胃壁筋層内へ穿破した膵粘液性嚢胞腫瘍の1例  [in Japanese] Perforation of a Mucinous Cystic Neoplasm of the Pancreas into the Stomach Wall with Hemorrhage—A Case Report—  [in Japanese]

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Abstract

症例は44歳,女性.主訴は心窩部不快感.CTで膵尾部に径約70mmの嚢胞性病変,それと連続し胃壁内に小嚢胞の集簇を認めた.経過観察中に突然の腹痛で当院へ救急搬送され,CTで胃側の嚢胞が長径95mmと増大しており入院した.超音波内視鏡検査で胃側の嚢胞は胃壁筋層内に存在し,膵尾部の嚢胞との交通を認めた.穿刺内容液は血性で,内容液中のamylase(AMY),CEAが高値であった.膵粘液性嚢胞腫瘍(MCN)が胃壁内へ穿破したことによる胃壁筋層内出血と診断し,待機的に手術を行った.手術は膵体尾部脾合併切除を行い,胃側の嚢胞は胃壁の筋層を温存し嚢胞壁のみ合併切除した.膵嚢胞内容液のAMY,CEAは高値で胃壁側の嚢胞液と類似していた.病理組織診断ではMCNの診断であった.MCNが膵管と交通を持ち,胃壁筋層内へ穿破し出血を生じたと考えられる1例を経験したため,文献的考察も含めて報告する.

A 44-year-old woman with sudden-onset severe abdominal pain was brought to our hospital by ambulance. Computed tomography (CT) scan showed coupled cystic lesions presenting as a 70 mm unilocular cystic lesion in the pancreatic tail, and a 95 mm unilocular cystic lesion in the stomach wall. Endoscopic ultrasound showed a unilocular anechoic cystic lesion with a thick wall in the pancreatic tail, which communicated with a multilocular cystic lesion in the stomach wall. Fine needle aspiration identified bloody fluid in the stomach cyst. Amylase and carcinoembryonic antigen (CEA) levels were elevated in the fluid. We diagnosed mucinous cystic neoplasm of the pancreatic tail perforating into the stomach wall with hemorrhage. Distal pancreatectomy with resection of the cystic lesion in the stomach wall was performed. The histopathological diagnosis was mucinous cyst adenoma of the pancreas with ovarian-like stroma. Analysis of the fluid showed that the amylase level was high in both lesions, suggesting that the mucinous cyst adenoma had communicated with the pancreatic duct and enlarged, before perforating the stomach wall.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 79(2), 405-411, 2018

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130007472984
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • NDL Article ID
    028881041
  • NDL Call No.
    Z19-227
  • Data Source
    NDL  J-STAGE 
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