Tokunaga Masahiro, Maeda Tetsuo, Fukuchi Nariaki, Tamai Koki, Minoji Takayuki, Sasakawa Hirokazu, Kondo Atsushi, Inoue Shinya, Morita Takako, Tominaga Nobuhiko
Department of Hematology, Suita Municipal Hospital.
Department of Surgery, Suita Municipal Hospital.
Rinsho Ketsueki. 2019;60(4):319-325. doi: 10.11406/rinketsu.60.319.
A 68-year-old female was diagnosed with follicular lymphoma (FL) grade 2, based on the excisional biopsy of her enlarged left cervical lymph node. Positron-emission tomography/computed tomography (PET/CT) revealed the F-fluoro-deoxyglucose-avid lesions in the sigmoid colon and at the fundus of the gallbladder, besides those in the left neck. A sigmoid colon polyp, which was endoscopically resected, proved histologically to be a well- to moderately-differentiated tubular adenocarcinoma with deep invasion into the submucosa. In addition, nodular lesions of the gallbladder were enhanced on dynamic CT, markedly suggesting gallbladder carcinoma. Among FL, colorectal cancer, and presumed gallbladder adenocarcinoma, FL was considered having the lowest priority of treatment because of its indolent nature and low tumor burden. We performed laparoscopic-assisted sigmoid colectomy, followed by gallbladder bed resection on the same day. Unpredictably, gallbladder lesions were histologically revealed to be FL. Often, FL involves extranodal sites such as the gastrointestinal tracts. However, the gallbladder involvement is extremely rare, and preoperative distinction from gallbladder adenocarcinoma remains challenging to date; this report discusses its characteristics along with the literature review. Furthermore, our case, in which another malignant neoplasm coexisted, needed histological identification of the gallbladder lesions to ascertain the therapeutic strategy.
一名68岁女性因左侧颈部淋巴结肿大行切除活检，被诊断为2级滤泡性淋巴瘤（FL）。正电子发射断层扫描/计算机断层扫描（PET/CT）显示，除左侧颈部病变外，乙状结肠和胆囊底部有氟脱氧葡萄糖摄取阳性病变。经内镜切除的乙状结肠息肉经组织学检查证实为高分化至中分化管状腺癌，侵犯至黏膜下层。此外，胆囊的结节性病变在动态CT上有强化，高度提示胆囊癌。在FL、结直肠癌和疑似胆囊腺癌中，由于FL生长缓慢且肿瘤负荷低，其被认为治疗优先级最低。我们在同一天进行了腹腔镜辅助乙状结肠切除术，随后进行了胆囊床切除术。出乎意料的是，胆囊病变经组织学检查显示为FL。FL常累及胃肠道等结外部位。然而，胆囊受累极为罕见，迄今为止，术前鉴别胆囊腺癌仍具有挑战性；本报告结合文献复习讨论了其特征。此外，我们的病例中存在另一种恶性肿瘤，需要对胆囊病变进行组织学鉴定以确定治疗策略。
