囊胞形成を伴う微小な膵管内乳頭腺癌の1例

Minute Intraductal Papillary Adenocarcinoma with Multiple Cysts of the Pancreas, Report of a Case

要旨　慢性膵炎として2年9か月経過観察した囊胞形成を伴った微小な膵管内乳頭腺癌(intraductal papillary adenocarcinoma of the pancreas)を経験し，報告した．患者は53歳の男性で，主訴は左季肋部痛である．人間ドックで血清アミラーゼ高値を指摘され，当院を受診した．超音波検査(US)で胆囊ポリープが検出され，内視鏡的逆行性膵胆管造影(ERCP)では膵管に異常を認めなかった．経過観察し，3回目のERCPおよび内視鏡的膵液細胞収集法(EPCC)で小膵癌と診断した．手術の結果，膵頭部主膵管に限局した10mmの膵管内乳頭腺癌があり，近接して，囊胞性病変が認められた．本症例は主膵管の拡張を伴わない非浸潤性主膵管内癌であり，膵癌の発生進展形式を検討するうえで貴重な症例と考え報告した．

　A 53-year-old man with a chief complaint of left hypochondralgia was followed-up for 2 years and 9 months under the diagnosis of chronic pancreatitis. An elevated serum amylase level was noted through a routine health check-up. A gallbladder polyp was found by ultrasonography. The pancreatic duct was normal by endoscopic retrograde cholangiopancreatography (ERCP). A diagnosis of small pancreatic carcinoma was made by the third follow-up ERCP and endoscopic pancreatic cell collection (EPCC). Intraductal papillary adenocarcinoma, measuring 10 mm in diameter, limited to the main duct of the pancreatic head was confirmed in the surgical specimen as well as multiple cysts adjacent to the carcinoma. This case, non-invasive intraductal adenocarcinoma without dilatation of the main pancreatic duct, seemed to provide valuable information with respect to the development of pancreatic cancer.