内容紹介
Surgical Resection of an Intraductal Papillary Mucinous Carcinoma Observed on Imaging Four Years after the Initial Diagnosis
Summary
We herein report a 75-year-old woman who presented with an intraductal papillary mucinous carcinoma(IPMC)who was treated with surgical resection 4 years after the initial diagnosis was made. She previously underwent a high anterior resection of the rectum for rectal cancer at 71 years of age. Preoperative CT revealed a multilocular cystic mass measuring 6 cm in size in the body of the pancreas, which was considered benign. We followed up the intraductal papillary mucinous neoplasm(IPMN)by using annual CT imaging for 4 years. CT revealed a gradual increase in the size of the mass and the development of an intramural nodule in the IPMN. Endoscopic retrograde pancreatography revealed dilatations of the main pancreatic duct communicating with the multilocular cystic lesion. The cytology of the pancreatic juice demonstrated class Ⅲb. We therefore diagnosed the patient as having IPMC and performed total pancreatectomy. The postoperative course was uneventful without any recurrence. To our knowledge, only few reports have described the natural history of IPMNs. This resected case of IPMC is rare on the basis of our observation of the natural history of an IPMN using long-term imaging studies.
要旨
症例は75歳,女性。71歳時,直腸癌に対し高位前方切除術を施行した。その際,術前腹部CT検査で膵体部に6 cm大の多房性囊胞性腫瘤を認めたが,良性の膵管内乳頭粘液性腫瘍(IPMN)と診断した。術後1年ごとに腹部造影CT検査を施行したが,4年間の経過観察中に腫瘍径が緩徐に増大し,腫瘍内部に結節が出現してきた。ERCPでは主膵管の拡張を認め,分枝膵管との交通も認めた。膵液細胞診でclass Ⅲbであった。膵管内乳頭粘液性腺癌(IPMC)の診断で膵全摘術を施行した。術後経過は良好で再発を認めていない。IPMNの自然史に関する報告は少なく,4年間の長期にわたりIPMNを画像で経過観察した点で貴重な症例のため報告する。
目次
Summary
We herein report a 75-year-old woman who presented with an intraductal papillary mucinous carcinoma(IPMC)who was treated with surgical resection 4 years after the initial diagnosis was made. She previously underwent a high anterior resection of the rectum for rectal cancer at 71 years of age. Preoperative CT revealed a multilocular cystic mass measuring 6 cm in size in the body of the pancreas, which was considered benign. We followed up the intraductal papillary mucinous neoplasm(IPMN)by using annual CT imaging for 4 years. CT revealed a gradual increase in the size of the mass and the development of an intramural nodule in the IPMN. Endoscopic retrograde pancreatography revealed dilatations of the main pancreatic duct communicating with the multilocular cystic lesion. The cytology of the pancreatic juice demonstrated class Ⅲb. We therefore diagnosed the patient as having IPMC and performed total pancreatectomy. The postoperative course was uneventful without any recurrence. To our knowledge, only few reports have described the natural history of IPMNs. This resected case of IPMC is rare on the basis of our observation of the natural history of an IPMN using long-term imaging studies.
要旨
症例は75歳,女性。71歳時,直腸癌に対し高位前方切除術を施行した。その際,術前腹部CT検査で膵体部に6 cm大の多房性囊胞性腫瘤を認めたが,良性の膵管内乳頭粘液性腫瘍(IPMN)と診断した。術後1年ごとに腹部造影CT検査を施行したが,4年間の経過観察中に腫瘍径が緩徐に増大し,腫瘍内部に結節が出現してきた。ERCPでは主膵管の拡張を認め,分枝膵管との交通も認めた。膵液細胞診でclass Ⅲbであった。膵管内乳頭粘液性腺癌(IPMC)の診断で膵全摘術を施行した。術後経過は良好で再発を認めていない。IPMNの自然史に関する報告は少なく,4年間の長期にわたりIPMNを画像で経過観察した点で貴重な症例のため報告する。