内容紹介
Summary
A 61-year-old man was examined for cervical pain and CT showed a 9 cm tumor to the third part of the duodenum and proximal jejunum. CT/MRI showed that the tumor was separated from the pancreas body. We scheduled a laparoscopic partial resection of the intestine with a suspected diagnosis of GIST of the intestine. The tumor was adhered to both the proximal jejunum and uncinate process of the pancreas. Therefore, we converted to an open surgery and resected part of the pancreas, duodenum, and proximal jejunum including the tumor. Histopathological examination showed the tumor capsule included the tissue of the pancreas and that the border between the intestine and the tumor was clear, suggesting that the origin of the tumor was the pancreas. We diagnosed the patient as having a grade 2 pancreatic neuroendocrine tumor based on the tumor growth pattern and immunohistochemistry findings. We examined the preoperative CT images retrospectively and found that the tumor had adhered to the uncinate process of the pancreas, which extends over the left side of the superior mesenteric artery. When GIST close to the proximal jejunum is suspected, the possibility of pancreatic neuroendocrine tumor should be considered.
要旨
症例は61歳,男性。後頸部痛の精査中,CTで十二指腸水平脚から近位空腸に接して不均一に造影される9 cm大の腫瘍を指摘された。CT/MRIでは腫瘍と膵体尾部の連続性を認めなかった。小腸GISTの疑いと診断し,腹腔鏡下小腸部分切除術の予定で手術を開始した。腫瘍は空腸起始部に固着していたが,膵鉤部にも一部密着しており剝離困難であった。開腹移行し,膵鉤部の一部とともに腫瘍を含む十二指腸上行部から近位空腸を摘出した。病理組織学的検査では腫瘍被膜内に取り込まれた膵実質を認め,小腸とは漿膜面で接するのみであったため膵由来の腫瘍と考えられた。また,腫瘍細胞の増生パターンおよび免疫組織学的検査所見より膵神経内分泌腫瘍(PanNET G2)と診断した。改めて術前画像を確認すると,上腸間膜動脈の左側で膵鉤部に腫瘍との連続性を認めた。空腸起始部近傍のGISTを疑う場合,膵鉤部由来の神経内分泌腫瘍の可能性を念頭に置いた術前診断が必要である。
目次
A 61-year-old man was examined for cervical pain and CT showed a 9 cm tumor to the third part of the duodenum and proximal jejunum. CT/MRI showed that the tumor was separated from the pancreas body. We scheduled a laparoscopic partial resection of the intestine with a suspected diagnosis of GIST of the intestine. The tumor was adhered to both the proximal jejunum and uncinate process of the pancreas. Therefore, we converted to an open surgery and resected part of the pancreas, duodenum, and proximal jejunum including the tumor. Histopathological examination showed the tumor capsule included the tissue of the pancreas and that the border between the intestine and the tumor was clear, suggesting that the origin of the tumor was the pancreas. We diagnosed the patient as having a grade 2 pancreatic neuroendocrine tumor based on the tumor growth pattern and immunohistochemistry findings. We examined the preoperative CT images retrospectively and found that the tumor had adhered to the uncinate process of the pancreas, which extends over the left side of the superior mesenteric artery. When GIST close to the proximal jejunum is suspected, the possibility of pancreatic neuroendocrine tumor should be considered.
要旨
症例は61歳,男性。後頸部痛の精査中,CTで十二指腸水平脚から近位空腸に接して不均一に造影される9 cm大の腫瘍を指摘された。CT/MRIでは腫瘍と膵体尾部の連続性を認めなかった。小腸GISTの疑いと診断し,腹腔鏡下小腸部分切除術の予定で手術を開始した。腫瘍は空腸起始部に固着していたが,膵鉤部にも一部密着しており剝離困難であった。開腹移行し,膵鉤部の一部とともに腫瘍を含む十二指腸上行部から近位空腸を摘出した。病理組織学的検査では腫瘍被膜内に取り込まれた膵実質を認め,小腸とは漿膜面で接するのみであったため膵由来の腫瘍と考えられた。また,腫瘍細胞の増生パターンおよび免疫組織学的検査所見より膵神経内分泌腫瘍(PanNET G2)と診断した。改めて術前画像を確認すると,上腸間膜動脈の左側で膵鉤部に腫瘍との連続性を認めた。空腸起始部近傍のGISTを疑う場合,膵鉤部由来の神経内分泌腫瘍の可能性を念頭に置いた術前診断が必要である。