A case of anaplastic ductal carcinoma with adenosquamous carcinoma of the pancreas

症例は73歳,女性.腹痛の精査目的で紹介された.CT検査で膵尾部に70mm大の不整形腫瘤を認めた.膵尾部浸潤性膵管癌と診断し根治手術を目指し,脾合併膵体尾部切除術,胃全摘術,空腸,横行結腸,左副腎合併切除術を施行した.摘出標本では,浸潤性に増殖する弾性硬の肉腫様腫瘤で,割面は黄白色で一部に壊死を認めた.病理組織学的に多型細胞型退形成性膵管癌と診断され,同一組織片の一部に腺扁平上皮癌への移行成分が混在していた.PSの悪化により術後補助化学療法の導入は困難であった.術後4ヵ月目に局所再発,腹膜播種が出現し,術後5ヵ月目に癌性悪液質で死亡した.本症例は同一組織内に増殖能の高い2組織型が混在し,その転帰は極めて不良であった.今後の治療方針確立のため報告した.

A 73-year-old woman was admitted to our hospital for further examination of abdominal pain. An abdominal CT showed an irregularly shaped tumor with a diameter of 70 mm in the tail of the pancreas. We diagnosed the case as pancreatic tail cancer and an operation was performed. At laparotomy, the tumor showed general expanding growth and direct invasion through the adjust organs. We performed distal pancreatectomy and splenectomy with total gastrectomy, partial resection of jejunum, partial transverse colectomy, and left adrenalectomy. The resected specimen showed an elastic hard tumor with sarcomatous change growing towards outside of the pancreas. The cut surface was yellow-white and showing partial necrotic change. The histopathologilcal diagnosis was pleomorphic cell type anaplastic ductal carcinoma with adenosquamous carcinoma. Abdominal CT scan performed four months after the operation revealed local recurrence and peritoneal dissemination. The patient died of cancer five months after resection. The tumor was diagnosed as coexist two histological types of cancer cells with high proliferating potential, so it is very difficult to cure with rapid progression. We hope to establish a more definitive treatment for this disease through ongoing encounters with patients.

退形成性膵管癌　

多形細胞型

腺扁平上皮癌