術式決定にIDUSが有用であった粘液産生胆管癌の1例

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  • A case of mucin-producing cholangiocarcinoma in which IDUS was useful for determining the surgical treatment

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The patient was a 76-year-old female. She became aware of a mass in the upper abdominal area and was referred to and hospitalized at our department with the suspicion of cystadenocarcinoma of the liver. Using the abdominal US, CT, and MRCP, we observed a papillary tumor which was continuous from the common bile duct to the left intrahepatic bile duct. During ERCP, we were able to confirm the dilation of the papillary orifice and mucus excretion. Using a contrast medium, we observed a marked enlargement and a large amount of mucous masses in the bile duct. A mucin-producing papillary tumor was observed by the bile duct biopsy, and the patient was diagnosed with mucin-producing bile duct tumor extending from the common bile duct to the left intrahepatic area. By a contrast study, we were not able to accurately diagnose the intramural extension of the tumor due to the large amount of mucous masses. Therefore, we performed intraductal ultrasonography (IDUS). Since the extension of the tumor was not observed in either the right hepatic duct or the right intrapancreatic bile duct, we performed an extended left hepatic lobectomy. The pathological diagnosis was adenocarcinoma, and the margins of the right hepatic bile duct and the common bile duct were negative.<BR>The preoperative diagnosis of mucin-producing cholangiocarcinoma is difficult in many cases because of diverse appearances of bile ducts due to modification by mucous masses. IDUS was considered an effective examination for diagnosing the tumor extension.

収録刊行物

  • Tando

    Tando 21 (4), 540-546, 2007

    Japan Biliary Association

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