膵液のK-ras遺伝子の突然変異を認めた多発性膵嚢胞の1例

膵癌の早期診断を行うために,最近の進歩の著しい遺伝子診断を用いて,膵液中のK-ras遺伝子の点突然変異の検討がなされている｡われわれは膵液の細胞診は陰性であるが,K-ras遺伝子の点突然変異を認め,膵全体に多発する膵嚢胞の1例を経験した｡本例は悪性であるとの確診が得られないことや切除するとなれば膵全摘となることなどのために,経過観察を行っているが,18カ月後の現在,嚢胞の増大など認めていない｡膵癌の遺伝子診断の文献的考察を含め,報告する｡

Pancreatic cancer is the one of the leading causes of death among cancer deaths and the early diagnosis is one of the main topics of pancreatic research. Mutation of K-ras oncogene at codon 12 has been reported in pancreatic adenoma, hyperplasia of the pancreatic duct, and also in pancreatic cancer, Recently, detection of K-ras point mutation in pure pancreatic juice is underinvestigation as a potential tool of early diagnosis of pancreatic cancer by setting a certain cut-off value. We recently experienced a case of multiple pancreatic cysts without any malignant cells in pancreatic juice, but with a positve point mutation of K-ras oncogene. Operation was deferred after obtaining informed consent from the family, because the lesions were so multiple and extensive as to require total pancreatectomy. Eighteen months follow-up studies did not reveal any deterioration in imaging tests as well as clinical picture.