POPSが腫瘍進展範囲の把握に有用であった主膵管型IPMN(gastric type)の1例  [in Japanese] Successful definition of tumor extension of main duct-type intraductal papillary-mucinous neoplasm (gastric type) of the pancreas with peroral pancreatoscopy  [in Japanese]

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Abstract

症例は61歳男性.3ヶ月で5~6kgの体重減少を認めたため近医で施行したCTにて主膵管の拡張を認め,精査加療目的で紹介となった.MDCT,MRCPでは体尾部主膵管の不整な拡張が認められ,EUSでは嚢状に拡張した主膵管内に多数の乳頭状結節が認められた.同結節はPOPSでは血管像を伴うイクラ状隆起として観察され,生検では軽度異型を呈するIPMNの診断であった.POPSを含む術前精査により決定された切離線に基づいて膵体尾部切除術が施行され,切除断端は陰性であり,最終病理診断は軽度~中等度異型を呈するIPMNであった.主膵管型IPMNは,術前に腫瘍進展範囲の把握が困難なことも多い.今回我々は,POPSを含む術前精査が腫瘍進展範囲の把握に有用であり,過大手術の回避に寄与した1例を経験したため報告する.<br>

A 61-year-old man was admitted to our hospital after detection of pancreatic duct dilation on abdominal computed tomography that was performed to investigate his weight loss. Multidetector computed tomography and magnetic resonance cholangiopancreatography revealed irregular dilation of the main pancreatic duct in the body and tail of the pancreas. Endoscopic ultrasonography revealed multiple papillary lesions in the sac-like, dilated main pancreatic duct. The lesions were visualized as papillary protrusions with redness of vascular vessels on peroral pancreatoscopy, and they were diagnosed as low-grade dysplasia on examination of biopsies. Based on the preoperative examinations, including peroral pancreatoscopy, surgery was decided. A distal pancreatectomy was performed, and the margin was described as negative. It is often difficult to correctly diagnose the range of intraductal expanse before surgical removal in "main duct type intraductal papillary-mucinous neoplasms". We report a case of main duct-type intraductal papillary-mucinous neoplasm with low- or intermediate-grade dysplasia of the pancreas in which a preoperative peroral pancreatoscopy was useful to evaluate tumor extension and was contributed to avoid unnecessary surgery.<br>

Journal

  • Suizo

    Suizo 28(5), 666-673, 2013

    Japan Pancreas Society

Codes

  • NII Article ID (NAID)
    130004496034
  • Text Lang
    JPN
  • ISSN
    0913-0071
  • Data Source
    J-STAGE 
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