Takahashi Hidenori, Suzuki Yasuko, Higuchi Kyoko, Yoshinouchi Satoshi, Enomoto Naoki, Yoshida Tsuyoshi, Ohno Ryo, Mutoh Mariko, Hirokawa Katsuiku
Dept. of Surgery, Nitobe Memorial Nakano General Hospital.
Gan To Kagaku Ryoho. 2017 Nov;44(12):1182-1184.
Gallbladder carcinoma producing alpha-fetoprotein(AFP)is rare.We report a case of AFP producing carcinoma of the gallbladder with huge metastatic hepatic tumor.A 81-year-old female with a hepatitis B virus(HBV)had a fever and right hypochondralgia.Abdominal CT showed an enlarged gallbladder with gallbladder stones, a huge tumor in the right lobe of liver, and swelling paraaortic lymph nodes.Acute cholecystitis was treated by percutaneous transhepatic gallbladder drainage (PTGBD).The hepatic tumor was diagnosed as hepatocellular carcinoma for HBV carrier and the high level of AFP and PIVKA- II .We performed right lobectomy, cholecystectomy and the resection of paraaortic lymph nodes.In the resected gallbladder, the papillary tumor was detected.Histopathological diagnosis was moderately to poorly differentiated adenocarcinoma of the gallbladder.The liver tumor and paraaortic lymph nodes were metastases of the gallbladder carcinoma.The both of gallbladder and liver tumor immunohistochemically stained positive to AFP.It was difficult to diagnose the hepatic tumor because of HBV carrier, the high level of AFP and the unnoticed gallbladder tumor.Gallbladder carcinoma with the high level of AFP might have relation to liver metastases.
产生甲胎蛋白(AFP)的胆囊癌很罕见。我们报告一例产生AFP的胆囊癌伴巨大肝脏转移瘤的病例。一名81岁患有乙型肝炎病毒(HBV)的女性出现发热和右季肋部疼痛。腹部CT显示胆囊增大伴胆结石,肝右叶有一个巨大肿瘤,以及主动脉旁淋巴结肿大。急性胆囊炎通过经皮经肝胆囊引流(PTGBD)进行治疗。由于该患者为HBV携带者且AFP和异常凝血酶原(PIVKA-II)水平升高,肝脏肿瘤被诊断为肝细胞癌。我们进行了右叶切除术、胆囊切除术和主动脉旁淋巴结切除术。在切除的胆囊中,发现了乳头状肿瘤。组织病理学诊断为中度至低分化胆囊腺癌。肝脏肿瘤和主动脉旁淋巴结是胆囊癌的转移灶。胆囊和肝脏肿瘤的免疫组化结果均显示AFP染色呈阳性。由于患者为HBV携带者、AFP水平高且未发现胆囊肿瘤,很难对肝脏肿瘤进行诊断。AFP水平高的胆囊癌可能与肝转移有关。