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以胰腺炎为首发表现伴腹腔淋巴结肿大1例
Pancreatitis as the initial manifestation and abdominal lymph node enlargement in a boy
患者，男性，14岁，以腹痛为主要表现，血淀粉酶及脂肪酶增高，腹部超声提示胰腺肿大、回声减低，磁共振胰胆管成像（MRCP）提示胰管扩张、胰头显示不清，考虑急性胰腺炎。经禁食、补液、抑酸、生长抑素等治疗症状未缓解，复查腹部CT及MRCP提示胰腺多处低密度灶，肝门部及腹膜后淋巴结肿大，剖腹探查发现胰腺水肿，肝门部多发结节并与周围结构分界不清，活检病理提示间变大细胞淋巴瘤。结合患儿无肝脾、骨髓及中枢神经系统受累，诊断Ⅲ期原发性胰腺淋巴瘤。予VD减轻肿瘤负荷后，予以一次VDLD化疗及8次长春瑞滨联合地塞米松化疗，影像学仍提示胰腺多发低密度病灶及腹膜后淋巴结肿大。患者家属放弃治疗。对于治疗效果不好的急性胰腺炎需考虑少见原因所致，尤其对于伴腹腔淋巴结肿大者，需警惕结外淋巴瘤，尽早行淋巴结活检以明确诊断。胰腺淋巴瘤预后与临床分期及病理相关。
A boy aged 14 years had abdominal pain as the major manifestation, with elevated serum amylase and lipase. Abdominal ultrasound performed early after onset in another hospital showed enlargement of the pancreas and a reduction in echo. Magnetic resonance cholangiopancreatography (MRCP) showed pancreatic duct dilation and an unclear image of the head of the pancreas. Acute pancreatitis was considered. However, his symptoms were not relieved after fasting, fluid infusion, anti-acid therapy, and somatostatin therapy. Then, abdominal CT scan and MRCP found multiple low-density lesions of the pancreas and enlargement of the hilar and retroperitoneal lymph nodes. Exploratory laparotomy found pancreatic edema and multiple hilar nodules with unclear boundaries, and pathological biopsy showed anaplastic large-cell lymphoma. Since the liver, the spleen, bone marrow, and the central nervous system were not involved, he was diagnosed with stage Ⅲ primary pancreatic lymphoma. After vindesine and dexamethasone were used to reduce tumor load, the patient underwent vindesine-pirarubicin-asparaginase-dexamethasone chemotherapy once and vinorelbine-dexamethasone chemotherapy 8 times. Imaging examination still showed multiple low-density lesions of the pancreas and retroperitoneal lymph node enlargement. His parents discontinued treatment. It is concluded that the rare causes of acute pancreatitis with poor response to conventional treatment should be considered, especially for patients with abdominal lymph node enlargement. Extranodal lymphoma should be considered, and lymph node biopsy should be performed as early as possible to confirm diagnosis. The prognosis of pancreatic lymphoma is associated with clinical stage and pathology.
急性胰腺炎 / 原发性胰腺淋巴瘤 / 间变大细胞淋巴瘤 / 儿童
Acute pancreatitis / Primary pancreatic lymphoma / Anaplastic large-cell lymphoma / Child
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