臨牀消化器内科 Vol.34 No.12(2-9)


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 (9) 小膵囊胞の観察法
発刊年月 2019年 11月
著者 笹平 直樹 がん研究会有明病院肝胆膵内科
著者 武田 剛志 がん研究会有明病院肝胆膵内科
著者 金田 遼 がん研究会有明病院肝胆膵内科
著者 松山 眞人 がん研究会有明病院肝胆膵内科
著者 佐々木 隆 がん研究会有明病院肝胆膵内科
著者 尾阪 将人 がん研究会有明病院肝胆膵内科
【 要旨 】 偶発的に診断される小さな膵囊胞は分枝型IPMN初期病変の可能性が高い.IPMNに関連した膵癌として,IPMN由来癌とIPMN並存癌がある.IPMNの進行に伴って出現する由来癌と異なり,IPMNの進行度と関係なく突然出現する並存癌は,IPMN初期病変からでも起こりうる,その頻度は年率0.5%程度と決して高くはないが,出現する膵癌は,ステージⅠからⅣまでわずか1年であるため,年1回の検診で早期に発見することは困難である.腹部超音波,造影CT,MRCP,超音波内視鏡のなかから患者に合った検査法を年2回行い,既知の囊胞の大きさのほか,腫瘤の出現や,膵管狭窄や拡張などの二次的所見に注意する.
Theme IPMN/Pancreatic Cyst as an Increasing Common Disease -- Current Status and Issues
Title How to Manage Small Pancreatic Cysts or Small IPMN
Author Naoki Sasahira Department of Hepato‒Biliary‒Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research
Author Tsuyoshi Takeda Department of Hepato‒Biliary‒Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research
Author Ryo Kanata Department of Hepato‒Biliary‒Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research
Author Masato Matsuyama Department of Hepato‒Biliary‒Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research
Author Takashi Sasaki Department of Hepato‒Biliary‒Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research
Author Masato Ozaka Department of Hepato‒Biliary‒Pancreatic Medicine, The Cancer Institute Hospital of Japanese Foundation for Cancer Research
[ Summary ] Incidental small pancreatic cysts include branch duct IPMN in its early stage. There are two types of IPMN‒related pancreatic cancer (PC); PC derived from IPMN and PC concomitant with IPMN. The latter one can develop not only from advanced IPMN, but also from early stage of IPMN. Although the annual rate of the cancer incidence from IPMN is estimated as high as 0.5 %, the T1‒stage cancer progresses to T4 stage in just over 1 year. Thus, routine follow‒up of IPMN in its early stage should be performed twice a year by ultrasonography, dynamic CT scan, MR cholangiopancreatography, or endoscopic ultrasound. We should pay attention to the ductal change as well as the size or mucinous nodule of IPMN on those imaging study to find small PC concomitant with IPMN.
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