膵・胆管合流異常に合併した共通管内乳頭状腫瘍の1例  [in Japanese] Papillary Neoplasm in a Common Channel in Patients with Pancreaticobiliary Maljunction  [in Japanese]

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Abstract

<p>膵・胆管合流異常に合併した共通管内乳頭状腫瘍の1例を報告する.症例は75歳の男性で,6か月間に2度の急性膵炎を発症し保存的加療で軽快した.急性膵炎の原因精査および加療目的で当院へ紹介となった.ERCPでは膵・胆管合流異常を認め,共通管内に7 mmの結節様陰影欠損像を認めた.上部内視鏡検査では乳頭部からの粘液排出は認めず,超音波内視鏡検査では共通管内に乳頭状の腫瘍が描出された.造影CTでは膵頭部に拡張した共通管と内部に増強効果を持つ8 mmの腫瘤を認めた.尾側の主膵管の拡張は認めなかった.膵・胆管合流異常に合併した共通管内乳頭状腫瘍と診断し,亜全胃温存膵頭十二指腸切除術を施行した.病理肉眼所見では共通管内に発育する有茎性の乳頭状腫瘍で,組織像は管状構造増生を主体とする腺腫であった.免疫組織学的染色ではMUC1,MUC2陰性,MUC5AC陽性で胃型腺腫と最終診断した.</p>

<p>We report a rare case of papillary neoplasm in a common channel with pancreaticobiliary maljunction. A 75-year-old man had acute pancreatitis twice during 6 months. He recovered with conservative treatment. He was admitted to our hospital for further examination. ERCP revealed pancreaticobiliary maljunction with a 7-mm filling defect in a dilated common channel. Gastroduodenoscopy revealed no discharge of mucin. Endoscopic US revealed a 7.9×7.5-mm pedunculated papillary tumor in the common channel. Contrast-enhanced CT revealed an 8.0×6.0 mm tumor in the dilated common channel, 10 mm in diameter. The distal main pancreatic duct was not dilated. Subtotal stomach-preserving pancreaticoduodenectomy was performed with a preoperative diagnosis of papillary neoplasm in the common channel with pancreaticobiliary maljunction. The resected specimen was pathologically diagnosed as a pedunculated papillary adenoma with a fine fibrovascular core in the common channel. Immunohistochemical findings of the tumor were negative for MUC1 and MUC2, and positive for MUC5AC and MUC6. The final diagnosis of gastric-type adenoma was made.</p>

Journal

  • The Japanese Journal of Gastroenterological Surgery

    The Japanese Journal of Gastroenterological Surgery 51(2), 114-121, 2018

    The Japanese Society of Gastroenterological Surgery

Codes

  • NII Article ID (NAID)
    130006386831
  • Text Lang
    JPN
  • ISSN
    0386-9768
  • Data Source
    J-STAGE 
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