膵管内乳頭粘液性腫瘍に併存し異時性多中心性に発生した膵癌の根治切除例  [in Japanese] Metachronous multicentric pancreatic cancer with multiple intraductal papillary mucinous neoplasms (IPMN)  [in Japanese]

Access this Article

Search this Article

Author(s)

Abstract

症例は58歳女性.父が膵癌の家族歴がある.2008年11月に背部痛で発症し,当院で精査を施行.膵鉤部と体尾部に複数の分枝型膵管内乳頭粘液性腫瘍(IPMN)に併存する膵体部の通常型膵癌に対し,2009年4月に膵体尾部切除術を施行した.組織学的には分枝型IPMNに併存した高分化型管状腺癌(tub1)であり,膵癌取扱い規約では,T3N0M0,Stage III,R0であった.膵断端近傍にPanIN1A-1B相当の所見を認めた.術後37ヶ月からCA19-9の上昇を認め,精査で異時性発生膵癌あるいは残膵再発と診断し初回手術から46ヶ月後に残膵全摘術・門脈合併切除術を施行.組織学的に膵鉤部IPMNとの連続性は認めず,初回手術と同様にtub1と診断されたが,組織像がやや異なることや時間経過等から異時性発生と診断された.IPMNに併存し異時性多中心性に発生した膵癌に関して文献的考察を加え報告する.

We report a rare surgical case of metachronous multicentric pancreatic cancer with multiple intraductal papillary mucinous neoplasms (IPMN). A 58-year-old woman with diabetes mellitus and a family history of pancreatic cancer (her father suffered from pancreatic cancer), was admitted to our hospital because of backache in November 2008. Distal pancreatectomy was performed for pancreatic cancer of the body concomitant with multiple IPMNs of uncinate process and distal pancreas in April 2009. Histopathological investigation revealed well-differentiated tubular adenocarcinoma concomitant with branch duct type IPMN. The final diagnosis based on general rules of JPS was T3N0M0, Stage III (R0). Although the margin of the surgical specimen was negative for carcinoma, a surgical specimen near the pancreatic stump showed PanIN1A-1B. Thirty-seven months after resection, the serum CA 19-9 value was elevated. Imaging examinations revealed a mass in the remnant pancreas. Forty-six months after the initial surgery, total pancreatectomy with portal vein resection was performed. Although the tumor was pathologically diagnosed as well-differentiated tubular adenocarcinoma, multicentric carcinogenesis was suggested because of histological differentiation from the initial tumor. The main tumor had no continuity with a branch duct type IPMN of the uncinate process. Therefore, the patient was diagnosed as metachronous multicentric pancreatic cancer concomitant with multiple IPMNs.

Journal

  • Suizo

    Suizo 31(1), 93-100, 2016

    Japan Pancreas Society

Codes

  • NII Article ID (NAID)
    130005137842
  • Text Lang
    JPN
  • ISSN
    0913-0071
  • Data Source
    J-STAGE 
Page Top