直腸癌術後の膵体部早期癌

Pancreatic Carcinoma After Resection of Rectal Carcinoma

患者　56歳，女性．

主訴　なし．

病歴　5年前直腸癌に対して直腸切断術を受ける．経過観察中CEAの上昇（5.5 ng／ml）と右下肢腫脹を認めた．超音波，CTで膵体部に1 cmの腫瘤を認め，手術目的で当科，入院となる．

既往歴　糖尿病，高血圧なし．

　A 56―year-old woman underwent Miles’ operation for rectal carcinoma five years ago. She noticed swelling of right lower extremity and serum CEA level was elevated. Ultrasonography showed a pancreatic body mass, measuring 1 cm, and she came to us for surgical resection. Serum level of CA19―9 was elevated to 15,377 IU／ml and CEA 18.5 ng／ml. Computed tomography and magnetic resonance imaging also showed a pancreatic body mass with delayed enhancement and dilatation of the upper stream pancreatic ducts. Lymph node swelling along the external iliac artery was evident. Endoscopic retrograde pancreatography showed a complete obstruction of the main pancreatic duct. Distal pancreatectomy and splenectomy was done with D2 lymph node dissection. Intraoperative radiation therapy（20 Gy）was also done. Biopsy of lymph node around the right external iliac artery showed metastasis by cytology. Histological examination showed a moderately to poorly differentiated adenocarcinoma, measuring 1.5 cm. Metastasis was not evident in level 2 lymph nodes. After operation, brain metastasis from rectal cancer developed and died three months after operation.

（Shokakigazo 2005 ; 7 : 417―420）