内容紹介
Summary
Case: A man in his 60s reported upper abdominal pain; close examination revealed a tumor in the body-tail of the pancreas that was suspected to be infiltrating the stomach. Multiple liver lesions(S3, S4)were also detected. Histological examination by EUS-FNA showed poorly-differentiated carcinoma; thus, this case was diagnosed with unresectable pancreatic cancer with liver metastases(cT3, cN1[No. 7], cM1[P0, H1], cStage Ⅳ: JPS 7th). After 2 kinds of systemic chemotherapy(9 courses of GEM plus nab-PTX and 9 courses of modified FOLFIRINOX), obvious distant metastases or local progression did not appear and conversion surgery was scheduled. Although a metastatic lesion was identified at S5 of the liver just before the surgery, it was assumed that an R0 resection could be achieved; therefore, the operation(distal pancreatectomy with combined proximal gastrectomy, left adrenalectomy, lymph node dissection, partial hepatectomy of S5, and cholecystectomy)was performed. Histopathological examination showed squamous metaplasia of the epithelial tissue combined with glandular formation. This case was, thus, diagnosed as adenosquamous carcinoma of pancreas. This patient was discharged 90 days after the operation. The patient is still alive 2 years and 2 months since the first diagnosis.
要旨
症例は60代,男性。上腹部痛を契機に精査で胃浸潤を伴う膵腫瘤と多発肝腫瘤(肝S3,S4)を指摘された。EUS-FNAによる細胞診で悪性所見を認め,切除不能膵体尾部癌,cT3,cN1(No. 7),cM1(P0,H1),cStage Ⅳと診断した。GEM+nab-PTX療法を9コース,modified FOLFIRINOX療法を9コース施行したところ,遠隔転移,局所進展の進行なくconversion surgeryを計画した。術直前に肝S5に新規転移巣の出現を認めたがR0手術が可能と判断し,膵体尾部切除(噴門側胃,左副腎合併切除),肝S5部分切除を施行した。原発巣の病理検査では一部腺腔様の構造を残す角化傾向を伴った異型上皮を認め,腺扁平上皮癌と診断された。術後に食道胃吻合部の縫合不全を認めたが保存的に加療し,術90日後に軽快退院した。初診時より約2年が経過した現在,外来にて治療継続中である。
目次
Case: A man in his 60s reported upper abdominal pain; close examination revealed a tumor in the body-tail of the pancreas that was suspected to be infiltrating the stomach. Multiple liver lesions(S3, S4)were also detected. Histological examination by EUS-FNA showed poorly-differentiated carcinoma; thus, this case was diagnosed with unresectable pancreatic cancer with liver metastases(cT3, cN1[No. 7], cM1[P0, H1], cStage Ⅳ: JPS 7th). After 2 kinds of systemic chemotherapy(9 courses of GEM plus nab-PTX and 9 courses of modified FOLFIRINOX), obvious distant metastases or local progression did not appear and conversion surgery was scheduled. Although a metastatic lesion was identified at S5 of the liver just before the surgery, it was assumed that an R0 resection could be achieved; therefore, the operation(distal pancreatectomy with combined proximal gastrectomy, left adrenalectomy, lymph node dissection, partial hepatectomy of S5, and cholecystectomy)was performed. Histopathological examination showed squamous metaplasia of the epithelial tissue combined with glandular formation. This case was, thus, diagnosed as adenosquamous carcinoma of pancreas. This patient was discharged 90 days after the operation. The patient is still alive 2 years and 2 months since the first diagnosis.
要旨
症例は60代,男性。上腹部痛を契機に精査で胃浸潤を伴う膵腫瘤と多発肝腫瘤(肝S3,S4)を指摘された。EUS-FNAによる細胞診で悪性所見を認め,切除不能膵体尾部癌,cT3,cN1(No. 7),cM1(P0,H1),cStage Ⅳと診断した。GEM+nab-PTX療法を9コース,modified FOLFIRINOX療法を9コース施行したところ,遠隔転移,局所進展の進行なくconversion surgeryを計画した。術直前に肝S5に新規転移巣の出現を認めたがR0手術が可能と判断し,膵体尾部切除(噴門側胃,左副腎合併切除),肝S5部分切除を施行した。原発巣の病理検査では一部腺腔様の構造を残す角化傾向を伴った異型上皮を認め,腺扁平上皮癌と診断された。術後に食道胃吻合部の縫合不全を認めたが保存的に加療し,術90日後に軽快退院した。初診時より約2年が経過した現在,外来にて治療継続中である。