A case report on synchronous double tumors of the early gastric cancer in a residual stomach and the brunch type of multiple intraductal papillary mucinous neoplasms of the pancreas.

今回われわれは,残胃癌とともに膵内に同時多発発生した膵管内乳頭粘液性腫瘍(以下,IPMN)の1例を経験したので報告する.症例は62歳の男性で30歳代に胃癌にて幽門側胃切除,Billroth II法再建の手術歴あり.心窩部痛を主訴に近医を受診し上部消化管内視鏡検査による生検で残胃内に早期胃癌を診断された.精査のため当院へ紹介され,画像診断で膵内に多発する多房性嚢胞性腫瘤を指摘されIPMNと診断した.胃癌に対してD1郭清を伴う胃全摘術を,膵腫瘤に対しては膵頭十二指腸切除術を施行した.病理組織学的には胃癌は粘膜内のみに浸潤する中分化型管状腺癌でありstage I Aであった.一方,膵嚢胞性病変には悪性所見はなく腺腫であった.手術侵襲より術後QOLの低下が懸念されたが,術後経過は良好で重篤な合併症は起こさず45病日目に退院した.今後は残膵や他臓器内の異時性発生癌に注意して慎重なる経過観察が必要である.

We report a case of double cancer, early gastric cancer of residual stomach and intraductal papillary mucinous neoplasms of the pancreas. A 62-year-old man was admitted to the hospital because of epigastralgia. He had been received distal partial gastrectomy with Billroth II method reconstruction for gastric cancer in his thirties. We found an early gastric cancer using by gastrointestinal endscopy. In further examination we found a multilobular cystic lesion in the pancreas. Total gastrectomy and pancreaticoduodene-ctomy with regional lymphadenectomy were carried out. The definitive pathological diagnosis was moderately differentiated tubular adenocarcinoma of the residual stomach invading to the mucosal layer. Gastric cancer was found to be finally stage I A. On the other hand, histopathologically pancreatic cystic lesions were showed intraductal papillary adenoma with no malignancy. Although we worried about a degradation of the QOL of the patient after surgery, postoperative course was almost uneventful. He was discharged from the hospital on the 45th postoperative day. We should carefully follow up this patient based on the presence of metachronous tumors in the residual pancreas and in other organs.

膵管内乳頭粘液性腫瘍

同時性重複癌

残胃癌