慢性膵炎にみられた膵リンパ上皮嚢胞 (Lymphoepithelial cyst) の1例 A CASE OF A LYMPHOEPITHELIAL CYST OF THE SPLEEN IN A PATIENT WITH CHRONIC PANCREATITIS

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症例は73歳,男性.3年2カ月前から当院内科にて慢性膵炎として外来通院していた.当初よりCTにて膵背側に嚢胞性の腫瘤があり膵仮性嚢胞の疑いで経過観察されていたが1年前より徐々に腫瘤が増大し血中CA19-9の異常高値(5,240U/ml)を認めた.悪性腫瘍との鑑別が困難なため手術目的で当科紹介となった.開腹すると膵背側の腫瘤は約4cmで周囲の組織にはさほど炎症所見が無く腫瘍性病変を考え膵体尾脾切除,胆嚢摘出術,膵管胃吻合を施行した.病理組織学的検査にて病変は大小2個の嚢胞より成り嚢胞壁は重層扁平上皮で覆われ所々にリンパ濾胞も有しておりリンパ上皮嚢腫(Lymphoepithelial cyst)と診断された.経過は良好で術後2カ月のCA19-9は11.4U/mlと正常化した.今回われわれは慢性膵炎の経過中に偶然発見され膵仮性嚢胞の疑いで経過観察の後に手術となった症例を経験した.病変が経過とともに増大していることと慢性膵炎を伴っていることからその成因を推測する上で示唆に富む症例であった.

The patient was a 73-year-old man who had been treated for chronic pancreatitis in the department of internal medicine in our hospital on an ambulant basis since 3 years 2 months earlier. When he was first seen, a cystic mass on the dorsal aspect of the pancreas was found by abdominal CT scan and thereafter the clinical course had been followed with a suspicion of a pancreatic pseudocyst. The cyst had started to enlarge gradually since one year earlier and the serum CA19-9 increased to an abnormally high level (5240U/ml) as well. Due to the difficulty in differentiation from a malignant tumor, the patient was referred to our department for the purpose of operation. Upon laparotomy, the tumor on the dorsal aspect of the pancreas was about 4cm in diameter and there were not so many inflammatory findings in the surrounding tissues. Considering a possibility of a tumorous lesion, resection of the pancreatic body and tail with splenectomy, cholecystectomy, and anastomosis of the pancreatic duct to the stomach were performed. Histopathologically the lesion was composed of a large and a small cyst and the cystic wall was covered with stratified squamous epithelium with lymphatic follicle in places. Lymphoepithelial cyst was thus diagnosed. The patient's postoperative course was uneventful and the CA19-9 level was normalized to 11.4U/ml 2 months after the operation.<BR>This time we experienced a case of a lymphoepithelial cyst which was incidentally found in the course of chronic pancreatitis and then was operated on with a suspicion of a pancreatic pseudocyst. This case is considered to be suggestive in inferring the etiology of the cyst because the lesion enlarged with time and was associated with chronic pancreatitis.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association  

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 69(7), 1786-1790, 2008-07-25 

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10021945007
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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