Iwahashi N, Hayakawa N, Yamamoto H, Maki A, Kawabata Y, Murayama A, Nimura Y, Kamiya J, Nagino M, Mori N
Department of Surgery, Tohkai Hospital, 1-1-1 Chiyodabashi, Chikusa-ku, Nagoya, 464-0011 Japan.
J Hepatobiliary Pancreat Surg. 1998;5(2):221-5. doi: 10.1007/s005340050038.
We describe a case of mucosal bile duct carcinoma with superficial spread in a 69-year-old man with gallstone pancreatitis. The patient was seen at the hospital because of abdominal pain, fever, and jaundice. Endoscopic retrograde cholangiography (ERC) demonstrated a protruding lesion in the lower third of the common bile duct (CBD) showing wall irregularity suggestive of malignancy. Percutaneous transhepatic cholangioscopy (PTCS) disclosed a papillary tumor with granular mucosa extending continuously to the middle third of the CBD. Cholangioscopic biopsy specimens taken from both the papillary tumor and surrounding granular mucosa revealed papillary adenocarcinoma. After this assessment of extent of cancer by PTCS, we performed pancreatoduodenectomy with extrahepatic bile duct resection and regional lymph node dissection. Pathology examination revealed papillary adenocarcinoma limited to the mucosal layer. The resected margin of the bile duct was free of tumor. We also reviewed 25 cases of early mucosal bile duct carcinoma described in detail in the Japanese literature, and we discuss the diagnostic advantages of PTCS.
我们描述了一例69岁患有胆结石性胰腺炎的男性黏膜胆管癌伴浅表扩散的病例。该患者因腹痛、发热和黄疸到医院就诊。内镜逆行胆管造影（ERC）显示胆总管（CBD）下三分之一处有一突出病变，其壁不规则，提示为恶性肿瘤。经皮经肝胆管镜检查（PTCS）发现一个乳头状肿瘤，其颗粒状黏膜连续延伸至CBD的中三分之一处。从乳头状肿瘤和周围颗粒状黏膜获取的胆管镜活检标本显示为乳头状腺癌。在通过PTCS评估癌症范围后，我们进行了胰十二指肠切除术，同时切除肝外胆管并进行区域淋巴结清扫。病理检查显示乳头状腺癌局限于黏膜层。胆管的切除边缘无肿瘤。我们还回顾了日本文献中详细描述的25例早期黏膜胆管癌病例，并讨论了PTCS的诊断优势。
