Department of Surgery, Kokura Memorial Hospital, 1-1 Kifune, Kokurakita-ku, Kitakyushu, Fukuoka, 802-8555, Japan.
Surg Today. 2011 Apr;41(4):579-84. doi: 10.1007/s00595-009-4304-2. Epub 2011 Mar 23.
We report a case of undifferentiated carcinoma of the common bile duct with intraductal tumor thrombi. A 73-year-old man presented with general malaise. Abdominal computed tomography and magnetic resonance imaging revealed a mass in the distal common bile duct, accompanied by dilatation of the intra- and extrahepatic bile ducts. The patient underwent pancreaticoduodenectomy with regional lymphadenectomy. Gross examination revealed that the distal common bile duct was obstructed by an elastic hard mass, 3.2 × 2.6 cm, accompanied by intraductal tumor thrombi. Microscopically, the nodule was well defined and composed of atypical large tumor cells with bizarre nuclei and little cytoplasm. Immunohistochemically, the tumor cells were diffusely positive for cytokeratin-7 and CAM5.2, but negative for CD56, chromogranin A, and synaptophysin. Thus, a histological diagnosis of undifferentiated carcinoma of the common bile duct was made. The patient recovered uneventfully and has remained free of any signs of recurrence for 18 months since the operation. Undifferentiated carcinomas of the extrahepatic bile duct can be detected early, with the chance of a good prognosis; however, because their biologic growth behavior is still considered aggressive, careful observation after surgery and the initiation of multidisciplinary treatment against recurrence are necessary.
我们报告 1 例伴有管内肿瘤血栓的胆总管未分化癌。1 例 73 岁男性，表现为全身不适。腹部 CT 和 MRI 显示胆总管下段有肿块，伴有肝内外胆管扩张。患者接受胰十二指肠切除术和区域淋巴结清扫术。大体检查发现，远端胆总管被一个弹性硬的肿块阻塞，大小为 3.2×2.6cm，伴有管内肿瘤血栓。显微镜下，结节边界清楚，由异型大肿瘤细胞组成，细胞核奇异，细胞质少。免疫组化显示肿瘤细胞弥漫性表达细胞角蛋白-7 和 CAM5.2，但不表达 CD56、嗜铬粒蛋白 A 和突触素。因此，组织学诊断为胆总管未分化癌。患者术后恢复顺利，无任何复发迹象，至今已 18 个月。肝外胆管未分化癌可早期发现，预后良好；但由于其生物学生长行为仍被认为具有侵袭性，因此术后需密切观察并启动多学科治疗以预防复发。
