腹腔鏡下に診断した膵癌卵巣転移の１例

抄録

　We report a case of an intrapelvic neoplasm detected after pancreatic body cancer surgery, which was diagnosed laparoscopically as ovarian metastasis of pancreatic cancer.

　A 70-year-old woman (gravida 4, para 2) was diagnosed with pancreatic body cancer at 68 years of age. She underwent laparoscopic distal pancreatectomy after preoperative chemotherapy. Histopathological evaluation confirmed diagnosis of pancreatic body adenocarcinoma (stage IA, ypT1cN0M0). Computed tomography revealed an intrapelvic neoplasm accompanied by right-sided hydronephrosis during follow-up after completing chemotherapy, 17 months postoperatively, and the patient was referred to the Department of Gynecology. Urography and urine cytology showed no signs of urological malignancy. Following right ureteral stent placement, we performed staging laparoscopy, which revealed a solid neoplasm of the right adnexa; however, we observed no signs of intraperitoneal dissemination, ascites, or cystic enlargement of the right adnexa. This presentation was atypical of primary ovarian cancer. Rapid intraoperative diagnosis of the right adnexal lesion revealed adenocarcinoma with histopathological findings similar to those of the previous pancreatic cancer specimen. We suspected ovarian metastasis of pancreatic cancer and performed bilateral adnexectomy. Based on histopathological evaluation of the resected specimen, we diagnosed the patient with ovarian metastasis of pancreatic cancer, and mFOLFIRINOX chemotherapy was initiated postoperatively.

　Laparoscopic resection of metastatic ovarian cancer was useful for diagnosis of ovarian metastasis of pancreatic cancer and therapeutic decision-making for management of recurrence. Laparoscopic surgery is minimally invasive and enables histopathological evaluation and prompt initiation of chemotherapy.