嚢胞腺癌との鑑別に苦慮した嚢胞性肝過誤腫の1例 A CASE REPORT OF HAMARTOMATOUS HEPATIC CYST PREOPERATIVELY DIAGNOSED AS CYSTADENOCARCINOMA

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Abstract

肝嚢胞は腹部超音波検査の発達により日常の臨床の場でよく経験されるが,まれに嚢胞性の悪性疾患が報告されている.その鑑別診断は極めて困難で切除標本の検索で初めて嚢胞腺癌と診断されることも多い.各種画像診断で肝嚢胞腺癌が疑われたものの,結果的に過誤腫であった1切除例について若干の文献的考察を加えて報告する.症例は72歳の女性で,偶然にCTで肝右葉に隔壁を伴う嚢胞性腫瘤が発見された.腹部超音波検査で8cm大の多房性嚢胞を認め,隔壁に石灰化,内腔に乳頭状結節様陰影を示し,嚢胞穿刺液のCEAが高値を示したため,肝嚢胞腺癌の診断で肝拡大右葉切除術を施行した.切除標本に悪性腫瘍の所見なく,病理学的には線維化した嚢胞壁に多数の胆管像を示し先天性形成異常を伴う過誤腫と診断された.

With a recent development of abdominal ultrasonography, we have increasingly experienced hepatic cysts routinely, but malignant hepatic cysts are rare which present extreme difficulty in differential diagnosis. A diagnosis of cystadenocarcinoma is often made by postoperative histopathological examination. We present a case suspected of cystadenocarcinoma of the liver which was eventually diagnosed as hamartomatous cyst after operation, with a review of the literature.<br> A 72-year-old woman was admitted to the hospital for close examination of a hepatic cystic lesion with septa, detected by accidental computed tomography. Abdominal ultrasonography showed a large multilocular cyst of 8cm in diameter in the right lobe of the liver. Septa with partial calcification and papillary tumors protruding into the cavity were also seen. US guided aspiration cytology and biopsy did not show any malignant cells, however, elevated CEA (101ng/ml) and CA19-9 (120000U/ml) in the cyst fluid led us to the diagnosis of cystadenocarcinoma. Extended lobectomy of the right lobe was carried out. Resected specimen contained grayish debris, however, neither solid mass nor papllary protruding tumors were recognized. Histopathological diagnosis was hamartomatous cyst and no malignant lesions were demonstrated. Immunohistochemical staining with CEA was negative.

Journal

  • The journal of the Japanese Practical Surgeon Society

    The journal of the Japanese Practical Surgeon Society 58(2), 434-438, 1997

    Japan Surgical Association

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