Andoh Hideaki, Yasui Ouki, Kurokawa Toshiaki, Sato Tsutomu
Department of Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
J Gastroenterol. 2004 Jan;39(1):64-8. doi: 10.1007/s00535-003-1249-x.
The relationship of parasitic liver disease to cholangiocarcinoma has long been debated, and it has been reported that cholangiocarcinoma is associated with opisthorchiasis viverrini. We report herein a rare case of cholangiocarcinoma associated with schistosomiasis japonica. A 76-year-old Japanese man with jaundice was diagnosed with cholangiocarcinoma. Radical resection was not done because of hepatic arterial and portal vein invasion. Biliary microwave tissue coagulation therapy was performed with placement of a metallic stent endoprosthesis. Twenty-two months after the treatment, however, the patient died from hematemesis. Autopsy findings revealed that there was no distant metastasis, even in the area of regional lymph node metastasis. The primary tumor in the hepatic hilar region had been replaced by necrotic debris resulting from the microwave therapy, and an expandable metallic stent was located in the center of the debris. Histological findings showed schistosome eggs, which were old and microcalcified, in veins in the colonic submucosa. Glisson's fibrosis around the cancer lesion suggested that schistosomiasis japonica and cholangiocarcinoma can occur together with severe chronic inflammation of the portal vein.
寄生虫性肝病与胆管癌之间的关系长期以来一直存在争议，并且有报道称胆管癌与华支睾吸虫病有关。我们在此报告一例罕见的与日本血吸虫病相关的胆管癌病例。一名76岁的日本男性因黄疸被诊断为胆管癌。由于肝动脉和门静脉受侵，未进行根治性切除。在放置金属支架内假体的情况下进行了胆道微波组织凝固治疗。然而，治疗22个月后，患者死于呕血。尸检结果显示，即使在区域淋巴结转移区域也没有远处转移。肝门区的原发性肿瘤已被微波治疗导致的坏死碎片所取代，一个可扩张金属支架位于碎片中心。组织学检查结果显示，在结肠黏膜下层的静脉中有陈旧且微钙化的血吸虫卵。癌灶周围的Glisson纤维组织增生表明，日本血吸虫病和胆管癌可与门静脉的严重慢性炎症同时发生。
