糞線虫感染を伴い浸潤癌様の狭窄所見を呈した上皮内肝内胆管癌の1例  [in Japanese] A CASE OF INTRAHEPATIC CHOLANGIOCARCINOMA IN SITU ASSOCIATED WITH STRONGYLOIDIASIS  [in Japanese]

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Abstract

症例は76歳,男性.悪寒戦慄を伴う発熱を主訴に当院救急センターを受診した.胆管炎の診断で消化器内科に入院となり,ENBDによる減黄と抗菌剤投与を行った.ENBD造影およびMRCPでは,B2・B3・B4の狭窄と末梢側の肝内胆管拡張を認めたが,明らかな腫瘤は認めなかった.胆汁細胞診より5回中2回class III bが検出されたため,胆管浸潤型肝内胆管癌と診断され手術目的で当科紹介となった.胆汁中から糞線虫も検出されたため,イベルメクチン経口投与による駆虫を行ったのち,肝左葉切除術を施行した.病理組織検査では,肝内胆管に表層拡大進展した上皮内癌を認めたが,胆管狭窄をきたすような浸潤癌は認めなかった.また,一部ではBilIN-1~2に相当する異型上皮を認めた.<BR>今回,糞線虫による慢性胆道感染を伴い,浸潤癌様の狭窄所見を呈した上皮内肝内胆管癌を経験した.慢性胆道疾患とBilIN,発癌との関連を考える上で非常に興味深い症例と考えられた.

A 76-year-old man was admitted because of a high fever associated with shaking relating to chills. Abdominal ultrasonography and CT showed dilatation of the intrahepatic bile duct ; no tumor was detected. ERCP and MRCP revealed stricture of bile ducts (B2, B3, B4b) and dilatation of peripheral bile ducts. ENBD bile cytology was defined as class III b ; thus, the periductal infiltrating type of intrahepatic cholangiocarcinoma was strongly suspected. In addition, Strongyloides stercoralis filariform larvae were detected in the bile. A left hepatectomy was performed after treatment with Ivermectin (a vermifuge). The histological findings included superficial spreading adenocarcinoma in situ without invasive adenocarcinoma ; atypical biliary epithelium corresponding to BilIN-1-2 was also noted. We report this case of intrahepatic cholangiocarcinoma in situ associated with bile duct stricture that presented similarly to invasive cancer and appeared to be related to the presence of strongyloidiasis.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 73(1), 116-120, 2012-01-25

    Japan Surgical Association

References:  13

Codes

  • NII Article ID (NAID)
    10030461345
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    13452843
  • Data Source
    CJP  J-STAGE 
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