胰腺尤因肉瘤/原始神经外胚层肿瘤的CT影像表现1例个案报道及文献复习

CT Findings of Ewing’s Sarcoma of Pancreas/Primitive Neuroectodermal Tumor: A Case Report and Literature Review

患者,男,64岁,20余天前无明显诱因出现腹痛,呕吐,上腹部剑突下及右上腹部为重;腹部触诊:腹软,上腹部触及一直径约8 cm左右包块,边界不清,无压痛、无反跳痛;CT平扫 + 增强显示:胰腺体尾部显示不清,其走行区见团块状软组织密度影,边界不清并局部与邻近胃壁分界不清,大小约6.8 cm × 9.0 cm × 8.3 cm,密度欠均匀,平均CT值约35 HU,增强扫描呈不均匀强化,各期CT值分别为51 HU、69 HU、73 HU,内见多发低、稍低密度强化减低区;CT诊断:考虑恶性肿瘤性病变(胰腺来源可能性大);患者局麻下行超声引导下胰腺包块穿刺活检术,病理诊断:考虑为(胰腺) Ewing肉瘤/原始神经外胚层肿瘤(PNET)。

The patient, a 64-year-old male, had abdominal pain and vomiting more than 20 days ago without obvious inducement, and heavier weight in the inferior xiphoid process and the right upper abdo-men. Abdominal palpation: the abdomen is soft, the upper abdomen touches a lump about 8 cm in diameter, the boundary is unclear, no tenderness, no rebound pain;CT plain scan + enhanced dis-play: The pancreatic body and tail were not clearly displayed, and clumpy soft tissue density shad-ows were seen in the walking area, with unclear boundaries and unclear local boundaries with the adjacent gastric wall. The size was about 6.8 cm × 9.0 cm × 8.3 cm, and the density was not uniform. The average CT value was about 35 HU, and the enhancement scan showed uneven enhancement, and the CT value of each stage was 51 HU, 69 HU, 73 HU, respectively. Multiple low and slightly low density enhancement reduction areas were observed;CT diagnosis: Malignant neoplastic lesions (pancreatic origin is more likely) were considered. The patient underwent ultrasound-guided pan-creatic mass biopsy under local anesthesia. Pathological diagnosis was considered as Ewing sarcoma (pancreas)/primitive neuroectodermal tumor (PNET).