腹痛，背部痛を主訴とする膵鉤部腫瘤の2例

Back Pain and Pancreatic Uncinate Carcinoma

［症例1］

患者　61歳，女性．

主訴　腹痛，背部痛．

病歴　腹痛，背部痛にて来院し，血液生化学検査で血清アミラーゼの上昇を，超音波検査で膵管拡張，膵腫大を，CTにて膵鉤部に2 cmの腫瘤と尾側主膵管の拡張を認めた．

既往歴　特記事項なし．

生活歴　飲酒歴なし，喫煙歴なし．

家族歴　特記事項なし．

入院時現症　頸部，腹部に特記事項なし．

入院時血液検査　血算，血液生化学：異常なし，CA19-9：119.7 IU／ml，CEA：0.5 ng／ml．

(Case 1)

A 61-year-old woman complained of abdominal pain and back pain. Computed tomography showed a pancreatic mass in the uncinate process, measuring 2 cm. Ultrasonography demonstrated a mass lesion, measuring 2 cm, in the uncinate process of the pancreas and dilatation of the main pancreatic duct. Magnetic resonance imagings displayed a pancreatic mass in the uncinate process of the pancreas with delayed enhancement. Pylorus preserving pancreatoduodenectomy with D2 lymph node dissection was performed under the diagnosis of pancreatic head cancer. Histological examination showed a well to moderately differentiated adenocarcinoma, measuring 1.5 cm. Lymph node metastasis was evident in the level 1. Surgical margins were free of cancer cells. She died of local recurrence and liver metastasis one year and seven months after the operation.

(Case 2)

A 70-year-old woman complained of abdominal pain and back pain. Ultrasonography showed a pancreatic head mass, measuring 1.3 cm, and a lymph node swelling at the right side of the superior mesenteric artery. Computed tomography and magnetic resonance cholangiopancreatogra-phy showed the normal biliary tree and pancreatic duct. Pylorus preserving pancreatoduodenectomy with D2 lymph node dissection was performed under the diagnosis of pancreatic head cancer. Histological examination showed a moderately differentiated adenocarcinoma, measuring 1.0 cm in the uncinate process of the pancreas and lymph node metastasis at the root of the superior mesenteric artery. She died of retroperitoneal recurrence and liver metastasis two years and six months after the operation.

（Shokakigazo 2004 ; 6 : 797―803）