胆嚢内分泌腺癌の１例

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  • A Case of Adenoendocrine Cell Carcinoma of the Gallbladder.

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Almost all malignant tumors of the gallbladder and gastroentestinal organs are adenocarcinoma and endocrine tumors are rare. In our knowledge, there have been less than 50 cases of endocrine tumor of the gallbladder in Japan, and among of them adenoendocrine cell carcinomas are very uncommon. This paper present a case of adenoendocrlne cell carcinoma of the gallbladder. A 79-year-old woman was admitted to the department of internal medicine in our hospital become of high fever and anorexia in November 1997. Plain abdominal computed tomography (CT) revealed a mass shadow showing homogenous absorption, a gallstone and thickening of the wall in the gallbladder. Moreover, swelling in the abdominal aortic lymph node as prominent. Magnetic resonance cholangio-pancreatography (MRCP) demonstrated more than one filling defect with slightly irregular margins in the fundus of the gallblader. On preoperative dignostic imaging, a malignant gallbladder tumor was suspected, but no definitive diagnosis could be obtained. Therefore, a surgery was performed on December 11. Since diagnostic lapaoscopy to observe the gallbladder showed a mass projecting over the serous surfece in the fundus of the gallbladder, a celiotomy was performed. Because accumulated ascites and swelling of more than one abdominal pasa-aortic lymph nodes were noted at the celiotomy, curative resection was abandoned, and only cholecystectomy and No. 12 lymph nede dissection were carried out. Histopathologicc examination demonstrated well-differentiated adenocarcinoma partially continuous with the mucosal epithelia of the gallbladder. At sites adjacent to this region, adenoendocrine cell carcinoma with positive Grimelius staining was observed. Based on these results, adenoendocrine cell carcinoma originating in the gallbladder was biagnosed. Therafter, cancerous ascites gradually increased, and the general condition worsened, untill the patient died on the 96th postoperative day.

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