肝転移を疑った肝内胆管癌と胃癌・大腸癌の同時性３重複癌の１例

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  • A CASE OF SYNCHRONOUS TRIPLE CANCER INVOLVING THE STOMACH, COLON AND INTRAHEPATIC BILE DUCT SUGGESTIVE OF METASTATIC LIVER TUMOR

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Triple cancer involving the stomach, colon and intrahepatic bile duct is rare. A 65-year-old man was detected having a solitary mass of the liver 25 mm in diameter at a madical checkup. The liver mass was visualized as an iso- to hypo-echoic mass on abdominal ultrasonography, and as a low density mass on abdominal CT. In addition to the liver tumor early gastric cancer and advanced sigmoid colon cancer were found. With a diagnosis of liver metastasis of colonic cancer, we performed partial gasrectomy, high anterior resection and partial hepatectomy. Histopathologically the liver tumor was adenocarcinoma. Immunohistochemical analysis for cytokeratin 7/20 resulted in 7 (+) 20 (-) for the liver tumor and 7 (-) 20 (+) for colonic cancer, showing that the liver tumor was not metastatic but tumor-forming intrahepatic cholangiocarcinoma. The patient died 10 months after the operation.<br>It is very rare that gastric cancer, colonic cancer and intrahepatic cholangiocarcinoma synchronously occur. It is difficult to differentiate cholangiocarcinoma from metastatic liver carcinoma by preoperative imaging methods, in that cytokeratin immunohistochemical analysis is thought to be of value.

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