case 3 膵管造影・膵液細胞診により確診し，切除可能であった膵体部癌の1例

A Case of Pancreatic Body Cancer: diagnosed by endoscopic pancreatography and aspiration cytology and was surgically resectcd

患　者：63歳　男子　会社員

既応歴：特になし．

現病歴：約1年前に下痢並びに腹痛があり内服加療にて軽快．3月前より心窩部の重圧感と共に腹痛を繰り返すため某医を受診．心窩部の腫瘤を指摘される．

現　症：黄疸なし．心窩部に驚卵大の硬い腫瘤を触知す．移動性なく軽度の圧痛を伴う．肝・脾・胆のう触知せず，心肺に著変を認めず．

　Case: a 63-year-old male company employee.

　Past history: non-contributoy.

　Present history: One year before he suffered from diarrhoea and abdominal pain, which became better upon medical management. Since 3 months before he had recurrent bouts of pressure feeling in the epigastrium with abdominal pain. He was then examined by a doctor and a tumor in the epigastrial region was pointed out.

　Status praesens: No jaundice. A hard tumor the size of a goose egg was palpated in the epigastrium. The growth was not movable and slighly tender on compression. The liver, spleen and gallbladder were not palpable. No abnormality was seen in the heart and lung.

　Laboratory data: the urine: sugar (-), protein (-); the stool: occult blood (-), fat (-). Examination of the blood: RBC 3,880,000, WBC 6,500. Sedimentation rate: 13mm (1 hour) and 32 (2 hours). Glucose tolerance test: slightly diabetic type. Liver function tests: TP 7.7gr. per 100ml, A/G ratio 0.92 Kunkel 10units, Co R₃, icterus index 8, SGOT 23 units SGPT 9 units, Al-P 3.0 units, LDH 300units; amylase 111 units (serum), 64 units (urine). PS test: three factors diminished.

　Hypotonic duodenograph (Fig. 1). Duodenoscopic findings (Fig. 2). Pancreatograph (Fig. 3). Aspiration cytology under direct vision (Fig.4).

　Operation: Excision of the caudal part of the body of the pancreas (Figs. 5, 6).

　Histological diagnosis: adenocarcinoma papillotubulare (Fig. 7, 8).

　Postoperative course: At the time of one year and six months after operation he was in good health.