症例は78歳の男性で,黄疸,白色便を主訴として当院受診.精査にて中下部胆管癌もしくは膵頭部癌と診断され亜全胃温存膵頭十二指腸切除+リンパ節郭清を施行.摘出標本では中下部胆管と膵頭部に2種の腫瘍を認め,病理組織学的検査では中下部胆管に印環細胞癌を認め膵臓に高度浸潤を認めた.また,膵頭部には高分化型管状腺癌を認め両腫瘍間に細胞移行像は認められないことから多発腫瘍による衝突癌と考えられた.患者はgemcitabineを用いた化学療法を施行中であり術後14か月現在,無再発生存中である.膵衝突癌は術前画像診断で中下部胆管癌と膵頭部癌の両者の特徴を併せ持っており術中所見においてもその診断は困難であった.
A 77-years-old man admitted for jaundice and white stool was diagnosed with a middle and lower bile duct or pancreas head cancer, necessitating subgastric preserving pancreaticoduodenectomy with lymph node dissection. Resected material showed two tumors in the middle and lower bile duct and pancreas head. Histopathologically, signet ring cell carcinoma of the middle and lower bile duct had infiltrated the pancreas severely, and well-differentiated tubular adenocarcinoma was found in the pancreas head. We diagnosed this as a collision of two cancers because no cell transference was found between the two tumors. The patient underwent adjuvant chemotherapy using gemcitabine and remains alive with no evidence of reccurrence 14 months after surgery. Collision cancer of the pancreas showed features of both middle～lower bile duct and pancreas head cancer in preoperative imaging, making the diagnosis very difficult.
膵頭部管状腺癌と中下部胆管印環細胞癌の衝突癌の1例
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