若年者に巨大肝腫瘍として発症した細胆管細胞癌の1例 [in Japanese] CHOLANGIOLOCELLULAR CARCINOMA PRESENTED WITH A LARGE HEPATIC TUMOR IN A YOUNG PATIENT : REPORT OF A CASE [in Japanese]
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症例は25歳，女性．右側腹部痛と発熱を主訴に近医受診，腹部超音波検査にて肝腫瘤を指摘され当院へ紹介入院となった．HBs抗原およびHCV抗体は陰性，軽度肝機能異常，軽度炎症所見を認めるのみで，腫瘍マーカーは正常範囲であった．CTでは，肝右葉を占める巨大腫瘍で，充実性部分と嚢胞性部分が混在しており，充実性部分は早期相で濃染，晩期相でwash outされる肝細胞癌様所見を呈し，嚢胞性部分辺縁は淡く造影され中心部は全く造影されず，血管造影では腫瘍血管の増生と口径の不整が見られた．悪性肝腫瘍と診断し肝右葉切除術を施行した．腫瘍割面は充実性部分と嚢胞性部分が混在し，病理組織検査にて，細胆管細胞に類似した腫瘍細胞が小管腔を形成し，cytokeratin 7が陽性で抗肝細胞抗体が陰性であり，細胆管細胞癌と診断された．術後17日目に退院し，補助療法は行なわず，術後4年の現在，無再発生存中である．
A 25-year-old woman was referred to our hospital under a diagnosis of a large hepatic tumor detected by abdominal ultrasonography at a previous clinic. Laboratory examinations revealed HBs-Ag and HCV-Ab negative, mild liver dysfunction, mild inflammatory finding and tumor markers in normal ranges. Abdominal CT scan showed a large hepatic tumor in the right lobe of the liver which had two components of solid and cystic parts. The solid part of the tumor was enhanced in the early phase and the enhancement effect disappeared in the late phase, which was similar to hepato cellular carcinoma (HCC). The peripheral region of the cystic part was slightly enhanced, but its central region was not enhanced at all. Angiography showed irregular tumor stain. Therefore we diagnosed the tumor as malignant hepatic tumor, and performed right lobectomy of the liver. Macroscopically cut surface of the resected specimen included solid and cystic components, in which cholangiole cell-like tumor cells formed small glandular lumens histologically. Immunohistochemical staining of cytokeratin 7 was positive and hepatocyte negative. Consequently the tumor was diagnosed as cholangiolocellular carcinoma. The patient was discharged from the hospital on the 17th day after the operation. There have been no recurrence as of four years after the operation without any adjuvant therapy.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 69(7), 1776-1781, 2008-07-25
Japan Surgical Association