肝外胆管内に乳頭状増殖を示した肝S4原発の結節型胆管細胞癌の1例 NODULAR CHOLANGIOCELLULAR CARCINOMA ARISING IN S4 WITH PAPILLARY INVOLVEMENT OF THE EXTRAHEPATIC BILIARY TREE : A CASE REPORT
胆管内に乳頭状増殖を示した肝S4原発の結節型胆管細胞癌の1例を経験したので報告した.<br> 患者は67歳の女性.心窩部痛を訴え来院.腹部CT検査で肝S4に径4.5cm大の腫瘍陰影と左肝内胆管の拡張を認めた. ERCPおよびMRCPで左肝内胆管の拡張と肝門部胆管内に径2.5cmの透亮像を認め,血管造影では同部に一致して濃染像を認めた.原発性肝癌およびその胆管内乳頭状増殖と診断し手術を施行した.手術は肝左葉切除,胆嚢胆管切除術を行い,右肝管空腸吻合術にて再建した.病理組織学的所見では腫瘍は中分化腺癌を示す胆管細胞癌で,内側区域胆管内に連続性に乳頭状増殖をきたしていた.術後経過は良好で39病日に退院し,術後8年1カ月の現在,再発徴候なく健在である.結節型胆管細胞癌が肝門部胆管内に乳頭状増殖を示した本邦報告例は本例を含め6例のみと極めて稀である.
This paper reports a case of nodular cholangiocellular carcinoma arising in S4 of the liver with papillary proliferation in the biliary tree.<br> A 67-year-old woman was seen at the hospital because of epigastric pain. Abdominal CT scan showed a tumor with the diameter of 4.5cm in S4 and dilation of the left hepatic duct. ERCP and MRCP showed enlargement of the left hepatic duct and a filling defect with the diameter of 2.5cm in the bile duct at the porta hepatis. Angiography showed a tumor stain corresponding to the filling defect. She was diagnosed as having primary hepatic cancer with bile duct involvement and underwent surgery. After resection of the left lobe of the liver and the cystic duct, reconstruction was done with right hepatocholan-giojejunostomy. Histopathological examination showed that the tumor was moderately differentiated cholangiocellular carcinoma with papillary involvement of the bile duct. The postoperative course was uneventful, and she was discharged on the 39<sup>th</sup> day after admission. She has been in good health without any signs of recurrence for 73 months postoperatively. In Japan, only 6 cases have been reported of nodular cholangiocellular carcinoma with papillary involvement of the bile duct at the porta hepatis.
- 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association
日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 67(6), 1380-1385, 2006-06-25
Japan Surgical Association