内容紹介
Summary
A 53—year—old woman was referred to our hospital because of upper abdominal pain and expansion of the pancreatic main duct. Enhanced computed tomography revealed expansion of the main pancreatic duct from the head to the tail;in addition, a 30 mm cystic tumor was observed in the pancreatic head and a 56 mm tumor was observed in the ventral side of the pancreatic body. Endoscopy revealed fistula formation in the duodenum of the Vater papilla on the oral side. The patient was diagnosed with an intraductal papillary mucinous carcinoma(IPMC). In addition, PET—CT revealed accumulation of FDG in the ventral side of the pancreatic body, and a disseminated nodule in the omental bursa was suspected. We administered 6 courses of gemcitabine plus nab—paclitaxel therapy, after which, the tumor in the ventral side of the pancreatic body disappeared. We then performed sub—stomach—preserving pancreatoduodenectomy. The results of abdominal cavity washing cytology were negative, and there were no disseminated nodules in the omental bursa. Therefore, we could perform R0 excision.
要旨
症例は53歳,女性。心窩部痛を主訴に前医を受診し主膵管拡張を指摘され,当院紹介となった。腹部造影CTでは膵頭部から尾部まで主膵管が拡張し膵頭部には30 mm大の囊胞性病変を認め,膵体部腹側にも56 mm大の腫瘤を認めた。ERCPではVater乳頭口側の十二指腸への瘻孔形成が疑われた。粘液細胞診と瘻孔部の生検にて膵管内乳頭粘液性腺癌(intraductal papillary mucinous carcinoma:IPMC)と診断された。また,PET—CTでは膵体部腹側にFDGの集積を認め,網囊内の播種性結節の可能性もあった。化学療法としてgemcitabine+nab—paclitaxel(GnP)療法を6コース行った。化学療法終了後,膵体部腹側の腫瘤影は消失したため,亜全胃温存膵頭十二指腸切除術を施行した。腹腔洗浄細胞診は陰性で網囊内にも播種は認めず,R0切除が可能であった。
目次
A 53—year—old woman was referred to our hospital because of upper abdominal pain and expansion of the pancreatic main duct. Enhanced computed tomography revealed expansion of the main pancreatic duct from the head to the tail;in addition, a 30 mm cystic tumor was observed in the pancreatic head and a 56 mm tumor was observed in the ventral side of the pancreatic body. Endoscopy revealed fistula formation in the duodenum of the Vater papilla on the oral side. The patient was diagnosed with an intraductal papillary mucinous carcinoma(IPMC). In addition, PET—CT revealed accumulation of FDG in the ventral side of the pancreatic body, and a disseminated nodule in the omental bursa was suspected. We administered 6 courses of gemcitabine plus nab—paclitaxel therapy, after which, the tumor in the ventral side of the pancreatic body disappeared. We then performed sub—stomach—preserving pancreatoduodenectomy. The results of abdominal cavity washing cytology were negative, and there were no disseminated nodules in the omental bursa. Therefore, we could perform R0 excision.
要旨
症例は53歳,女性。心窩部痛を主訴に前医を受診し主膵管拡張を指摘され,当院紹介となった。腹部造影CTでは膵頭部から尾部まで主膵管が拡張し膵頭部には30 mm大の囊胞性病変を認め,膵体部腹側にも56 mm大の腫瘤を認めた。ERCPではVater乳頭口側の十二指腸への瘻孔形成が疑われた。粘液細胞診と瘻孔部の生検にて膵管内乳頭粘液性腺癌(intraductal papillary mucinous carcinoma:IPMC)と診断された。また,PET—CTでは膵体部腹側にFDGの集積を認め,網囊内の播種性結節の可能性もあった。化学療法としてgemcitabine+nab—paclitaxel(GnP)療法を6コース行った。化学療法終了後,膵体部腹側の腫瘤影は消失したため,亜全胃温存膵頭十二指腸切除術を施行した。腹腔洗浄細胞診は陰性で網囊内にも播種は認めず,R0切除が可能であった。