腹腔鏡検査で発見された胆管腺腫の1例

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  • A CASE OF BILE DUCT ADENOMA DETECTED AT LAPAROSCOPY

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A 44-year-old man with chronic hepatitis C was examined by laparoscopy, which showed 3 whitish lesions of 1 to 2 mm in size on the anterior surface of the left liver lobe, and also a lesion of 2 mm in size on the anterior surface and a lesion of 5 mm in size at the edge of the right liver lobe. The 4 lesions of 1 to 2 mm in size were flat and well defined. The lesion of 5 mm in size had a mild rand-wall and looked like a plate. It showed neither central umbilication nor tumorous vessels. These whitish lesions are somewhat similar to laparoscopic findings of granulomatous liver diseases and cholangiocarcinoma. The punch biopsy specimen was diagnosed as bile duct adenoma, which was composed of small duct-like structures without cystic lumen and contained portal areas and lymphocyte infiltration. Some epitheliums were stained fine granularly with PAS and diastase-treated PAS. Luminal border of the epitheliums and mucin in the lumen were stained with alcian blue. Immunohistochemistry revealed that the ductular cells were positive in the cytoplasm for cytokeratin and CEA, and on their luminal border for CA19-9. The specimen biopsied from the liver parenchyma was diagnosed as chronic active hepatitis 2B. Bile duct adenomas have been found at laparotomy or at autopsy. But recognition of bile duct adenomas at laparoscopy would be expected because most of bile duct adenomas are located subcapsularly. So we should consider bile duct adenoma as one of differential diseases when whitish lesions were seen on the liver.

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