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症例は53歳, 男性. 既往に48歳時, 胃潰瘍出血にて幽門側胃切除術 (B-I) 施行歴あり. 心窩部痛を主訴に近医受診. 精査にて腹腔内出血と診断され当院へ搬送された. 腹部CTにて上腹部に貯留液と膵尾部から小網の腹側にsentinel clot signを認め急性期の出血が疑われた. 緊急血管造影検査にて左胃大網動脈に3mm大の瘤状の拡張像を認めた. 明らかな出血像は認めなかった. 以上より左胃大網動脈瘤破裂と診断した. 全身状態が比較的安定し出血がコントロールされている為, 保存的に経過観察し待機手術の適応とした. 手術は左胃大網動脈瘤切除術を施行した. 左胃大網動脈からの大網枝に径20mm大の動脈瘤を認め切除した. 切除標本の病理所見では仮性動脈瘤と診断された. 経過良好で, 術後7日目に退院となった. 内臓動脈瘤の破裂の中で全身状態が安定している場合は待機手術可能例もあるが, 迅速な診断と治療適応の判断が必要であると考えられた.

Atypical carcinoid (endocrine cell carcinoma) of the breast which is a rare entity is reported. A 76-year-old woman had a palpable tumor 3.2×2.7cm in size in the ABC area of the left breast. Echography revealed a broad-based intracystic tumor. Dynamic MRI mammography revealed early enhanced intracystic tumor. A aspiration cytology resulted in class IV. Intraoperative frozen section diagnosis was intracyctic solid-tublar carcinoma, and a modiffied radical mastectomy (Auchincloss's method) was performed. Hematoxylin and eosin (HE) stain showed carcinoid like appearance. Grimerius silver staining demonstrate numerous argyrophillic granules in the cytoplasm of many tumor cells. And chromogranin A stain was positive. Mucin stain also revealed mucin in the cytoplasm. Electron microscopy of the tumor showed numerous neurosecretory granules. At last, from the figure of tumor cells, diagmosis was atypical carcinoid (endocrine cell carcinoma) of the breast. Lymph node metastasis was not seen. Estrogen receptor (ER) was positive, but progesterone receptor (PgR) was negative. No distant metastasis was found at the time of operation. She died of multiple liver metastasis 10 months after the operation. Carcinoid syndrome was not found.