十二指腸粘膜下腫瘍との鑑別が困難であったGroove Pancreatitisの1例 (医学部外科学(第2)講座 亀岡信悟教授退任記念特別号(2))  [in Japanese] A Case of Groove Pancreatitis Mimicking Duodenal Submucosal Tumor  [in Japanese]

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Abstract

症例は44歳、男性の大酒家である.3ヶ月前から続く食後の上腹部痛を主訴に前医を受診した.腹部超音波検査で右季肋下の腫瘤を指摘され、同部に圧痛を認めた.上部内視鏡検査で十二指腸内腔に突出する隆起性病変を認め、十二指腸腫瘍を疑い当院紹介となった.当院での上部内視鏡および消化管造影検査でも、十二指腸下行脚の膵側に粘膜下腫瘍を疑わせる多結節状の隆起性病変を認め、内腔狭窄を認めた.CTでは十二指腸下行脚左側に径7cm大の不整形腫瘤がみられ、内部には石灰化と嚢胞性変化を認めた.膵との境界は不明瞭であったが、MRIでは腫瘤と膵との境界は保たれていた.十二指腸粘膜生検では明らかな腫瘍性変化は認められず、画像的にも総胆管や膵管に腫瘍性変化を示唆する所見はないことから、臨床的には十二指腸粘膜下腫瘍の可能性を考えた.術中、十二指腸下行脚と膵頭部の間に弾性硬の腫瘤を触知し、腫瘤周囲には高度の炎症性変化を認め、亜全胃温存膵頭十二指腸切除術を施行した.病理組織学検索で、膵、Groove領域や十二指腸壁には広範な線維化や慢性炎症細胞浸潤がみられたが、腫瘍性変化は認められなかった.以上の所見からGroove pancreatitisと診断した.Groove pancreatitisはgroove領域に発生する限局性慢性膵炎で、その特徴的所見について文献的考察を加え報告する.

A 44-year-old man with a history of alcoholism suffered from upper abdominal pain for 3 months and was referred to a local hospital. Physical examination showed tenderness in the right hypochondrium, and abdominal ultrasonography revealed a mass shadow 5 cm in diameter. Upper gastrointestinal endoscopy and gastroduodenography showed stenosis with multinodular elevated lesions, suggesting duodenal submucosal tumor. Contrast-enhanced computed tomography of the abdomen showed an irregularly shaped mass, 7 cm in diameter, with calcification and cystic change between the second portion of the duodenum and the pancreatic head. Because mucosal biopsy showed no malignancy and imaging findings failed to identify any neoplastic changes in the common bile duct or pancreatic duct, duodenal submucosal tumor was suspected. During laparotomy, an elastic, hard mass was palpable between the second portion of the duodenum and the pancreatic head, and marked inflammatory changes were apparent around the mass. Subtotal stomach-preserving pancreaticoduodenectomy was therefore performed. Histological findings showed fibrosis and chronic inflammation between the duodenal wall and pancreas without any evidence of malignancy, leading to a diagnosis of groove pancreatitis. Groove pancreatitis is a localized chronic pancreatitis affecting the pancreatic groove. Due to the similar radiological findings and a lack of awareness of this entity, it is challenging to differentiate from malignant tumor diagnostically. We report a case of groove pancreatitis mimicking duodenal submucosal tumor and discuss its characteristic appearance with consideration of the literature.

Journal

  • Journal of Tokyo Women's Medical College

    Journal of Tokyo Women's Medical College 85(臨増1), E43-48, 2015-03

    Tokyo Women's Medical University

Codes

  • NII Article ID (NAID)
    110009888980
  • NII NACSIS-CAT ID (NCID)
    AN00161368
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • Journal Type
    大学紀要
  • ISSN
    0040-9022
  • NDL Article ID
    026284366
  • NDL Call No.
    Z19-400
  • Data Source
    NDL  NII-ELS  IR 
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