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EndoTODAY 내시경 교실

[SmallTODAY 003 - AoV cancer or pancreas cancer]

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10일간의 소화불량으로 외부에서 내시경 검사 후 '십이지장의 악성신생물'이라는 소견서를 가지고 방문한 환자입니다.

일견 Ampulla of Vater cancer로 생각되었으나 CT 검사 후 pancreas cancer with duodenal invasion으로 진단할 수 있었습니다.


II. Histopathologic Diagnosis
(1) Histologic type: ductal adenocarcinoma
(2) Histologic Grade: G2 (moderately differentiated)
(3) Tumor size: 4.8x3.5 cm (microscopic measurement)
(4) T3: Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery
(5) Extension into common bile duct (absent), duodenum (present), peripancreatic (retroperitoneal) soft tissue (present) {T3 in JPS}
(6) N1: Regional lymph node metastasis (12/25)
(7) cM0: Clinically No distant Metastasis
(8) Involvement of superior mesenteric vein: present (tumor invasion into vessel intima) [I]
(9) Margin status
- SMA side margin: negative but very close (safety margin: 200 ㎛)[K]
- Portal vein side margin: negative but very close (safety margin: 500 ㎛)[I]
- Pancreas neck margin: negative (safety margin: 2.4 cm)
(10) Perineural and neural invasion: present
(11) Lymphovascular invasion: present

[Additional note]
(1) Proportion: well to moderately (75 %) / poorly (25 %) differentiated
(2) Tumor Pattern Score (PS): 5(2+3)
(3) Mucoepidermoid-like feature: absent
(4) Stromal reaction: desmoplasia (2) / inflammation (2) / myxoid degeneration (0)
(5) Tumor necrosis: absent
(6) Nuclear pleomorphism: moderate
(7) Mucin production: irregular
(8) Chronic cholecystitis, autolysis
(9) ICD code (ICD-O): M8500PDAC
(10) Tumor Regression grade: Not applicable

[rR1]: grossly negative but microscopically positive resection margins due to very close to retroperitoneal(portal vein /SMA side margin)

AJCC stage (2010, 7th ed) Stage IIB T3 N1 M0


1) EsoTODAY - Esophageal diseases

2) SmallTODAY - Small bowel diseases

3) ColonTODAY - Colorectal diseases

© EndoTODAY Endoscopy Learning Center. Jun Haeng Lee. 일원내시경교실 바른내시경연구소 이준행