術前に診断が可能であった上部胆管腺扁平上皮癌の1切除例  [in Japanese] Case report of adenosquamous carcinoma of the upper bile duct diagnosed preoperatively  [in Japanese]

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Author(s)

    • 大塚 英郎 OHTSUKA Hideo
    • 東北大学大学院医学研究科外科病態学講座 消化器外科学分野 Department of Surgery, Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 鈴木 正徳 SUZUKI Masanori
    • 東北大学大学院医学研究科外科病態学講座 消化器外科学分野 Department of Surgery, Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 海野 倫明 UNNO Michiaki
    • 東北大学大学院医学研究科外科病態学講座 消化器外科学分野 Department of Surgery, Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 片寄 友 KATAYOSE Yu
    • 東北大学大学院医学研究科外科病態学講座 消化器外科学分野 Department of Surgery, Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 竹内 丙午 TAKEUCHI Heigo
    • 東北大学大学院医学研究科外科病態学講座 消化器外科学分野 Department of Surgery, Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 佐藤 武揚 SATO Takeaki
    • 東北大学大学院医学研究科外科病態学講座 消化器外科学分野 Department of Surgery, Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 水間 正道 MIZUMA Masamichi
    • 東北大学大学院医学研究科外科病態学講座 消化器外科学分野 Department of Surgery, Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 松野 正紀 MATSUNO Seiki
    • 東北大学大学院医学研究科外科病態学講座 消化器外科学分野 Department of Surgery, Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)

Abstract

胆管原発の悪性腫瘍のうち,比較的稀なものとして胆管腺扁平上皮癌があるが,その報告例の多くは高度な脈管侵襲を伴い,極めて予後不良とされる.症例は56歳・女性.胆道系酵素の異常で発症. 腹部CT検査で肝十二指腸間膜に一致した径2cm大の腫瘍を認めた. ERCP , MRCP では左右肝管から総胆管・総肝管まで約5cmにわたる狭窄と肝内胆管の拡張を認め,上部胆管癌と診断された.経乳頭的に腫瘍生検を行い確診を得た.術前診断が可能であった本症例では,疾患の生物学的特徴より周囲組織を含めた十分な切除が必要と考え,拡大肝右葉切除,尾状葉全切除,胆管切除,肝内胆管空腸吻合を施行した.切除標本の病理組織学的診断は胆管腺扁平上皮癌であった. 術後12ヶ月を経た現在, 再発の兆候を認めていない.

We have experienced a rare case of adenosquamous carcinoma of the upper bile duct. This type of carcinoma usually shows advanced vascular invasion and an extremely poor prognosis. A 56year-old woman suffered from liver dysfunction and was admitted to our institute. Abdominal CT showed a solid tumor, about 2 cm in diameter, into the hepatic hilum. ERCP and MRCP revealed the stricture extended about 5 cm in length in the upper and middle bile duct, and also dilatation of the intrahepatic bile duct, indicating upper bile duct carcinoma. To determine the histological type of the tumor, we performed transpapillary tumor biopsy under endoscopic observation, which revealed the histological diagnosis of squamous cell carcinoma of the bile duct. Taking into account the biological malignancy, extended radical resection was necessary. We performed extended right hepatic lobectomy, total caudate lobectomy and extrahepatic bile duct resection with intrahepatic bilio-jejunostomy. The histopathological examination of the resected specimen showed adenosquamous carcinoma of the bile duct. The patient has been doing well with no complications nor recurrence for 12 months since the operation.

Journal

  • Tando

    Tando 15(5), 399-405, 2001

    Japan Biliary Association

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