臨牀消化器内科 Vol.13 No.11(11)


特集名 知っておくべき疾患 --胆・膵
題名 Solid and Cystic Tumor
発刊年月 1998年 10月
著者 井出 雄幸 航空自衛隊第一補給処医務室 防衛医科大学校第一外科
【 要旨 】 われわれは2例のsolid and cystic tumor(以下,SCTと略す)と考えられた症例を経験した.症例1は13歳,女児.腹部腫瘤が発見され,腹部超音波,CTにて真胞状・充実性の腫瘤を認めた.手術的に膵鉤部の9.O×7.5×6.5cmの腫瘤を被膜ごと摘出した.電子顕微鏡像にて分泌顆粒と神経内分泌顆粒が認められ,内分泌系への分化を示すSCTと考えた.症例2は15歳,女子.腹痛を契機に画像検査上,石灰化を伴う腫瘤が発見され,手術時に膵尾部に3.4×2.7×2.7cmの充実性・嚢泡状腫瘤を認め,脾温存膵尾部切除にて摘出した.病理学的所見からSCTと考えた.両症例ともに血液生化学値,内分泌ホルモン値,腫瘍マーカーに異常を認めなかった.
Theme Digestive Diseases to Know -- Biliary Tract, Pancreas
Title Solid and Cystic Tumor
Author Takeyuki Idei Dispensary of First Air Depot, Japan Air Self-Defense Force / First Department of Surgery, National Defense Medical College
[ Summary ] Case 1: A 13-year-old girl was admitted with an abdominal mass, which had been palpated by chance. Ultrasonography and CT revealed a cystic, partially solid mass in the head of pancreas. Performing a laparotomy, the mass was seen to be encapsulated by a thick wall, adhering to the head of the pancreas. The resected mass was 9.0 x 7.5 x 6.5cm in size. Upon dissection, it was seen to be composed of solid, and cystic lesions, including hemorrhagic and necrotic materials. Microscopically, uniform eosinophilic cells, with round to oval nuclei, formed solid sheets or pseudopapillary structures in the solid lesion. PAS-reaction was focal positive : The tumor cells were stained by Grimelius' silver stain. Electron examinations showed secretory granules and neurosecretory granules in the tumor cells ; no abnormality was found in the pre-operative endocrine data (including insulin, gastrin and glucagon) in her blood. So we understood it to be a case of solid cystic tumor with endocrine differentiation. Case 2 : A 15-year-old girl was admitted with complaints of abdominal pain. Radiography showed a partially calcificated mass in the tail of the pancreas. No abnormality was found in the pre-operative endocrine data(including insulin, gastrin and glucagon) in her blood. Distal pancreatectomy revealed a solid, cystic mass, 3.4 x 2.7 x 2.7cm in size. Microscopic structures of the tumor resembled those of the Case 1. PAS-reaction was positive. The tumor cells were not stained by Grimelius' silver stain. Electron examinations showed secretory granules and only a few neurosecretory granules in some of the tumor cells. We understood it to be a case of a solid cystic tumor.
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