内容紹介
Summary
A 60s woman was found to have wall thickening of the gastric body and gallbladder in the follow-up CT scan after surgery for cervical carcinoma. An endoscopic examination revealed a type 3 tumor, located in the lesser curvature of the middle stomach. Abdominal CT showed lymphadenopathy at the lesser curvature. An enhanced thickened wall was also noted in the fundus of the gallbladder. FDG-PET/CT showed negative uptake in the gallbladder lesion. Distal gastrectomy and cholecystectomy were performed under the preoperative diagnosis of gastric cancer and adenomyomatosis. Histopathologically, the gastric lesion was a poorly differentiated adenocarcinoma, SE, ly1c, v1b. Moreover, the gallbladder lesion was a poorly differentiated adenocarcinoma proliferating mainly in the muscularis propria and subserosa, which had similar histological features as those in the adenocarcinoma part of gastric cancer. From these findings, the patient was diagnosed with gallbladder metastasis from gastric cancer. Gastric cancer rarely metastasizes to the gallbladder, and only 16 cases have been reported in Japan. We present the clinicopathological features with a review of the literature.
要旨
症例は60歳台,女性。子宮頸癌術後,経過観察目的のCT検査にて胃体部の壁肥厚および胆囊壁の肥厚を指摘され,精査・加療目的に当科紹介となった。上部消化管内視鏡検査で胃体中部小弯に3型病変(生検: 低分化腺癌)を認めた。CT検査では胃小弯側のリンパ節腫大,胆囊の壁肥厚と造影効果を認めた。胆囊病変に関して悪性の可能性は否定できなかったが,PET検査で胆囊に明らかなFDG異常集積はなく,胆囊以外に転移を疑う所見を認めなかったことから胆囊腺筋腫症を第一に疑い,幽門側胃切除術,胆囊摘出術を施行した。病理組織学的に,胃癌は低分化腺癌,深達度SE,ly1c,v1bであった。胆囊は,粘膜面から漿膜下層に胃病変と同様の低分化腺癌を認め,胃癌の胆囊転移と診断した。胃癌胆囊転移はまれであり,本邦では過去16例が報告されているにすぎない。今回われわれは,胃癌の同時性孤立性胆囊転移の症例を経験したので若干の文献的考察を加えて報告する。
目次
A 60s woman was found to have wall thickening of the gastric body and gallbladder in the follow-up CT scan after surgery for cervical carcinoma. An endoscopic examination revealed a type 3 tumor, located in the lesser curvature of the middle stomach. Abdominal CT showed lymphadenopathy at the lesser curvature. An enhanced thickened wall was also noted in the fundus of the gallbladder. FDG-PET/CT showed negative uptake in the gallbladder lesion. Distal gastrectomy and cholecystectomy were performed under the preoperative diagnosis of gastric cancer and adenomyomatosis. Histopathologically, the gastric lesion was a poorly differentiated adenocarcinoma, SE, ly1c, v1b. Moreover, the gallbladder lesion was a poorly differentiated adenocarcinoma proliferating mainly in the muscularis propria and subserosa, which had similar histological features as those in the adenocarcinoma part of gastric cancer. From these findings, the patient was diagnosed with gallbladder metastasis from gastric cancer. Gastric cancer rarely metastasizes to the gallbladder, and only 16 cases have been reported in Japan. We present the clinicopathological features with a review of the literature.
要旨
症例は60歳台,女性。子宮頸癌術後,経過観察目的のCT検査にて胃体部の壁肥厚および胆囊壁の肥厚を指摘され,精査・加療目的に当科紹介となった。上部消化管内視鏡検査で胃体中部小弯に3型病変(生検: 低分化腺癌)を認めた。CT検査では胃小弯側のリンパ節腫大,胆囊の壁肥厚と造影効果を認めた。胆囊病変に関して悪性の可能性は否定できなかったが,PET検査で胆囊に明らかなFDG異常集積はなく,胆囊以外に転移を疑う所見を認めなかったことから胆囊腺筋腫症を第一に疑い,幽門側胃切除術,胆囊摘出術を施行した。病理組織学的に,胃癌は低分化腺癌,深達度SE,ly1c,v1bであった。胆囊は,粘膜面から漿膜下層に胃病変と同様の低分化腺癌を認め,胃癌の胆囊転移と診断した。胃癌胆囊転移はまれであり,本邦では過去16例が報告されているにすぎない。今回われわれは,胃癌の同時性孤立性胆囊転移の症例を経験したので若干の文献的考察を加えて報告する。