A 48-year-old woman with abdominal pain presented for a detailed examination because abdominal ultrasonography revealed a mass in the head of the pancreas. Contrast-enhanced CT scan showed a 15mm solid mass with delayed enhancement on the ventral side of the pancreatic head and T2-weighted MRI showed a high intensity mass. EUS showed a 15mm hypoechoic well-circumscribed mass in the pancreatic head. Based on these imaging findings, a pancreatic tumor was suspected, possibly a neuroendocrine tumor or solid pseudopapillary tumor, but further diagnosis was difficult. Therefore, EUS-FNB was performed and histopathology showed proliferated spindle cells arranged in fascicles with positive for protein S-100 on immunohistostaining, consistent with a pancreatic Schwannoma. With the history of abdominal pain, a decision was made to proceed with surgery and laparoscopic enucleation successfully performed. Final histopathological evaluation showed a pancreatic Schwannoma without malignancy. She was discharged on postoperative day 12 without complications and has no abdominal pain or recurrence 1 year postoperatively.
"},{"@language":"ja","@value":"症例は48歳，女性，腹痛を主訴に近医を受診し，腹部超音波検査で膵頭部腫瘤を指摘され，精査加療目的に当院を紹介され受診した．造影CTで膵頭部に15mm大の遅延性に増強される充実性腫瘤を認め，MRIのT2強調画像で高信号を示し，EUSでは膵頭部に境界明瞭な15mm大の低エコー腫瘤を認め，画像上は神経内分泌腫瘍や充実性偽乳頭状腫瘍が鑑別診断に挙げられた．EUS-FNBによる生検で束状に増殖した紡錘形細胞を認め，免疫染色でS-100蛋白陽性であることから膵神経鞘腫と診断した．経過観察も検討されたが，核出術での摘出が可能，かつ，症状消失が期待されたため，切除を選択し，腹腔鏡下膵腫瘍核出術を施行した．術後合併症を認めず第12病日に退院となった．最終病理診断も膵神経鞘腫の診断であった．術後に腹痛は消失し，術後1年経過し，再発を認めていない．
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