主膵管内腫瘍進展を伴った膵尾部MiNENの1例
症例は61歳，男性．心窩部痛にて紹介受診され，精査加療を行った．画像検査では膵尾部に50×30mm大の造影効果の乏しい腫瘤影を認め，膵癌が疑われた．一方，膵頭部主膵管内に膵尾部腫瘍と連続しない主膵管内結節が認められた．膵尾部腫瘍生検では腺房細胞癌成分を伴うmixed neuroendocrine-non-neuroendocrine neoplasm （MiNEN）と診断され，主膵管内結節は擦過細胞診にて膵尾部組織と類似した高異型度細胞集塊を認めた．膵尾部MiNENとMiNENに由来する膵頭部主膵管内腫瘍栓と診断し，両病変に対して膵全摘術を施行した．病理検査の結果，膵尾部MiNENを認め，膵頭...
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| Published in | 日本臨床外科学会雑誌 Vol. 81; no. 2; pp. 343 - 348 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.81.343 |
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| Abstract | 症例は61歳，男性．心窩部痛にて紹介受診され，精査加療を行った．画像検査では膵尾部に50×30mm大の造影効果の乏しい腫瘤影を認め，膵癌が疑われた．一方，膵頭部主膵管内に膵尾部腫瘍と連続しない主膵管内結節が認められた．膵尾部腫瘍生検では腺房細胞癌成分を伴うmixed neuroendocrine-non-neuroendocrine neoplasm （MiNEN）と診断され，主膵管内結節は擦過細胞診にて膵尾部組織と類似した高異型度細胞集塊を認めた．膵尾部MiNENとMiNENに由来する膵頭部主膵管内腫瘍栓と診断し，両病変に対して膵全摘術を施行した．病理検査の結果，膵尾部MiNENを認め，膵頭部の主膵管内腫瘍は主腫瘍から主膵管内へintraductal polypoid growth （IPG）しているものであった．Ki-67は50％を呈しており，術後4カ月時に肝転移再発を認め，エベロリムスを開始したが術後1年で死亡した．IPGを伴うMiNENの報告は非常に稀であり，文献的考察も含めて報告する． |
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| AbstractList | 症例は61歳，男性．心窩部痛にて紹介受診され，精査加療を行った．画像検査では膵尾部に50×30mm大の造影効果の乏しい腫瘤影を認め，膵癌が疑われた．一方，膵頭部主膵管内に膵尾部腫瘍と連続しない主膵管内結節が認められた．膵尾部腫瘍生検では腺房細胞癌成分を伴うmixed neuroendocrine-non-neuroendocrine neoplasm （MiNEN）と診断され，主膵管内結節は擦過細胞診にて膵尾部組織と類似した高異型度細胞集塊を認めた．膵尾部MiNENとMiNENに由来する膵頭部主膵管内腫瘍栓と診断し，両病変に対して膵全摘術を施行した．病理検査の結果，膵尾部MiNENを認め，膵頭部の主膵管内腫瘍は主腫瘍から主膵管内へintraductal polypoid growth （IPG）しているものであった．Ki-67は50％を呈しており，術後4カ月時に肝転移再発を認め，エベロリムスを開始したが術後1年で死亡した．IPGを伴うMiNENの報告は非常に稀であり，文献的考察も含めて報告する． |
| Author | 長田, 盛典 長谷川, 慎一郎 山田, 大作 藤井, 渉 和田, 浩志 高橋, 秀典 飛鳥井, 慶 |
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| Copyright | 2020 日本臨床外科学会 |
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| References | 1) Bosman F, Carneiro F, Hruban R, et al : WHO Classification of Tumours of the Digestive System. Forth edition, International Agency for Research on Cancer, Lyon, 2010, p314-318 2) 日本膵臓学会/編:膵癌取扱い規約．第7版，金原出版，東京，2016，p72-73 11) Kobayashi S, Asakura T, Ohike N, et al : Mixed acinar-endocrine carcinoma of the pancreas with intraductal growth into the main pancreatic duct : Report of a case. Surg Today 2010 ; 40 : 380-384 4) Boards WHO Classification of Tumours Editorial Board : Digestive System Tumours (WHO Classification of Tumours). Fifth edition, International Agency for Recerch on Cancer, Lyon, 2019, p370-372 5) 小林照宗，佐藤やよい，清水辰一郎他:AFP産生膵mixed acinar-neuroendocrine carcinomaの1例．膵臓 2016;31:688-696 7) Yu R, Jih L, Zhai J, et al : Mixed acinar-endocrine carcinoma of the pancreas new clinical and pathological features in a contemporary series. Panreas 2013 ; 42 : 429-435 8) Basturk O, Zamboni G, Klimstra DS, et al : Intraductal and papillary variants of acinar cell carcinomas : a new addition to the challenging differential diagnosis of intraductal neoplasms. Am J Surg Pathol 2007 ; 31 : 363-370 3) Brierley JD, Gospodarowics MK, Witteking C : TNM Classification of Malignant Tumours. 8th ed., Wiley Blackwell, Oxford, 2017 9) Ban D, Shimada K, Sekine S, et al : Pancreatic ducts as an important route of tumor extension for acinar cell carcinoma of the pancreas. Am J Surg Pathol 2010 ; 34 : 1025-1036 10) Nagata S, Tomoeda M, Kubo C, et al : Intraductal polypoid growth variant of pancreatic acinar cell carcinoma metastasizing to the intrahepatic bile duct 6 years after surgery : a case report and literature review. Pancreatology 2012 ; 12 : 23-26 6) Hara T, Fujiwara Y, Takahashi H, et al : Metastatic mixed acinar-endocrine carcinoma of the pancreas treated with a multidisciplinary approach : a case report. Surg Case Rep 2017 ; 3 : 1-5 |
| References_xml | – reference: 4) Boards WHO Classification of Tumours Editorial Board : Digestive System Tumours (WHO Classification of Tumours). Fifth edition, International Agency for Recerch on Cancer, Lyon, 2019, p370-372 – reference: 2) 日本膵臓学会/編:膵癌取扱い規約．第7版，金原出版，東京，2016，p72-73 – reference: 9) Ban D, Shimada K, Sekine S, et al : Pancreatic ducts as an important route of tumor extension for acinar cell carcinoma of the pancreas. Am J Surg Pathol 2010 ; 34 : 1025-1036 – reference: 5) 小林照宗，佐藤やよい，清水辰一郎他:AFP産生膵mixed acinar-neuroendocrine carcinomaの1例．膵臓 2016;31:688-696 – reference: 10) Nagata S, Tomoeda M, Kubo C, et al : Intraductal polypoid growth variant of pancreatic acinar cell carcinoma metastasizing to the intrahepatic bile duct 6 years after surgery : a case report and literature review. Pancreatology 2012 ; 12 : 23-26 – reference: 3) Brierley JD, Gospodarowics MK, Witteking C : TNM Classification of Malignant Tumours. 8th ed., Wiley Blackwell, Oxford, 2017 – reference: 11) Kobayashi S, Asakura T, Ohike N, et al : Mixed acinar-endocrine carcinoma of the pancreas with intraductal growth into the main pancreatic duct : Report of a case. Surg Today 2010 ; 40 : 380-384 – reference: 1) Bosman F, Carneiro F, Hruban R, et al : WHO Classification of Tumours of the Digestive System. Forth edition, International Agency for Research on Cancer, Lyon, 2010, p314-318 – reference: 6) Hara T, Fujiwara Y, Takahashi H, et al : Metastatic mixed acinar-endocrine carcinoma of the pancreas treated with a multidisciplinary approach : a case report. Surg Case Rep 2017 ; 3 : 1-5 – reference: 7) Yu R, Jih L, Zhai J, et al : Mixed acinar-endocrine carcinoma of the pancreas new clinical and pathological features in a contemporary series. Panreas 2013 ; 42 : 429-435 – reference: 8) Basturk O, Zamboni G, Klimstra DS, et al : Intraductal and papillary variants of acinar cell carcinomas : a new addition to the challenging differential diagnosis of intraductal neoplasms. Am J Surg Pathol 2007 ; 31 : 363-370 |
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| Snippet | 症例は61歳，男性．心窩部痛にて紹介受診され，精査加療を行った．画像検査では膵尾部に50×30mm大の造影効果の乏しい腫瘤影を認め，膵癌が疑われた．一方，膵頭部主膵管内に膵尾部腫瘍と連続しない主膵管内結節が認められた．膵尾部腫瘍生検では腺房細胞癌成分を伴うmixed... |
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| Title | 主膵管内腫瘍進展を伴った膵尾部MiNENの1例 |
| URI | https://www.jstage.jst.go.jp/article/jjsa/81/2/81_343/_article/-char/ja |
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