内容紹介
A Case of Port Site Recurrence of Gallbladder Carcinoma after Laparoscopic Cholecystectomy
Summary
The patient was a 76-year-old man who underwent laparoscopic cholecystectomy with a diagnosis of cholecystolithiasis. Since the definite diagnosis of gallbladder carcinoma was made after the operation, he underwent additional resection. Four years later, he revisited the hospital complaining of painful swelling of the port site of his epigastrium. Magnetic resonance imaging of the abdomen revealed a mass 3.4 cm in diameter at the epigastrium. Thus, port site recurrence of gallbladder carcinoma was the suspected diagnosis. We resected the peritoneum, rectus abdominis muscle, and skin, as well as the tumor, and the abdominal wall was reconstructed using synthetic composite mesh. Histological examinations revealed recurrence of gallbladder carcinoma. Port site recurrence of gallbladder carcinoma is known to have a poor prognosis, but long survival can be expected in patients after complete resection of the metastatic lesion, if the recurrence develops more than a year after the initial operation.
要旨
症例は76歳,男性。2012年1月,胆石症の診断にて腹腔鏡下胆嚢摘出術(laparoscopic cholecystectomy: LC)を施行後に病理組織診断にて胆嚢癌と診断され,2か月後に肝床切除術およびリンパ節郭清を施行した。術後補助化学療法は施行せず経過観察中であったが,2016年8月心窩部皮下腫瘤を認め,腹部MRIやPET-CTなどの画像検査により胆嚢癌の腹壁への局所再発(ポート部再発)と診断した。全身麻酔下に腫瘤を摘出し,術中迅速病理検査にて胆嚢癌再発と診断された。周囲の腹壁を断端陰性になるまで広範囲に追加切除を加えた結果,縦径9×横径7 cmの腹壁欠損を生じたため,モノフィラメントポリプロピレン製メッシュを用いて修復した。6か月後に初回再発部の約3 cm頭側に再度局所再発を来し切除したが,遅発性に生じたLC後の胆嚢癌ポート部再発は低悪性度であると考えられるため切除によって長期生存が期待できる。
目次
Summary
The patient was a 76-year-old man who underwent laparoscopic cholecystectomy with a diagnosis of cholecystolithiasis. Since the definite diagnosis of gallbladder carcinoma was made after the operation, he underwent additional resection. Four years later, he revisited the hospital complaining of painful swelling of the port site of his epigastrium. Magnetic resonance imaging of the abdomen revealed a mass 3.4 cm in diameter at the epigastrium. Thus, port site recurrence of gallbladder carcinoma was the suspected diagnosis. We resected the peritoneum, rectus abdominis muscle, and skin, as well as the tumor, and the abdominal wall was reconstructed using synthetic composite mesh. Histological examinations revealed recurrence of gallbladder carcinoma. Port site recurrence of gallbladder carcinoma is known to have a poor prognosis, but long survival can be expected in patients after complete resection of the metastatic lesion, if the recurrence develops more than a year after the initial operation.
要旨
症例は76歳,男性。2012年1月,胆石症の診断にて腹腔鏡下胆嚢摘出術(laparoscopic cholecystectomy: LC)を施行後に病理組織診断にて胆嚢癌と診断され,2か月後に肝床切除術およびリンパ節郭清を施行した。術後補助化学療法は施行せず経過観察中であったが,2016年8月心窩部皮下腫瘤を認め,腹部MRIやPET-CTなどの画像検査により胆嚢癌の腹壁への局所再発(ポート部再発)と診断した。全身麻酔下に腫瘤を摘出し,術中迅速病理検査にて胆嚢癌再発と診断された。周囲の腹壁を断端陰性になるまで広範囲に追加切除を加えた結果,縦径9×横径7 cmの腹壁欠損を生じたため,モノフィラメントポリプロピレン製メッシュを用いて修復した。6か月後に初回再発部の約3 cm頭側に再度局所再発を来し切除したが,遅発性に生じたLC後の胆嚢癌ポート部再発は低悪性度であると考えられるため切除によって長期生存が期待できる。