肝外発育型細胆管癌の1例  [in Japanese] A Case of Cholangiocellular Carcinoma with Extrahepatic Growth  [in Japanese]

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Author(s)

    • 永川 裕一 NAGAKAWA Yuichi
    • 東京医科大学消化器・小児外科学分野 Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University
    • 佐原 八束 SAHARA Yatsuka
    • 東京医科大学消化器・小児外科学分野 Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University
    • 瀧下 智恵 TAKISHITA Chie
    • 東京医科大学消化器・小児外科学分野 Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University
    • 土方 陽介 HIJIKATA Yosuke
    • 東京医科大学消化器・小児外科学分野 Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University
    • 勝又 健次 KATSUMATA Kenji
    • 東京医科大学消化器・小児外科学分野 Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University
    • 土田 明彦 TSUCHIDA Akihiko
    • 東京医科大学消化器・小児外科学分野 Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University

Abstract

67歳,女性.肝外側区域および左上腹部に巨大腫瘤を認め,当院紹介となった.AFPが16,500ng/mlと高値であり,肝外発育型肝細胞癌の診断にて手術を施行した.腫瘍は肝外側区域に存在し肝外発育を伴い,左横隔膜,左下肺および脾上極に浸潤していた.肝外側区域切除,脾臓摘出,左下肺部分切除,横隔膜部分切除術を施行した.病理所見では肝内腫瘍部は細胆管癌で,肝外腫瘍部は中分化型肝細胞癌であったことから肝細胞癌に分化し肝外発育した細胆管癌と診断した.免疫組織学的検討を行ったところ,肝内腫瘍の細胆管癌部はCEA・cytokeratin 19が陽性であった他,AFPが一部陽性を示した.肝外腫瘍の中分化型肝細胞癌部ではAFP,CEA,cytokeratin 19すべてが陽性であった.術後6カ月で残肝再発し,肝生検行ったところ組織像は中分化型肝細胞癌であった.稀な肝外発育型細胆管癌を経験したので報告する.

A 67-year-old female patient presented with a hepatic tumor in the lateral segment of the liver with an extrahepatic tumor in the left upper quadrant of the abdomen, as detected on screening ultrasonography. Her serum alpha-fetoprotein (AFP) level was elevated to 16,500 ng/ml. The diagnosis was hepatocellular carcinoma with extra hepatic growth, and a left lateral sectionectomy with resection to the extrahepatic tumor and spleen and a left lung partial resection were performed. Regarding pathological findings, the majority of the intrahepatic tumors were cholangiocellular carcinoma with Hering tube-like structures. Immunohistochemical staining revealed that the tumor cells were cytokeratin 19-positive. Some AFP-positive cells were also observed. Pathological examination of the extrahepatic tumor showed moderately differentiated hepatocellular carcinoma with AFP- and cytokeratin 19-positive cells. Six months after the surgery, a recurrent tumor was confirmed in segment 6. Pathological findings of the recurrent tumor showed moderately differentiated hepatocellular carcinoma.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 79(5), 1083-1087, 2018

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130007538151
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • NDL Article ID
    029099125
  • NDL Call No.
    Z19-227
  • Data Source
    NDL  J-STAGE 
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