膵頭部のカルシトニン産生膵内分泌腫瘍核出術後10年目に同部位に多発発生した非機能性内分泌腫瘍の1例

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  • A case of multiple nonfunctioning pancreatic endocrine tumors occurring at the same site 10 years after enucleation for the calcitonin-secreting endocrine tumor of the head of the pancreas

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A 52-year-old woman was referred to our hospital because of tumors of the head of the pancreas. Ten years earlier, she had undergone surgical resection (enucleation) of the calcitonin-secreting, neuroendocrine tumor of the head of the pancreas. The preoperative serum value of calcitonin was 438pg/ml and immunohistochemical examination of the tumor showed strong positivity for calcitonin. This time, enhanced abdominal CT revealed existence of 4 isovascular tumors (diameter of 4cm, 1cm, 2cm, 2cm, respectively) in the head of the pancreas. These tumors seemed to be multiple pancreatic endocrine tumors occurring at the same site that the calcitonin-secreting endocrine tumor had existed 10 years earlier. Complete resection by pylorus-preserving pancreaticoduodenectomy was performed. Immunohistochemical examination of the tumors showed positivity for neuroendocrine markers such as chromogranin A, although no stain was seen for any hormone markers including calcitonin. These tumors were diagnosed as pancreatic neuroendocrine tumor (NET) G2 by the new WHO classification. The calcitonin-secreting pancreatic neuroendocrine tumor is extremely rare, and this seemed to be an interesting case for the thinking about the classification of nonfunctioning tumors as either recurrence or second primary tumors.<br>

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  • 膵臓

    膵臓 27 (5), 716-724, 2012

    一般社団法人 日本膵臓学会

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