rights: 本文データは日本消化器外科学会の許諾に基づき、CiNiiから複製したものである 黄疸の発症する前の胆管癌の早期診断はいまだ困難であるが, 今回, 我々は初診時に無黄疸の粘膜内胆管癌の1例を経験した. 症例は72歳の女性. 火事による気道, 角膜熱傷などにて当院に入院したが, 入院時検査から持続する肝胆道系酵素の上昇を認めた. USとCTにて下部胆管に腫瘤像を認め, ERCPにて4.5cm長の結節集族様の陰影欠損を認めた. 全胃幽門輪温存膵頭十二指腸切除術施行し, 術中操作にて腫瘍は一部脱落したが, 切除標本では乳頭状に増殖する連続性のない2個の病変(1.2×1.2cm, 1.8×0.9cm)が見られた. 病理組織像はいずれも粘膜内に限局した乳頭腺癌であった(pap, m, med, INFα, ly_0, v_0, pn_0, hinf_0, ginf_0,
... [Show full abstract] panc_0, du_0, pv_0, a_0, n(-), hm_0, dm_0,em_0, t_1, stageI, curA). 術後17か月現在, 再発なく外来通院中である. A diagnosis of bile duct carcinoma is difficult to make in the early stage before the onset of jaundice. We report here, a patient with carcinoma in the mucosal layer of the bile duct, who was without jaundice, and who was diagnosed in the early stage. The patient was a 72-year-old woman who was admitted to our hospital because of a burn that occurred in her home. She exhibited liver dysfunction (elevation of GOT, GPT, ALP and γ-GTP) but without jaundice. Ultrasonography and computed tomography showed dilatation of the bile duct and a mass in the lower third portion of the extrahepatic bile duct. Endoscopic retrograde cholangiography revealed a 4.5 cm filling defect in the bile duct, and magnetic resonance cholangiography showed similar findings. Subsequently, pylorus-preserving pancreato-duodenectomy was performed. Pathological analysis revealed 2 papillary tumors (12×12 mm, and 18×9 mm in size) in the bile duct, which were characterized as papillary adenocarcinoma located in the mucosal layer with no lymph node metastasis (Bi, pap, m, hinf_0, ginf_0, panc_0, du_0, pv_0, a_0, n (-) , stage I) . The patient has been well for 17 months after surgery without recurrence.
