内視鏡的膵生検で診断しえた膵管内小乳頭腺癌の1例

Minute Intraductal Papillary Adenocarcinoma Diagnosed by Endoscopic Pancreatic Biopsy, Report of a Case

要旨　患者は52歳，女性．急性膵炎で入院．症状回復の後に施行したERCPで，頭部主膵管内に長径3mmの半球状の隆起性病変を発見．その部の内視鏡的膵生検（endoscopic pancreatic biopsy；以下EPBと略す）により乳頭腺腫と診断した．ERCPを主体に経過観察を行ったところ，15か月後のERCP所見で，前病変は長径が5.5mmと明らかな増大を示し，この時点で再度行った同部のEPBで乳頭腺癌の診断を得たので，外科的切除術を行った．このような小膵癌の発見はまれであり，その診断におけるEPBの有用性を指摘すると共に，乳頭腺癌の成り立ちにつき考察を加え報告した．

　A case of minute Intraductal papillary adenocarcinoma under 6 mm in diameter which was diagnosed by endoscopic pancreatic biopsy (EPB) was reported. A 52-year-old female was admitted to our hospital because of abdominal pain caused by actue pancreatitis. After recovery of the patient's condition, ERCP was performed. A round elevated lesion, 3 mm in size in main pancreatic duct was noted. Histopathological examination of the EPB specimen revealed adenoma. We decided, therefore, to follow-up this patient closely.

　ERCP findings 15 months after the initial ERCP showed that the elevated lesion had enlarged to 5.5 mm in size. The second EPB yielded the specimen which, histopathologically, revealed papillary adenocarcinoma. Consequently, pancreaticoduodenectomy was performed. The resected specimen thus obtained had intraductal papillary adenocarcinoma, 6 mm in size, in the main duct of the pancreatic head.