臨牀消化器内科 Vol.34 No.12(2-4)


特集名 遭遇の機会が増えたIPMN/膵囊胞―現状と課題
題名 IPMN/膵囊胞の診療 (4) 悪性IPMNとIPMN併存膵癌の診断におけるEUSの役割
発刊年月 2019年 11月
著者 鎌田 研 近畿大学病院消化器内科
著者 原 茜 近畿大学病院総合医学教育研修センター
著者 山雄 健太郎 近畿大学病院消化器内科
著者 竹中 完 近畿大学病院消化器内科
著者 工藤 正俊 近畿大学病院消化器内科
【 要旨 】 IPMNの良悪性鑑別を行ううえで,囊胞内における壁在結節の有無を診断することが重要である.2017年に「IPMN国際診療ガイドライン」が改訂され,壁在結節に造影効果および結節高に関する基準が新たに設けられた.近年,IPMNの良悪性鑑別を目的とし,造影ハーモニックEUS(CH‒EUS)による壁在結節の評価に着目した研究が散見される.CH‒EUSは壁在結節と粘液塊の鑑別やIPMNの良悪性診断に有用な診断法となりうる.本邦を中心にIPMNを有する症例にIPMN併存膵癌が発生するリスクが高いことが多数報告されている.自験例において,EUSおよびCH‒EUSはIPMN経過観察例やIPMN外科的切除後の残膵フォローアップ例に発生しうるIPMN併存膵癌の早期発見に有用であった.
Theme IPMN/Pancreatic Cyst as an Increasing Common Disease -- Current Status and Issues
Title Role of EUS in the Diagnosis of Malignant IPMN and IPMN Concomitant Pancreatic Ductal Adenocarcinoma
Author Ken Kamata Department of Gastroenterology and Hepatology, Kindai University Hospital
Author Akane Hara Center for General Medical Education and Clinical Training, Kindai University Hospital
Author Kentaro Yamao Department of Gastroenterology and Hepatology, Kindai University Hospital
Author Mamoru Takenaka Department of Gastroenterology and Hepatology, Kindai University Hospital
Author Masatoshi Kudo Department of Gastroenterology and Hepatology, Kindai University Hospital
[ Summary ] It is important to diagnose the presence or absence of mural nodules in cysts in order to distinguish between benign and malignant IPMN. The international consensus Fukuoka guidelines for the management of IPMN of the pancreas were revised in 2017, and the criteria for mural nodules was newly established with respect to contrast effects and nodule height. In recent years, several studies have focused on the evaluation of mural nodules by contrast‒enhanced harmonic EUS (CH‒EUS) for the purpose of discriminating between benign and malignant IPMN. CH‒EUS can be a useful diagnostic method for differentiating mural nodules and mucous masses and for diagnosing benign and malignant IPMN. There are many reports regarding the risk of developing IPMN concomitant pancreatic ductal adenocarcinoma (PDAC) is high in cases with IPMN mainly in Japan. In our case, EUS and CH‒EUS were useful for early detection of IPMN concomitant PDAC which may occur in IPMN follow‒up cases and remnant pancreas follow‒up cases after surgical resection of IPMN.
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