膵管内に限局した10mmの微小膵癌の1例

Small Carcinoma (10 mm in size) of the Pancreatic Body, Report of a Case

要旨　膵管内に限局した10mmの膵体部癌を経験したので報告した．患者は49歳の男性で，下痢，体重減少を主訴として入院した．入院時の血液検査成績でGOT，GPT，LAPの軽度上昇がみられたが，膵酵素，腫瘍マーカーは正常範囲であった．US，CTでも膵に異常は認めず，上部，下部消化管の検査でも明らかな病変は認められなかった．症状が持続するためERCPを施行し，体部主膵管に不整な狭窄を認め，その尾側膵管も数珠状に拡張していた．血管造影では明らかなencasementはみられなかったが，膵管像から膵癌が強く疑われたため，膵体尾部切除術を行った．組織学的検索で，主膵管およびその分枝に限局した高分化型腺癌が認められた．

　A 49-year-old male was hospitalized because of persistent dirarrhea and weight loss. No abnormality was detected by ultrasonogram, computed tomogram, upper GI series and barium enema. Endoscopic retrograde cholangiopancreatography showed stenosis and proximal dilatation of the main duct in the pancreatic body. Direct serial magnification angiogram of the dorsal pancreatic artery, however, demonstrated no abnormality. Small pancreatic carcinoma was suspected based on pancreatographic findings and distal pancreatectomy was performed. Histological study showed well differentiated adenocarcinoma measuring 10 mm located in the pancreatic duct.