内容紹介
The Surgical Experience for Bulky Serous Cystic Neoplasm of Pancreas
Summary
A 74-year-old female was admitted to our hospital due to the bulky abdominal tumor pointed out by ultrasonography of medical screening. Abdominal CT revealed the tumor, in a diameter 20 cm, replaced the total pancreas and compressed the surrounding organs and portal vein. We diagnosed as a pancreatic serous cystic neoplasm with a possibility of malignancy. The operative findings showed the tumor tightly adhered to stomach, duodenum, liver, transverse colon mesenterium, retroperitoneum and the surrounding main vessels. Total pancreatectomy, cholecystectomy, splenectomy and distal gastrectomy were performed. As a histopathological finding, the tumor surface was smooth and the inside was sponge-like appearance mixed with microcystic and solid components. No malignant finding was observed. The patient was discharged without major complications on postoperative day 42, and remains alive with no recurrence for 9 months after surgery.
要旨
症例は74歳,女性。検診の腹部エコーにて巨大腹部腫瘍を指摘され,腹部CTにて膵を置換する直径20 cm大で内部に石灰化を伴う隔壁様構造を有し囊胞部と充実部の混在する腫瘍を認めた。腫瘍は周辺臓器および門脈を圧排していた。以上の所見から悪性の可能性が否定し得ない膵漿液性囊胞腫瘍と診断し,膵全摘術,門脈合併切除再建術,胆囊摘出術,脾臓摘出術,幽門側胃切除を施行した。手術所見として,腫瘍は膵原発であり十二指腸,横行結腸間膜,後腹膜および周囲の動静脈(門脈,総肝動脈,固有肝動脈,上腸間膜動脈)と強固に癒着していた。摘出標本の表面は比較的平滑で,割面には小型囊胞構造が密在しスポンジ状の外観を示す部分が主であった。悪性を疑うような浸潤所見は認めず膵漿液性囊胞腺腫と診断した。特に大きな合併症はなく経過し術後42日目に退院,術後9か月現在まで生存中である。
目次
Summary
A 74-year-old female was admitted to our hospital due to the bulky abdominal tumor pointed out by ultrasonography of medical screening. Abdominal CT revealed the tumor, in a diameter 20 cm, replaced the total pancreas and compressed the surrounding organs and portal vein. We diagnosed as a pancreatic serous cystic neoplasm with a possibility of malignancy. The operative findings showed the tumor tightly adhered to stomach, duodenum, liver, transverse colon mesenterium, retroperitoneum and the surrounding main vessels. Total pancreatectomy, cholecystectomy, splenectomy and distal gastrectomy were performed. As a histopathological finding, the tumor surface was smooth and the inside was sponge-like appearance mixed with microcystic and solid components. No malignant finding was observed. The patient was discharged without major complications on postoperative day 42, and remains alive with no recurrence for 9 months after surgery.
要旨
症例は74歳,女性。検診の腹部エコーにて巨大腹部腫瘍を指摘され,腹部CTにて膵を置換する直径20 cm大で内部に石灰化を伴う隔壁様構造を有し囊胞部と充実部の混在する腫瘍を認めた。腫瘍は周辺臓器および門脈を圧排していた。以上の所見から悪性の可能性が否定し得ない膵漿液性囊胞腫瘍と診断し,膵全摘術,門脈合併切除再建術,胆囊摘出術,脾臓摘出術,幽門側胃切除を施行した。手術所見として,腫瘍は膵原発であり十二指腸,横行結腸間膜,後腹膜および周囲の動静脈(門脈,総肝動脈,固有肝動脈,上腸間膜動脈)と強固に癒着していた。摘出標本の表面は比較的平滑で,割面には小型囊胞構造が密在しスポンジ状の外観を示す部分が主であった。悪性を疑うような浸潤所見は認めず膵漿液性囊胞腺腫と診断した。特に大きな合併症はなく経過し術後42日目に退院,術後9か月現在まで生存中である。