Kawasaki Yota, Maemura Kosei, Kurahara Hiroshi, Mataki Yuko, Iino Satoshi, Sakoda Masahiko, Ueno Shinichi, Shinchi Hiroyuki, Takao Sonshin, Natsugoe Shoji
Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Sakuragaoka 8-35-1, Kagoshima 890-8520, Japan.
BMC Cancer. 2014 Dec 13;14:946. doi: 10.1186/1471-2407-14-946.
Sarcoid-like reaction is often seen in various types of carcinoma, not only in the primary tumor, but also in regional lymph nodes, and can occur at any time, not only at the time of diagnosis, but also after treatment. However, few cases of hepatopancreatobiliary carcinoma, and no cases of gallbladder cancer with sarcoid-like reaction involving the lymph nodes have been described. This report is the first report of a sarcoid-like reaction involving the lymph nodes in a case of gallbladder cancer.
We encountered a rare case of gall bladder cancer with sarcoid-like reaction in the lymph nodes. Since regional lymph node swelling that was difficult to differentiate from metastasis was found preoperatively, swollen nodes were examined histologically using frozen sections. Based on this histology, the swollen nodes were diagnosed as showing sarcoid reaction and therefore extended lymphadenectomy was avoided. The patient did not receive any adjuvant chemotherapy and has shown no recurrence of disease as of 4 years after surgery.
Distinguishing between metastasis and sarcoid-like reaction in lymph nodes by preoperative imaging is still difficult. The present case shows that it is important to histologically examine swollen nodes by biopsy or by sampling before deciding on the treatment strategy for gall bladder cancer with swollen lymph nodes.
结节样反应常见于各类癌症，不仅在原发肿瘤中可见，在区域淋巴结中也可出现，且可在任何时间发生，不仅在诊断时，治疗后也可能出现。然而，肝胰胆管癌出现这种反应的病例较少，胆囊癌伴有累及淋巴结的结节样反应的病例尚无报道。本报告首次报道了一例胆囊癌伴有累及淋巴结的结节样反应。
我们遇到了一例罕见的胆囊癌伴有淋巴结结节样反应的病例。由于术前发现区域淋巴结肿大，难以与转移相鉴别，因此使用冰冻切片对肿大的淋巴结进行了组织学检查。基于此组织学检查结果，肿大的淋巴结被诊断为表现出结节反应，因此避免了扩大淋巴结清扫术。该患者未接受任何辅助化疗，截至术后4年未出现疾病复发。
术前通过影像学区分淋巴结转移和结节样反应仍然困难。本病例表明，对于伴有淋巴结肿大的胆囊癌，在决定治疗策略之前，通过活检或取样对肿大的淋巴结进行组织学检查非常重要。
