非浸潤性膵管内乳頭粘液性腺癌

Intraductal Papillary-Mucinous Carcinoma（Non-Invasive）

患者　62歳，女性．

主訴　なし．

病歴　1995年より健診で主膵管の拡張を指摘されていたが，原因不明と言われていた．1998年8月発熱，上腹部痛で近医にて総胆管結石，膵頭部腫瘍が疑われ，当科を受診した．緊急ERCPをし，急性化膿性胆管炎の診断でEST，ERBDを施行し，当科入院となった．

既往歴　特記事項なし．

生活歴　飲酒歴：なし，喫煙癧：なし．

家族歴　特記事項なし．

入院時現症　頸部や腹部に異常所見なし．

入院時血液検査　白血球5,160，総ビリルビン4.9 mg/dl，直接ビリルビン3.2 mg/dl，AST164，ALT401，ALP745，アミラーゼ48，CEA：0.8 ng/ml，CA19-9：15.1 U/ml，75 gGTT：糖尿病．

Abstract

　A 62-year-old woman was diagnosed as having acute cholangitis due to cholecysto-choledocholithiasis by a neighboring physician. Endoscopic sphincterotomy and endoscopic retrograde biliary drainage were performed emergently. Ultrasonography showed dilatation of the branch ducts in the head of the pancreas and of the main pancreatic duct. Serum level of CA19-9 was 15.1 IU/ml and CEA 0.8 ng/ml. Computed tomography and magnetic resonance imaging also showed a multilocular cystic mass in the head of the pancreas and diffuse dilatation of the main pancreatic duct. No mural nodules or solid components were noticed. Endoscopic retrograde pancreatography showed a dilatation of the main pancreatic duct. Pylorus preserving pancreatoduodenectomy was performed under the tentative diagnosis of intraductal papillary-mucinous neoplasm（main pancreatic duct type）of the pancreas. Histological examination showed non-invasive intraductal papillary-mucinous carcinoma in adenoma of the pancreas. Carcinoma focus, mucinous carcinoma of muconodular type, was evident in the dilated branch duct. Most of the dilated pancreatic ducts were lined by dysplastic mucous epithelium of mild to moderate degree. Lymph node metastasis was not evident. Her postoperative course was uneventful and she was discharged on postoperative day 52. She has been doing well five years and eight months after the operation.