内容紹介
Summary
The patient was a male in his early 60s. Diabetes had aggravated 6 months earlier, and the patient was referred to our hospital for close examination. On contrast CT, enhanced mass shadows filling the lumen of the main pancreatic duct, which was dilated throughout the pancreas, were observed, and the mass was diagnosed as an adenocarcinoma on EUS-FNA. Based on these findings, main-duct IPMN was suspected and total pancreatectomy was performed. On macroscopic observation of the resected specimen, outgrowth of a solid tumor was observed in the main pancreatic duct, whereas only low-level mucus retention was noted in the pancreatic duct. Histopathological examination revealed a papillary/tubular tumor growth, suggesting interstitial infiltration throughout the pancreas. On immunostaining, the tumor was partially positive for MUC5AC, based on which the patient was diagnosed with an intraductal pancreatic mallignant tumor, with difficulty in differentiating between IPMC and ITPC. Clinicopathologically, many aspects regarding ITPN remain unclear. Further accumulation of such cases and investigation of the tumor pathology are necessary.
要旨
症例は60歳台前半,男性。6か月前より糖尿病が悪化し,精査目的で当院紹介となった。造影CTで膵全体に拡張した主膵管の内腔を満たす造影効果を伴う腫瘤影を認めた。EUS-FNAではadenocarcinomaの診断であった。以上より主膵管型IPMNを疑い,膵全摘出術を行った。切除標本の肉眼所見では腫瘍は主膵管内に充実性に増生しており,膵管内の粘液貯留は乏しかった。病理組織学的には乳頭状・管状に増殖する腫瘍を認め,adenocarcinomaの診断であった。膵全体で間質浸潤を示唆する所見を認めた。免疫染色ではMUC5ACが部分的に陽性であり,IPMCとITPCの鑑別が困難な膵管内悪性腫瘍と診断した。ITPNは臨床病理学的に不明な点も多く,今後さらなる症例を集積し病態の検討を重ねていく必要がある。
目次
The patient was a male in his early 60s. Diabetes had aggravated 6 months earlier, and the patient was referred to our hospital for close examination. On contrast CT, enhanced mass shadows filling the lumen of the main pancreatic duct, which was dilated throughout the pancreas, were observed, and the mass was diagnosed as an adenocarcinoma on EUS-FNA. Based on these findings, main-duct IPMN was suspected and total pancreatectomy was performed. On macroscopic observation of the resected specimen, outgrowth of a solid tumor was observed in the main pancreatic duct, whereas only low-level mucus retention was noted in the pancreatic duct. Histopathological examination revealed a papillary/tubular tumor growth, suggesting interstitial infiltration throughout the pancreas. On immunostaining, the tumor was partially positive for MUC5AC, based on which the patient was diagnosed with an intraductal pancreatic mallignant tumor, with difficulty in differentiating between IPMC and ITPC. Clinicopathologically, many aspects regarding ITPN remain unclear. Further accumulation of such cases and investigation of the tumor pathology are necessary.
要旨
症例は60歳台前半,男性。6か月前より糖尿病が悪化し,精査目的で当院紹介となった。造影CTで膵全体に拡張した主膵管の内腔を満たす造影効果を伴う腫瘤影を認めた。EUS-FNAではadenocarcinomaの診断であった。以上より主膵管型IPMNを疑い,膵全摘出術を行った。切除標本の肉眼所見では腫瘍は主膵管内に充実性に増生しており,膵管内の粘液貯留は乏しかった。病理組織学的には乳頭状・管状に増殖する腫瘍を認め,adenocarcinomaの診断であった。膵全体で間質浸潤を示唆する所見を認めた。免疫染色ではMUC5ACが部分的に陽性であり,IPMCとITPCの鑑別が困難な膵管内悪性腫瘍と診断した。ITPNは臨床病理学的に不明な点も多く,今後さらなる症例を集積し病態の検討を重ねていく必要がある。