Abstract
症例は76歳の男性で，2007年に膵頭部の混合型膵管内乳頭粘液性腫瘍（intraductal papillary mucinous neoplasm；以下，IPMNと略記）と診断され，以後5年間明らかな変化を認めなかった．2012年のCT，MRIにてもほとんど変化を認めなかったが，上部消化管内視鏡検査にて十二指腸乳頭開大の軽度増加を認め，ERCPにて十二指腸に瘻孔を認めた．同部位からの造影では囊胞内に欠損像を認め，膵管内超音波検査にては囊胞内に充実性の腫瘤を認めた．以上より，混合型IPMNの十二指腸穿破，悪性化を考え，幽門輪温存膵頭十二指腸切除術を施行した．病理組織学的検査では，最も異型の強い部位はcarcinoma in situであったが，瘻孔形成部は腺腫相当の病変で悪性所見を認めなかった．混合型IPMNの長期観察中に十二指腸へ穿破し，画像所見の変化が軽微であった悪性化の1例であった．
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