内容紹介
Summary
A 51-year-old man with a gallstone was found to have a tumor in the tail of the pancreas during preoperative examination. We performed EUS-FNA and a pancreatic neuroendocrine tumor was suspected. Therefore, laparoscopic distal pancreatectomy and cholecystectomy were performed. Pathological examination and immunohistochemistry showed that the pancreatic endocrine cells were uniformly increased and were composed of normal Langerhans islets. Therefore, the patient was diagnosed with pancreatic endocrine cell hyperplasia. Typical pancreatic endocrine cell hyperplasia does not form a tumor and is asymptomatic. However, some cases are symptomatic; therefore, when hypoglycemia or pancreatic hormone elevation are found without a clear cause, it should be distinguished. Because pancreatic tumors are difficult to diagnose definitely by imaging inspection alone, needle biopsy is necessary. However, neuroendocrine tumor and neuroendocrine cell hyperplasia are difficult to differentiate by biopsy.
要旨
症例は51歳,男性。胆石症に対し胆囊摘出術を予定されていたが,術前精査にて膵尾部に直径1 cm弱の腫瘤を指摘された。CT・MRI検査とEUS-FNAの結果,膵神経内分泌腫瘍疑いの診断にて腹腔鏡下膵体尾部切除術,胆囊摘出術を施行した。術後病理検査・免疫組織化学検査にて,通常のランゲルハンス島と同様の膵内分泌細胞が均一に過形成している所見が得られ,膵内分泌細胞過形成と診断した。膵内分泌細胞過形成の報告はあるが,今回のように腫瘤を形成し切除に至ったという症例は極めてまれである。有症状症例では画像上明らかでなくても,低血糖や膵臓のホルモン上昇の際は鑑別に入れるべき疾患である。膵臓の腫瘍性病変は,画像検査のみでの確定診断は難しく針生検が有用であるが,神経内分泌腫瘍と神経内分泌細胞過形成は針生検での鑑別は困難であり,双方の可能性を考慮する必要があると考えられた。
目次
A 51-year-old man with a gallstone was found to have a tumor in the tail of the pancreas during preoperative examination. We performed EUS-FNA and a pancreatic neuroendocrine tumor was suspected. Therefore, laparoscopic distal pancreatectomy and cholecystectomy were performed. Pathological examination and immunohistochemistry showed that the pancreatic endocrine cells were uniformly increased and were composed of normal Langerhans islets. Therefore, the patient was diagnosed with pancreatic endocrine cell hyperplasia. Typical pancreatic endocrine cell hyperplasia does not form a tumor and is asymptomatic. However, some cases are symptomatic; therefore, when hypoglycemia or pancreatic hormone elevation are found without a clear cause, it should be distinguished. Because pancreatic tumors are difficult to diagnose definitely by imaging inspection alone, needle biopsy is necessary. However, neuroendocrine tumor and neuroendocrine cell hyperplasia are difficult to differentiate by biopsy.
要旨
症例は51歳,男性。胆石症に対し胆囊摘出術を予定されていたが,術前精査にて膵尾部に直径1 cm弱の腫瘤を指摘された。CT・MRI検査とEUS-FNAの結果,膵神経内分泌腫瘍疑いの診断にて腹腔鏡下膵体尾部切除術,胆囊摘出術を施行した。術後病理検査・免疫組織化学検査にて,通常のランゲルハンス島と同様の膵内分泌細胞が均一に過形成している所見が得られ,膵内分泌細胞過形成と診断した。膵内分泌細胞過形成の報告はあるが,今回のように腫瘤を形成し切除に至ったという症例は極めてまれである。有症状症例では画像上明らかでなくても,低血糖や膵臓のホルモン上昇の際は鑑別に入れるべき疾患である。膵臓の腫瘍性病変は,画像検査のみでの確定診断は難しく針生検が有用であるが,神経内分泌腫瘍と神経内分泌細胞過形成は針生検での鑑別は困難であり,双方の可能性を考慮する必要があると考えられた。