Sato Yutaka, Kagawa Shingo, Yoshitomi Hideyuki, Furukawa Katsunori, Takayashiki Tsukasa, Kuboki Satoshi, Takano Shigetsugu, Suzuki Daisuke, Sakai Nozomu, Nojima Hiroyuki, Mishima Takashi, Nakadai Eri, Ohtsuka Masayuki
Dept. of General Surgery, Graduate School of Medicine, Chiba University.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2548-2550.
An 81-year-old man was referred to our department because of rapid progression of a cystic lesion in the pancreatic tail. Abdominal CT revealed a heterogeneously enhancing tumor, measuring 70mm in diameter, in the pancreatic tail, encompassing a low-density area with calcification and directly invading the spleen. We diagnosed the patient with malignant transformation of solid-pseudopapillary neoplasm and performed distal pancreatectomy with splenectomy, partial transverse colectomy, and partial resection of the diaphragm. Histopathological examination revealed anaplastic carcinoma of the pancreas of the spindle cell type, and R0 resection was achieved. Anastomotic leakage of the transverse colon occurred on postoperative day 4, and ileostomy was performed. Multiple liver metastases were observed on postoperative day 27, and the patient was orally administered with S-1. Although he was discharged on postoperative day 50, he died of cancer on postoperative day 61. Anaplastic carcinoma of the pancreas has a poor prognosis, and an early multidisciplinary treatment should be performed.
一名81岁男性因胰尾囊性病变迅速进展被转诊至我科。腹部CT显示胰尾有一个直径70mm的不均匀强化肿瘤,包绕一个伴有钙化的低密度区,并直接侵犯脾脏。我们诊断该患者为实性假乳头状肿瘤恶变,并进行了胰体尾切除术、脾切除术、部分横结肠切除术和部分膈肌切除术。组织病理学检查显示为梭形细胞型胰腺间变性癌,实现了R0切除。术后第4天发生横结肠吻合口漏,遂行回肠造口术。术后第27天观察到多发肝转移,患者口服S-1。尽管他在术后第50天出院,但在术后第61天死于癌症。胰腺间变性癌预后较差,应尽早进行多学科治疗。