膵炎症状を初発とした小膵癌の1例

Small Pancreatic Carcinoma Detected by US and ERCP in Patient with Pancreatitis-like Symptoms, Report of a Case

要旨　膵炎症状を初発とした小膵癌の1例を経験した．患者は59歳，女性．主訴は心窩部痛．血清・尿アミラーゼの軽度上昇と，USでは膵管の軽度拡張を認めた．ERCPでは膵頭部主膵管に長さ約5mmの狭窄像があり，その尾側膵管は軽度拡張していた．狭窄部の所見より膵頭部癌と診断，膵頭十二指腸切除術を施行．病理学的には膵頭部の7×6×5mmの中等度分化型管状腺癌であった．膵癌の早期診断，小膵癌の発見のためには，随伴性膵炎症状やそれに伴うアミラーゼの上昇を捉え，積極的にUS，ERCPを施行することが重要であると考えられた．

　A 59-year-old woman was admitted to our hospital because of epigastralgia. Laboratory findings showed elevated serum amylase, elastase 1 and urine amylase. US showed slight dilatation of the main pancreatic duct. ERCP showed 5 mm-long stenosis of the main pancreatic duct in the head, and slightly dilated distal portion of the duct. Based on these findings, the patient was diagnosed as having pancreatic carcinoma. Pancreatoduodenectomy with lymph node dissection was carried out. Although pancreatic tumor was not palpable during operation, pathological study of the resected specimen showed the tumor of 7×6×5 mm in size. Microscopically it consisted of moderately differentiated tubular adenocarcinoma cells.

　This case confirms the usefulness of ERCP in diagnosing early pancreatic cancer. We propose that US and ERCP be performed on any patient with elevated serum pancreatic enzymes.