同時性肝転移を伴うmixed acinar-neuroendocrine carcinomaの1例
症例は69歳，男性．上腹部痛を主訴に受診した．CTで膵頭部腫瘤を認め，十二指腸浸潤・上腸間膜静脈腫瘍栓を伴っていた．また，肝に2箇所，転移を疑う腫瘍を認めた．十二指腸浸潤部からの生検にて膵内分泌癌の診断．イリノテカン・シスプラチンによる化学療法が開始され，1コース目の途中でセカンドオピニオン目的に当院を受診．前医標本の病理組織の再検討により，膵内分泌腫瘍 WHO grade 3と診断．膵・消化管神経内分泌腫瘍診療ガイドライン2019年でも，治癒切除可能病変な同時性遠隔転移を伴う膵内分泌腫瘍は切除を中心とした集学的治療を行うことが推奨されていることから，手術の方針とした．膵頭十二指腸切除術，門脈...
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| Published in | 日本臨床外科学会雑誌 Vol. 83; no. 4; pp. 755 - 761 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.83.755 |
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| Abstract | 症例は69歳，男性．上腹部痛を主訴に受診した．CTで膵頭部腫瘤を認め，十二指腸浸潤・上腸間膜静脈腫瘍栓を伴っていた．また，肝に2箇所，転移を疑う腫瘍を認めた．十二指腸浸潤部からの生検にて膵内分泌癌の診断．イリノテカン・シスプラチンによる化学療法が開始され，1コース目の途中でセカンドオピニオン目的に当院を受診．前医標本の病理組織の再検討により，膵内分泌腫瘍 WHO grade 3と診断．膵・消化管神経内分泌腫瘍診療ガイドライン2019年でも，治癒切除可能病変な同時性遠隔転移を伴う膵内分泌腫瘍は切除を中心とした集学的治療を行うことが推奨されていることから，手術の方針とした．膵頭十二指腸切除術，門脈合併切除+再建，肝部分切除術を施行した．切除標本による病理診断はmixed acinar-neuroendocrine carcinomaであった．S-1による術後補助化学療法を施行し，現在術後15カ月，無再発にて経過観察中である．同時性肝転移を伴う膵腫瘍に対する治療戦略は原発膵腫瘍の診断により異なるため，実臨床において示唆に富む症例と考えられた． |
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| AbstractList | 症例は69歳，男性．上腹部痛を主訴に受診した．CTで膵頭部腫瘤を認め，十二指腸浸潤・上腸間膜静脈腫瘍栓を伴っていた．また，肝に2箇所，転移を疑う腫瘍を認めた．十二指腸浸潤部からの生検にて膵内分泌癌の診断．イリノテカン・シスプラチンによる化学療法が開始され，1コース目の途中でセカンドオピニオン目的に当院を受診．前医標本の病理組織の再検討により，膵内分泌腫瘍 WHO grade 3と診断．膵・消化管神経内分泌腫瘍診療ガイドライン2019年でも，治癒切除可能病変な同時性遠隔転移を伴う膵内分泌腫瘍は切除を中心とした集学的治療を行うことが推奨されていることから，手術の方針とした．膵頭十二指腸切除術，門脈合併切除+再建，肝部分切除術を施行した．切除標本による病理診断はmixed acinar-neuroendocrine carcinomaであった．S-1による術後補助化学療法を施行し，現在術後15カ月，無再発にて経過観察中である．同時性肝転移を伴う膵腫瘍に対する治療戦略は原発膵腫瘍の診断により異なるため，実臨床において示唆に富む症例と考えられた． |
| Author | 有田, 淳一 長谷川, 潔 河口, 義邦 田中, 麻理子 吉崎, 雄飛 牛久, 哲男 |
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| References | 6) 橘高弘忠，髙橋秀典，大東弘明他:多発肝転移・脾静脈腫瘍栓を伴ったmixed acinar-endocrine carcinomaの1例．日臨外会誌 2012;73:130-134 13) Mayo SC, de Jong MC, Bloomston M, et al : Surgery versus intra-arterial therapy for neuroendocrine liver metastasis : a multicenter international analysis. Ann Surg Oncol 2011 ; 18 : 3657-3665 2) Klimstra DS, Kloppel G, La Rosa S, et al : Classification of Neuroendocrine Neoplasms of the Digestive System. In : WHO Classification of Tumours Editorial Board editors, WHO Classification of Tumours, 5th ed., Digestive System Tumours, IARC Press, Lyon, 2019, p16-19 4) Frank M, Bittinger A, Rothmund M, et al : Immunohistochemical analysis and clinical course of high-malignant composite endocrine-acinar cell carcinoma : a case report. Pancreas 1998 ; 17 : 210-212 18) Uesaka K, Boku N, Fukutomi A, et al : Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer : a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet 2016 ; 388 : 248-257 7) Liu Z, Dong C, Wang C, et al : Mixed acinar-endocrine carcinoma of pancreas : A case report and brief review of the literature. Onco Targets Ther 2015 ; 8 : 1633-1642 12) Chamberlain RS, Canes D, Brown KT, et al : Hepatic neuroendocrine metastases : does intervention alter outcomes? J Am Coll Surg 2000 ; 190 : 432-445 5) 西居孝文，天野良亮，中尾重富他:各種局所療法を施行したMixed Acinar-Endocrine Carcinoma肝転移の1例．癌と化療 2008;35:2126-2128 9) Kitagami H, Kondo S, Hirano S, et al : Acinar cell carcinoma of the pancreas : clinical analysis of 115 patients from Pancreatic Cancer Registry of Japan Pancreas Society. Pancreas 2007 ; 35 : 42-46 10) Wisnoski NC, Townsend CM Jr., Nealon WH, et al : 672 patients with acinar cell carcinoma of the pancreas : a population-based comparison to pancreatic adenocarcinoma. Surgery 2008 ; 144 : 141-148 3) Klimstra DS, Adsay V : Acinar neoplasms of the pancreas-A summary of 25 years of research. Semin Diagn Pathol 2016 ; 33 : 307-318 15) Dasari A, Shen C, Halperin D, et al : Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States. JAMA Oncol 2017 ; 3 : 1335-1342 11) Schmidt CM, Matos JM, Bentrem DJ, et al : Acinar cell carcinoma of the pancreas in the United States : prognostic factors and comparison to ductal adenocarcinoma. J Gastrointest Surg 2008 ; 12 : 2078-2086 8) Al-Hader A, Al-Rohil RN, Han H, et al : Pancreatic acinar cell carcinoma : A review on molecular profiling of patient tumors. World J Gastroenterol 2017 ; 23 : 7945-7951 14) Kawaguchi Y, De Bellis M, Panettieri E, et al : Debate : Improvements in Systemic Therapies for Liver Metastases Will Increase the Role of Locoregional Treatments. Surg Oncol Clin N Am 2021 ; 30 : 205-218 17) Oneda E, Liserre B, Bianchi D, et al : Diagnosis of Mixed Adenoneuroendocrine Carcinoma (MANEC) after Neoadjuvant Chemotherapy for Pancreatic and Gastric Adenocarcinoma : Two Case Reports and a Review of the Literature. Case Rep Oncol 2019 ; 12 : 434-442 1) Howe JR, Cardona K, Fraker DL, et al : The Surgical Management of Small Bowel Neuroendocrine Tumors : Consensus Guidelines of the North American Neuroendocrine Tumor Society. Pancreas 2017 ; 46 : 715-731 16) Murata M, Takahashi H, Yamada M, et al : A case of mixed adenoneuroendocrine carcinoma of the pancreas : Immunohistochemical analysis for histogenesis. Medicine (Baltimore) 2017 ; 96 : e6225 |
| References_xml | – reference: 13) Mayo SC, de Jong MC, Bloomston M, et al : Surgery versus intra-arterial therapy for neuroendocrine liver metastasis : a multicenter international analysis. Ann Surg Oncol 2011 ; 18 : 3657-3665 – reference: 14) Kawaguchi Y, De Bellis M, Panettieri E, et al : Debate : Improvements in Systemic Therapies for Liver Metastases Will Increase the Role of Locoregional Treatments. Surg Oncol Clin N Am 2021 ; 30 : 205-218 – reference: 8) Al-Hader A, Al-Rohil RN, Han H, et al : Pancreatic acinar cell carcinoma : A review on molecular profiling of patient tumors. World J Gastroenterol 2017 ; 23 : 7945-7951 – reference: 2) Klimstra DS, Kloppel G, La Rosa S, et al : Classification of Neuroendocrine Neoplasms of the Digestive System. In : WHO Classification of Tumours Editorial Board editors, WHO Classification of Tumours, 5th ed., Digestive System Tumours, IARC Press, Lyon, 2019, p16-19 – reference: 5) 西居孝文，天野良亮，中尾重富他:各種局所療法を施行したMixed Acinar-Endocrine Carcinoma肝転移の1例．癌と化療 2008;35:2126-2128 – reference: 16) Murata M, Takahashi H, Yamada M, et al : A case of mixed adenoneuroendocrine carcinoma of the pancreas : Immunohistochemical analysis for histogenesis. Medicine (Baltimore) 2017 ; 96 : e6225 – reference: 10) Wisnoski NC, Townsend CM Jr., Nealon WH, et al : 672 patients with acinar cell carcinoma of the pancreas : a population-based comparison to pancreatic adenocarcinoma. Surgery 2008 ; 144 : 141-148 – reference: 3) Klimstra DS, Adsay V : Acinar neoplasms of the pancreas-A summary of 25 years of research. Semin Diagn Pathol 2016 ; 33 : 307-318 – reference: 1) Howe JR, Cardona K, Fraker DL, et al : The Surgical Management of Small Bowel Neuroendocrine Tumors : Consensus Guidelines of the North American Neuroendocrine Tumor Society. Pancreas 2017 ; 46 : 715-731 – reference: 4) Frank M, Bittinger A, Rothmund M, et al : Immunohistochemical analysis and clinical course of high-malignant composite endocrine-acinar cell carcinoma : a case report. Pancreas 1998 ; 17 : 210-212 – reference: 6) 橘高弘忠，髙橋秀典，大東弘明他:多発肝転移・脾静脈腫瘍栓を伴ったmixed acinar-endocrine carcinomaの1例．日臨外会誌 2012;73:130-134 – reference: 9) Kitagami H, Kondo S, Hirano S, et al : Acinar cell carcinoma of the pancreas : clinical analysis of 115 patients from Pancreatic Cancer Registry of Japan Pancreas Society. Pancreas 2007 ; 35 : 42-46 – reference: 18) Uesaka K, Boku N, Fukutomi A, et al : Adjuvant chemotherapy of S-1 versus gemcitabine for resected pancreatic cancer : a phase 3, open-label, randomised, non-inferiority trial (JASPAC 01). Lancet 2016 ; 388 : 248-257 – reference: 7) Liu Z, Dong C, Wang C, et al : Mixed acinar-endocrine carcinoma of pancreas : A case report and brief review of the literature. Onco Targets Ther 2015 ; 8 : 1633-1642 – reference: 11) Schmidt CM, Matos JM, Bentrem DJ, et al : Acinar cell carcinoma of the pancreas in the United States : prognostic factors and comparison to ductal adenocarcinoma. J Gastrointest Surg 2008 ; 12 : 2078-2086 – reference: 17) Oneda E, Liserre B, Bianchi D, et al : Diagnosis of Mixed Adenoneuroendocrine Carcinoma (MANEC) after Neoadjuvant Chemotherapy for Pancreatic and Gastric Adenocarcinoma : Two Case Reports and a Review of the Literature. Case Rep Oncol 2019 ; 12 : 434-442 – reference: 12) Chamberlain RS, Canes D, Brown KT, et al : Hepatic neuroendocrine metastases : does intervention alter outcomes? J Am Coll Surg 2000 ; 190 : 432-445 – reference: 15) Dasari A, Shen C, Halperin D, et al : Trends in the Incidence, Prevalence, and Survival Outcomes in Patients With Neuroendocrine Tumors in the United States. JAMA Oncol 2017 ; 3 : 1335-1342 |
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| Title | 同時性肝転移を伴うmixed acinar-neuroendocrine carcinomaの1例 |
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