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Intraductal papillary mucinous neoplasm (IPMN):UPDATE
Get PDF論文(Article)At present, IPMN is broadly divided into two main types: main duct and branch duct. However, as discussed below, the definition of mixed-type IPMN is gradually becoming accepted. In main duct IPMN, the main pancreatic duct is very dilated, while in branch duct IPMN, the branches of the pancreatic duct are dilated, resembling a bunch of grapes.
IPMN is most frequently diagnosed in the elderly (around 65 years old), and the male to female ratio is 2:1, indicating that the incidence of the disease is twofold higher in males than in females. IPMN most commonly originates in the head of the pancreas, and approximately 70% of IPMN lesions are found in the head of the pancreas. It also tends to occur in multiple sites.
With regard to imaging, endoscopy has revealed that the opening of the papilla of Vater, located in the duodenum close to the stomach, is dilated by mucus. This dilation of the papillary opening of Vater by mucus is a key characteristic of IPMN. When directly viewed by pancreatoscopy, IPMN appears as small protrusions similar to salmon roe
後天性止血異常を合併しlow density lipoproteinアフェレーシス施行時および子宮頸部生検時に止血困難な性器出血を来した家族性高コレステロール血症合併子宮頸癌の一例
Get PDF論文(Article)今回我々は、家族性高コレステロール血症（FH）を合併し、low density lipoprotein（LDL）アフェレーシス後に不正性器出血を繰り返した臨床的に子宮頸癌と診断した症例を経験したので報告する。症例は49 歳、未経妊の女性。既往歴として、FH の他、心血管系疾患の術後治療として、ワーファリンとアスピリンを内服していた。LDL アフェレーシス後に、大量の不正性器出血を主訴に当院へ救急搬送された。腟鏡診では子宮腟部に明らかな腫瘍を認めなかったが、magnetic resonance imaging（MRI）検査で子宮頸管内に長径25 mm の腫瘤を認めた。子宮頸部細胞診は異常を認めなかった。頸管内の組織採取を試みたが、大量出血を来たし採取できなかった。初診より約4 ヶ月後、LDL アフェレーシス後に再度大量の性器出血を来たし入院。MRI 検査にて頸管内の腫瘤は長径47 mm に増大。18F-fluorodeoxyglucose （FDG）positron emission tomography（PET）/computed tomography（CT） 検査にて同部位にFDG の高集積を認めた。病理組織学的な診断は得られていなかったが、MRI およびPET/CT 検査所見から、臨床的に子宮頸癌IB2 期と診断した。放射線療法にて完全止血し、頸管内の腫瘤は消失した。本症例は、薬剤性の後天性の止血機能異常に子宮頸癌が合併し不正性器出血を来したと考えられた。子宮頸部病変に対して、生検による病理組織学的診断が困難な場合には、治療方針決定に際して、PET/CT が有用であると考えられた
Variations in portal and hepatic vein branching of the liver
Get PDF論文(Article)The present study provided an overview of the Couinaud’s segmentation system of the portal and hepatic veins, the controversies surrounding it and the typical variations the anatomy of the portal and hepatic veins. Even with the advent of three-dimensional CT (3DCT), it goes without saying that a basic knowledge of Couinaud’s classification is essential. Future advances in technology are expected to enable the superimposition of preoperative 3D images and intraoperative real-time ultrasound images. Looking forward, a secure knowledge of the fundamentals of liver anatomy is necessary for patient safety during liver transplantation or R0 resection, in which the tumour is not exposed. (Kimura in Kan Tan Sui Gazo 13: 355-363, 2011
