内容紹介
Summary
A 32-year-old woman presented with epigastric pain and an abdominal mass. Abdominal CT showed a 130 mm pancreatic tail mass with an enhanced rim, central necrosis, and small calcification. A 6 mm lung tumor was also found via chest CT. Her medical history included surgical resection of cerebral solitary fibrous tumor when she was 24 years old. When she was 31 years old, it had recurred but was cured by gamma knife radiosurgery. We performed distal pancreatectomy and splenectomy with lymph node dissection. According to pathological and immunohistochemical findings, it was diagnosed as an anaplastic carcinoma with osteoclast-like giant cells. She underwent surgical resection of the lung tumor 2 months after pancreatic resection and was diagnosed with metastasis from the solitary fibrous tumor. Fourteen months since undergoing pancreatectomy, the patient experienced no recurrence from both diseases. We report a rare resected case of anaplastic carcinoma of pancreas concomitant with recurrent solitary fibrous tumor.
要旨
症例は32歳,女性。心窩部痛,腹部腫瘤を主訴に前医を受診した。膵尾部に100 mm大の腫瘤を認め,精査加療目的に当科紹介となった。24歳時に脳solitary fibrous tumor(SFT)摘出術の既往があり,31歳時に頭蓋内再発病変に対してγナイフによる治療を施行した。当院のCT検査では膵に130 mm大で辺縁に造影効果を伴い,中心部は造影不良で一部に石灰化を有する腫瘤を,また左肺に6 mm大の腫瘤影を認めた。膵病変はsolid pseudopapillary neoplasm(SPN)や転移性膵腫瘍などが疑われ,左肺の6 mm大の腫瘤影は転移性の腫瘍が疑われた。脾合併尾側膵切除術を施行し,病理組織学的所見から破骨型多核巨細胞を伴う膵退形成癌と診断した。 術後合併症なく第11病日に退院した。 膵切除術後2か月目に肺腫瘤を切除し,SFTの肺転移と診断された。術後14か月現在,無再発生存中である。膵退形成癌は予後不良とされるが亜型によっては良好な転帰をたどる症例もあり,積極的な外科的切除が患者の予後に寄与すると考えられた。
目次
A 32-year-old woman presented with epigastric pain and an abdominal mass. Abdominal CT showed a 130 mm pancreatic tail mass with an enhanced rim, central necrosis, and small calcification. A 6 mm lung tumor was also found via chest CT. Her medical history included surgical resection of cerebral solitary fibrous tumor when she was 24 years old. When she was 31 years old, it had recurred but was cured by gamma knife radiosurgery. We performed distal pancreatectomy and splenectomy with lymph node dissection. According to pathological and immunohistochemical findings, it was diagnosed as an anaplastic carcinoma with osteoclast-like giant cells. She underwent surgical resection of the lung tumor 2 months after pancreatic resection and was diagnosed with metastasis from the solitary fibrous tumor. Fourteen months since undergoing pancreatectomy, the patient experienced no recurrence from both diseases. We report a rare resected case of anaplastic carcinoma of pancreas concomitant with recurrent solitary fibrous tumor.
要旨
症例は32歳,女性。心窩部痛,腹部腫瘤を主訴に前医を受診した。膵尾部に100 mm大の腫瘤を認め,精査加療目的に当科紹介となった。24歳時に脳solitary fibrous tumor(SFT)摘出術の既往があり,31歳時に頭蓋内再発病変に対してγナイフによる治療を施行した。当院のCT検査では膵に130 mm大で辺縁に造影効果を伴い,中心部は造影不良で一部に石灰化を有する腫瘤を,また左肺に6 mm大の腫瘤影を認めた。膵病変はsolid pseudopapillary neoplasm(SPN)や転移性膵腫瘍などが疑われ,左肺の6 mm大の腫瘤影は転移性の腫瘍が疑われた。脾合併尾側膵切除術を施行し,病理組織学的所見から破骨型多核巨細胞を伴う膵退形成癌と診断した。 術後合併症なく第11病日に退院した。 膵切除術後2か月目に肺腫瘤を切除し,SFTの肺転移と診断された。術後14か月現在,無再発生存中である。膵退形成癌は予後不良とされるが亜型によっては良好な転帰をたどる症例もあり,積極的な外科的切除が患者の予後に寄与すると考えられた。