内容紹介
Prolonged Survival Achieved with Surgical Resection and Multidisciplinary Therapy for Acinar Cell Carcinoma of the Pancreas with Liver Metastases
Summary
We report 2 cases of prolonged survival achieved with surgical resection and multidisciplinary therapy for acinar cell carcinoma of the pancreas with liver metastases. Case 1: The patient was a 55-year-old woman. She presented with upper right abdominal pain and anemia. We diagnosed a tumor originating from the pancreas and multiple liver metastases. To avoid death caused by bleeding from the tumor, we performed pancreaticoduodenectomy and right-hemi hepatectomy, and a rapid diagnosis of acinar cell carcinoma of the pancreas was confirmed intraoperatively. After the hospital discharge, we administered hepatic intra-arterial chemotherapy and performed microwave ablation for the remnant liver metastases. Additionally, systemic chemotherapy with gemcitabine was administered; however, multiple metastases of the lung and liver became uncontrollable and she died 2 and half years postoperatively. Case 2: The patient was a 42-year-old woman. Through a medical checkup, gastric varix and elevated tumor markers were detected. The examination revealed a tumor at the tail of the pancreas and liver metastasis. We performed distal pancreatomy and partial liver resection. The pathological diagnosis was acinar cell carcinoma and liver metastasis. We administered adjuvant chemotherapy by using gemcitabine and achieved 5 years of relapse-free survival. The prognosis of ACC is better than that for PDAC. However, prognosis of unresectable cases is still unfavorable. Therapeutic strategies including aggressive surgical resection for metastatic ACC are worthy of consideration.
要旨
膵腺房細胞癌同時性肝転移に対して切除を含む集学的治療を行った症例を経験したので報告する。症例1は55歳,女性。右季肋部痛と貧血を主訴に受診し精査の結果,膵原発腫瘍および多発肝転移を指摘された。出血コントロールのために手術の方針となり,術中迅速病理診断で膵腺房細胞癌の結果を得たので膵頭十二指腸切除および肝右葉切除を施行した。術後に残肝転移巣に対し肝動注療法およびマイクロ波凝固壊死療法,化学療法(gemcitabine: GEM)を行うも,肺・肝転移のため術後2年6か月目に死亡した。症例2は42歳,女性。検診にて胃静脈瘤とCA19-9高値を指摘され精査の結果,膵尾部腫瘍と肝転移の診断となった。根治切除可能とみなし膵尾側切除術と肝部分切除術を行った。病理診断では膵腺房細胞癌および肝転移であった。術後補助化学療法はGEM療法を行い,現在5年無再発生存中である。膵腺房細胞癌は浸潤性膵管癌に比べ予後良好な腫瘤とされるが,切除不能例では依然として予後不良である。しかしながら転移巣を含む積極的外科的切除と集学的治療を行うことで長期生存が見込める可能性がある。
目次
Summary
We report 2 cases of prolonged survival achieved with surgical resection and multidisciplinary therapy for acinar cell carcinoma of the pancreas with liver metastases. Case 1: The patient was a 55-year-old woman. She presented with upper right abdominal pain and anemia. We diagnosed a tumor originating from the pancreas and multiple liver metastases. To avoid death caused by bleeding from the tumor, we performed pancreaticoduodenectomy and right-hemi hepatectomy, and a rapid diagnosis of acinar cell carcinoma of the pancreas was confirmed intraoperatively. After the hospital discharge, we administered hepatic intra-arterial chemotherapy and performed microwave ablation for the remnant liver metastases. Additionally, systemic chemotherapy with gemcitabine was administered; however, multiple metastases of the lung and liver became uncontrollable and she died 2 and half years postoperatively. Case 2: The patient was a 42-year-old woman. Through a medical checkup, gastric varix and elevated tumor markers were detected. The examination revealed a tumor at the tail of the pancreas and liver metastasis. We performed distal pancreatomy and partial liver resection. The pathological diagnosis was acinar cell carcinoma and liver metastasis. We administered adjuvant chemotherapy by using gemcitabine and achieved 5 years of relapse-free survival. The prognosis of ACC is better than that for PDAC. However, prognosis of unresectable cases is still unfavorable. Therapeutic strategies including aggressive surgical resection for metastatic ACC are worthy of consideration.
要旨
膵腺房細胞癌同時性肝転移に対して切除を含む集学的治療を行った症例を経験したので報告する。症例1は55歳,女性。右季肋部痛と貧血を主訴に受診し精査の結果,膵原発腫瘍および多発肝転移を指摘された。出血コントロールのために手術の方針となり,術中迅速病理診断で膵腺房細胞癌の結果を得たので膵頭十二指腸切除および肝右葉切除を施行した。術後に残肝転移巣に対し肝動注療法およびマイクロ波凝固壊死療法,化学療法(gemcitabine: GEM)を行うも,肺・肝転移のため術後2年6か月目に死亡した。症例2は42歳,女性。検診にて胃静脈瘤とCA19-9高値を指摘され精査の結果,膵尾部腫瘍と肝転移の診断となった。根治切除可能とみなし膵尾側切除術と肝部分切除術を行った。病理診断では膵腺房細胞癌および肝転移であった。術後補助化学療法はGEM療法を行い,現在5年無再発生存中である。膵腺房細胞癌は浸潤性膵管癌に比べ予後良好な腫瘤とされるが,切除不能例では依然として予後不良である。しかしながら転移巣を含む積極的外科的切除と集学的治療を行うことで長期生存が見込める可能性がある。