内容紹介
Summary
A 59-year-old man was diagnosed with cholecystolithiasis and cholecystitis and underwent cholecystectomy. The pathological findings were moderately differentiated adenocarcinoma(pT2)in the gallbladder fundus. Sixteen days after surgery, he visited our hospital due to jaundice. Abdominal enhanced CT and EOB-MRI revealed multiple liver metastases and lymph node metastases in the hepatoduodenal ligament that we deemed to be unresectable. A metallic stent was inserted for bile duct obstruction, and he underwent chemotherapy with gemcitabine plus cisplatin(GC). After 12 courses of GC, the metastatic lesions disappeared, and the patient showed complete response. FDG-PET/CT showed FDG uptake in the hepatoduodenal ligament and we subsequently decided to perform surgery. He underwent resection of the extrahepatic bile duct and regional lymphadenectomy. The pathological findings revealed no residual carcinomas in the bile duct or lymph nodes. We are continuing chemotherapy at present, and the patient is alive with no signs of recurrence at 1 year and 3 months following the diagnosis of multiple liver metastases.
要旨
症例は59歳,男性。右季肋部痛の精査で胆石性胆囊炎の診断となり,手術目的に当科へ紹介となった。腹腔鏡下に手術を開始したが,胆囊頸部の炎症が高度で胆囊管の同定が困難であったため,開腹移行し胆囊を摘出した。病理組織学的診断では胆囊底部に限局する中分化型腺癌,壁深達度pT2の診断となり,追加切除を予定したが,胆囊摘出術後16日で閉塞性黄疸を来し,CT,MRIで肝十二指腸間膜内リンパ節転移による胆管閉塞,多発肝転移の診断となった。根治的切除不能と判断し,胆管ステントを留置し,gemcitabine+cisplatin(GC)療法を開始した。GC療法12コース後,CT,MRIで肝転移,リンパ節転移は不鮮明化しcomplete response(CR)と判断した。PET-CTで肝門部に陽性集積があり肝外胆管切除を施行したが癌遺残はみられなかった。GC療法継続中で肝転移診断から1年3か月,肝外胆管切除後3か月現在,無再発生存中である。
目次
A 59-year-old man was diagnosed with cholecystolithiasis and cholecystitis and underwent cholecystectomy. The pathological findings were moderately differentiated adenocarcinoma(pT2)in the gallbladder fundus. Sixteen days after surgery, he visited our hospital due to jaundice. Abdominal enhanced CT and EOB-MRI revealed multiple liver metastases and lymph node metastases in the hepatoduodenal ligament that we deemed to be unresectable. A metallic stent was inserted for bile duct obstruction, and he underwent chemotherapy with gemcitabine plus cisplatin(GC). After 12 courses of GC, the metastatic lesions disappeared, and the patient showed complete response. FDG-PET/CT showed FDG uptake in the hepatoduodenal ligament and we subsequently decided to perform surgery. He underwent resection of the extrahepatic bile duct and regional lymphadenectomy. The pathological findings revealed no residual carcinomas in the bile duct or lymph nodes. We are continuing chemotherapy at present, and the patient is alive with no signs of recurrence at 1 year and 3 months following the diagnosis of multiple liver metastases.
要旨
症例は59歳,男性。右季肋部痛の精査で胆石性胆囊炎の診断となり,手術目的に当科へ紹介となった。腹腔鏡下に手術を開始したが,胆囊頸部の炎症が高度で胆囊管の同定が困難であったため,開腹移行し胆囊を摘出した。病理組織学的診断では胆囊底部に限局する中分化型腺癌,壁深達度pT2の診断となり,追加切除を予定したが,胆囊摘出術後16日で閉塞性黄疸を来し,CT,MRIで肝十二指腸間膜内リンパ節転移による胆管閉塞,多発肝転移の診断となった。根治的切除不能と判断し,胆管ステントを留置し,gemcitabine+cisplatin(GC)療法を開始した。GC療法12コース後,CT,MRIで肝転移,リンパ節転移は不鮮明化しcomplete response(CR)と判断した。PET-CTで肝門部に陽性集積があり肝外胆管切除を施行したが癌遺残はみられなかった。GC療法継続中で肝転移診断から1年3か月,肝外胆管切除後3か月現在,無再発生存中である。