胆管癌との鑑別に難渋した胆管断端神経腫の1例  [in Japanese] A case of neuroma of the bile duct, which looks like cancer of the bile duct  [in Japanese]

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Author(s)

    • 清住 雄希 KIYOZUMI Yuki
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 高森 啓史 TAKAMORI Hiroshi
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 堀野 敬 HORINO Kei
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 生田 義明 IKUTA Yoshiaki
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 中原 修 NAKAHARA Osamu
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 近本 亮 CHIKAMOTO Akira
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 別府 透 BEPPU Toru
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University
    • 馬場 秀夫 BABA Hideo
    • 熊本大学大学院消化器外科学 Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University

Abstract

<b>要旨:</b>症例は80歳女性.1982年に胆石症に対し開腹胆嚢摘出術を施行された.2010年1月前医の精査にて中部胆管に腫瘍性病変を認め,当科紹介となった.血液検査上,胆道系酵素の上昇は認めず,腫瘍マーカーも全て基準値内であった.造影CT上,中部胆管に造影効果を有する境界明瞭な片側性の腫瘤を認めた.同腫瘤は,MRIのT2WIおよび拡散強調画像上,高信号病変として描出された.超音波内視鏡検査では,点状高エコーを有する低エコー腫瘤として描出された.FDG-PET検査では腫瘍に淡い集積を認めた.擦過細胞診では悪性所見を認めなかった.胆管癌を否定できず,肝外胆管切除を施行した.切除標本では,粘膜面は平滑で境界明瞭な充実性腫瘍であった.術後病理標本では腫瘍部に悪性細胞認めず,粘膜下に神経繊維束の密な増生を認め,断端神経腫と診断した.胆嚢摘出後の中部胆管の片側性で境界明瞭な腫瘤性病変では,胆管断端神経腫も鑑別診断として念頭に置く必要がある.<br>

An 80-year-old female had undergone cholecystectomy in 1982. She was admitted because several images revealed a tumor of the bile duct. Biliary enzymes and tumor markers on blood sample were within normal limits. CT showed the enhanced nodule, which size was 13 mm in diameter, with clear boundary in the middle part of the common bile duct. This tumor described as a well defined high intensity nodule on T2-weighted and Diffusion weighted MR images. It was described as a low intensity tumor with hyper-echoic foci by Endoscopic ultrasonography. FDG-PET CT detected a minute abnormal uptake at the tumor. There were no signs of lymph node swelling, invasion to adjacent tissues and vessels.<br> Malignant disease could not be excluded, although brushing cytology during ERCP proved no malignant cells. Therefore, extra-hepatic bile duct resection with D2 lymph node dissection was performed. Resected specimen showed submucosal tumor with smooth mucosa. Histopathological examination of the tumor showed hyperplastic and disorganized nerve fibers, surrounded by fibrous connective tissue containing fibroblasts. There were no evidence of malignant cells. Pathological diagnosis was the amputation neuroma of the bile duct.<br> The amputation neuroma of the bile duct is difficult to differentiate from cancer of the bile duct. It should be considered as a differential diagnosis of middle bile duct tumor if cholecystectomy was performed.<br>

Journal

  • Tando

    Tando 25(5), 774-778, 2011-12-31

    Japan Biliary Association

References:  12

Codes

  • NII Article ID (NAID)
    10031122817
  • NII NACSIS-CAT ID (NCID)
    AN10062001
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    09140077
  • Data Source
    CJP  J-STAGE 
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