内容紹介
Summary
A 74-year-old man was referred to our hospital for further investigation of a cystic lesion in the pancreatic body, which had been detected by ultrasonography at a local hospital. He was diagnosed as intraductal papillary mucinous neoplasm(IPMN)and further preoperative examinations were conducted. Upper gastrointestinal endoscopy demonstrated a type 0-Ⅱc tumor of the greater curvature in the upper third of the stomach. Endoscopic ultrasonography showed no sign of submucosal invasion. Endoscopic submucosal dissection(ESD)was carried out and pathological examination of a specimen revealed well differentiated adenocarcinoma with submucosal invasion, which fulfilled the indication for additional gastrectomy with lymph node dissection. Laparoscopy-assisted proxymal gastrectomy with D1 plus lymph node dissection and distal pancreatectomy with splenectomy was performed. Pathological examination demonstrated intraductal papillary mucious adenoma(IPMA)in the pancreatic body and no residual gastric cancer in a specimen, however 7 lymph node metastases from gastric cancer was confirmed(pN3a), including 3 metastatic lymph nodes incidentally-detected adjacent to the pancreatic parenchyma. We report a rare case of early gastric cancer with N3 lymph node metastases, with a brief literature review.
要旨
症例は74歳,男性。近医で施行された腹部超音波検査で膵体部囊胞性病変を指摘され,精査目的に当院へ紹介受診となった。精査にて膵管内乳頭粘液性腫瘍(IPMN)と診断された。手術目的の術前精査で施行した上部消化管内視鏡検査にて胃体上部大弯側にtype 0-Ⅱc病変を指摘された。超音波内視鏡検査で粘膜内癌と診断し,endoscopic submucosal dissection(ESD)が施行された。術後の病理組織診断にて粘膜下層浸潤を伴う高分化型腺癌と診断され,リンパ節郭清を伴う追加外科切除の適応となった。本症例に対し腹腔鏡補助下噴門側胃切除術,D1+リンパ節郭清および膵体尾部切除術,脾摘を施行した。病理組織診断にて膵体部膵管内乳頭粘液性腺腫(IPMA),胃病変については癌遺残を認めなかったが,計7個のリンパ節転移を認め(pN3a),そのうち3個は同時に摘出された膵実質に隣接する組織内に偶発的に認められた。N3の粘膜下層浸潤早期胃癌はまれであり,文献的考察を加え報告する。
目次
A 74-year-old man was referred to our hospital for further investigation of a cystic lesion in the pancreatic body, which had been detected by ultrasonography at a local hospital. He was diagnosed as intraductal papillary mucinous neoplasm(IPMN)and further preoperative examinations were conducted. Upper gastrointestinal endoscopy demonstrated a type 0-Ⅱc tumor of the greater curvature in the upper third of the stomach. Endoscopic ultrasonography showed no sign of submucosal invasion. Endoscopic submucosal dissection(ESD)was carried out and pathological examination of a specimen revealed well differentiated adenocarcinoma with submucosal invasion, which fulfilled the indication for additional gastrectomy with lymph node dissection. Laparoscopy-assisted proxymal gastrectomy with D1 plus lymph node dissection and distal pancreatectomy with splenectomy was performed. Pathological examination demonstrated intraductal papillary mucious adenoma(IPMA)in the pancreatic body and no residual gastric cancer in a specimen, however 7 lymph node metastases from gastric cancer was confirmed(pN3a), including 3 metastatic lymph nodes incidentally-detected adjacent to the pancreatic parenchyma. We report a rare case of early gastric cancer with N3 lymph node metastases, with a brief literature review.
要旨
症例は74歳,男性。近医で施行された腹部超音波検査で膵体部囊胞性病変を指摘され,精査目的に当院へ紹介受診となった。精査にて膵管内乳頭粘液性腫瘍(IPMN)と診断された。手術目的の術前精査で施行した上部消化管内視鏡検査にて胃体上部大弯側にtype 0-Ⅱc病変を指摘された。超音波内視鏡検査で粘膜内癌と診断し,endoscopic submucosal dissection(ESD)が施行された。術後の病理組織診断にて粘膜下層浸潤を伴う高分化型腺癌と診断され,リンパ節郭清を伴う追加外科切除の適応となった。本症例に対し腹腔鏡補助下噴門側胃切除術,D1+リンパ節郭清および膵体尾部切除術,脾摘を施行した。病理組織診断にて膵体部膵管内乳頭粘液性腺腫(IPMA),胃病変については癌遺残を認めなかったが,計7個のリンパ節転移を認め(pN3a),そのうち3個は同時に摘出された膵実質に隣接する組織内に偶発的に認められた。N3の粘膜下層浸潤早期胃癌はまれであり,文献的考察を加え報告する。