Fujisaki Shigeru, Takashina Motoi, Tomita Ryouichi, Sakurai Kenichi, Takayama Tadatoshi
Dept. of Surgery, Fujisaki Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):1662-1664.
We report 2 cases of pancreatic cancer discovered incidentally in the wake of acute abdomen from other causes. Case 1 is a 67-year-old man who was referred to our hospital in October 2010 for the treatment of an incarcerated right inguinal hernia. The hernia was manually reduced, and mesh plug hernioplasty was scheduled for the next day. A 2.9 cm diameter tumor was detected in the tail of the pancreas on plain CT at the first visit and confirmed on enhanced CT soon after the hernia repair. A follow-up abdominal CT scan approximately 1 month later showed modest enlargement of the tumor to 3.5 cm diameter. The patient underwent distal pancreatectomy with lymph node dissection in December 2010. The histopathological diagnosis was tubular adenocarcinoma(tub1>tub2). Comprehensive findings were pT2, pN0, cM0, fStage II . He was treated with adjuvant chemotherapy consisting of gemcitabine 1,000mg/m2 for 6 months after surgery, and at 5 years and 7 months after surgery, he was alive and recurrence-free. Case 2 is a 74-year-old man who presented to our hospital with lower abdominal pain and diarrhea in early January 2016. Colonoscopy and barium enema revealed severe stenosis of the rectum(Rs). Rectal biopsy confirmed adenocarcinoma of the rectum. In addition, an enhanced CT scan showed irregular dilatation of the pancreatic duct in the pancreatic tail. The patient underwent low anterior resection and distal pancreatectomy, which was performed following an intraoperative pancreatic ultrasound examination that supported a diagnosis of pancreatic cancer. Pathological and comprehensive findings of rectal cancer were tubular adenocarcinoma(tub2)and pT3, pN0, cM0, fStage II , and those of the pancreatic cancer were tubular adenocarcinoma(tub2)and pT1, pN0, cM0, fStage I . The patient was discharged from the hospital 46 days after surgery. However, he died 18 days later due to sudden out-of-hospital cardiopulmonary arrest.
我们报告2例因其他原因导致急腹症而偶然发现的胰腺癌病例。病例1是一名67岁男性，2010年10月因右侧腹股沟嵌顿疝被转诊至我院。疝内容物被手法复位，次日计划行网塞疝修补术。首次就诊时平扫CT发现胰尾部有一个直径2.9 cm的肿瘤，疝修补术后不久增强CT证实了这一发现。大约1个月后的腹部CT随访扫描显示肿瘤适度增大至直径3.5 cm。患者于2010年12月接受了远端胰腺切除术及淋巴结清扫术。组织病理学诊断为管状腺癌（tub1>tub2）。综合检查结果为pT2、pN0、cM0、f分期II期。术后他接受了6个月的吉西他滨辅助化疗，剂量为1000mg/m2，术后5年7个月时，他仍存活且无复发。病例2是一名74岁男性，2016年1月初因下腹痛和腹泻就诊于我院。结肠镜检查和钡剂灌肠显示直肠严重狭窄（Rs）。直肠活检证实为直肠腺癌。此外，增强CT扫描显示胰尾部胰管不规则扩张。患者接受了低位前切除术和远端胰腺切除术，术中胰腺超声检查支持胰腺癌诊断后进行了该手术。直肠癌的病理和综合检查结果为管状腺癌（tub2）、pT3、pN0、cM0、f分期II期，胰腺癌的病理和综合检查结果为管状腺癌（tub2）、pT1、pN0、cM0、f分期I期。患者术后46天出院。然而，他在18天后因院外突发心肺骤停死亡。
