Kadono Jun, Hamada Nobuo, Higashi Michiyo, Ishizaki Naoki, Nakamura Noboru, Sakata Ryuzo
Second Department of Surgery, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
J Hepatobiliary Pancreat Surg. 2005;12(4):328-31. doi: 10.1007/s00534-005-0988-x.
A rare case of a carcinosarcoma of the extrahepatic bile duct demonstrating interesting features is described. A 75-year-old woman with a history of choledocholithotomy presented with acute obstructive suppurative cholangitis. Ultrasonography and computed tomography showed a thickened choledochal wall, with calcification. Percutaneous transhepatic and endoscopic retrograde cholangiography revealed a round filling defect accompanied by an irregular obstruction in the common bile duct. Carcinosarcoma was diagnosed from a protruding lesion in the common bile duct obtained by intraoperative frozen sectioning, and pylorus-preserving pancreatoduodenectomy was performed. Histological examination by light microscopy showed a transition between the carcinomatous and sarcomatous components and positive immunoreactivity for epithelial markers in the sarcomatous component. The patient died of a local recurrence 2 years after the surgery. Polypoid growth and ossification in the tumor could be representative features of carcinosarcoma of the extrahepatic bile duct.
本文描述了一例罕见的肝外胆管癌肉瘤，具有一些有趣的特征。一名有胆总管切开取石术病史的75岁女性，因急性梗阻性化脓性胆管炎就诊。超声和计算机断层扫描显示胆总管壁增厚并伴有钙化。经皮肝穿刺胆管造影和内镜逆行胆管造影显示胆总管内有圆形充盈缺损并伴有不规则梗阻。通过术中冰冻切片检查从胆总管内突出的病变中诊断出癌肉瘤，并进行了保留幽门的胰十二指肠切除术。光镜下组织学检查显示癌性成分和肉瘤性成分之间有过渡，且肉瘤性成分中上皮标志物免疫反应呈阳性。患者术后2年死于局部复发。肿瘤中的息肉样生长和骨化可能是肝外胆管癌肉瘤的典型特征。
