Terada Tadashi, Terai Tadashi, Yamawaki Takemori
Department of Pathology, Shizuoka Shimizu Municipal Hospital, Shimizu, Japan.
Pathol Int. 2003 Aug;53(8):563-8. doi: 10.1046/j.1440-1827.2003.01505.x.
A 99-year-old woman was admitted to Shizuoka Shimizu Municipal Hospital because of fever and anasarca. Imaging and laboratory tests showed pneumonia, urinary tract infection, and cardiac failure. The patient died 20 days after admission. An autopsy revealed marked diffuse dilations of the biliary tree ranging from the lower common bile duct to intrahepatic bile ducts. Intrahepatic calcium bilirubinate stones and biliary sludges were recognized within the dilated bile ducts. A unilocular cyst (2 cm in diameter) was present in the pancreatic head adjacent to the lower common bile duct, and it appeared to compress the common bile duct. Histologically, the walls of the dilated biliary tree showed proliferation of peribiliary glands, fibrosis, and infiltration of lymphocytes and neutrophils (cholangitis). The lumens of the dilated biliary ducts contained neutral and acidic mucins, fibrinous materials, bacteria, neutrophils, and Aspergillus fungi, in addition to the calculi and sludges. The background liver showed atrophy (400 g). The pancreatic unilocular cyst was composed of mucous columnar cells with a few infoldings, and the pancreas also showed foci of mucinous duct hyperplasia and ectasia; the pathological diagnosis of the cyst was cystic dilations of a pancreatic duct branch (mucinous ductal ectasia or mucinous cyst). Other lesions included aspiration pneumonia, emaciation, atrophy of systemic organs, gastric leiomyoma, serous cystadenoma of the right ovary, and arteriosclerotic nephrosclerosis. The present case suggests that a mucinous cyst of the pancreas may compress the biliary tree and lead to marked diffuse dilations of the biliary tree. Alternatively, the dilations of the bile ducts may be associated with aging or may be of congenital origin. The dilated bile ducts may, in turn, give rise to bacterial and fungal cholangitis and formation of biliary sludges and intrahepatic calcium bilirubinate stones.
一名99岁女性因发热和全身水肿入住静冈清水市立医院。影像学和实验室检查显示患有肺炎、尿路感染和心力衰竭。患者入院20天后死亡。尸检发现，从胆总管下段至肝内胆管的胆管树有明显的弥漫性扩张。扩张的胆管内可见肝内胆红素钙结石和胆泥。在胆总管下段相邻的胰头处有一个单房囊肿（直径2 cm），似乎压迫了胆总管。组织学检查显示，扩张胆管壁的胆管周围腺体增生、纤维化，并有淋巴细胞和中性粒细胞浸润（胆管炎）。除结石和胆泥外，扩张胆管腔内还含有中性和酸性粘蛋白、纤维蛋白物质、细菌、中性粒细胞和曲霉菌。肝脏背景显示萎缩（400 g）。胰腺单房囊肿由有少量褶皱的粘液柱状细胞组成，胰腺还可见粘液性导管增生和扩张灶；囊肿的病理诊断为胰管分支的囊性扩张（粘液性导管扩张或粘液性囊肿）。其他病变包括吸入性肺炎、消瘦、全身器官萎缩、胃平滑肌瘤、右卵巢浆液性囊腺瘤和动脉硬化性肾硬化。本病例提示，胰腺粘液性囊肿可能压迫胆管树，导致胆管树明显弥漫性扩张。或者，胆管扩张可能与衰老有关，也可能是先天性的。扩张的胆管继而可能引发细菌和真菌性胆管炎以及胆泥和肝内胆红素钙结石的形成。
