CT findings and pathologic classification. Korean J Radiol 2011; 12: 731–9.
4. Kosmahl M, Pauser U, Anlauf M, Kloppel G. Pancreatic ductal adenocarcinomas with cystic features: neither rare nor uniform. Mod Pathol 2005; 18: 1157–64.
5. Yoon SE, Byun JH, Kim KA et al. Pancreatic ductal adenocarcinoma with intratumoral cystic lesions on MRI: correlation with histopathological findings. Br J Radiol 2010; 83: 318–26.
6. Hruban RH, Boffetta P, Hiraoka N. Ductal adenocarcinoma of the pancreas. In: FT Bosman, ed. World Health Organization Classification of tumours of the digestive system. 4th ed. Lyon, France: International Agency for Research on Cancer, 2010; p. 281–95.
7. Chen J, Baithun SI. Morphological study of 391 cases of exocrine pancreatic tumours with special reference to the classification of exocrine pancreatic carcinoma. J Pathol 1985; 146: 17–29.
8. Bagci P, Andea AA, Basturk O et al. Large duct type invasive adenocarcinoma of the pancreas with microcystic and papillary patterns: a potential microscopic mimic of non-invasive ductal neoplasia. Mod Pathol 2012; 25: 439–48.
9. Hori S, Shimada K, Ino Y et al. Macroscopic features predict outcome in patients with pancreatic ductal adenocarcinoma. Virchows Archiv: an international journal of pathology. 2016; 469: 621–34.
10. Yamada Y, Mori H, Matsumoto S et al. Invasive carcinomas derived from intraductal papillary mucinous neoplasms of the pancreas: a long-term follow-up assessment with CT imaging. J Comput Assist Tomogr 2006; 30: 885–90.
11. Yoon MA, Lee JM, Kim SH et al. MRI features of pancreatic colloid carcinoma. AJR: Am J Roentgenol 2009; 193: W308–W313.
12. Kalb B, Sarmiento JM, Kooby DA et al. MR imaging of cystic lesions of the pancreas. Radiographics 2009; 29: 1749–65.
13. Dzeletovic I, Harrison ME, Crowell MD et al. Pancreatitis before pancreatic cancer: clinical features and influence on outcome. J Clin Gastroenterol 2014; 48: 801–5.
14. Kimura W, Sata N, Nakayama H et al. Pancreatic carcinoma accompanied by pseudocyst: report of two cases. J Gastroenterol 1994; 29: 786–91.
15. Seicean A, Mosteanu O, Seicean R. Maximizing the endosonography: The role of contrast harmonics, elastography and confocal endomicroscopy. World J Gastroenterol 2017; 23 (1): 25–41.
16. Alvarez-Sánchez MV, Napoléon B. Contrast-enhanced harmonic endoscopic ultrasound imaging basic principles, present situation and future perspectives. World J Gastroenterol 2014; 20 (42): 15549–63.
17. Napoleon B, Alvarez-Sanchez MV, Gincoul R et al. Contrast-enhanced harmonic endoscopic ultrasound in solid lesions of the pancreas: results of a pilot study. Endoscopy 2010; 42 (7): 564–70.
18. Figueiredo FA, da Silva PM, Monges G et al. Yield of Contrast-Enhanced Power Doppler Endoscopic Ultrasonography and Strain Ratio Obtained by EUS-Elastography in the Diagnosis of Focal Pancreatic Solid Lesions. Endoscopic Ultrasound 2012; 1 (3): 143–9.
19. Kitano M, Kamata K, Imai H et al. Contrast-enhanced harmonic endoscopic ultrasonography for pancreatobiliary diseases. Digestive Endoscopy 2015; 27 (Suppl. 1): 60–7.
20. Săftoiu A, Vilmann P, Dietrich CF et al. Quantitative contrast-enhanced harmonic EUS in differential diagnosis of focal pancreatic masses. Gastrointestinal Endoscopy 2015; 82 (1): 59–69.
21. Gincul R, Palazzo M, Pujol B et al. Contrast-harmonic endoscopic ultrasound for the diagnosis of pancreatic adenocarcinoma: a prospective multicenter trial. Endoscopy 2014; 46 (5): 373–9.
22. Van der Waaij LA, van Dullemmen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions:a pooled analysis. Gastrointest Endosc 2005; 62: 383–9.

Авторы

Д.Д.Коваленко1, Г.М.Пронина1, Е.В.Быстровская*1, К.А.Никольская1, К.К.Носкова1, В.В.Щадрова1, Д.С.Бордин1,2, Е.А.Дубцова1

1 ГБУЗ «Московский клинический научно-практический центр им. А.С.Логинова» Департамента здравоохранения г. Москвы. 111123, Россия, Москва, ш. Энтузиастов, д. 86;
2 ФГБОУ ВО «Тверской государственный медицинский университет» Минздрава России. 170100, Россия, Тверь, ул. Советская, д. 4
*e.bystrovskaya@mknc.ru

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D.D.Kovalenko1, G.M.Pronina1, E.V.Bystrovskaya*1, K.A.Nikolskaya1, K.K.Noskova1, V.V.Shchadrova1, D.S.Bordin1,2, E.A.Dubtsova1

1 A.S.Loginov Moscow Clinical Scientific Practical Center of the Department of Health of Moscow. 111123, Russian Federation, Moscow, sh. Entuziastov, d. 86;

2 Tver State Medical University of the Ministry of Health of the Russian Federation. 170100, Russian Federation, Tver, ul. Sovetskaja, d. 4
*e.bystrovskaya@mknc.ru

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