主膵管拡張を伴う早期膵頸部癌

Pancreatic Mass and Dilatation of the Main Pancreatic Duct

主膵管拡張を伴う早期膵頸部癌

患者　58歳，男性．

主訴　心窩部痛．

病歴　心窩部痛で近医受診したところ，超音波検査で膵体部に2 cmの腫瘤と尾側主膵管拡張を指摘された．手術目的で当科入院となった．

A58-year-old man presented us with hypochondralgia and ultrasonography showed a pancreatic body mass, measuring 2 cm, and dilatation of the main pancreatic duct distal to the mass. Computed tomography showed a pancreatic body mass with delayed enhancement and dilatation of the upper stream pancreatic duct. Endoscopic retrograde pancreatography showed stenosis of the main pancreatic duct at the neck and dilatation of the main pancreatic duct distal to the stenosis. Distal pancretectomy and splenectomy was done with D2 lymph node dissection under the diagnosis of pancreatic neck cancer. Histological examination showed a well differentiated adenocarcinoma, measuring 1.5 cm. Lymph node metastasis was evident in the level 1 and surgical margins were free of cancer cells. After operation, cemotherapy (gemzal) was done and is followed up at the out-patient ward two yeara and two months after the operation.

（Shokakigazo 2004 ; 6 : 139―142）