Sasatomi E, Miyazaki K, Mori M, Satoh T, Nakano S, Tokunaga O
Department of Surgery, Saga Medical School, Japan.
J Gastroenterol. 1997 Oct;32(5):704-7. doi: 10.1007/BF02934126.
We describe a distinctive polypoid lesion of the gallbladder (16 mm in diameter) at the fundus, associated with a granulomatous mass in the liver adjacent to the gallbladder fossa, in a 64-year-old Japanese woman. Preoperatively, the lesion was diagnosed as advanced gallbladder cancer infiltrating the liver, and hepatopancreato-duodenectomy was performed. In the resected specimen, the polyp was round and pedunculate in shape, and, microscopically, it consisted of a mixture of small glandular and surrounding muscular elements, but atypia was not noted. The constituent elements were identical with those of adenomyoma, but the polypoid appearance was unusual. The hepatic lesion proved to be a foreign body granuloma containing multiple barium fragments and giant cells. A deep gastric ulcer, which penetrated into the gallbladder fossa, was also noted, near the granuloma. The histologic features indicate that the polypoid appearance of the tumor was due to a secondary modification of pre-existing adenomyoma by hepatic granuloma. To our knowledge, this is the second reported case of an adenomyomatous lesion of the gallbladder with a polypoid appearance.
我们描述了一名64岁日本女性的病例，其胆囊底部有一个独特的息肉样病变（直径16毫米），与胆囊窝附近肝脏中的肉芽肿性肿块相关。术前，该病变被诊断为浸润肝脏的进展期胆囊癌，并进行了肝胰十二指肠切除术。在切除的标本中，息肉呈圆形且有蒂，显微镜下，它由小腺管和周围肌肉成分混合而成，但未发现异型性。其组成成分与腺肌瘤相同，但息肉样外观并不常见。肝脏病变被证实是一个含有多个钡剂碎片和巨细胞的异物肉芽肿。在肉芽肿附近还发现了一个穿透至胆囊窝的深部胃溃疡。组织学特征表明，肿瘤的息肉样外观是由于先前存在的腺肌瘤受到肝脏肉芽肿的继发性改变所致。据我们所知，这是第二例报告的具有息肉样外观的胆囊腺肌瘤样病变。
