内容紹介
Summary
A 64—year—old man visited our hospital because of weight loss and after being detected with a tumor in the pancreatic body and tail on abdominal ultrasonography at a nearby hospital. Abdominal contrast—enhanced CT revealed a 45 mm tumor with celiac artery invasion in the pancreatic body and tail. This case was diagnosed as unresectable pancreatic cancer. After 2 regimens of systemic chemotherapy(5 courses of gemcitabine plus nab—paclitaxel and 2 courses of S—1), CT revealed a partial response(ie, reduction in the tumor size). Therefore, distal pancreatectomy was performed with en bloc celiac axis resection, portal vein resection, and left adrenalectomy, as well as lymph node dissection. The pathological diagnosis was adenosquamous carcinoma, and R0 resection was achieved. The histological response was Grade 1b. However, the patient developed lung metastasis 16 months after surgery and liver metastasis 18 months after surgery;he died 33 months after starting treatment.
要旨
症例は64歳,男性。体重減少を主訴に近医を受診した。腹部超音波検査で膵体尾部に腫瘍を指摘され,当院を紹介受診した。腹部造影CT検査では膵体部に長径45 mm大の腹腔動脈浸潤を有する腫瘍を認め,切除不能膵体部癌と診断し,化学療法としてgemcitabine+nab—paclitaxel療法を5コース,S—1療法を2コース施行した。腫瘍はCT上22 mm大まで縮小を認め切除可能と判断し,膵体尾部切除,左副腎合併切除,腹腔動脈合併切除,門脈合併切除・再建を施行した。病理組織学的診断は腺扁平上皮癌であり,R0切除が達成され,組織学的治療効果判定はGrade 1bであった。術後16か月で肺転移,術後18か月で肝転移を認め,加療開始から33か月で死亡した。
目次
A 64—year—old man visited our hospital because of weight loss and after being detected with a tumor in the pancreatic body and tail on abdominal ultrasonography at a nearby hospital. Abdominal contrast—enhanced CT revealed a 45 mm tumor with celiac artery invasion in the pancreatic body and tail. This case was diagnosed as unresectable pancreatic cancer. After 2 regimens of systemic chemotherapy(5 courses of gemcitabine plus nab—paclitaxel and 2 courses of S—1), CT revealed a partial response(ie, reduction in the tumor size). Therefore, distal pancreatectomy was performed with en bloc celiac axis resection, portal vein resection, and left adrenalectomy, as well as lymph node dissection. The pathological diagnosis was adenosquamous carcinoma, and R0 resection was achieved. The histological response was Grade 1b. However, the patient developed lung metastasis 16 months after surgery and liver metastasis 18 months after surgery;he died 33 months after starting treatment.
要旨
症例は64歳,男性。体重減少を主訴に近医を受診した。腹部超音波検査で膵体尾部に腫瘍を指摘され,当院を紹介受診した。腹部造影CT検査では膵体部に長径45 mm大の腹腔動脈浸潤を有する腫瘍を認め,切除不能膵体部癌と診断し,化学療法としてgemcitabine+nab—paclitaxel療法を5コース,S—1療法を2コース施行した。腫瘍はCT上22 mm大まで縮小を認め切除可能と判断し,膵体尾部切除,左副腎合併切除,腹腔動脈合併切除,門脈合併切除・再建を施行した。病理組織学的診断は腺扁平上皮癌であり,R0切除が達成され,組織学的治療効果判定はGrade 1bであった。術後16か月で肺転移,術後18か月で肝転移を認め,加療開始から33か月で死亡した。