内容紹介
A Case of Resection for Lymph Node Recurrence around the Inferior Vena Cava after Radical Surgery of Undifferentiated Carcinoma of the Pancreatic Head Region
Summary
A 60-year-old man underwent palliative surgery with a diagnosis of unresectable cancer, and he visited our hospital for further treatment. Since the cancer was unresectable and multiple hepatic tumors were revealed in CT images that were not metastases, we decided to perform curative surgery for the pancreatic cancer accompanied by partial liver invasion. Pancreaticoduodenectomy plus partial hepatectomy were performed, and 2 tumors were detected in the resected specimen: one in the pancreas-duodenum region and a submucosal tumor in the duodenum bulb. The large tumor that occupied the pancreas-duodenum region was histologically diagnosed as an undifferentiated carcinoma, and the duodenal submucosal tumor was consistent with findings of a poorly differentiated adenocarcinoma. Two years after surgery, CT examination revealed a mass extending into the inferior vena cava(IVC)from near the right renal vein. We eventually diagnosed lymph node recurrence with tumor thrombosis in the IVC and started chemotherapy(FOLFIRINOX). After the tumor decreased, we performed salvage surgery involving resection of the lymph node, thrombectomy, and right nephrectomy. The tumor revealed atypical cells in the region of thrombosis, and the pathological findings were not in conflict with the findings of metastases from pancreatic cancer 2 years prior. After the treatment, chemotherapy was administered and he survived without any recurrence for 15 months after surgery.
要旨
症例は60歳,男性。嘔吐を主訴に前医を受診した。肝浸潤・多発肝転移を伴う膵頭部領域癌の診断で姑息手術を施行され,以降の治療目的に当院へ紹介となった。精査にて多発肝転移を疑い,病変は血管腫と診断した。膵頭部領域癌肝浸潤に対し,肝部分切除合併膵頭十二指腸切除術を施行した。切除標本では十二指腸および膵頭部に広がる腫瘍と十二指腸粘膜下腫瘍の2病変を認め,病理結果では十二指腸-膵頭部から発生した未分化癌であり,十二指腸粘膜下への転移を伴っていると考えられた。術後2年間無再発であったが,定期画像検索で右腎静脈根部付近から下大静脈(inferior vena cava: IVC)内へ伸展する腫瘤を認め,IVC内の腫瘍栓を伴うリンパ節再発と診断した。抗癌剤治療によって腫瘍栓の縮小が得られ,他の再発病変を認めなかったため,salvage手術を施行した。病理結果では,腫瘍栓に異型細胞を認め,原病転移として矛盾しない像であった。退院後化学療法を施行し,術後15か月時点で無再発生存中である。
目次
Summary
A 60-year-old man underwent palliative surgery with a diagnosis of unresectable cancer, and he visited our hospital for further treatment. Since the cancer was unresectable and multiple hepatic tumors were revealed in CT images that were not metastases, we decided to perform curative surgery for the pancreatic cancer accompanied by partial liver invasion. Pancreaticoduodenectomy plus partial hepatectomy were performed, and 2 tumors were detected in the resected specimen: one in the pancreas-duodenum region and a submucosal tumor in the duodenum bulb. The large tumor that occupied the pancreas-duodenum region was histologically diagnosed as an undifferentiated carcinoma, and the duodenal submucosal tumor was consistent with findings of a poorly differentiated adenocarcinoma. Two years after surgery, CT examination revealed a mass extending into the inferior vena cava(IVC)from near the right renal vein. We eventually diagnosed lymph node recurrence with tumor thrombosis in the IVC and started chemotherapy(FOLFIRINOX). After the tumor decreased, we performed salvage surgery involving resection of the lymph node, thrombectomy, and right nephrectomy. The tumor revealed atypical cells in the region of thrombosis, and the pathological findings were not in conflict with the findings of metastases from pancreatic cancer 2 years prior. After the treatment, chemotherapy was administered and he survived without any recurrence for 15 months after surgery.
要旨
症例は60歳,男性。嘔吐を主訴に前医を受診した。肝浸潤・多発肝転移を伴う膵頭部領域癌の診断で姑息手術を施行され,以降の治療目的に当院へ紹介となった。精査にて多発肝転移を疑い,病変は血管腫と診断した。膵頭部領域癌肝浸潤に対し,肝部分切除合併膵頭十二指腸切除術を施行した。切除標本では十二指腸および膵頭部に広がる腫瘍と十二指腸粘膜下腫瘍の2病変を認め,病理結果では十二指腸-膵頭部から発生した未分化癌であり,十二指腸粘膜下への転移を伴っていると考えられた。術後2年間無再発であったが,定期画像検索で右腎静脈根部付近から下大静脈(inferior vena cava: IVC)内へ伸展する腫瘤を認め,IVC内の腫瘍栓を伴うリンパ節再発と診断した。抗癌剤治療によって腫瘍栓の縮小が得られ,他の再発病変を認めなかったため,salvage手術を施行した。病理結果では,腫瘍栓に異型細胞を認め,原病転移として矛盾しない像であった。退院後化学療法を施行し,術後15か月時点で無再発生存中である。