2年2か月間経過観察した後に膵体尾部切除を施行した膵囊胞性病変の1例

Follow-up Study of a Cystic Lesion of the Pancreas, Report of a Case

要旨　患者は65歳，無症状の男性である．人間ドックのUSで膵の異常を指摘され，来院した．US，CTで体部に2.5×1.5cmの多房性囊胞を認めた．ERCPで主膵管は軽度拡張し，体部の膵管分枝の囊胞状拡張を認めた．乳頭の腫大，発赤，開口部開大はなかった．血管造影所見では特に異常所見は認めなかった．膵液細胞診ではClass Ⅰであった．以上より，悪性所見が得られなかったため経過観察となった．初期診断より2年2か月後のCT，USでは膵囊胞性病変の形態に著明な変化はなかったが，ERCPでは囊胞性病変部の増大傾向を指摘されたため，悪性を疑い膵体尾部切除を施行した．病理組織学的診断は粘液産生性過形成であった．術後経過は良好で，全経過を通して，自覚症状，血液生化学検査，腫瘍マーカーなどに異常はなく，術後3年経過し元気に社会復帰している

　We present here a patient with a cystic lesion of the pancreas, who was followed-up for 26 months preoperatively.

　An otherwise asymptomatic 65-year-old man was admitted to our hospital for further examination of the pancreas. Ultrasonography (US) and computed tomography (CT) revealed a multilocular cystic lesion, measuring 2.5 × 1.5 cm, in the body of the pancreas. Endoscopic retrograde choledochopancreatography (ERCP) demonstrated a mildly dilated main pancreatic duct as well as a cystic dilatation of a branch of the pancreatic duct in the body of the pancreas. No morphologic changes, such as swelling, redness of the papilla of the Vater or mucus flowing out from the orifice, were revealed by duodenoscopy. Angiography showed no abnormality in the pancreas. The patient was since then follwed-up because of no evidence of malignancy. Two years and two months later, although asymptomatic, he came to us for further examination. US and CT revealed no remarkable change, but ERCP revealed that the cystic lesion in the body of the pancreas increased in size. Distal pancreatectomy was performed because of suspicion of malignancy. Histopathology revealed mucinous hyperplasia of the pancreatic duct. Having returned to work, the patient is currently being followed on an out-patient basis.