Yoshioka Ryo, Tomimaru Yoshito, Noguchi Kozo, Nagase Hirotsugu, Hamabe Atsushi, Hirota Masashi, Oshima Kazuteru, Tanida Tsukasa, Kawase Tomono, Morita Shunji, Imamura Hiroshi, Iwazawa Takashi, Akagi Kenzo, Adachi Shiro, Dono Keizo
Dept. of Surgery, Toyonaka Municipal Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):1782-1784.
A 74-year-old man underwent pancreaticoduodenectomy for intraductal pupillary mucinous neoplasm(IPMN)of the pancreatic head. Histopathological examination of the specimen revealed non-invasive intraductal papillary mucinous carcinoma( IPMC). Two years after surgery, recurrent IPMN developed in the remnant pancreas, and a liver tumor was identified in S8 of the liver. The patient underwent total pancreatectomy of the remnant pancreas and partial resection of S8. These tumors were histopathologically diagnosed as invasive IPMC and hepatocellular carcinoma, respectively. Five years after the resec- tions, another liver tumor was identified in S4/3 of the liver, and partial resection of S4/3 was performed. The tumor was histopathologically identified as cholangiocellular carcinoma. Seven months after the last surgery, the patient remains in good health without any recurrences. IPMN is characterized by IPMN recurrence in the remnant pancreas and malignant neoplasms in other organs, and the present case showed both characteristics. The case suggested the importance of postoperative follow-up of IPMN patents with regard to the characteristics of IPMN.
一名74岁男性因胰头部导管内乳头状黏液性肿瘤(IPMN)接受了胰十二指肠切除术。标本的组织病理学检查显示为非侵袭性导管内乳头状黏液癌(IPMC)。术后两年,残余胰腺出现复发性IPMN,且在肝脏S8区发现一个肝肿瘤。患者接受了残余胰腺全切除术及S8部分切除术。这些肿瘤经组织病理学分别诊断为侵袭性IPMC和肝细胞癌。切除术后五年,在肝脏S4/3区又发现一个肝肿瘤,并进行了S4/3部分切除术。该肿瘤经组织病理学鉴定为胆管细胞癌。最后一次手术后七个月,患者身体健康,无任何复发迹象。IPMN的特点是残余胰腺出现IPMN复发以及其他器官出现恶性肿瘤,本病例具备这两个特点。该病例提示了鉴于IPMN的特点,对IPMN患者进行术后随访的重要性。