Taniai N, Onda M, Tajiri T, Yoshida H, Naitou Z
First Department of Surgery, Nippon Medical School, Tokyo, Japan.
Hepatogastroenterology. 2000 Jan-Feb;47(31):121-4.
An 83-year-old woman, diagnosed as having cholelithiasis, was admitted to the Department of Surgery, Nippon Medical School, with right hypochondrial pain. Ultrasonography and computed tomography revealed a mass in the gallbladder fundus and a hypovascular tumor in the anterior segment of the liver. Magnetic resonance imaging showed stenosis of the intrahepatic bile duct and dilatation of its proximal portion. She was diagnosed as having intrahepatic bile duct carcinoma combined with gallbladder carcinoma. At laparotomy, there was evidence of multiple peritoneal metastases and intraoperative histological examination of the gallbladder tumor revealed adenocarcinoma. Accordingly, only cholecystectomy and needle biopsy of the liver tumor was performed. Histological examination of the gallbladder revealed papillary adenocarcinoma invading the muscularis propria with medullary growth or intermediate stroma. There was no microvessel invasion, no perineural invasion and no lymph node involvement. On the other hand, the liver tumor was a cholangiocarcinoma with a well-differentiated tubular pattern. Therefore, this was a rare case of synchronous carcinoma of the gallbladder associated with intrahepatic bile duct carcinoma.
一名83岁女性，被诊断为患有胆结石，因右季肋部疼痛入住日本医科大学外科。超声检查和计算机断层扫描显示胆囊底部有一肿块，肝脏前段有一少血管肿瘤。磁共振成像显示肝内胆管狭窄及其近端扩张。她被诊断为肝内胆管癌合并胆囊癌。剖腹手术时，有多处腹膜转移的证据，术中对胆囊肿瘤进行组织学检查显示为腺癌。因此，仅进行了胆囊切除术和肝肿瘤穿刺活检。胆囊组织学检查显示为乳头状腺癌，侵犯固有肌层，呈髓样生长或间质中等。无微血管侵犯、无神经周围侵犯且无淋巴结受累。另一方面，肝肿瘤为高分化管状模式的胆管癌。因此，这是一例罕见的胆囊癌与肝内胆管癌同步发生的病例。
