膵癌に伴った皮下結節性脂肪壊死症の1例  [in Japanese] A Case of Subcutaneous Nodular Fat Necrosis Associated with Islet Cell Carcinoma  [in Japanese]

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Abstract

56歳男性.平成10年8月頃より右膝関節の発赤,腫脹が出現.抗生剤の投与にて臨床症状は改善したが,9月頃より両側下腿後面に暗紅色の皮下硬結が出現し,以後両足背,両手背にも発赤,腫脹,疼痛が出現してきた.また,右肘関節,左手関節,左手指関節をはじめとする多関節炎も認められた.病理組織学的所見では,皮下脂肪織の炎症性細胞浸潤と脂肪細胞の壊死像を認めた.経過中に血清アミラーゼの上昇を認め,腹部CTを施行したところ,膵体部に直径7 cm大の腫瘍が確認された.リパーゼ,トリプシン,ホスホリパーゼA<sub>2</sub>も異常高値を示していた.平成11年1月,膵体部切除術を施行.腫瘍はAFP産生性の島細胞癌であった.術後皮膚症状,関節症状とも落ち着いたが,平成12年1月肝転移,腹膜転移に伴い膵酵素が再度上昇し,皮膚症状,関節症状とも再発した.肝転移等に対して動注化学療法を行うも徐々に全身状態悪化し,9月10日永眠された.本症は膵炎や膵癌に伴って生じる稀な病態で,膵癌の中では腺房細胞癌に多いのが特徴である.本邦で島細胞癌の報告例はなく,本症例が第1例目でありここに報告する.

We report a case of subcutaneous nodular fat necrosis associated with islet cell carcinoma. A 56-year-old male began to notice redness and swelling in the right knee joint around August of 1998. Clinical symptoms improved with administration of antibiotics. From around September, a dark red subcutaneous induration appeared on the posterior aspect of both legs; thereafter, redness, swelling and pain began to appear on the backs of both feet and hands. Polyarthritis was also found. Histopathological examination revealed inflammatory cell infiltrations of subcutaneous adipose tissue and necrosis of fat cells. An increase in the serum amylase level was found during the clinical course. A 7 cm diameter tumor in the pancreatic body was confirmed by abdominal CT. Lipase, trypsin, and phospholipase A<sub>2</sub> also showed abnormally high values. In January of 1999, the tumor was totally resected. It was found to be an AFP-productive islet cell carcinoma. After resection of the tumor, the dermal and articular symptoms subsided. In January of 2000, however, the pancreatic enzymes increased again, and the dermal and articular symptoms recurred with metastasis to the liver. Hepatic arterial infusion chemotherapy was administered, but his general condition worsened gradually, and he died on September 10.

Journal

  • The Japanese Journal of Dermatology

    The Japanese Journal of Dermatology 112(1), 43-49, 2002-01-20

    Japanese Dermatological Association

References:  16

Codes

  • NII Article ID (NAID)
    10008386483
  • NII NACSIS-CAT ID (NCID)
    AN00196602
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    0021499X
  • NDL Article ID
    025120411
  • NDL Call No.
    Z19-202
  • Data Source
    CJP  NDL  J-STAGE 
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