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━━ Background. In cases of primary lung cancer accompanying pancreatic tumors, it is extremely difficult to differentiate the primary and metastatic pancreatic tumors based only on CT or MRI images. However, the therapeutic strategy and prognosis of these diseases are significantly different. Case. A 63-year-old female underwent left lower lobectomy for pulmonary adenocarcinoma in June 2007 and was followed up as an outpatient. She consulted a gastroenterologist for abdominal pain in January 2012. Due to elevated hepatic enzyme levels, biliary dilatation and a 2-cm tumor in the pancreatic head, a diagnosis of pancreatic cancer was suspected. Although endoscopic brushing of the biliary duct failed to provide a definitive diagnosis, the patient was diagnosed with lung cancer metastasizing to the pancreas based on the results of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA). She received chemotherapy for lung adenocarcinoma, achieving a partial response and one year of disease control. Conclusions. Patients with pancreatic tumors and a history of lung cancer should actively undergo histopathological examinations via EUS-FNA. (JJLC. 2013;53:836-839) KEY WORDS━━ Lung cancer, Pancreatic metastasis, Endoscopic ultrasound-guided fine needle aspiration (EUSFNA) Reprints: Jitian Zhang, Department of Thoracic Surgery, Respiratory Disease Center, Kyoto Katsura Hospital, 17 Yamada-Hirao-cho, Nishikyo-ku, Kyoto 615-8256, Japan. Received June 4, 2013; accepted November 5, 2013. 要旨━━背景.肺癌に膵腫瘍を併発した場合,肺癌の膵 転移と原発性膵腫瘍との画像的鑑別は困難であるが,治 療方針や予後が大きく異なる.症例.63 歳,女性.2007 年 6 月に肺腺癌で左下葉切除術を施行後,外来にて経過 観察されていた.2012 年 1 月に腹痛で消化器内科を受診 し,肝胆道系酵素の上昇と,腹部エコーで胆管の拡張を 伴い,膵頭部に約 2 cmの腫瘍を認め,造影CTでは肝転 移と腹部多発リンパ節転移を認めたため,膵癌が疑われ た.中下部胆管にブラシ細胞診で悪性所見を認めなかっ た.超音波内視鏡下穿刺吸引(endoscopic ultrasoundguided fine needle aspiration;EUS-FNA)を行い,病理 組織診にて肺癌の再発膵転移と診断された.肺腺癌に対 して化学療法を施行し,部分奏効(partial response;PR) 相当の縮小及び 1年間の病勢制御が得られた.結論.肺 癌症例に膵腫瘍が認められた場合は,積極的にEUSFNAで生検を行い,病理組織診を行うべきである. 索引用語━━肺癌,膵転移,超音波内視鏡下穿刺吸引 京都桂病院 1呼吸器センター呼吸器外科,2病理診断科. 別刷請求先:張 吉天,京都桂病院呼吸器センター呼吸器外科, 〒615-8256 京都市西京区山田平尾町 17 番地. 受付日:2013 年 6 月 4 日,採択日:2013 年 11 月 5 日. (肺癌.2013;53:836-839) 2013 The Japan Lung Cancer Society Metastatic Pancreatic Tumor Diagnosed by Endoscopic Ultrasound-guided Fine Needle Aspiration―Zhang et al Japanese Journal of Lung Cancer―Vol 53, No 7, Dec 20, 2013―www.haigan.gr.jp 837 Figure 1. a. Abdominal CT revealed a 35-mm tumor (black arrow) in the pancreatic head and body and a metastatic liver tumor (white arrow). b. Coronal CT also showed biliary dilatation, cholecystectasia and portal-mesenteric vein (arrows) invasion by the tumor. a

A Case of Postoperative Pancreatic Metastasis of Lung Cancer Diagnosed on Endoscopic Ultrasound-guided Fine Needle Aspiration