粘膜に限局する乳頭型肝門部胆管癌治癒切除術後遠隔期に生じた肝腫瘍の1切除例  [in Japanese] A resected case of hepatic neoplasm developed long after the operation for papillary hepatohilar bile duct carcinoma involved only mucosal layer  [in Japanese]

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Author(s)

    • 阿部 友哉 ABE Tomoya
    • 東北大学大学院消化器外科学分野 Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 鈴木 正徳 SUZUKI Masanori
    • 東北大学大学院消化器外科学分野 Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 海野 倫明 UNNO Michiaki
    • 東北大学大学院消化器外科学分野 Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 片寄 友 KATAYOSE Yu
    • 東北大学大学院消化器外科学分野 Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 力山 敏樹 RIKIYAMA Toshiki
    • 東北大学大学院消化器外科学分野 Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 竹内 丙午 TAKEUCHI Heigo
    • 東北大学大学院消化器外科学分野 Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 水間 正道 MIZUMA Masamichi
    • 東北大学大学院消化器外科学分野 Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)
    • 松野 正紀 MATSUNO Seiki
    • 東北大学大学院消化器外科学分野 Division of Gastroenterological Surgery, Tohoku University Graduate School of Medicine (Sendai)

Abstract

肝門部胆管癌拡大肝右葉切除後遠隔期に残肝左葉外側区域に肝腫瘍を生じ,異時性多中心発生による肝内胆管癌と肝内胆管癌の肝内転移との鑑別に苦慮した症例を経験した.症例は67歳・男性.1996年12月に肝門部胆管癌で,拡大肝右葉切除・尾状葉全切除・肝外胆管切除・胆道再建術を施行した.腫瘍は胆管内腔に乳頭状に増殖し,胆管沿いに上皮内進展が認められた.組織学的にはpap,m,ly<SUB>0</SUB>,v<SUB>0</SUB>,pn<SUB>0</SUB>である.術後4年を経過した2001年2月,CTでS<SUB>2</SUB>に約3cmの低吸収域を認め,同年3月肝部分切除術を施行した.組織診断はpapを主とする中~高分化型腺癌で,初回摘出標本と組織型が類似し,原発巣からの血行性もしくはリンパ行性転移の可能性,あるいは肝内胆管枝の粘膜に生じていたskip lesionからの異時性発生の可能性も考えられた.肝門部胆管癌のpap症例は粘膜表層進展やskip lesionの頻度も高く,このような病巣が残肝左葉に残存した可能性もあり,定期的な画像診断による病巣の検出と早期治療が必要と考えられた.

We experienced a case of hepatic tumor hard to distinguish from intrahepatic cholangiocellular carcinoma by rnulticentric carcinogenesis and intrahepatic metastasis of hepatohilar tumor. The patient was a 67 years-old man. He had received extended right hepatic lobectomy for hepato-hilar bile duct tumor on December 1996.<BR>Macroscopically, the tumor showed papillary growth to be clogged near the hepato-hilar bile duct with a: stalk. Histologically, it classified papillary adenocarcinoma, m, ly<SUB>0</SUB>, v<SUB>0</SUB>, pn<SUB>0</SUB>. On February 2001, a hepatic tumor (3 cm) was detected in the segment 2. Partial resection of the lateral segment was performed and the tumor showed similar character with preceding tumor. Its pathogenesis was considered by two alternatives, a hematogenous or lymphogenous metastasis of first tumor and a newly developed carcinoma based on carcinoma-dysplasia sequence. Therefore we should take care of such as remaining dysplasia or skip lesion.

Journal

  • Tando

    Tando 16(2), 125-131, 2002

    Japan Biliary Association

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