内容紹介
Summary
We herein report the case of a 65-year-old man who presented with an anaplastic carcinoma of the pancreas, producing granulocyte colony-stimulating factor(G-CSF). The patient's laboratory data showed an increase in his serum CA19-9 levels 1 year after he had undergone surgery for transverse colon cancer. Computed tomography(CT)showed a mass in the pancreatic head. Following a diagnosis of primary or metastatic pancreatic cancer, we performed the pancreatoduodenectomy. The postoperative course was uneventful. However, on postoperative day 28, he suffered a disturbance of consciousness and demonstrated hypercalcemia with elevated serum levels of parathyroid hormone-related protein(PTHrP). CT revealed multiple liver metastases and massive ascites. His serum Ca level decreased temporarily, and he subsequently died 58 days after the pancreatoduodenectomy. A pathological examination revealed pleomorphic-type anaplastic carcinoma of the pancreas. Immunohistochemical staining showed the tumor cells to be positive for G-CSF. To the best of our knowledge, there have been no reports of G-CSF-producing anaplastic carcinoma of the pancreas associated with humoral hypercalcemia of malignancy.
要旨
症例は65歳,男性。横行結腸癌術後1年の定期検査でCA19-9が上昇した。腹部CT検査を施行し,膵頭部に22 mm大の腫瘤を認めたため精査を行い,原発性あるいは転移性膵癌の疑いで膵頭十二指腸切除術を施行した。術後経過は良好であったが,術後28日目に一過性の意識消失発作を来した。全身精査のCT検査で頭部に異常はなかったが,多発肝転移と大量腹水を認めた。血液検査所見で高カルシウム血症,血中parathyroid hormone-related protein(PTHrP)高値を認め,humoral hypercalcemia of malignancy(HHM)と診断した。高カルシウム血症は一時改善したが再度悪化し,術後58日目に高カルシウム血症および癌性腹膜炎により死亡した。病理診断は多形細胞型膵退形成癌で,免疫染色でgranulocyte colony-stimulating factor(G-CSF)が陽性であった。われわれが検索し得た限りHHMを伴うG-CSF産生膵退形成癌の報告例はなく,極めてまれな症例と考えられた。
目次
We herein report the case of a 65-year-old man who presented with an anaplastic carcinoma of the pancreas, producing granulocyte colony-stimulating factor(G-CSF). The patient's laboratory data showed an increase in his serum CA19-9 levels 1 year after he had undergone surgery for transverse colon cancer. Computed tomography(CT)showed a mass in the pancreatic head. Following a diagnosis of primary or metastatic pancreatic cancer, we performed the pancreatoduodenectomy. The postoperative course was uneventful. However, on postoperative day 28, he suffered a disturbance of consciousness and demonstrated hypercalcemia with elevated serum levels of parathyroid hormone-related protein(PTHrP). CT revealed multiple liver metastases and massive ascites. His serum Ca level decreased temporarily, and he subsequently died 58 days after the pancreatoduodenectomy. A pathological examination revealed pleomorphic-type anaplastic carcinoma of the pancreas. Immunohistochemical staining showed the tumor cells to be positive for G-CSF. To the best of our knowledge, there have been no reports of G-CSF-producing anaplastic carcinoma of the pancreas associated with humoral hypercalcemia of malignancy.
要旨
症例は65歳,男性。横行結腸癌術後1年の定期検査でCA19-9が上昇した。腹部CT検査を施行し,膵頭部に22 mm大の腫瘤を認めたため精査を行い,原発性あるいは転移性膵癌の疑いで膵頭十二指腸切除術を施行した。術後経過は良好であったが,術後28日目に一過性の意識消失発作を来した。全身精査のCT検査で頭部に異常はなかったが,多発肝転移と大量腹水を認めた。血液検査所見で高カルシウム血症,血中parathyroid hormone-related protein(PTHrP)高値を認め,humoral hypercalcemia of malignancy(HHM)と診断した。高カルシウム血症は一時改善したが再度悪化し,術後58日目に高カルシウム血症および癌性腹膜炎により死亡した。病理診断は多形細胞型膵退形成癌で,免疫染色でgranulocyte colony-stimulating factor(G-CSF)が陽性であった。われわれが検索し得た限りHHMを伴うG-CSF産生膵退形成癌の報告例はなく,極めてまれな症例と考えられた。