内容紹介
Summary
A 60’s man came to our hospital for jaundice. Contrast—enhanced CT showed irregular thickening of the hilar bile duct, and the lymph nodes(LN)were swollen from the hilar to the abdominal aorta. These LNs showed similar findings in endoscopic ultrasonography(EUS), and fine needle aspiration cytology(FNA)was performed on the enlarged No.13LN to diagnose LN metastasis of hilar cholangiocarcinoma. Since the peri—aortic LN was also markedly enlarged, it was considered to be metastasis, and was diagnosed as unresectable hilar cholangiocarcinoma with distant LN metastasis. When gemcitabine/cisplatin therapy(GC therapy)was started, tumor markers normalized and LN decreased in 4 months. We performed GC therapy for a total of 12 cycles and did not re—exacerbate. Cholangioscopy revealed that bile duct stenosis at the hilar portion had improved. We have determined that curative resection is possible and performed surgery. We confirmed that No.16b1LN was negative by pathological diagnosis during surgery and performed left hepatic caudate lobectomy, extrahepatic cholangectomy, and biliary reconstruction. Diagnosis was pT2aN1(n8a)M0, fStage ⅢB, and pR0. After surgery, adjuvant chemotherapy with S—1 was continued.
要旨
症例は60歳台,男性。黄疸を主訴に紹介受診した。腹部造影CTで肝門部胆管に不整な壁肥厚を認め,リンパ節(LN)は肝門部から腹部大動脈周囲にかけて腫大していた。これらのLNはendoscopic ultrasonography(EUS)でも同様の所見を呈し,腫大したNo.13LNにfine needle aspiration cytology(FNA)を行い,肝門部胆管癌のLN転移と診断した。大動脈周囲LNも著明に腫大していることから転移と考え,遠隔LN転移を伴う切除不能肝門部胆管癌と診断した。ゲムシタビン・シスプラチン療法(GC療法)を開始したところ,約4か月で腫瘍マーカーは正常化し,LNも縮小した。GC療法を計12サイクル継続して再増悪を認めなかった。胆道鏡検査を行い,肝門部の胆管狭窄は改善していた。切除可能と判断し,手術を施行した。迅速病理組織学的検査でNo.16b1LNの陰性を確認した後,肝左葉尾状葉切除,肝外胆管切除,胆道再建術を行った。pT2aN1(n8a 1個)M0,fStage ⅢBと診断し,pR0であった。術後はS—1内服による補助化学療法を継続している。
目次
A 60’s man came to our hospital for jaundice. Contrast—enhanced CT showed irregular thickening of the hilar bile duct, and the lymph nodes(LN)were swollen from the hilar to the abdominal aorta. These LNs showed similar findings in endoscopic ultrasonography(EUS), and fine needle aspiration cytology(FNA)was performed on the enlarged No.13LN to diagnose LN metastasis of hilar cholangiocarcinoma. Since the peri—aortic LN was also markedly enlarged, it was considered to be metastasis, and was diagnosed as unresectable hilar cholangiocarcinoma with distant LN metastasis. When gemcitabine/cisplatin therapy(GC therapy)was started, tumor markers normalized and LN decreased in 4 months. We performed GC therapy for a total of 12 cycles and did not re—exacerbate. Cholangioscopy revealed that bile duct stenosis at the hilar portion had improved. We have determined that curative resection is possible and performed surgery. We confirmed that No.16b1LN was negative by pathological diagnosis during surgery and performed left hepatic caudate lobectomy, extrahepatic cholangectomy, and biliary reconstruction. Diagnosis was pT2aN1(n8a)M0, fStage ⅢB, and pR0. After surgery, adjuvant chemotherapy with S—1 was continued.
要旨
症例は60歳台,男性。黄疸を主訴に紹介受診した。腹部造影CTで肝門部胆管に不整な壁肥厚を認め,リンパ節(LN)は肝門部から腹部大動脈周囲にかけて腫大していた。これらのLNはendoscopic ultrasonography(EUS)でも同様の所見を呈し,腫大したNo.13LNにfine needle aspiration cytology(FNA)を行い,肝門部胆管癌のLN転移と診断した。大動脈周囲LNも著明に腫大していることから転移と考え,遠隔LN転移を伴う切除不能肝門部胆管癌と診断した。ゲムシタビン・シスプラチン療法(GC療法)を開始したところ,約4か月で腫瘍マーカーは正常化し,LNも縮小した。GC療法を計12サイクル継続して再増悪を認めなかった。胆道鏡検査を行い,肝門部の胆管狭窄は改善していた。切除可能と判断し,手術を施行した。迅速病理組織学的検査でNo.16b1LNの陰性を確認した後,肝左葉尾状葉切除,肝外胆管切除,胆道再建術を行った。pT2aN1(n8a 1個)M0,fStage ⅢBと診断し,pR0であった。術後はS—1内服による補助化学療法を継続している。