下部胆管狭窄による閉塞性黄疸で発症した高度進行胆嚢癌の1例

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  • A CASE OF FAR ADVANCED GALL BLADDER CARCINOMA WITH INFERIOR BILIARY STRICTURE DUE TO MARKED TRANSMURAL AND LYMPHATIC SPREAD

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A 53-year-old female with obstructive jaundice was found in abdominal ultrasonography to have a papillary type lesion, about 4.5cm in diameter, with stones in the fundus and body of the peritoneal side of the gallbladder (GB). Enhanced CT demonstrated slightly enhanced homogeneous protruded lesion of the GB, swollen pancreas head (PH), and enhanced inferior-biliary duct with a wall thickness. MRCP showed distal stenosis of the lower bile duct. The patient was diagnosed with synchronous carcinoma of the GB and inferior bile duct and so underwent resection of the GB bed and extrahepatic bile duct and subtotal stomach preserving pancreatoduodenectomy. Histopathologic diagnosis of the gallbladder was poorly differentiated tubular adenocarcinoma with extensive spreading to the lymphatic canal and stroma, resulting in biliary stricture owing to marked transmural extension of the tumor and cancer positive cut margin of the left hepatic duct, anterior and posterior branch of the right hepatic duct, and the pancreas, whereas the mucosa of each biliary duct and MPD were not invaded. On the 62nd postoperative day, the patient died of the carcinomatosis. The autopsy revealed marked lymphatic and interstitial spread in several organs. It should be noted that the clinical strategy must be decided prudently because of the diffuculty in diagnosing the evolution of such a rare carcinoma.

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