A resected case of preoperatively diagnosed glucagonoma of the pancreas using EUS-FNA

症例は80歳男性．近医で軽度の肝機能異常を指摘され，腹部超音波検査を受けたところ膵体部に20mm大の内部エコー均一な低エコー腫瘤を指摘され当院に精査入院．造影CTでは，膵体部に動脈相で造影効果に乏しく，門脈相で腫瘍辺縁部に軽度の造影効果を示す20mm大の腫瘍を認め，FDG-PETでは，SUV 3.3と軽度の集積を認めた．内分泌腫瘍を疑い血中膵ホルモンを測定するとグルカゴンが610pg/ml と上昇していた．確定診断のためにEUS-FNABを施行した．組織所見では内分泌腫瘍と考えられ，免疫染色でグルカゴン陽性であった．無症候性グルカゴノーマの診断で，腹腔鏡補助下に脾合併膵体尾部切除を行った．切除標本では，25mm大の白色調腫瘍を認め，免疫染色でグルカゴン陽性であり，また脾動脈周囲リンパ節転移を認め，well differentiated endocrine carcinoma（glucagonoma）と診断された．術後3年の現在再発無く元気である．

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