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血清糖質抗原19-9レベルの急激な変化を示す膵臓内副脾臓内の表皮腫瘤：1例の報告
Epidermoid cyst within an intrapancreatic accessory spleen exhibiting abrupt changes in serum carbohydrate antigen 19-9 level: a case report.
PMID: 32533275 PMCID: PMC7292848. DOI: 10.1186/s40792-020-00892-z.
抄録
背景:
膵臓内付属脾臓内の表皮嚢胞（ECIAS）は稀な疾患である。付属脾臓に関連する固形成分の検出は診断上重要な所見であるが、他に付属脾臓の所見がない患者では切除せずにECIASと悪性腫瘍との鑑別診断は困難である。
BACKGROUND: Epidermoid cyst within an intrapancreatic accessory spleen (ECIAS) is a rare disease. While the detection of solid components relevant to an accessory spleen is a key diagnostic finding, the differential diagnosis between ECIAS and malignant tumors is difficult without resection in patients with no other findings of an accessory spleen.
ケースプレゼンテーション:
73歳の男性が年1回の健康診断で糖質抗原（CA）19-9値（95U/mL）が上昇しており、腹部超音波検査で膵臓尾部に嚢胞性病変を認めた。腹部磁気共鳴画像法（MRI）では直径24mmの多嚢胞性の腫瘤が認められ，T2強調画像では異なる強度を示した．造影CTおよび磁気共鳴画像では固形物を示唆する所見はなかった。血清CA19-9値の再評価では901U/mLまで急速に上昇し，3週間後には213U/mLまで低下した．病変の悪性度の判定が困難であったため，遠位膵臓摘出術と脾臓摘出術を行った．組織学的所見では，複数の嚢胞を含むECIASが認められ，各嚢胞の粘液成分は異なる生物学的反応の段階を示した．
CASE PRESENTATION: A 73-year-old male was found to have an elevated carbohydrate antigen (CA) 19-9 level (95 U/mL) at an annual checkup, and a cystic lesion in the pancreatic tail was located by abdominal ultrasound. Abdominal magnetic resonance imaging (MRI) revealed a multicystic mass, 24 mm in diameter, which exhibited varying intensities on T2-weighted images. There were no findings suggesting solid components on contrast-enhanced computed tomography and magnetic resonance imaging. Re-evaluation of serum CA 19-9 level revealed a rapid increase to 901 U/mL, which declined to 213 U/mL 3 weeks later. Ruling out the lesion's malignant potential was difficult, and the patient underwent distal pancreatectomy with splenectomy. Histological findings revealed an ECIAS including multiple cysts, with the mucinous component of each cyst exhibiting different stages of biological reaction; one ruptured cyst exhibited inflammatory changes.
結論:
血清CA19-9レベルの変化やMRI所見を注意深く観察することで、画像検査による固形成分を含まないECIASの診断が容易になる可能性がある。
CONCLUSIONS: Careful observation for changes in serum CA 19-9 level and MRI findings might facilitate the diagnosis of ECIAS without a solid component by imaging studies.