<症例>原発性胆嚢管癌の1例

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A 73-year-old female complaining of abdominal pain and body weight loss was admitted to a hospital and was suspected of having the bile duct malignancy. She was transferred to our clinic on January 25,1986. Although she had neither jaundice nor abdominal mass, abnormal high values of serum tumor marker assays were noted. On ERCP, the cystic duct was extremely long and inserted into the lower part of the common bile duct. The cystic duct was occluded near the gallbladder neck and the common hepatic duct was pressed by the occlusion. On CT, a suspicion of neoplasm at the site of cystic duct occlusion was entertained. With a tentative diagnosis of primary cystic duct carcinoma (PCDC), laparotomy was carried out on March 17,1986. An elastic hard tumor of 2.5×2.0×1.3 cm completely occluded the cystic duct and invaded into the adjacent structure with a suspicion of metastasis to the pancreatic-head lymphnode. After en bloc resection of the gallbladder and cystic duct including the confluence region of the bile ducts, Roux-Y type of choledochojejunostomy was performed. The patient was discharged on the 34th postoperative day. Histologically, the tumor showed moderately differentiated adenocarcinoma partially mixed with squamous cell carcinoma. Since 1964,21 cases of resected PCDC including our own case have been reported in the Japanese literature ; the male-to-female ratio was 1 : 1.2,all the patients except one were 51-year-old or older. PCDC limited to the cystic duct per se was noted in 13 cases (62%). Histologically, 12 cases showed highly or moderately differentiated adenocarcinoma. The complication by the insertion of the cystic duct at a lower part as in the present case was not recorded in other reports. Some patients with PCDC survived more than one year despite the relatively longer interval be tween the onset of symptoms and surgery. Direct cholangiography and evaluation of tumor marker assays are useful to detect and resect such a slow-growing PCDC.
近畿大学の論文
1987-09-25

<症例>原発性胆嚢管癌の1例

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