子宮平滑筋肉腫膵転移に対して腹腔鏡下脾温存尾側膵切除術を施行した1例

Laparoscopic spleen preserving distal pancreatectomy for metastasis of uterine leiomyosarcoma to the pancreas : A case report

◆要旨：65歳，女性．20XX年子宮平滑筋肉腫の診断で子宮全摘および両側付属器切除，補助化学療法としてドセタキセル＋ゲムシタビン療法を4コース施行した．術後10年目に左腎転移に対して左腎摘出，11年目に右肺転移に対して右肺上葉切除，12年目に右下葉部分切除を施行した．13年目の腹部CTで膵尾部に25mm大の腫瘤を認め，精査にて子宮平滑筋肉腫膵転移と診断した．他部位への転移や周囲組織への浸潤所見を認めなかったため，脾動静脈温存を伴う腹腔鏡下脾温存尾側膵切除術（LSPDP）を施行した．子宮平滑筋肉腫はしばしば遠隔転移を認めるが，膵転移はきわめて稀である．LSPDPは低侵襲かつ臓器機能温存可能な術式であり，よい適応と思われた．

　We report a case of metastasis of uterine leiomyosarcoma to the pancreas in a 65-year-old woman, who was treated with laparoscopic spleen-preserving distal pancreatectomy （LSPDP）. She underwent total hysterectomy and adnexectomy for the uterine leiomyosarcoma and received 4 cycles of adjuvant chemotherapy with docetaxel and gemcitabine in 20XX. Subsequently, she underwent left nephrectomy, right upper lung lobectomy, and right lung wedge resection 10, 11, and 12 years, respectively, after the primary operation. Histopathological evaluation confirmed a diagnosis of metastases from the uterine leiomyosarcoma. Abdominal computed tomography performed 13 years after the primary operation revealed a mass （13mm） in the tail of the pancreas. The tumor was diagnosed as metastatic uterine leiomyosarcoma. No extrapancreatic invasion or distant metastases were detected and thus, LSPDP was performed. LSPDP is a minimally invasive and function-sparing procedure. Metastasis of uterine leiomyosarcoma to the pancreas was considered a good indication for LSPDP.