Penetrierendes Ulcus duodeni als Primärmanifestation eines intraduktalen papillär-muzinösen Pankreastumors

Zusammenfassung

Ein 60-jähriger Patient mit chronischrezidivierenden Pankreatitiden und insulinpflichtigem Diabetes mellitus bot endoskopisch das Bild eines tief exkavierten Duodenalulkus, das unter 4-wöchiger parenteraler Ernährung sowie Protonenpumpenblocker-Therapie nicht abheilte. In der endoskopischen und bildgebenden Diagnostik ließ sich das Vorliegen eines primären Pankreasprozesses mit Anschluss an das Bulbusulkus nachweisen. Nach operativer Resektion durch eine pyloruserhaltende Duodenopankreatektomie konnte morphologisch ein abszedierender intraduktaler papillär-muzinöser Pankreastumor vom Borderline-Typ als Ursache des Duodenalulkus gesichert werden.

Penetrating duodenal ulcer as primary manifestation of an intraductal papillary-mucinous tumor of the pancreas

A 60-year-old patient with a history of chronic pancreatitis and insulin-dependent diabetes was admitted to our hospital with a deeply excavated duodenal ulcer showing no signs of regression under 4-week parenteral nutrition and proton pump inhibitor therapy. Radiologic and endoscopic diagnostics could demonstrate a primary tumor of the pancreatic head penetrating into the duodenal lumen. After surgical treatment by pylorus-preserving pancreatoduodenectomy an abscessing intraductal papillary-mucinous neoplasm of the pancreas was established morphologically.

Duodenalulkus - Pankreastumor - intraduktales papillär-muzinöses Neoplasma - chronische Pankreatitis

Duodenal Ulcer - Pancreatic Tumor - Intraductal Papillary-Mucinous Neoplasm - Chronic Pancreatitis

Literatur

• 1 Ohhashi K, Murakimi Y, Maruyama. et al . Four cases of mucous secreting pancreatic cancer.  Prog Dig Endosc. 1982;  20 348-351
• 2 Klöppel K. Clinicopathologic view of intraductal papillary-mucinous tumor of the pancreas.  Hepatogast³roenterology. 1998;  45 1981-1985
• 3 Rickaert F, Cremer M, Deviere J. et al . Intraductal mucin-hypersecreting neoplasms of the pancreas. A clinicopathological study of eight patients.  Gastroenterology. 1991;  101 512-519
• 4 Loftus E V Jr, Olivares-Pakzad B A, Batts K P. et al . Intraductal papillary-mucinous tumors of the pancreas: Clinicopathologic features, outcome, and nomenclature.  Gastroenterology. 1996;  110 1909-1918
• 5 Yasuda H, Takada T, Amano H, Yoshida M. Surgery for mucin-producing pancreatic tumor.  Hepatogastroenterology. 1998;  45 2009-2015
• 6 Kawarada Y, Yano T, Yamamoto T. et al . Intraductal mucin-producing tumors of the pancreas.  Am J Gastroenterol. 1992;  87 634-638
• 7 Nagai E, Ueki T, Chijiiwa K, Tanaka M, Tsunegoshi M. Intraductal papillary mucinous neoplasms of the pancreas associated with so-called „mucinous ductal ectasia”.  Am J Surg Pathol. 1995;  19 576-589
• 8 Obara T, Maguchi H, Saitoh Y. et al . Mucin-producing tumor of the pancreas: A unique clinical entity.  Am J Gastroenterol. 1991;  86 1619-1625
• 9 Procacci C, Graziani R, Bicego E. et al . Intraductal mucin-producing tumors of the pancreas: Imaging findings.  Radiology. 1996;  198 249-257
• 10 Compagno J, Oertel J E. Microcystic adenomas of the pancreas (glycogen-rich cystadenomas). A clinicopathologic study of 34 cases.  Am J Clin Pathol. 1978;  69 289-298
• 11 Yamamada M, Kozuka S, Yamao K. et al . Mucin-producing tumor of the pancreas.  Cancer. 1991;  68 159-168
• 12 Warshaw A L. Mucinous cystic tumors and mucinous ductal ectasia of the pancreas.  Gastrointest Endosc. 1991;  37 199-201
• 13 Uehara H, Nakaizumi A, Iishi H. et al . Cytologic examination of pancreas juice for differential diagnosis of benign and malignant mucin-producing tumors of the pancreas.  Cancer. 1994;  74 826-833
• 14 Gazelle G S, Mueller P R, Raafat N. et al . Cystic neoplasms of the pancreas: Evaluation with endoscopic retrograde pancreatography.  Radiology. 1993;  188 633-636
• 15 Kondo H, Sugano K, Fukuyama N. et al . Detection of K-ras gene mutations at codon 12 in the pancreatic juice of patients with intraductal papillary mucinous tumors of the pancreas.  Cancer. 1997;  79 900-905
• 16 Kimura W, Makuuchi M, Kuroda A. Characteristics of mucin-producing tumor of the pancreas.  Hepatogastroenterology. 1998;  45 2001-2008
• 17 Sessa F, Solcia E, Capella C. et al . Intraductal papillary-mucinous tumours represent a distinct group of pancreatic neoplasms: An investigation of tumour cell differentiation and K-ras, p53, and c-erbB-2 abnormalities in 26 patients.  Virchows Arch. 1994;  425 357-367
• 18 Kaye P S, Steinberg S E, Montbriand J R. Intraductal papillary-mucinous tumor of the pancreas: Presentation in a young adult.  Am J Gastroenterol. 1999;  94 1958-1961

Anschrift für die Verfasser: