臨牀消化器内科 Vol.21 No.2(4-2-4)


特集名 膵管内乳頭粘液性腫瘍 (IPMT ; intraductal papillary-mucinous tumor)
題名 診断 (2) 診断と鑑別 d. IDUS, POPS
発刊年月 2006年 02月
著者 野村 幸伸 藤田保健衛生大学第二病院内科
著者 乾 和郎 藤田保健衛生大学第二病院内科
著者 芳野 純治 藤田保健衛生大学第二病院内科
著者 奥嶋 一武 藤田保健衛生大学第二病院内科
著者 三好 広尚 藤田保健衛生大学第二病院内科
著者 中村 雄太 藤田保健衛生大学第二病院内科
【 要旨 】 膵管内超音波検査 (intraductal ultrasonography ; IDUS),経口膵管内視鏡検査 (peroral pancreatoscopy ; POPS) を用いたIPMTの診断について述べた,IPMTのIDUS所見として,嚢胞内の隔壁様構造,嚢胞壁の性状,壁在結節,粘液エコー,主膵管拡張が特徴的である.良・悪性の鑑別診断をするうえで,嚢胞壁の性状,壁在結節,腫瘤像のエコーパターンによる分類で良好に判別できた.IPMTのPOPS所見では,種々の隆起性病変が認められ,血管透見を伴うイクラ状隆起,絨毛状隆起,結節状隆起は悪性を示唆する所見とされ,IDUSとの併用で高い鑑別診断能が報告されている.
Theme IPMT ; Intraductal Papillary-Mucinous Tumor
Title Diagnosis of Intraductal Papillary-Mucinous Tumor -- IDUS, POPS
Author Yukinobu Nomura Department of Internal Medicine, Second Teaching Hospital, Fujita Health University School of Medicine
Author Kazuo Inui Department of Internal Medicine, Second Teaching Hospital, Fujita Health University School of Medicine
Author Jyunji Yoshino Department of Internal Medicine, Second Teaching Hospital, Fujita Health University School of Medicine
Author Kazumu Okushima Department of Internal Medicine, Second Teaching Hospital, Fujita Health University School of Medicine
Author Hironao Miyoshi Department of Internal Medicine, Second Teaching Hospital, Fujita Health University School of Medicine
Author Yuta Nakamura Department of Internal Medicine, Second Teaching Hospital, Fujita Health University School of Medicine
[ Summary ] We described the current methods and the usefulness of intraductal ultrasonography (IDUS) and peroral pancreatoscopy (POPS) for differentiating between benign intraductal papillary-mucinous tumors (IPMT) and malignant ones.
IDUS images of IPMT revealed cystic lesions with mural nodules, a distinct cystic wall, mucous echoes, and solid tumors with mixed echo patterns. The classification of IDUS images of IPMT was considered to be useful for differential diagnosis of benign and malignant IPMT. Protruding lesions were identified in IPMT with POPS. The type which was fish-egg-like, as seen with vascular images. The villous type, and the vegetatine type were considered to be malignant.
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