特異な膵管拡張を呈した十二指腸副乳頭部癌の1切除例 Adenocarcinoma of the minor duodenal papilla in a patient with unique pancreatic duct dilatation: a case report

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著者

    • 黒崎 功 KUROSAKI Isao
    • 新潟大学大学院消化器・一般外科 Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University
    • 高野 可赴 TAKANO Kabuto
    • 新潟大学大学院消化器・一般外科 Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University
    • 味岡 洋一 AJIOKA Youichi
    • 新潟大学大学院分子病態病理学 Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University

抄録

十二指腸副乳頭部の腺癌は極めてまれである.本稿では特異な膵管拡張を呈した副乳頭部癌の1切除例を報告する.症例は74歳女性.貧血の精査時にCA19-9の高値(274mg/m<i>l</i>)が指摘された.上部・下部消化管内視鏡検査,腹部CTで病変は発見されなかったが,CA19-9は経時的に上昇した.7か月後にFDG-PET検査にて右上腹部に集積が認められ,上部消化管内視鏡再検査にて十二指腸第2部に2型腫瘍が指摘された.CTとMRCPでは膵頭部腹側に限局した膵管拡張が認められ,副乳頭部癌または十二指腸癌の副乳頭浸潤の診断で膵頭十二指腸切除術が施行された.切除標本上,病変は3.2cm大で陥凹部中央に副膵管が開口していた.組織学的検索で副膵管内に腺癌の上皮内進展が認められ,副乳頭部癌と診断された.領域性の膵管拡張が副乳頭部癌を診断する契機となった.副乳頭は診断の死角になりやすく,注意深い画像診断が重要である.<br>

We reported herein an extremely rare case of adenocarcinoma arising from the minor duodenal papilla in association with unique pancreatic duct dilatation. The patient was 74 year-old woman, in whom the increased level of the serum CA19-9 (274mg/m<i>l</i>) was pointed out by the medical check-up for anemia. The upper and lower gastrointestinal endoscopy and the CT did not demonstrate any abdominal lesion, but the serum CA19-9 level had been increasing with time. Seven months after the first endoscopy, the lesion, which showed FDG accumulation, was detected around the 2<sup>nd</sup> portion of the duodenum by PET. Therefore, upper gastrointestinal endoscopy was performed again, and the type 2 tumor of the duodenum was found. In CT and MR, the prominent dilatation of the pancreatic duct confined to the lower portion of the pancreatic head was disclosed. It took 9 months from the first medical examination to pancreaticoduodenectomy. The tumor was 32mm in diameter and the opening of the accessory pancreatic duct was located in the center of the tumor. Microscopically, the intraepithelial spread of cancer was observed in the accessory pancreatic duct. In this report, we can point out that the minor papilla is easily overlooked by routine endoscopic observation.<br>

収録刊行物

  • 膵臓

    膵臓 27(6), 762-767, 2012

    Japan Pancreas Society

各種コード

  • NII論文ID(NAID)
    130004496006
  • 本文言語コード
    JPN
  • ISSN
    0913-0071
  • データ提供元
    J-STAGE 
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