下部胆管腺扁平上皮癌の1例 A RESECTED CASE OF ADENOSQUAMOUS CELL CARCIOMA OF THE LOWER BILE DUCT
胆管原発の腺扁平上皮癌は非常に稀な疾患であり,われわれは下部胆管に発生した腺扁平上皮癌の1例を経験したので報告する.症例は55歳,男性.近医で肝機能異常と閉塞性黄疸を指摘され,精査加療目的に当院紹介入院となった.入院時T-bil 12.19mg/dlと高値であり,腹部超音波検査,腹部CTにて総胆管の拡張が認められたため,直ちに経皮経肝胆道ドレナージ(PTBD)施行した. PTBD造影や超音波内視鏡検査にてVater乳頭近傍に狭窄を認めた.下部胆管癌の診断にて膵頭十二指腸切除術を施行した.病理組織診断の結果,癌は粘膜層から筋層では高～中分化型腺癌の像を呈しており,筋層から膵実質までは充実性の胞巣を形成する部位が多く,その胞巣内には角化や細胞間橋が明瞭な扁平上皮癌が認められたため,腺扁平上皮癌と診断された.現在術後8カ月経過し,再発の兆候はない.
Primary adenosquamous cell carcinoma of the bile duct is an extremely rare entity. We report a case of adenosquamous cell carcinoma arising from the lower bile duct.<br>A 55-year-old man was referred to the hospital for close exploration and treatment because abnormalities in hepatic function and obstructive jaundice were pointed out at another hospital. On admission, the serum-bilirubin level was high, 12.19 mg/dl, and abdominal ultrasonography and abdominal CT scan revealed dilatation of the common bile duct. Percutaneous transhepatic biliary drainage (PTBD) was thus immediately conducted. PTBD and ultrasonic endoscopic examination showed narrowing at distal end of the bile duct. Carcinoma of the lower bile duct was diagnosed and pancreatoduodenectomy was carried out. On histopathological findings, cancer foci involving from mucosal layer to muscular tunics presented findings of well to moderately differentiated adenocarcinoma, and those involving from the proper muscle layer to pancreas parenchyma involved many portions forming nest of squamous cells in which obvious cornification and desmosome was identified. Adenosquamous cell carcinoma was definitely diagnosed. There have been no signs of recurrence, as of 8 months after the operation.
- 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association
日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 65(9), 2454-2458, 2004-09-25