術前診断に苦慮した中年男性の巨大Solid pseudopapillary neoplasmの1例  [in Japanese] A case of a giant solid pseudopapillary neoplasm of the pancreas in a middle-aged man with difficulty in preoperative diagnosis  [in Japanese]

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Author(s)

    • 伊関 雅裕 ISEKI Masahiro
    • 東北大学大学院医学系研究科外科病態学講座・消化器外科学分野 Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine
    • 内藤 剛 NAITO Takeshi
    • 東北大学大学院医学系研究科外科病態学講座・消化器外科学分野 Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine
    • 片寄 友 KATAYOSE Yu
    • 東北大学大学院医学系研究科寄附講座・統合がん治療外科学講座 Division of Integrated Surgery and Oncology, Department of Surgery, Tohoku University Graduate School of Medicine
    • 海野 倫明 UNNO Michiaki
    • 東北大学大学院医学系研究科外科病態学講座・消化器外科学分野|東北大学大学院医学系研究科寄附講座・統合がん治療外科学講座 Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine|Division of Integrated Surgery and Oncology, Department of Surgery, Tohoku University Graduate School of Medicine
    • 水間 正道 MIZUMA Masamichi
    • 東北大学大学院医学系研究科外科病態学講座・消化器外科学分野 Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine
    • 坂田 直昭 SAKATA Naoaki
    • 東北大学大学院医学系研究科外科病態学講座・消化器外科学分野 Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine
    • 林 洋毅 HAYASHI Hiroki
    • 東北大学大学院医学系研究科外科病態学講座・消化器外科学分野 Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine
    • 中川 圭 NAKAGAWA Kei
    • 東北大学大学院医学系研究科寄附講座・統合がん治療外科学講座 Division of Integrated Surgery and Oncology, Department of Surgery, Tohoku University Graduate School of Medicine
    • 岡田 恭穂 OKADA Takaho
    • 東北大学大学院医学系研究科外科病態学講座・消化器外科学分野 Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine
    • 森川 孝則 MORIKAWA Takanori
    • 東北大学大学院医学系研究科外科病態学講座・消化器外科学分野 Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine
    • 吉田 寛 YOSHIDA Hiroshi
    • 東北大学大学院医学系研究科外科病態学講座・消化器外科学分野 Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine
    • 元井 冬彦 MOTOI Fuyuhiko
    • 東北大学大学院医学系研究科外科病態学講座・消化器外科学分野 Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine

Abstract

症例は47歳男性.体重減少と心窩部痛がみられ精査を行った.腹部CTで上腹部に径21cm大の被膜で覆われた膵原発腫瘍を認めた.辺縁に多血性の充実成分を有し,中心性壊死・腫瘍内出血・石灰化を認めた.確定診断には至らなかったが,この腫瘍に対して,亜全胃温存膵全摘術・結腸合併切除術・門脈合併切除再建術を施行した.切除標本では,径26cm大の線維性の被膜に覆われた膵腫瘍を認め,内部に中心性壊死・出血を認めた.病理組織学的所見では類円型の核と好酸性細胞質を有する異型細胞が偽乳頭状配列を有し,免疫染色でCD10陽性,vimentin陽性,<i>β</i>-catenin陽性であり,SPNと診断された.<br> SPNは比較的稀な膵腫瘍であり,多くが若年女性に発症するとされる.術前診断に苦慮した中年男性に発症した本邦最大級の巨大なSPNの1例を経験したので報告する.<br>

A 47-year-old man presented with continuous epigastric pain and body weight loss. The abdominal CT scan revealed a 21cm encapsulated mass with central necrosis and peripheral calcification in the pancreas. This tumor showed an enhanced solid component in the marginal area. The patient underwent total pancreatectomy with portal vein resection and reconstruction. In the resected specimen, a 26cm tumor of the pancreas, surrounded by a fibrous pseudocapsule, gave rise to central necrosis and intratumoral hemorrhage. Histological examination revealed that the tumor cells with enlarged nucleus and granular eosinophillic cytoplasm were arranged in sheets and nests, forming pseudopapillary structures. They were immunohistologically positive for CD10 and vimentin. Since nuclear accumulation of beta-catenin protein was shown, this tumor was pathologically diagnosed as SPN. SPN of the pancreas is a rare neoplasm and typically afflicts young women. Here we report a case of one of the largest SPNs in Japan, with difficulty in the preoperative diagnosis, arising in a middle-aged man.<br>

Journal

  • Suizo

    Suizo 29(1), 67-73, 2014

    Japan Pancreas Society

Codes

  • NII Article ID (NAID)
    130004496053
  • Text Lang
    JPN
  • ISSN
    0913-0071
  • Data Source
    J-STAGE 
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