内容紹介
Summary
This report describes a case of primary adenosquamous carcinoma of the liver with hepatolithiasis. A 70's man was followed up at a clinic for hepatolithiasis, gallbladder stone, and dilatation of the intrahepatic duct. He visited our hospital for computed tomography(CT)examination. CT showed a 30 mm diameter low-density mass in the S2 liver and dilatation of the intrahepatic duct filled with hepatolithiasis. Blood examination showed elevated levels of tumor markers(CEA 8.0 ng/mL, CA19-9 19,196 U/mL). We diagnosed the tumor as cholangiocellular carcinoma(cT2N1M0, cStage ⅣA)with hepatolithiasis and performed left hepatectomy and lymphadenectomy. In the specimen, a 39×22 mm diameter solid tumor was detected and the intrahepatic duct was filled with haptolithiasis. Pathologically, a mixture of adenocarcinoma and squamous cell carcinoma was observed adjacent to the bile duct. Accordingly, a diagnosis of adenosquamous carcinoma was made(pT3N0M0, pStage Ⅲ). Multiple liver metastases were detected 8 months after the operation, and chemotherapy was started. He remains alive 11 months after the operation. We experienced a rare case of adenosquamous carcinoma in the liver with hepatolithiasis.
要旨
症例は70歳台,男性。約4年前より肝内結石,左肝内胆管拡張,胆囊結石に対して近医で経過観察されており,今回,画像精査目的にて当院に紹介受診となった。造影CTでは肝左葉全体に充満する肝内結石,左葉肝内胆管拡張,左葉萎縮に加えて,肝S2に約30 mm大の乏血性の腫瘤と総肝動脈幹リンパ節に転移を疑う腫大を認めた。血液検査ではCEA 8.0 ng/mL,CA19-9 19,196 U/mLと腫瘍マーカーの上昇を認めた。肝内胆管癌(cT2N1M0,cStage ⅣA)の診断で,肝左葉切除術,肝外胆管切除術,胆囊摘出術,リンパ節郭清術,胆管(右肝管)空腸吻合術を施行した。切除標本の病理組織検査では,胆管壁から連続する形で存在する腫瘍を認め,組織像で腺癌と扁平上皮癌の混在を認めたため腺扁平上皮癌と診断された(pT3N0M0,pStage Ⅲ)。術後8か月後に多発肝転移を認め,化学療法を開始した。術後11か月現在,化学療法を継続しながら生存中である。肝内結石症を伴う肝原発腺扁平上皮癌の1切除例を経験した。
目次
This report describes a case of primary adenosquamous carcinoma of the liver with hepatolithiasis. A 70's man was followed up at a clinic for hepatolithiasis, gallbladder stone, and dilatation of the intrahepatic duct. He visited our hospital for computed tomography(CT)examination. CT showed a 30 mm diameter low-density mass in the S2 liver and dilatation of the intrahepatic duct filled with hepatolithiasis. Blood examination showed elevated levels of tumor markers(CEA 8.0 ng/mL, CA19-9 19,196 U/mL). We diagnosed the tumor as cholangiocellular carcinoma(cT2N1M0, cStage ⅣA)with hepatolithiasis and performed left hepatectomy and lymphadenectomy. In the specimen, a 39×22 mm diameter solid tumor was detected and the intrahepatic duct was filled with haptolithiasis. Pathologically, a mixture of adenocarcinoma and squamous cell carcinoma was observed adjacent to the bile duct. Accordingly, a diagnosis of adenosquamous carcinoma was made(pT3N0M0, pStage Ⅲ). Multiple liver metastases were detected 8 months after the operation, and chemotherapy was started. He remains alive 11 months after the operation. We experienced a rare case of adenosquamous carcinoma in the liver with hepatolithiasis.
要旨
症例は70歳台,男性。約4年前より肝内結石,左肝内胆管拡張,胆囊結石に対して近医で経過観察されており,今回,画像精査目的にて当院に紹介受診となった。造影CTでは肝左葉全体に充満する肝内結石,左葉肝内胆管拡張,左葉萎縮に加えて,肝S2に約30 mm大の乏血性の腫瘤と総肝動脈幹リンパ節に転移を疑う腫大を認めた。血液検査ではCEA 8.0 ng/mL,CA19-9 19,196 U/mLと腫瘍マーカーの上昇を認めた。肝内胆管癌(cT2N1M0,cStage ⅣA)の診断で,肝左葉切除術,肝外胆管切除術,胆囊摘出術,リンパ節郭清術,胆管(右肝管)空腸吻合術を施行した。切除標本の病理組織検査では,胆管壁から連続する形で存在する腫瘍を認め,組織像で腺癌と扁平上皮癌の混在を認めたため腺扁平上皮癌と診断された(pT3N0M0,pStage Ⅲ)。術後8か月後に多発肝転移を認め,化学療法を開始した。術後11か月現在,化学療法を継続しながら生存中である。肝内結石症を伴う肝原発腺扁平上皮癌の1切除例を経験した。