微小浸潤性膵管内乳頭粘液性腺癌

Intraductal Papillary-mucinous Carcinoma（minimal invasion）

微小浸潤性膵管内乳頭粘液性腺癌

患者　68歳，女性．

主訴　上腹部痛．

病歴　2001年10月急性腹症（急性膵炎）で近医，入院し保存的治療を受けた．軽快後，腹部超音波検査で膵頭部に膵管内乳頭腫瘍が疑われ，精査目的で当科紹介となった．

既往歴　1997年Hodgkin病．

　A 68-year-old woman had acute pancreatitis and was recovered by conservative treatment. Ultrasonography showed cystic lesion in the head of the pancreas in a neighboring hospital. She was referred to Department of Surgery, Kitakyushu Municipal Hospital. Ultrasonography and computed tomography showed a multilocular cystic lesion in the head of the pancreas, measuring 1.5cm. Endoscopic retrograde cholangiopancreatography showed mucin the main pancreatic duct but failed to visualize a cystic lesion in the head of the pancreas. Cytology of the pancreatic juice obtained under endoscopic retrograde pancreatography showed adenocarcinoma. Serum CEA was 4.1 ng／ml, and CA19―9 2.0 IU／ml. Pancreatoduodnectomy was performed with level 1 lymph node dissection. Histologically, there was intraductal papillary-mucinous carcinoma in the head of the pancreas and mucinous carcinoma invading the stroma（1mm）was evident. Lymph node metastases were not present. She had uneventful postoperative course. She is doing well without any signs of local recurrence and distant metastasis three years after the operation.

（Shokakigazo 2005 ; 7 : 725―728）