腹腔鏡下膵部分切除術を施行した有茎性膵過誤腫の1例

Laparoscopic partial pancreatectomy for pancreatic hamartoma : A case report

◆要旨：症例は46歳女性，子宮筋腫増大の精査中に，単純CTで膵尾部腫瘤を指摘された．Dynamic CTで膵尾部の足側に突出し，造影効果を伴う28mmの辺縁平滑充実性楕円形腫瘤を認めた．MRIではT1強調画像で低信号，T2強調画像で中等度高信号であった．EUS-FNAでは複数回の腫瘍穿刺にても紡錘形細胞を伴う線維性間質組織を少量のみ認めた．術前診断は膵神経内分泌腫瘍疑いで，腹腔鏡下脾合併膵体尾部切除術を予定した．術中所見では，膵と1cm幅で連続するのみの有茎性腫瘍であり，腹腔鏡下膵部分切除術を施行した．術中迅速診断で悪性所見を認めず，最終病理診断は膵過誤腫であった．

　A 46-year-old woman presented with an asymptomatic pancreatic tail tumor, which was detected incidentally on plain computed tomography as an examination for a growing uterine myoma. Dynamic computed tomography revealed a 28-mm solid tumor with a smooth surface, protruding from the pancreatic surface caudal to the pancreatic tail, with increased late enhancement in the dorsal part of the tumor. Magnetic resonance imaging revealed that the tumor had low intensity in T1-weighted images and slight high-intensity in T2-weighted images. Endoscopic ultrasound-guided fine-needle aspiration samples contained only fibrous stromal tissue with spindle cells, even though the needle definitely punctured the tumor. The preoperative diagnosis was suspected to be pancreatic neuroendocrine tumor, and laparoscopic distal pancreatectomy with splenectomy was planned. Intraoperatively, the tumor protruded to the caudal side of the pancreatic tail and was pedunculated with a 1-cm-wide stem. Laparoscopic partial pancreatectomy was performed because intraoperative rapid pathological diagnosis indicated a benign tumor. The final pathological diagnosis was pancreatic hamartoma.