<Case Report>A Case of Pancreatic Cancer with the Sign of Leser-Trélat

Abstract

A case of 79-year-old man with pancreatic cancer associated with the sign of Leser-Trelat was presented. Abdominal CT scanning was performed and a pancreatic tail tumor involving the spleen and the greater omentum as well as ascitic retention were detected. Ba-enema study showed the stenosis of the sigmoid colon, suggesting the peritoneal disseminations . Absolute non-curative operation of side-to-side transverso-sigmoidostomy was performed for colonic stenosis, and biopsy of the disseminated omental tumor was performed, which was histologically diagnosed as well differentiated papillary adenocarcinoma compatible with pancreatic cancer. The postoperative course was uneventful and at present the patient was followed at outpatient clinic. To our knowledge, this case is the first report with pancreatic cancer associated with the sign of Leser-Trélat in Japan.

79歳の男性で Leser-Trélat 徴候を呈した膵癌の1例を報告する. 腹部不快感・腹痛にて当科を受診する. 腹部症状の発現より約2ヶ月前に前頸部・前胸部・背部を中心に老人性疣贅の多発に気付いていた. また, 同部に皮膚瘙痒症を伴っている. 本院入院後, 腹部 CT 等の精査により膵尾部癌と診断し, 開腹するもすでに癌性腹膜の状態にて姑息的 bypass 手術のみ施行した. 本症例は Leser-Trélat 徴候にもかかわらず, すでに進行癌であったが, 一般診療においては Leser-Trélat 徴候のような dermadrome にも十分注意を払い内臓悪性腫瘍の早期発見に努めることが重要と考えられた. また, 文献上本症例は Leser-Trélat 徴候を呈した膵癌の本邦第一例目である.