Okamura K, Hayakawa H, Kuze M, Takahashi H, Kosaka A, Mizumoto R, Katsuta K
Department of Surgery, Matsusaka City Hospital, Matsusaka, Japan.
J Gastroenterol. 2000;35(6):465-71. doi: 10.1007/s005350070093.
We report a rare case of triple carcinomas of the biliary tract associated with congenital choledochal dilatation (CCD) and pancreaticobiliary maljunction (PBM). The patient was a 58-year-old Japanese man who complained of epigastralgia. Ultrasonography and computed tomography revealed an elevated lesion inside the markedly dilated extrahepatic bile duct, thickening of the gallbladder wall, and small polypoid lesions in the gallbladder. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography showed CCD and PBM. With a diagnosis of carcinoma of the bile duct and cholesterol polyps in the gallbladder, pylorus-preserving pancreaticoduodenectomy was performed. The resected specimen showed two elevated lesions in the dilated bile duct, cholesterol polyps, and an area of irregular mucosa in the gallbladder. Histopathological examination showed two carcinomas in the bile duct, an adenosquamous cell carcinoma, and a moderately differentiated tubular adenocarcinoma, and a well differentiated tubular adenocarcinoma of the gallbladder. Two years and 6 months after the operation, a solitary metastatic liver tumor was detected. Left hepatic lobectomy was performed. At present, 7 months after the second operation, the patient is doing well with no signs of recurrence. Multiple carcinomas in the biliary tract associated with CCD and PBM, including the details in the present patient, were reviewed.
我们报告一例罕见的与先天性胆管扩张症（CCD）和胰胆管合流异常（PBM）相关的胆道三联癌病例。患者为一名58岁的日本男性，主诉上腹部疼痛。超声检查和计算机断层扫描显示肝外胆管明显扩张内有一隆起病变、胆囊壁增厚以及胆囊内有小的息肉样病变。磁共振胆胰管造影和内镜逆行胆胰管造影显示存在CCD和PBM。诊断为胆管癌和胆囊胆固醇息肉后，实施了保留幽门的胰十二指肠切除术。切除标本显示扩张胆管内有两个隆起病变、胆固醇息肉以及胆囊内一处不规则黏膜区域。组织病理学检查显示胆管内有两种癌，一种为腺鳞癌，另一种为中分化管状腺癌，以及胆囊的高分化管状腺癌。术后两年零6个月，检测到一个孤立的肝转移瘤。实施了左肝叶切除术。目前，第二次手术后7个月，患者情况良好，无复发迹象。我们对与CCD和PBM相关的胆道多发癌进行了综述，包括本病例的详细情况。
