Igami Tsuyoshi, Yokoyama Yukihiro, Nishio Hideki, Ebata Tomoki, Shimoyama Yoshie, Nakamura Shigeo, Nagino Masato
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(4):579-84. doi: 10.1007/s00534-009-0056-z. Epub 2009 Mar 4.
We report a case of small pancreatic carcinoma misdiagnosed as superficially spreading cholangiocarcinoma using percutaneous transhepatic cholangioscopy (PTCS). The patient was a 72-year-old man admitted to a local hospital with obstructive jaundice. The patient underwent percutaneous transhepatic biliary drainage and PTCS. He was referred to our hospital with a diagnosis of superficially spreading cholangiocarcinoma. Cholangiography revealed a stenosis of the common bile duct, and also revealed some irregularities from the common hepatic duct to the left hepatic duct, suggesting a superficial spread of cancer. No pancreatic tumor was identified by endoscopic retrograde pancreatography or by enhanced computed tomography. Cholangioscopy disclosed an elevated tumor with torsional vessels and granular mucosal lesions, which were extended to the left hepatic duct. Repeated cholangioscopic biopsies of the bile duct mucosa revealed adenocarcinoma. The patient was diagnosed with superficially spreading cholangiocarcinoma extending to the left hepatic duct and the right anterior hepatic duct. Left trisectionectomy combined with pancreatoduodenectomy was performed. The cut surface of the resected specimen showed a pancreatic head tumor that was 8 mm in diameter. Histological findings of the resected specimen revealed adenocarcinoma arising from the pancreatic head with invasion in the common bile duct. Additionally, extensive inflammatory granulation tissue was observed along the surface of the bile duct, without any evidence of carcinoma. This case implies to us that the results of PTCS, even after repeated biopsies, should be interpreted with great caution.
我们报告一例经皮经肝胆道镜检查（PTCS）误诊为浅表扩散型胆管癌的小胰腺癌病例。患者为一名72岁男性，因梗阻性黄疸入住当地医院。患者接受了经皮经肝胆道引流和PTCS。他被转诊至我院，诊断为浅表扩散型胆管癌。胆管造影显示胆总管狭窄，从肝总管至左肝管也有一些不规则之处，提示癌症浅表扩散。经内镜逆行胰胆管造影术或增强计算机断层扫描均未发现胰腺肿瘤。胆道镜检查发现一个隆起的肿瘤，伴有扭曲的血管和颗粒状黏膜病变，病变延伸至左肝管。对胆管黏膜进行多次胆道镜活检显示为腺癌。患者被诊断为浅表扩散型胆管癌，累及左肝管和右前肝管。实施了左半肝切除术联合胰十二指肠切除术。切除标本的切面显示一个直径为8mm的胰头肿瘤。切除标本的组织学检查结果显示为起源于胰头的腺癌，并侵犯了胆总管。此外，沿胆管表面观察到广泛的炎性肉芽组织，未发现任何癌的证据。该病例提示我们，即使经过多次活检，PTCS的结果也应谨慎解读。
