術前診断に難渋した副膵管領域原発膵管癌の1例 A Case of Adenocarcinoma in Accessory Duct of the Pancreas and its Difficulty in Preoperative Diagnosis

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主膵管,総胆管に異常を来さなかったために,術前診断に難渋した副膵管領域原発膵管癌の1例を経験したので報告する.症例は69歳の男性で,主訴は嘔気,嘔吐.上部消化管内祝鏡検査で十二指腸下行脚が令周性狭窄を呈し,粘膜に発赤,浮腫などの変化を認め,UGIでは一部,不整像,硬化像を認めた.CTでは膵頭部領域腫瘤像が描出され,magnetic resonance cholangiopancreatographyでは総胆管,膵管には異常所見を認めなかった.開腹すると十二指腸下行脚から膵頭部前面の漿膜のひきつれを認め,迅速組織診で腺癌と診断されたために,亜全胃温存膵腸頭十二指腸切除術を施行した.腫瘍は十二指腸粘膜下から膵頭部にかけて存在し,膵実質よりは十二指腸側への進展が優位であった.病理組織学的には主膵管に異常なく,副膵管に乳頭状に腺癌が存在し,副膵管領域原発の高分化型管状腺癌と診断された.

We report a case of adenocarcinoma in the accessory duct of the pancreas and its difficulty in preoperative diagnosis. A 69-year-old man admitted for nausea and vomiting was found in endoscopic examination to havestenosis at the descending duodenum with edema and redness of the mucosa. Biopsy showed no malignancy,and physical examination and blood tests were unremarkable. Duodenography showed irregularity in thewall of the duodenal bulb. CT showed a tumorous leision at the head of the pancreas. The common bile ductand main pancreatic duct was normal on MRCP. We conducted a pylorus resecting pancreatoduodenectomy,because intraoperative rapid histopathological examination of the shrinkage at the head of pancreas indicatedadenocarcinoma. The tumor was localized between the submucosa of the duodenum and the head of the pancreas. The cut surface of the specimen showed that invasion to the duodenum was greater than to the pancreas. Pathological study showed that the main pancreatic duct was normal, but adenocarcinoma was localized in the accessory pancreatic duct. The Accessory pancreatography with contrast medium in the resected specimen showed stenosis due to adenocarcinoma.

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  • 日本消化器外科学会雑誌

    日本消化器外科学会雑誌 37(9), 1565-1570, 2004-09-01

    一般社団法人日本消化器外科学会

参考文献:  12件中 1-12件 を表示

被引用文献:  3件中 1-3件 を表示

各種コード

  • NII論文ID(NAID)
    10013673439
  • NII書誌ID(NCID)
    AN00192066
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03869768
  • データ提供元
    CJP書誌  CJP引用  NII-ELS 
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