Noda Hiroshi, Chiba Fumihiro, Toyama Nobuyuki, Konishi Fumio
Department of Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(1):83-5. doi: 10.1007/s00534-008-0001-6. Epub 2008 Dec 19.
Mucin-producing carcinoma of the gallbladder is very rare. We report here a case of mucin-producing carcinoma of the gallbladder associated with primary sclerosing cholangitis (PSC) and ulcerative colitis (UC). A 74-year-old female had been treated with salazosulfapyridine and ursodesoxycholic acid becase of UC and PSC. After 7 years of treatment, laboratory data showed that the liver function took a turn for the worse, and the patient was admitted to our hospital for further examination. Enhanced computed tomography and ultrasonography showed an enlarged gallbladder associated with wall thickening and diffuse papillary protrusion. Endoscopic retrograde cholangiography showed stenosis and dilatation of the bile duct, which were compatible with PSC. Under the diagnosis of an early carcinoma of the gallbladder, we performed simple cholecystectomy. The tumor showed a papillary growth pattern located diffusely in the gallbladder with a massive amount of mucin filling the gallbladder. Histologically, it was diagnosed as a papillary adenocarcinoma localized in the mucosal layer. To the best of our knowledge, this is the first case of mucin-producing carcinoma of the gallbladder associated with PSC and UC. PSC and UC patients should be regarded as a high-risk group not only for cholangiocarcinoma but also carcinoma of the gallbladder.
胆囊黏液腺癌非常罕见。我们在此报告一例与原发性硬化性胆管炎(PSC)和溃疡性结肠炎(UC)相关的胆囊黏液腺癌病例。一名74岁女性因UC和PSC一直在接受柳氮磺胺吡啶和熊去氧胆酸治疗。治疗7年后,实验室数据显示肝功能恶化,该患者被收入我院进一步检查。增强计算机断层扫描和超声检查显示胆囊增大,伴有胆囊壁增厚和弥漫性乳头状突出。内镜逆行胆管造影显示胆管狭窄和扩张,符合PSC表现。在诊断为早期胆囊癌后,我们实施了单纯胆囊切除术。肿瘤呈乳头状生长模式,弥漫分布于胆囊内,大量黏液充满胆囊。组织学上,其被诊断为局限于黏膜层的乳头状腺癌。据我们所知,这是首例与PSC和UC相关的胆囊黏液腺癌病例。PSC和UC患者不仅应被视为胆管癌的高危人群,也是胆囊癌的高危人群。