膵頭部神経鞘腫の1例

Neurinoma in the Head of the Pancreas, Report of a Case

要旨　患者は52歳，男性．1か月半前に突然，上腹部痛・嘔吐を来し近医を受診したところ，腹部腫瘤を指摘された．膵ホルモンを含む血液検査には著変を認めなかった．上部消化管X線およびERCPで十二指腸脚の開大，総胆管・主膵管の圧排を認めた．US，CT，MRIおよび血管造影ではhypovascularな多房性囊胞性腫瘍として描出された．膵solid and cystic tumorの術前診断で，膵頭十二指腸切除術を施行した．腫瘍は14×12×8cm大で，割面では腫瘍内に著明な出血・壊死を認めた．組織学的にはS-100蛋白に陽性の紡錘形細胞よりなる神経鞘腫であった．膵神経鞘腫は，膵囊胞性疾患の鑑別診断の1つとして念頭に置く必要がある．

　A case of neurinoma in the head of the pancreas is reported.

　A 52-year-old man was admitted to our department because of epigastric pain and an abdominal tumor. Laboratory data showed nothing in particular. X-ray of duodenum and ERCP revealed compression of the duodenum, bile duct, and pancreatic duct by the tumor. Ultrasonography, computed tomography, and magnetic resonance imaging showed a multilocular cystic tumor due to necrosis of the tumor. On angiograms, the tumor was hypovascular. With suspicion of solid and cystic tumor of the pancreas, pancreatoduodenectomy was performed.

　The tumor was 14×12×8 cm in size and the section showed marked hemorrhage and necrosis. Histologically, the diagnosis of neurinoma was demonstrated.

　Neurinoma of the pancreas is very rare and was reviewed in Japanese medical literature.