内容紹介
Summary
A 78-year-old woman with jaundice was referred to our hospital. On admission, serological testing for viral hepatitis was negative and serum levels of AFP and PIVKA-Ⅱ were elevated(925 ng/mL and 6,820 mAU/mL, respectively). Computed tomography revealed a main tumor measuring 3 cm in size at segment 1 of the liver and bile duct tumor thrombus extending to the right hepatic duct. A diagnosis of hepatocellular carcinoma with a bile duct tumor thrombus was made. After endoscopic biliary drainage for obstructive jaundice and transarterial chemoembolization for the lesions, she underwent left hepatectomy, resection of the caudate lobe, extrahepatic bile duct resection, and cholecystectomy. The hepatic side of the extrahepatic bile duct was transected at the confluence of the right anterior and posterior ducts because invasion of the tumor thrombus to the right hepatic duct was suspected on cholangioscopy. Histological examination revealed the tumor to be a moderately differentiated hepatocellular carcinoma with bile duct tumor thrombus. Surgical margins were negative, and vascular invasion was not found. She remains alive and well with no evidence of disease 64 months after hepatectomy.
要旨
症例は78歳,女性。黄疸を主訴に来院した。ウイルス性肝炎は陰性で,AFP 925 ng/mL,PIVKA-Ⅱ 6,820 mAU/mLはともに上昇していた。CT検査で肝S1に径3 cm大の腫瘍と,これより連続して右肝管内に至る胆管内腫瘍栓を認めた。胆管内腫瘍栓を伴う肝細胞癌と診断し,減黄を図りつつ肝動脈化学塞栓療法を実施後に肝左葉切除,尾状葉切除,肝外胆管切除を実施した。胆道鏡検査で胆管内腫瘍栓の右肝管への浸潤が疑われ,右前・後区域胆管合流部直下で胆管を切離した。病理組織学的には中分化型肝細胞癌で胆管内腫瘍栓を認めたが,血管侵襲陰性,切離断端陰性であった。術後5年4か月が経過し,無再発生存中である。自験例の経験および文献的考察から,根治切除が可能な胆管内腫瘍栓を伴う肝細胞癌では長期生存が得られる症例が存在するので,肝切除を考慮するべきである。
目次
A 78-year-old woman with jaundice was referred to our hospital. On admission, serological testing for viral hepatitis was negative and serum levels of AFP and PIVKA-Ⅱ were elevated(925 ng/mL and 6,820 mAU/mL, respectively). Computed tomography revealed a main tumor measuring 3 cm in size at segment 1 of the liver and bile duct tumor thrombus extending to the right hepatic duct. A diagnosis of hepatocellular carcinoma with a bile duct tumor thrombus was made. After endoscopic biliary drainage for obstructive jaundice and transarterial chemoembolization for the lesions, she underwent left hepatectomy, resection of the caudate lobe, extrahepatic bile duct resection, and cholecystectomy. The hepatic side of the extrahepatic bile duct was transected at the confluence of the right anterior and posterior ducts because invasion of the tumor thrombus to the right hepatic duct was suspected on cholangioscopy. Histological examination revealed the tumor to be a moderately differentiated hepatocellular carcinoma with bile duct tumor thrombus. Surgical margins were negative, and vascular invasion was not found. She remains alive and well with no evidence of disease 64 months after hepatectomy.
要旨
症例は78歳,女性。黄疸を主訴に来院した。ウイルス性肝炎は陰性で,AFP 925 ng/mL,PIVKA-Ⅱ 6,820 mAU/mLはともに上昇していた。CT検査で肝S1に径3 cm大の腫瘍と,これより連続して右肝管内に至る胆管内腫瘍栓を認めた。胆管内腫瘍栓を伴う肝細胞癌と診断し,減黄を図りつつ肝動脈化学塞栓療法を実施後に肝左葉切除,尾状葉切除,肝外胆管切除を実施した。胆道鏡検査で胆管内腫瘍栓の右肝管への浸潤が疑われ,右前・後区域胆管合流部直下で胆管を切離した。病理組織学的には中分化型肝細胞癌で胆管内腫瘍栓を認めたが,血管侵襲陰性,切離断端陰性であった。術後5年4か月が経過し,無再発生存中である。自験例の経験および文献的考察から,根治切除が可能な胆管内腫瘍栓を伴う肝細胞癌では長期生存が得られる症例が存在するので,肝切除を考慮するべきである。