Shingo Sakata

Lymphoepithelial cyst of the pancreas associated with elevated CA 19-9 levels

An extremely rare case of a lymphoepithelial cyst associated with persistent elevation of serum carbohydrate antigen (CA) 19-9 levels is described. A 72-year-old man was incidentally found to have a cystic tumor in the uncus of the pancreas and to have a high serum CA 19-9 level. At 2-year follow up, the tumor size had gradually increased and the high CA 19-9 level persisted. Because the malignant potential of the tumor could not be ruled out, a laparotomy was performed. The tumor was excised from the pancreas. On pathological examination, the tumor was proven to be a lymphoepithelial cyst. After the operation, the patients serum CA 19-9 level decreased to the normal range. Lymphoepithelial cysts of the pancreas are a rare, benign entity. They are true pancreatic cysts, characterized by a mature, keratinizing, squamous lining surrounded by lymphoid tissue. Because the treatment options and the prognosis of these entities are quite different from those of other cystic neoplasms of the pancreas, preoperative differential diagnosis is the main issue. Thus, although they are rare, lymphoepithelial cysts should be considered in the differential diagnosis of cystic tumors of the pancreas.

A Case of Advanced Gastric Carcinoma with Multiple Liver Metastasis Surviving more than 7 Years by the Treatment of Local and Systemic Chemotherapy.

症例は67歳の男性, 腹部不快感を訴え, 1991年11月当院受診, 精査にて胃幽門前庭部に2型進行癌を指摘され, 1992年3月手術を施行した. 術前の診断では肝転移 (-) なるも, 術中迅速病理診断にて多発肝転移が判明し, 胃亜全摘術, 肝動脈内カテーテル留置術を施行した. 術後5-FU, ADM, MMC, レンチナンによる肝動注を反復施行し, 画像上肝転移の出現は認められなかった. 1995年より右肺下葉に単発転移巣が出現し, 腫瘍の増大にて喀血も来したため, 1997年4月から放射線照射を施行し, その結果腫瘍は縮小, 症状も軽快した. 1998年3月肺転移巣が再度増大して喀血などの症状も増悪し, ロイコボリン, 5-FUによる全身化学療法を行い, 症状の軽快を得た. 1999年6月小脳転移巣が出現し, 術後7年9か月目に死亡した. stage IV胃癌の予後は極めて不良であるが, 補助療法にて長期生存しうる可能性も本例にて示唆された.