EUS-FNAで疑い剖検にて確定し得た胆嚢未分化癌の1例 A case of undifferentiated carcinoma of gallbladder suspected by EUS-guided FNA, and confirmed the diagnosis by autopsy

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<b>要旨:</b>胆嚢未分化癌は比較的稀であるが急速な転帰をたどり極めて予後不良な疾患とされている.今回われわれは急速に増大した腹部腫瘤を主訴に受診し,EUS-FNAで疑い剖検にて確定し得た胆嚢未分化癌(undifferentiated carcinoma with osteoclast-like giant cells)の1例を経験したため文献的考察を加えて報告する.症例は85歳女性.右側腹部の腫瘤を自覚し受診した.CT検査にて内部壊死を伴う10 cmを超える腫瘤を認めEUS-FNAにて胆嚢未分化癌の診断とした.入院後腫瘍は急速に増大し十二指腸狭窄をきたしたため十二指腸ステントを留置した.留置後24日にステントに起因する消化管穿孔を合併し留置後31日に死亡した.胆嚢未分化癌は増殖能および悪性度が高く非切除症例も多い.手術症例においても術後生存率は低く,化学療法も含めた集学的な治療法の確立が必要であると考えられる.<br>

Undifferentiated carcinoma of gallbladder is rare and has a poor prognosis. We report a case of undifferentiated carcinoma of gallbladder suspected by EUS-guided FNA, and diagnosed by autopsy. 85-year-old woman presented with right hypochondralgia and palpable bulky tumor. Abdominal CT scan, MRI and US showed a tumor over 10 cm in diameter with necrosis within. There was no indication for surgery because of age and extent of the tumor. We performed EUS-guided FNA. Histopathological findings were suspicious of undifferentiated carcinoma of gallbladder. We performed endoscopic stent placement for duodenal stenosis caused by rapid growth of the tumor. The patient developed perforation of stomach 24 days after the stent placement, and died 31 days after the procedure. EUS-FNA may be able to make the diagnosis gallbladder carcinoma. However, it is extremely difficult to make the diagnosis of undifferentiated carcinoma, due to the necessity of several samples for the confirmation of the diagnosis. Most undifferentiated carcinoma of gallbladder is unresectable. Moreover, resected cases have a low survival rate. It is necessary to establish multidisciplinary treatment by accumulation of cases.<br>

収録刊行物

  • 胆道 = Journal of Japan Biliary Association

    胆道 = Journal of Japan Biliary Association 25(4), 658-666, 2011-10-31

    日本胆道学会

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各種コード

  • NII論文ID(NAID)
    10030362327
  • NII書誌ID(NCID)
    AN10062001
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    09140077
  • データ提供元
    CJP書誌  J-STAGE 
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