内容紹介
Summary
The patient was an 81-year-old woman. She had undergone extended cholecystectomy with lymph node dissection for primary gallbladder cancer. The pathological diagnosis was moderately differentiated tubular adenocarcinoma(pT2, N0, M0, pStageⅡ). Eleven months after the initial surgery, dynamic CT revealed a solitary low-enhanced tumor in S5 of the liver. As the tumor was detected with abnormal FDG uptake by PET-CT, we diagnosed the patient with a metastatic liver tumor from gallbladder cancer. Although chemotherapy was considered, conservative treatment was selected as the patient did not want to undergo chemotherapy. Therefore, laparoscopic partial liver resection was performed 15 months after the initial surgery with the consideration that no other distant metastasis was found, and tumor markers were within normal ranges. The postoperative course was uneventful, and the patient was discharged 13 days after liver resection without any morbidities. The resected tumor was pathologically diagnosed as a metastatic liver tumor from gallbladder cancer. She has achieved 18 months recurrence free survival after the liver resection without adjuvant chemotherapy. Although liver resection for a metastatic liver tumor from gallbladder cancer is not a standardized treatment, it may be a therapeutic option in cases of limited metastasis.
要旨
症例は81歳,女性。心窩部痛を契機に診断された胆囊癌に対し,胆囊床を含む開腹下拡大胆囊摘出術およびリンパ節郭清が施行された。病理組織学的診断は中分化型管状腺癌,pT2(ss),N0,M0,pStageⅡであった。術後補助化学療法は施行せずに経過観察していたが,術後11か月目の単純MRIで肝S5に10 mm大の孤立性腫瘤が認められた。PET-CTでFDGの異常集積が認められ,胆囊癌肝転移と診断した。腎機能障害の併存や高齢であることを考慮し化学療法は行わず経過観察していたが,S5腫瘤は緩徐に増大するも他病変は出現せず,腫瘍マーカー値が正常範囲内で推移していたことより限局した肝転移と考え,初回手術後1年3か月目に腹腔鏡下肝S5部分切除術を施行した。術後,特記すべき合併症はなく,術後13日目に退院した。病理組織学的に中分化型腺癌が認められ,胆囊癌肝転移と診断した。術後補助化学療法は施行せずに経過観察中であるが,肝転移切除術後1年6か月現在,無再発生存中である。
目次
The patient was an 81-year-old woman. She had undergone extended cholecystectomy with lymph node dissection for primary gallbladder cancer. The pathological diagnosis was moderately differentiated tubular adenocarcinoma(pT2, N0, M0, pStageⅡ). Eleven months after the initial surgery, dynamic CT revealed a solitary low-enhanced tumor in S5 of the liver. As the tumor was detected with abnormal FDG uptake by PET-CT, we diagnosed the patient with a metastatic liver tumor from gallbladder cancer. Although chemotherapy was considered, conservative treatment was selected as the patient did not want to undergo chemotherapy. Therefore, laparoscopic partial liver resection was performed 15 months after the initial surgery with the consideration that no other distant metastasis was found, and tumor markers were within normal ranges. The postoperative course was uneventful, and the patient was discharged 13 days after liver resection without any morbidities. The resected tumor was pathologically diagnosed as a metastatic liver tumor from gallbladder cancer. She has achieved 18 months recurrence free survival after the liver resection without adjuvant chemotherapy. Although liver resection for a metastatic liver tumor from gallbladder cancer is not a standardized treatment, it may be a therapeutic option in cases of limited metastasis.
要旨
症例は81歳,女性。心窩部痛を契機に診断された胆囊癌に対し,胆囊床を含む開腹下拡大胆囊摘出術およびリンパ節郭清が施行された。病理組織学的診断は中分化型管状腺癌,pT2(ss),N0,M0,pStageⅡであった。術後補助化学療法は施行せずに経過観察していたが,術後11か月目の単純MRIで肝S5に10 mm大の孤立性腫瘤が認められた。PET-CTでFDGの異常集積が認められ,胆囊癌肝転移と診断した。腎機能障害の併存や高齢であることを考慮し化学療法は行わず経過観察していたが,S5腫瘤は緩徐に増大するも他病変は出現せず,腫瘍マーカー値が正常範囲内で推移していたことより限局した肝転移と考え,初回手術後1年3か月目に腹腔鏡下肝S5部分切除術を施行した。術後,特記すべき合併症はなく,術後13日目に退院した。病理組織学的に中分化型腺癌が認められ,胆囊癌肝転移と診断した。術後補助化学療法は施行せずに経過観察中であるが,肝転移切除術後1年6か月現在,無再発生存中である。